CASE

A 55 y.o. Male presents to the medical examiner for his Commercial Motor Vehicle (CMV) driver certification exam. His normal job description includes long haul driving across the country and occasional heavy lifting.

During the history portion of the exam he reports occasionally feeling some palpitations, especially after a poor night of sleep. He denies any chest pain or shortness of breath. In fact, he is feeling some palpitations at present, but denies any other symptoms or concerns. He takes no medications and has no history of any prior cardiac problems or stroke.

A 25-year-old truck driver presents for his Medical Fitness for Duty exam. He states that he recently changed psychiatrists because he did not agree with the doctor's diagnosis of Bipolar Disorder. His new psychiatrist thinks he has Attention Deficit Disorder, and Major Depressive Disorder. He has discontinued his Bipolar Medication for mood stabilization, and is now managed on methylphenidate and fluoxetine. On further questioning, the driver candidate mentions his father, who was killed while driving a truck, had a bad temper. Although he has a history of alcohol use, currently he denies imbibing in the past three years.