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% Document Info
\author{xkissmekatex (kissmekate)}
\pdfinfo{
  /Title (pft-acnp-student.pdf)
  /Creator (Cheatography)
  /Author (xkissmekatex (kissmekate))
  /Subject (PFT ACNP Student Cheat Sheet)
}

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\noindent
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{PFT ACNP Student Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{xkissmekatex (kissmekate)} via \textcolor{DarkBackground}{\uline{cheatography.com/33594/cs/10488/}}}
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\begin{multicols}{3}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}xkissmekatex (kissmekate) \\
  \uline{cheatography.com/kissmekate} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 13th January, 2017.\\
   Updated 16th January, 2017.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Function Tests}}  \tn
% Row 0
\SetRowColor{LightBackground}
Pulmonary function tests (PFTs) & •Categorization of different types of lung processes (restrictive versus obstructive)\{\{nl\}\} •Assessment of disease severity (prognosis and preoperative evaluation)\{\{nl\}\} •Post-treatment evaluation of lung function. \tn 
% Row Count 10 (+ 10)
% Row 1
\SetRowColor{white}
Evaluate PFT's & 1. When evaluating a PFTs think: •expiratory flow • Lung volumes •Diffusion capacity •Response to bronchodilators\{\{nl\}\} 2. Look for all {\bf{normals everything \textgreater{}80\%}}. Most smokers have normal values.\{\{nl\}\} 3. Look for {\bf{restrictive disease TLC\textless{} 80\% }}. If TLC not known reflected in a proportional decrease in FEV1 and FVC (i.e., FEV1/FVC = 80\% but FVC is\textless{} 80\%).\{\{nl\}\} 4. If {\bf{restrictive check DLCO}} for extra-thoracic or in intra-thoracic. If the decrease in DLCO is proportional to the decrease in TLC means the restriction is not due to parenchymal disease it is of extra-thoracic origin think of obesity and kyphosis. If the decrease in DLCO is disproportionately low compared to the decrease in TLC think of interstitial lung disease.\{\{nl\}\} 5. Look for {\bf{obstructive FEV1 and FEV1/FVC are low (\textless{}70\%)}}.\{\{nl\}\} 6. If {\bf{obstructive, check the TLC, DLCO, and reaction to beta2-agonists}}: Emphysema if the TLC is high but the DLCO is low (alveolar disease); minimal-to-no response to beta2-agonist. Asthma if the DLCO is normal, or there typically is a reaction to beta2-agonist. \tn 
% Row Count 60 (+ 50)
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\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Function Tests (cont)}}  \tn
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Obstructive Disease & {\bf{Overexpansion}} of lungs – loss of recoil. {\bf{Reduction in AIRFLOW}}. {\bf{FEV1/FVC Ratio is decreased (\textless{}70\%). }}Difficulty exhaling, narrowed airways, bronchoconstriction, mucus accumulation. {\bf{COPD {[}Emphysema, Chronic bronchitis{]}, Asthma.}} \tn 
% Row Count 12 (+ 12)
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Restrictive Disease & {\bf{Reduction in lung VOLUME}}. Difficulty taking air in from {\bf{STIFF lung}}. {\bf{Total lung capacity decreased (\textless{} 80\%)}}. {\bf{ILD, scoliosis, obesity, PNA, Fibrosis, consolidation, Tumors}} due to both a decreased VC and RV. \tn 
% Row Count 23 (+ 11)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Function Tests}}  \tn
% Row 0
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TLC (total lung capacity: VC+RV) N=80–120\% & The volume of air in the lungs after maximum inspiration. {\bf{High in obstructive (\textgreater{}120\% hyperinflation)}}. {\bf{Low in restrictive (\textless{}80\%, decreased lung volume)}}. \tn 
% Row Count 9 (+ 9)
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FEV1 (forced expiratory volume) N=80–120\% & Total volume of air able to exhale in the first second during maximal effort. {\bf{Low (\textless{}80\%) in obstructive}}. Normal to slightly low (\textless{}80\%) in restrictive (proportional to volume). {\bf{Bronchodilator response \textgreater{}12\% and 200mL increased FEV1 (+asthma vs -COPD)}}. \tn 
% Row Count 23 (+ 14)
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VC (vital capacity) & Volume of air expelled from the lungs during a maximum expiration. {\bf{Low in restrictive}} (problem with lung dynamic, large airway is intact, so ILD). \tn 
% Row Count 31 (+ 8)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Function Tests (cont)}}  \tn
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FVC (forced vital capacity) & Total volume of air able to exhale for the total duration of the test during maximal effort. {\bf{Low restrictive}} ({\bf{decreased expansion}} from fibrosis, tumor/cancer, consolidation, heart failure with pulmonary edema, thick pleura, effusion, cardiomegaly, chest wall issues, muscle weakness). \tn 
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FEV1/FVC Ratio N=80\% & Percentage of the FVC expired in one second (do the volumes, flow out of lung as expected). {\bf{Low (\textless{}70\%) in obstructive diseases (COPD or asthma)}}. Normal/high (\textgreater{}70\%) in restrictive diseases (ILD, sarcoidosis, asbestosis, CHF, MSK, neuromuscular diseases + morbid obesity). \tn 
% Row Count 31 (+ 15)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Function Tests (cont)}}  \tn
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FRC (functional residual capacity) & Volume of air in the lungs after a normal expiration (increase indicates hyperinflation). \tn 
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RV (residual volume) N=75–120\% & Volume of air in the lungs at maximal expiration. {\bf{High in obstructive (dead space air, increase indicates air trapping)}}. Low in restrictive. \tn 
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TV (tidal volume) & Volume of air breathed in a and out of the lungs during quiet breathing. \tn 
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DLCO (gas exchange) N=75–120\% & Lung diffusion testing (ability of the body to absorb carbon monoxide from a single breath) is used to determine how well oxygen passes from the alveolar space (alveolar membrane permeability) of the lungs into the blood. {\bf{Low in ILD, pulmonary vascular diseases}}, anemia, emphysema (loss of alveolar-capillary units). Normal in chronic bronchitis, asthma \seqsplit{(bronchoconstriction}, but NO alveolar disease. {\bf{Increased in problems that increase effective blood flow to the functional lung}}, such as heart failure, disease alveolar hemorrhage, pulmonary infarction, and idiopathic pulmonary hemosiderosis (IPH). \tn 
% Row Count 48 (+ 31)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pulmonary Function Tests (cont)}}  \tn
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DLCO/VA & {\bf{PERFUSION}} Diffusing capacity corrected for alveolar \seqsplit{volume/Hct-adjusted.} \tn 
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PFTs for Specific Lung Diseases}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Interstitial Lung Disease}} Restrictive} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}•Normal to increased FEV/FVC.\{\{nl\}\} •Straight or slightly convex expiratory  flow-volume loop tracing.\{\{nl\}\} •Proportional decrease in all lung volumes.\{\{nl\}\} •{\bf{DLCO is reduced}} (due to thickening of the alveolar capillary interface) and is the 1st pulmonary parameter to change with disease progression} \tn 
% Row Count 8 (+ 8)
% Row 1
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Asthma}} Obstructive} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}•PFTs may be normal if no active disease.\{\{nl\}\} •Decreased expiratory flow. \{\{nl\}\} •Concave expiratory flow-volume loop tracing.\{\{nl\}\} •{\bf{Significant response to beta2-agonist}}.\{\{nl\}\} •Normal or increased TLC (due to hyperinflation) and normal or reduced VC. \{\{nl\}\} •{\bf{DLCO is normal}}.} \tn 
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Emphysema}} Obstructive} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}•Decreased expiratory flow volume \{\{nl\}\} •Concave expiratory flow-volume loop tracing.\{\{nl\}\} •{\bf{Minimal response to beta2-agonist}}:\textless{} 12\% improvement or \textless{} 200mL improvement in FEV1 or FVC. \{\{nl\}\} •{\bf{Increased TLC, reduced VC=hyperinflation with trapped air}}.\{\{nl\}\} •{\bf{DLCO is decreased }}(destruction of alveolar capillary interface-{}-suggests emphysema) but early on maybe normal spirometry and lung volume} \tn 
% Row Count 26 (+ 10)
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Chronic Bronchitis}} Obstructive} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}•Decreased expiratory flow volume \{\{nl\}\} •Concave expiratory flow-volume loop tracing.\{\{nl\}\} •{\bf{Minimal response to beta2-agonist}}:\textless{} 12\% improvement or \textless{} 200mL improvement in FEV1 or FVC.\{\{nl\}\} •Normal or only slight increase in TLC = normal or slightly reduced VC.\{\{nl\}\} •DLCO is normal to slightly decreased, but it is not as low as in patients with emphysema. \{\{nl\}\} •DLCO is  to differentiate emphysema from chronic bronchitis and asthma. \{\{nl\}\} Most cases of COPD have mixed physiology with components of both chronic bronchitis and emphysema.} \tn 
% Row Count 39 (+ 13)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{FEV}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/kissmekate_1484317425_Messages Image(1405776722).png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Flow Volume Loops}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/kissmekate_1484317985_Messages Image(850302826).png}}} \tn 
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\mymulticolumn{1}{x{5.377cm}}{The relationship between airflow rates compared with lung volumes.}  \tn 
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Flow Loop}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/kissmekate_1484273691_Messages Image(56238184).png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{1.9908 cm} x{2.9862 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Test to Order}}  \tn
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Smoker: age 40+ & Spirometry with bronchodilator q3-4yrs \tn 
% Row Count 2 (+ 2)
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Hx COPD & •Spirometry with bronchodilator q 1-2 yrs\{\{nl\}\} •Also DLCO and if FEV1 \textless{} 50\% check blood gases\{\{nl\}\} •Static lung volumes, looking for increased RV\{\{nl\}\} \tn 
% Row Count 9 (+ 7)
% Row 2
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Asthma: diagnosis & •Spirometry with challenge/ bronchodilator q1yr \{\{nl\}\} •{\bf{Daily peak flows}} \{\{nl\}\} •Written plan in place \tn 
% Row Count 14 (+ 5)
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Allergic Rhinitis & Correlates w/Asthma so baseline for reactive airways with spirometry with methacholine challenge and bronchodilator \tn 
% Row Count 19 (+ 5)
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Exertional Dyspnea & Spirometry with dilators \& methacholine, DLCO, Pox, Exercise Testing \tn 
% Row Count 22 (+ 3)
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Chest Tightness & Spirometry with methacholine and bronchodilators \tn 
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Chronic Cough & Spirometry with methacholine, bronchodilators, and inspiratory flow loop \tn 
% Row Count 27 (+ 3)
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CAD (smoker and HF) & Spirometry with bronchodilator \tn 
% Row Count 29 (+ 2)
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Recurrent PNA or Bronchitis & Spirometry with methacholine and bronchodilators \tn 
% Row Count 31 (+ 2)
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\begin{tabularx}{5.377cm}{x{1.9908 cm} x{2.9862 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Test to Order (cont)}}  \tn
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Neuromuscular Disease & Spirometry with methacholine and bronchodilators, DLco testing, maximal respiratory pressures \tn 
% Row Count 4 (+ 4)
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Occupational exposures & Spirometry \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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% That's all folks
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