Aerospace Medical Association

THE

ROLE OF AVIATION MEDICINE

Dr Ioannis Dimitrakopoulos

Authorised Medical Examiner JAR-FCL3 Class 1&2

Aerospace Medical Association

AVIATION MEDICINE

Branch of Preventive Medicine

that deals with the clinical and

preventive medical requirements

of man in atmospheric flight

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Approach to Aviation Medicine

AVIATIONNormal Physiology

Abnormal environment

CLASSICALAbnormal Physiology

Normal environment

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HISTORY OF AVIATION

MEDICINE

With the advent of powered flight at the

beginning of the 20th century, there was a

need for selection of those who wished to fly.

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HISTORY OF AVIATION

MEDICINE Fitness criteria were

developed, and the

determination of

who met the criteria

and who did not

created the need for

a physician trained

to make this

determination.

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THE FLIGHT SURGEON Initially this was driven by a need for

qualified military pilots to fly planes in war

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THE FLIGHT SURGEON Main function was

to first develop and

then apply physical

qualifications for

flight duty

Driven by high

losses of life due to

physically

unqualified pilots

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THE FLIGHT SURGEON

During World War II

many technologic

advances led to increasing

functions in research to

develop means of

extending man’s ability to

function in an

increasingly hostile

environment.

Led to aeromedical

research

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THE FLIGHT SURGEON

Increasing numbers

of aircrew needed

to man the

warfighting

aircraft

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HISTORYAfter World War II the technologic

advances were applied to the airline

industry. Increases in aircrew led to

increases in civilian aviation medicine.

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HISTORY

In the 1960’s advances

were made to meet the

challenge of manned

flight beyond the earth’s

atmosphere. . .Aviation

Medicine evolved to

Aerospace Medicine

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WHAT DOES AN

AEROMEDICAL DOCTOR

(FLIGHT SURGEON) DO ?

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He takes care of the Aviator…a

physiologically normal individual

who works in the hostile environment

of flight

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THE HOSTILE

ENVIRONMENT OF FLIGHT

Man is an earth-bound creature who

must have protection to enter the

hostile environment of atmospheric or

space flight

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Highest Human Habitation...18,000 ft

Environmental RequirementsOxygen

OXYGEN UNDER

PRESSURE NEEDED

PRESSURE SUIT NEEDED

ARMSTRONG’S LINE

TROPOPAUSEMt Everest

29,028 ft

Andes Mt Whitney

TROPOSPHERE

STRATOSPHERE

SEA LEVEL

OXYGEN

NEEDED

0

10

20

30

40

50

60

70

760

523

349

226

141

87

54

34

As altitude increases,

available oxygen decreases

0

10

20

30

40

50

60

70

760

523

349

226

141

87

54

34

Press Alt in

mm Hg Thou. Ft

Aerospace Medical Association

Environmental RequirementsOxygen

Lack of oxygen will

affect the brain and

cause fatigue,

sleepiness, headache,

dizziness, blurred

vision and will

eventually cause you

to lose consciousness.

Oxygen must be

provided at high

altitudes

10,000 MSLHYP XIA

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Environmental RequirementsOxygen

A flight surgeon

must be able to

recognize when

problems are due to

lack of oxygen

Altitude chamber

training helps

aircrew to discover

their own hypoxia

symptoms

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Environmental RequirementsPressure

Normal atmospheric

pressure at sea level

is 760 mm Hg

As you go up in

altitude, atmospheric

pressure decreases.

SEA LEVEL

OXYGEN UNDER

PRESSURE NEEDED

PRESSURE SUIT NEEDED

ARMSTRONG’S LINE

OXYGEN

NEEDED

0

10

20

30

40

50

60

70

760

523

349

226

141

87

54

34

Press Alt in

mm Hg Thou. Ft

Aerospace Medical Association

Environmental RequirementsPressure

As atmospheric pressure

decreases, the air tends to

expand and get thinner

The human body has

several responses to

changes in atmospheric

pressure.

GAS

EXPANSION

FL 430

FL 350

FL 250

FL 180

BOYLE’S LAW

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There are several places in the human body where

air can get trapped. The ear, the sinuses, and the

stomach and intestines are a few examples.

Trapped Air

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Trapped AirAs you go up in altitude, air expands... if this

air is trapped, expanding air can lead to

pain. A blocked Eustachian tube could lead

to pain in the middle ear.

Eustachian Tube

Ear Drum

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Sinus Blocks and Ear Blocks

There are spaces in the

sinuses and middle ear

where air can get

trapped.

Under normal

conditions this air can

escape through

passages to the outside

(Eustachian tube)

MAXILLARY

FRONTAL

ETHMOIDS

SPHENOIDS

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Trapped Air Usually expanding air

is not a problem since

it can be released.

When you come back

down after being at

altitude, the expanded

air gets smaller... if

this occurs in a closed

space it creates a

vacuum effect...This is

a BIG problem.

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Ear Block If you fly with a cold

these passages can

swell up enough to

block the passage of

air, especially when

you are trying to get

air in to equalize

pressure on descent.

Leads to a painful ear

or sinus block!

Do Not Fly with a Cold!

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Other effects of pressure

DECOMPRESSION

SICKNESS

– Air bubbles can form in

the body if you go to high

enough altitudes

– These bubbles are made of

nitrogen and usually

dissolve as you descend.

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Decompression Sickness

– Bubbles that do not

dissolve can get

trapped in the joints

and cause pain (bends)

– If they form in the

blood and go to the

brain they can cause

serious neurologic

symptoms.

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Decompression Sickness

Prevention

Prebreathing 100% oxygen for at least an

hour before high altitude flights can

decrease the amount of nitrogen in the body

and decrease the chance of getting

decompression sickness.

Pressurized cabins or, if necessary, pressure

suits can be used.

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Decompression Sickness

Treatment

Decompression sickness

can often be successfully

treated in a hyperbaric

chamber which dilutes out

the nitrogen with high

pressure concentrated

oxygenHyperbaric Chamber, Brooks AFB, TX

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Acceleration Forces

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Acceleration Forces

The very rapid rate of acceleration used in most

military jet fighters and in the space vehicles

imposes another hazard on the aviator.

Acceleration results in an increase in the force of

gravity on the aviator which can be up to nine

times what he experiences on earth

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Acceleration forces tend to be directed

downward, and as they increase, they cause an

aviator’s blood to be pushed downward in his

body, moving blood from his brain to his feet.

If this force is not counteracted, the aviator

will first lose his vision (black-out) and then

consciousness (G-induced loss of

consciousness or GLOC)

Acceleration Forces

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Positive Acceleration (+Gz)(Sustained)

POOLING BEGINS

1-3 “G”

GREYOUT

3-4 “G”

BLACKOUT

4-5 “G”

UNCONSCIOUSNESS

5-6 “G”

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Acceleration

Countermeasures

To counteract this force, “G” suits have been

developed which squeeze the legs and abdomen

during high G conditions to prevent blood from

being pushed there.

G suits are made up of five interconnected

bladders covering the legs and abdominal region.

Pressurization of the bladders occurs during

increases in G forces.

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Acceleration

Countermeasures

The aviator can also do

a special “straining”

maneuver and tighten

all his muscles. An

adequate straining

maneuver can be

mastered during

centrifuge trainingCentrifuge Facility, Brooks AFB, TX

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Spatial Disorientation

A state characterized by an erroneous

sense of one’s position and motion

relative to the earth’s surface

There are three types– Type I: Unrecognized

– Type II: Recognized

– Type III: Incapacitating

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Types of Spatial Disorientation

Type 1 “Unrecognized”

– The pilot does not perceive that something is wrong

– Very dangerous in that the pilot will continue to operate his aircraft

according to his misperception

Type 2 “Recognized”

– Usually recognized in the sense that the pilot knows something is wrong or

he feels vertigo; but may not recognize it as spatial disorientation

– May be that his instruments tell him something different from the “seat of

the pants” sense

– Often the pilot can correct this by “making the instruments read right”

Type 3 “Incapacitating”

– Pilot is disoriented, knows it, but can’t do anything about it

– Overwhelmed by the strength of his vestibular response to the

disorientation

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Spatial Disorientation

SEAT-OF-THE-PANTS

VISION VESTIBULAR

ORIENTATION

AND

BODY

RESPONSES

SENSES OF

BALANCE

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Spatial Disorientation

While we are in contact

with the earth, the pull

of gravity squeezes

pressure sensors in the

various portions of the

body, thus telling us in

which direction the earth

lies.

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THE SEAT-OF-THE-

PANTS SENSE

FORCE OF GRAVITY

GRAVITY

PLUS

CENTRIFUGAL

FORCE

Spatial Disorientation

In flight, however, G-

forces combine with the

pull of gravity to make

the seat-of-the-pants

sense completely

unreliable as an attitude

indicator.

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INNER EAR PERCEPTION PROBLEMS

OTOLITH

ORGANS

SEMICIRCULAR

CANALS

Sense rotation

Spatial Disorientation

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Aviation Medicine

Thus, there are many problems with the abnormal

environment encountered in aviation. The flight

surgeon is just one of many highly trained

individuals working to minimize the effects of

these adverse effects so that man can continue to

have mastery over the air.

Aerospace Medical Association

ΑΠΑΙΣΗΔΙ ΙΑΣΡΙΚΗ ΚΑΣΑΛΛΗΛΟΣΗΣΑ

ΚΑΣΑ JAR FCL3 ΓΙΑ ΔΠΑΓΓΔΛΜΑΣΙΔ

ΥΔΙΡΙΣΔ

Παποςζίαζη: Ι.Δημηηπακόποςλορ ,Γενικόρ Ιαηπόρ

Εξοςζιοδοηημένορ αεποϊαηπικόρ εξεηαζηήρ

Authorised Medical Examiner AME

θαλνληζκνύο ζηνλ

ΔΠΙΥΔΙΡΗΙΑΚΟ,

ΣΔΥΝΙΚΟ ΚΑΙ

ΙΑΣΡΙΚΟ ηνκέα ηεο

ΠΟΛΙΣΙΚΗ ΑΔΡΟΠΟΡΙΑ

Με ζκοπό ηην αζθάλεια ηων πηήζεων…

…oδήγεζε ζηα ηέιε ηνπ Β’ παγθνζκίνπ πόιεκνπ

ζηελ ίδξπζε ηνπ

ICAO 1944(International Civil Aviation Organisation )

ECAC 1955European Civil Aviation Conference ην

(αληεπηζηέιινλ κέινο ηνπ ICAO)

JAA 1990Joint Aviation Authorities CYPRUS agreement

(αληεπηζηέιινλ κέινο ηεο ECAC)

Από ηνλ JAA εθαξκόδνληαη ηα

JARs:

Joint Aviation Requirements: Κνηλέο

Αεξνπνξηθέο Απαηηήζεηο

ΑΦΟΡΟΤΝ Δ ΜΗΥΑΝΙΚΑ ΜΔΡΗ ΚΑΙ ΠΡΟΩΠΙΚΟ

ύκθσλα κε ηελ ππ. αξ. 3922/91

(νδεγία ηεο ΔΔ)

“όια ηα θξάηε κέιε ηεο πξέπεη λα

εληαρζνύλ ζηνπο θόιπνπο ηνπ JAA

θαη λα εθαξκόζνπλ ηα JARs”

Η ελαξκόληζε

επηηπγράλεηαη κέζα από ηελ

ζπλεξγαζία θαη ηελ εθαξκνγή ησλ

θνηλώλ θαλνληζκώλ σο θνηλέο

απαηηήζεηο

JOINT AVIATION REQUIREMENTS

JARs

JAR’s: Joint Aviation

Requirements

Απαηηήζεηο θαηά JAA

Για αδειοδόηηζη

(FCL - Flight Crew Licensing)

JAR FCL-1 Αεποπλάνα

JAR FCL-2 Ελικόπηεπα

JAR FCL-3 Ιαηπικέρ απαιηήζειρ

Tα JARs ικανοποιούν ηα κπιηήπια ηος ICAΟ και μάλιζηα είναι πιο αςζηηπά!

Η Διιάδα ελαξκνλίζηεθε κε ηελ

Δπξσπατθή λνκνζεζία κε ην ΠΓ

247/02 πνπ απνηειεί αθξηβή

κεηάθξαζε ησλ JAR FCL3 όζν

αθνξά ζηελ πηζηνπνίεζε ηαηξηθήο

θαηαιιειόηεηαο

Από ηα JARs εθδίδνληαη ηα θάησζη

πηζηνπνηεηηθά:

Ι) επαγγεικαηηώλ ρεηξηζηώλ

Class 1

ΙΙ) ηδησηώλ ρεηξηζηώλ

Class2

Η εθαξκνγή ησλ JARs FCL-3 ζπλδέεηαη

άξξεθηα κε ηελ

i) Αεξνηαηξηθή Αξρή (AMS)

ii) ηα εμνπζηνδνηεκέλα θέληξα αεξνπνξηθήο

Ιαηξηθήο (AMCs)

iii) έλα εμεηδηθεπκέλν ζώκα ηαηξώλ,

Δμνπζηνδνηεκέλνη Ιαηξνί Δμεηαζηέο

(ΑΜΔs= Authorized Medical Examiners)

ΣΑ JARs FCL3 ΑΠΟΣΕΛΟΤΝ ΕΝΑ

ΑΠΟΚΕΝΣΡΧΜΕΝΟ ΤΣΗΜΑ

ΙΑΣΡΙΚΗ ΠΙΣΟΠΟΙΗΗ ΓΙΑ ΣΟΤ

ΥΕΙΡΙΣΕ ΣΗ ΠΟΛΙΣΙΚΗ

ΑΕΡΟΠΟΡΙΑ

εμεηαζηή ΑΜΔ, φπσο δηαηππψλεηαη ζηα JAR

FCL 3, ΠΔ 247/02/3.090 θαηέρεη

πξσηεύνληα ξόιν ζηε

α) δηαπίζησζε ηεο ηαηξηθήο θαηαιιειφηεηαο

ησλ ρεηξηζηψλ

β) ζπκβάιιεη ζηελ αζθάιεηα πηήζεσλ

απνθιείνληαο αηθλίδηα αληθαλφηεηα ηνπ

ρεηξηζηή ιφγσ πξνβιεκάησλ πγείαο

Οη ΑΜΕs απνηεινχλ ηε βάζε γηα ηελ Ιαηξηθή

εμέηαζε θαη πηζηνπνίεζε ηεο ηαηξηθήο

θαηαιιειφηεηαο ησλ ρεηξηζηψλ.

Σα AMCs (Κέληξα Αεξνπνξηθήο Ιαηξηθήο)

απαξηίδνληαη θπξίσο απφ ΑΜΕs θαη είλαη

πξνυπφζεζε ν δηεπζχλσλ ελφο AMC θαη ν

αλαπιεξσηήο ηνπ, λα είλαη εμνπζηνδνηεκέλνη

απφ ηελ ΤΠΑ γηα ηελ δηελέξγεηα

αεξνταηξηθψλ εμεηάζεσλ Σάμεο 1

Οη εμνπζηνδνηεκέλνη εμεηαζηέο γηαηξνί,

ΑΜΕs,

δηελεξγνύλ θαη ζπληνλίδνπλ ηηο ηαηξηθέο

εμεηάζεηο πνπ είλαη απαξαίηεηεο γηα ηελ

έθδνζε, αλαλέσζε ή επαλεπηθύξσζε

πηζηνπνηεηηθνύ ηαηξηθήο θαηαιιειφηεηαο

Τπνγξάθνπλ ην πηζηνπνηεηηθό ηεο

θαηεγνξίαο γηα ηελ νπνία έρνπλ

εμνπζηνδνηεζεί.

ηόρνο ηεο αεξνταηξηθήο

εμέηαζεο από ηνλ ΑΜΔ

Σξέρνπζα εηθόλα ηεο

πγείαο ηνπ ρεηξηζηή

Η δπλαηόηεηα λα

αληαπνθξηζεί ν

εμεηαδόκελνο ζηα

θαζήθνληά ηνπ, ζε

ζπλζήθεο εξγαζίαο

Ο ΑΜΔ πξέπεη λα :

είλαη θαιόο θιηληθόο γηαηξόο

εμεηάδεη πξνζεθηηθά θάζε ζύζηεκα ηνπ

ππνςεθίνπ

λα εκβαζύλεη ζηηο ιεπηνκέξεηεο

Ο ΑΜΔ πξέπεη λα θάλεη ηνλ

ππνςήθην λα λνηώζεη άλεηα θαη λα

αληηιεθζεί όηη ν ζθνπόο απηήο

ηεο εμέηαζεο δελ είλαη λα ηνλ

απνξξίςεη ηαηξηθά , αιιά λα

επηβεβαησζεί ην αιεζέο γηα ηελ

θαιή θαηάζηαζε ηεο πγείαο ηνπ

ε θάζε πεξίπησζε πξέπεη λα ηεξείηαη

ην απφξξεην ηεο δηαρείξηζεο ησλ

πξνζσπηθψλ ηαηξηθψλ δεδνκέλσλ!

Γελ λνείηαη αεξνταηξηθή εμέηαζε

αξρηθή γηα επαγγεικαηία ρεηξηζηή πνπ

λα δηαξθεί ιηγόηεξν από 3-4 ώξεο ζε

θέληξν αεξνπνξηθήο ηαηξηθήο,

όπσο θαη απηή ηεο απιήο αλαλέσζεο

ζε ΑΜΔ δηάξθεηαο κηθξόηεξεο ησλ 45

ιεπηώλ ηεο ώξαο

ηε ρώξα καο δηελεξγνύληαη πεξί ηηο

4000 αεξνταηξηθέο εμεηάζεηο πηιόησλ

από 20 εμνπζηνδνηεκέλνπο ηαηξνύο

ΑΜΔs θαη δύν AeMCs εηεζίσο εθ ησλ

νπνίσλ νη 3500 πεξίπνπ ζην

ιεθαλνπέδην ηεο Αηηηθήο θαη νη

ππόινηπεο ζηε Θεζζαινλίθε

Κξηηήξηα Ιαηξηθήο Καηαιιειόηεηαο

Έρνπλ ηε δνκή ελφο πνιχπινθνπ λνκηθνχ

ζπζηήκαηνο(Regulatory Medicine)

Δηέπνληαη απφ αξρέο πνπ πξνθχπηνπλ απφ ηε

αεποϊαηπική έπεςνα κε βάζε θαη ηελ εκηίμηζη

ηηρ πιθανόηηηαρ για αιθνίδια ακαηαλληλόηηηα

θαηά ηε πηήζε πνπ ζρεηίδεηαη κε ηηο επηκέξνπο

λνζνινγηθέο νληφηεηεο θαη παζνινγηθέο

θαηαζηάζεηο θαζψο θαη ηε ιήςε θαξκάθσλ γηα

ηελ αληηκεηψπηζε ηνπο

Χο εθ ηνχηνπ ε αλαιπηηθή παξνπζίαζε ησλ

θξηηεξίσλ θαηαιιειφηεηαο γηα επαγγεικαηίεο

ρεηξηζηέο αεξνζθαθψλ δελ είλαη εθηθηή.

Επεηδή ππάξρνπλ γεληθέο αξρέο , πξνυπνζέζεηο

αιιά θαη πνιχπινθνη νξηζκνί θαη νξνινγία πνπ ε

εξκελεία ηνπο πνηθίιεη αλάινγα κε ην ηζηνξηθφ

ηελ θιηληθή θαη παξαθιηληθή εηθφλα θάζε

ππνςεθίνπ

πκπεξαζκαηηθά πξνο απνθπγή λανθαζμένηρ

επμηνείαρ ηνπ θαλνληζκνχ ζπληζηάηαη ζηνπο

ππνςεθίνπο λα απεπζχλνληαη γηα πιεξνθνξίεο ζρεηηθά

κε ηε δπλαηφηεηα ηαηξηθήο πηζηνπνίεζεο ηνπο ζην

i) Γπαθείο Αεποποπικήρ Ιαηπικήρ (AMS)

ii) ηα Κένηπα Αεποποπικήρ Ιαηπικήρ (AMCs- Κ.Α.Ι.)

iii) Τοςρ εξοςζιοδοηημένοςρ Αεποϊαηπικούρ εξεηαζηέρ

(AMEs)

Η πξφνδνο ηεο Αεξνταηξηθήο έξεπλαο θάλεη ηα θξηηήξηα

θαηαιιειφηεηαο ιηγφηεξν απζηεξά κε ηελ παξνδν ηνπ ρξφλνπ

Δελ πξέπεη λα επηθξαηεί ε αληίιεςε φηη γηα λα γίλεη θάπνηνο

επαγγεικαηίαο ρεηξηζηήο πξέπεη λα έρεη απφιπηα θαζαξφ ηαηξηθφ

ηζηνξηθφ

Τπάξρνπλ επαγγεικαηίεο ρεηξηζηέο πνπ πεηνχλ κε

πηζηνπνηεκέλα πξνζζεηηθά κέιε- βνεζήκαηα αθνήο …

Τπάξρνπλ εηδηθέο δηαδηθαζίεο πηζηνπνίεζεο ηθαλφηεηαο πηήζεο

κε (test flight) ζε ζρεηηθέο κε ηηο παξαπάλσ πεξηπηψζεηο θαη

πξνζζήθε θάπνησλ πεξηνξηζκψλ ζην πηζηνπνηεηηθφ πγείαο (π.ρ.

OML)

Ιδηαίηεξε έκθαζε δίλεηαη ζηελ αμηνιφγεζε ησλ παξαθάησ:

Καξδηαγγεηαθά (εθηίκεζε θαξδηαγγεηαθνχ θηλδχλνπ)

Οθζαικνινγηθά

Χηνξηλνιαξπγγνινγηθά

Φπρηαηξηθά

Νεπξνινγηθά

Φπρνινγηθά

Παξαθιηληθφο έιεγρνο

πρλέο εξσηήζεηο

Απαηηήζεηο όξαζεο ?

Διαθλαστικό συάλμα

(i)Καηά ηελ αξρηθή εμέηαζε ην δηαζιαζηηθφ ζθάικα πξέπεη λα είλαη κεηαμχ εχξνπο +5 έσο –6 δηνπηξηψλ

(ii)Καηά ηηο εμεηάζεηο επαλεπηθχξσζεο ή

αλαλέσζεο, ν ππνςήθηνο, πνπ ζεσξείηαη

πεπεηξακέλνο απφ ηελ Αξρή, κε δηαζιαζηηθφ

ζθάικα πνπ δελ ππεξβαίλεη ηηο +5 δηνπηξίεο

ή κε πςειφ κπσπηθφ δηαζιαζηηθφ ζθάικα

πνπ ππεξβαίλεη ηηο –6 δηνπηξίεο κπνξεί λα

θξηζεί σο ηθαλφο απφ ην AMS

Υξσκαηηθή αληίιεςε ?

σκαηνκεηξηθά ραξαθηεξηζηηθά?

Φάξκαθα θαη πηήζε?

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Σξαπκαηηζκνί-κπνζθειεηηθά πξνβιήκαηα θαη

πηήζε?

Πξέπεη λα ηνληζηεί φηη ν θαλνληζκφο είλαη πνιχ πην επηεηθήο γηα εμεηάζεηο αλαλέσζεο ε επαλεπηθχξσζεο πηζηνπνηεηηθψλ πγείαο πηπρηνχρσλ ρεηξηζηψλ ζε ζρέζε κε ηηο αξρηθέο αμηνινγήζεηο ησλ λέσλ ππνςεθίσλ

Π.ρ. έκθξαγκα κπνθαξδίνπ

Επαλαπηζηνπνίεζε κε OML πεξηνξηζκφ κεηά απφ εμάκελν εάλ πιεξνί ζπγθεθξηκέλεο πξνυπνζέζεηο κεηά απφ ιεπηνκεξή αμηνιφγεζε

ΕΡΧΣΗΕΙ;

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