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CFI Practical Test Standards: Technical Subject Areas

Aeronautical Information Manual

Chapter 8. Medical Facts for Pilots

Section 1. Fitness for Flight

8-1-1. Fitness For Flight
8-1-2. Effects of Altitude
8-1-3. Hyperventilation in Flight
8-1-4. Carbon Monoxide Poisoning in Flight
8-1-5. Illusions in Flight
8-1-6. Vision in Flight
8-1-7. Aerobatic Flight
8-1-8. Judgment Aspects of Collision Avoidance

Read the online version at

14 CFR 61.23 Medical certificates

Medical certificates: Requirement and duration

Read the whole thing at

FAA Pilot Portal: Medical Certification

The FAA's Pilot Portal includes information on Medical Certification.

Aeromedical Factors

Medical Certificates and 'SODA'

The Aeromedical Factors task of the CFI oral exam is a bit of a grab-bag. Some of it is regulatory, such as explaining how to get an FAA Medical Certificate and how to use MedXPress. You also need to counsel student pilots on how to proceed if they suspect they have a disqualifying condition.

During the oral exam, point to the Medical Certification page on the FAA's pilot portal as a primary resource for student pilots.

While it's not referenced in the PTS task, 14 CFR 67 is the regulatory document for all FAA Medical Certification topics. This spells out qualifying and disqualifying criteria for the three certificate classes.

The task also mentions "How to obtain a medical certificate in the event of a possible medical deficiency," which leads to § 67.401 Special issuance of medical certificates. The key language here is:

"…if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical certificate applied for can be performed without endangering public safety.

"At the discretion of the Federal Air Surgeon, a Statement of Demonstrated Ability (SODA) may be granted, instead of an Authorization, to a person whose disqualifying condition is static or nonprogressive and who has been found capable of performing airman duties without endangering public safety."

Aeromedical Risks

The second part of this task is straight-up ground school — but note that all of the information required by the task is cautionary, not just academic. Student pilots need to know the real risks of hypoxia, hyperventilation, and ear/sinus issues. They need to understand that they can be misled by motion sickness and illusions during flight. A faulty airplane can cause C02 poisoning, which requires a specific type of monitor. Fatigue, stress, and dehydration are other risks that student pilots mitigate through their own pre-flight behaviors.

And of course, flying doesn't mix with alcohol or drugs. Scuba diving carries specific risks and mitigation strategies.

Try discussing this section as a type of spiral curriculum — has your student ever felt adverse effects in other settings, such as when at work or driving a car? Can they recall a time when they were fatigued, or drank more than they intended to? Does your student understand that intoxication is simply one kind of hypoxia? (Toxic hypoxia.) Have they experienced motion sickness? Do they have any diving experience, or do they have friends or relatives who dive?

Practical Test Standards: Flight Instructor

II. Technical Subject Areas
Task A: Aeromedical Factors


  1. Aeronautical Information Manual (AIM)
  2. Airplane Flying Handbook (FAA-H-8083-3)
  3. Commercial Pilot: Airplane Practical Test Standards (FAA-S-8081-12) (cancelled)
  4. Commercial Pilot: Airplane Airman Certification Standards (FAA-S-ACS-7A)
  5. Private Pilot Airman Certification Standards (FAA-S-ACS-6)

Objective: To determine that the applicant exhibits instructional knowledge of the elements related to aeromedical factors by describing:

  1. How to obtain an appropriate medical certificate.
  2. How to obtain a medical certificate in the event of a possible medical deficiency.
  3. The causes, symptoms, effects, and corrective action of the following medical factors:
    1. Hypoxia
    2. Hyperventilation
    3. Middle ear and sinus problems
    4. Spatial disorientation
    5. Motion sickness
    6. Carbon monoxide poisoning
    7. Fatigue and stress
    8. Dehydration
  4. The effects of alcohol and drugs, and their relationship to flight safety.
  5. The effect of nitrogen excesses incurred during scuba dives and how this affects pilots and passengers during flight.

Flight Instructor Test Questions


Hypoxia is the result of decreasing amounts of oxygen as your altitude increases.

During a climb to 18,000 feet, the percentage of oxygen in the atmosphere remains the same.

Which statement regarding hypoxia is true? Belligerence or a false sense of security may be symptoms of hypoxia.

How can smoking affect a pilot? Reduces the oxygen-carrying capability of the blood.
— Smoking also reduces night vision by approximately 20%. (A distractor puts this at 50%. Another distractor suggests smoking increases carbon dioxide gasses, rather than carbon monoxide. Both distractors are a bit sneaky, since all three answers look plausible.)

Anemic hypoxia has the same result as hypoxic hypoxia, but it is most of the result of a leaking exhaust manifold.
— Anemic hypoxia is also known as hypemic hypoxia, and is caused by contaminated blood. CO poisoning would cause anemic/hypemic hypoxia.

Which statement is true regarding alcohol in the human system? Alcohol renders a pilot more susceptible to hypoxia.

What physical change would most likely occur to occupants of an unpressurized aircraft flying above 15,000 feet without supplemental oxygen? A blue coloration of the lips and fingernails develop along with tunnel vision.
— Blue discoloration of the lips and fingernails is cynanosis.

The advantage of experiencing hypoxia in an altitude chamber is it helps pilots learn to recognize their own symptoms in a controlled environment.


Hyperventilation results in a lack of carbon dioxide in the body.

A person should be able to overcome the symptoms of hyperventilation by slowing the breathing rate and increasing the amount of carbon dioxide in the body.

Which is a common symptom of hyperventilation? Tingling sensations.

Motion Sickness

What suggestion could you make to students who are experiencing motion sickness? Tell the students to avoid unnecessary head movement and to keep their eyes on a point outside the aircraft.

Motion sickness is caused by continued stimulation of the tiny portion of the inner ear which controls sense of balance..


No person may act as a crewmember of a civil aircraft with a minimum blood alcohol level of 0.04 percent or greater. (91.17)

Scuba Diving

If an individual has gone scuba diving which has not required a controlled ascent and will be flying to cabin pressure altitudes of 8,000 feet or less, the recommended waiting time is at least 12 hours.

If an individual has gone scuba diving which has required a controlled ascent and will be flying to cabin pressure altitudes of 8,000 feet or less, the recommended waiting time is at least 24 hours.

Oral Exam Questions

  1. How can a student pilot obtain a Medical Certificate?
  2. How long is a Medical Certificate valid?
  3. Where can a student pilot research disqualifying medical conditions?
  4. Can a student pilot be issued a medical certificate if they have a disqualifying condition?
  5. What are the four types of hypoxia? Under what circumstances would each type occur?
  6. What causes hyperventilation? What is the appropriate treatment?
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Robert Wederquist   CP-ASEL - AGI - IGI
Commercial Pilot • Instrument Pilot
Advanced Ground Instructor • Instrument Ground Instructor

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