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First Aid for the USMLE Step 1 (2021)
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First Aid for the USMLE Step 1 (2021) | Physician Assistant (PA) School Study Aid

Page 407 -
9 Picmonics to Learn | 19 mins
Porcelain Gallbladder
Characteristics
Associated with Chronic Cholecystitis or Cholelithiasis
Increased Risk of Gallbladder Adenocarcinoma
Presentation
RUQ Pain
Usually Asymptomatic
Often Found Incidentally
Workup/Management
Confirm with CT or Ultrasound
Prophylactic Cholecystectomy
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3 mins
Acute Cholangitis Characteristics and Clinical Features
Characteristics
Biliary Tract Infection
Biliary Tract Obstruction
Clinical Features
Charcot's Triad
Fever
Jaundice
Abdominal Pain
Reynold's Pentad
+ Hypotension
+ Altered Mental Status
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2 mins
Ascending Cholangitis Diagnosis and Treatment
Imaging
ERCP
CT Scan
Ultrasound
Biliary Duct Dilation and/or Stones
Labs
Hyperbilirubinemia
Elevated Alkaline Phosphatase
Elevated GGT
Treatment
Broad Spectrum Antibiotics
Biliary Drainage
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4 mins
Acute Pancreatitis Disease
Autodigestion of Pancreas by Pancreatic Enzymes
Symptoms
Epigastric Abdominal Pain Radiating to Back
Anorexia
Nausea
Labs
Increased Amylase and Lipase
Complications
Disseminated Intravascular Coagulation (DIC)
Infection
Hypocalcemia
Systemic Inflammatory Response Syndrome (SIRS)
Acute Respiratory Distress Syndrome (ARDS)
Pancreatic Pseudocyst
Hemorrhage
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3 mins
Acute Pancreatitis Assessment
Mechanism
Heavy Alcohol Use and Gallstones
Signs and Symptoms
Abdominal Pain
Nausea/Vomiting/Anorexia
Abdominal Rigidity/Guarding
Decreased or Absent Bowel Sounds
Hypotension and Tachycardia
Jaundice
Increased White Blood Cells
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2 mins
Acute Pancreatitis Causes
"GET SMASHHED" Mnemonic
Gallstones
(Ethanol) Alcohol
Trauma
Steroids
Mumps
Autoimmune
Scorpion Sting
Hypercalcemia
Hypertriglyceridemia > 1000
ERCP
Drugs
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1 min
Acute Pancreatitis Interventions
NPO with NG Tube to Suction
Pain Management
Albumin
Lactated Ringers Solution
Proton Pump Inhibitor (PPI)
Antibiotics
Surgery
Nutrition
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2 mins
Acute Abdomen Differential Diagnosis: Upper Quadrants
Right Upper Quadrant
Cholecystitis
Biliary Colic
Cholangitis
Perforated Duodenal Ulcer
Acute Hepatitis
Left Upper Quadrant
Splenic Rupture
IBS (Splenic Flexure Syndrome)
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2 mins
Acute Abdomen Differential Diagnosis: Midepigastrium and Diffuse
Midepigastrium
Peptic Ulcer Disease
Pancreatitis
Aortic Dissection
Myocardial Infarction
Any Place
Peritonitis
Hemorrhage or Perforation
Bowel Obstruction
Strangulation
Acute Hepatitis
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2 mins

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