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% Document Info
\author{xkissmekatex (kissmekate)}
\pdfinfo{
  /Title (pulmonary-rotation-acnp.pdf)
  /Creator (Cheatography)
  /Author (xkissmekatex (kissmekate))
  /Subject (Pulmonary Rotation ACNP 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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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pulmonary Rotation ACNP Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{xkissmekatex (kissmekate)} via \textcolor{DarkBackground}{\uline{cheatography.com/33594/cs/10482/}}}
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\noindent
\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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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Asthma (Obstructive Disease)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{Definition} & • {\bf{Inflammatory}} condition of the airways\{\{nl\}\} • {\bf{hyperresponsiveness}} leading to {\bf{airway edema + bronchoconstriction}} \{\{nl\}\} • Recurrent/intermittent episodes of wheezing, shortness of breath, and/or cough\{\{nl\}\} • Usually {\bf{reversible}} either spontaneously or with treatment. \tn 
% Row Count 11 (+ 11)
% Row 1
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Causes & Atopy ({\bf{IgE mediated}}) + Environmental triggers (allergens, irritants, chemicals, respiratory infections, physical stress, and emotional stress). \tn 
% Row Count 17 (+ 6)
% Row 2
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Diagnosis & {\bf{Reversible bronchoconstriction}} on own or with bronchodilator and a history. {\bf{Consider challenge test}} \tn 
% Row Count 22 (+ 5)
% Row 3
\SetRowColor{white}
Severity & Intermittent, mild persistent, moderate persistent, and severe persistent \tn 
% Row Count 25 (+ 3)
% Row 4
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\seqsplit{Relationships} & • GERD, Allergic rhinitis\{\{nl\}\} • Worsened by Allergic bronchopulmonary aspergillosis (ABPA), Obstructive sleep apnea-hypopnea (OSA), Stress \tn 
% Row Count 30 (+ 5)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{TESTS}}  \tn
% Row 0
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PFT's & • Normal if no active disease.\{\{nl\}\} • {\bf{FEV1/FVC \textless{} 70\%}}\{\{nl\}\} • Decreased expiratory flow \{\{nl\}\} • {\bf{Significant response to beta2-agonist}}. \{\{nl\}\} • Normal or increased TLC (due to hyperinflation). \{\{nl\}\}  • Normal or reduced VC. \{\{nl\}\} • DLCO is normal.\{\{nl\}\} \tn 
% Row Count 16 (+ 16)
% Row 1
\SetRowColor{white}
Exercise induced bronchospasm & Decrease in FEV1 of \textgreater{}10\% on a treadmill or a stationary bicycle. \tn 
% Row Count 20 (+ 4)
% Row 2
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CXR & Normal in mild cases. {\bf{Severe asthma shows hyperinflation}}. \tn 
% Row Count 24 (+ 4)
% Row 3
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Arterial Blood Gas & • Indicated in respiratory distress. \{\{nl\}\} • Hypocarbia from hyperventilation. \{\{nl\}\} • Hypoxemia may be present. \{\{nl\}\} • If CO2 level is normal or high sign that the patient is decompensating due to fatigue or severe airway obstruction and {\bf{intubation}} may be required. \tn 
% Row Count 40 (+ 16)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{TESTS (cont)}}  \tn
% Row 4
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Challenge Test & •Methacholine challenge, histamine challenge, and thermal (cold air). Principle of nonspecific hyperirritability. \{\{nl\}\} •{\bf{Must both tighten up with the challenge and loosen up with subsequent bronchodilators}}.\{\{nl\}\} • Response to short-acting bronchodilator {\bf{(increase in the FEV1 \textgreater{} 12\% and increase of 200 mL}}). \tn 
% Row Count 17 (+ 17)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Treatment}}  \tn
% Row 0
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Rescue & SABA (albuterol) \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Quick relief (acute, mild, intermittent disease) & • Short-acting beta2-agonists (SABAs)\{\{nl\}\} • Systemic corticosteroids \{\{nl\}\} • Anticholinergics \tn 
% Row Count 7 (+ 6)
% Row 2
\SetRowColor{LightBackground}
Long-Term control & • {\bf{Inhaled corticosteroids}} (ICS; most potent and most effective) \{\{nl\}\} • Long-acting beta2-agonists (LABAs) \{\{nl\}\} • Mast-cell stabilizers (cromolyn sodium +nedocromil) \{\{nl\}\} • Leukotriene modifiers \{\{nl\}\} • Methylxanthines (theophylline)  • Immunomodulators (omalizumab = anti-IgE) \tn 
% Row Count 24 (+ 17)
% Row 3
\SetRowColor{white}
Acute Exacerbation & • Inhaled B agonist and ipratropium via nebulizer or MDI. Assess response clinically and with peak flow. \{\{nl\}\} • IV or oral corticosteroids, then taper when improvement occurs. \{\{nl\}\} • Third-line agents include IV magnesium, which helps with bronchospasm in severe refractory cases. \{\{nl\}\} • Supplemental oxygen to keep Osat\textgreater{}90\%. Antibiotics if necessary. Intubation for respiratory failure. \tn 
% Row Count 45 (+ 21)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Treatment (cont)}}  \tn
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Mild Intermittent & • Symptoms \textless{}2 times per week, nighttime awakenings \textless{}2x per month. \{\{nl\}\} • Normal baseline FEV1 and FEV1/FVC. \{\{nl\}\} • Needs no long-term control medications, just short acting beta agonist (albuterol). \tn 
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Mild Persistent & • Symptoms \textgreater{}2 times per week but not every day. 3-4 nighttime awakenings per month, minor limitations on activities. \{\{nl\}\} • Normal PFTs. \{\{nl\}\} • {\bf{Low dose inhaled corticosteroid}} indicated with PRN albuterol inhaler. \tn 
% Row Count 23 (+ 12)
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Moderate Persistent & • {\bf{Daily symptoms}} with frequent exacerbations. \{\{nl\}\} • FEV1 is 60-80\% of expected. \{\{nl\}\} • Daily inhaled low dose corticosteroid, PRN albuterol inhaler, and LABA inhaler. +/- \seqsplit{cromolyn/methylxanthine/antileukotriene}. \tn 
% Row Count 35 (+ 12)
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% Row 7
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Severe Persistent & • Continual symptoms with frequent exacerbations and {\bf{limited physical activity}}. \{\{nl\}\} • {\bf{FEV1 \textless{}60\% of predicted}}. \{\{nl\}\} • Daily high dose inhaled corticosteroid, PRN albuterol, and long-acting beta agonists. +/- methylxanthine and systemic corticosteroids. \tn 
% Row Count 14 (+ 14)
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\mymulticolumn{2}{x{5.377cm}}{.}  \tn 
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Treatment and Maintenance}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/kissmekate_1484335810_Messages Image(1526111450).png}}} \tn 
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Differential Diagnosis of Wheezing}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{•  CHF: due to edema of airways and congestion of bronchial mucosa. \{\{nl\}\} •  COPD: inflamed airways may be narrowed or bronchospasm may be present. \{\{nl\}\} •  {\bf{Asthma: most common cause}}. \{\{nl\}\} •  \seqsplit{Cardiomyopathy/Pericarditis:} can lead to edema around the bronchi. \{\{nl\}\} •  Lung Cancer: due to obstruction of airways (central tumor or mediastinal invasion).} \tn 
% Row Count 8 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{5.377cm}}{.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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% That's all folks
\end{multicols*}

\end{document}