Source / episode info
- **Episode:**153
- **Title:**Divine Intervention Episode 153 – USMLE Step 2CK Rapid Review Series 15 (Surgery).
- **Published:**2019-09-14
- Source:Episode page
One-liner
This episode rapidly reviews critical board topics including the paraneoplastic syndromes of lung cancer (SCLC), neuromuscular junction disorders (LEMS), various acquired bleeding diatheses (ITP, vWD, Glanzmann's), and surgical emergencies like esophageal rupture, acute pancreatitis, and high output heart failure.
High-yield summary
- Small Cell Lung Cancer (SCLC): Can cause paraneoplastic syndromes such as SIADH (hyponatremia) due to ADH production, or hypercalcemia via PTHrP secretion.
- Lambert-Eaton Myasthenic Syndrome (LEMS): Characterized by proximal muscle weakness that improves with repetitive use; associated with SCLC and antibodies against P/Q-type calcium channels.
- Hypocalcemia Management: The rescue agent for symptomatic hypocalcemia is Calcium Gluconate. Causes include hypoparathyroidism, rhabdomyolysis, and George syndrome.
- Coagulation Defects: Must differentiate between platelet defects (Glanzmann's, Bernard-Soulier) and factor deficiencies (vWD). Elevated PTT + prolonged bleeding time suggests vWD.
- High Output Heart Failure (HOHF): A common complication post-dialysis or after creating an arteriovenous fistula due to the loss of capillary resistance/slowdown mechanism in blood flow.
- MEN1 Syndrome: Triad involves parathyroid issues, pituitary tumors (prolactinoma), and pancreatic neuroendocrine tumors (VIPoma, Gastrinoma, Glucagonoma).
Learning objectives
- Differentiate paraneoplastic syndromes associated with lung cancer (SCLC vs SCC).
- Recognize the clinical presentation and management of acquired bleeding diatheses (ITP, vWD, Glanzmann's).
- Master the differential diagnosis and initial workup for hypocalcemia in a surgical context.
- Understand the pathophysiology and complications of high output heart failure following dialysis access creation.
- Recall the specific endocrine tumor associations within Multiple Endocrine Neoplasia Type 1 (MEN1) syndrome.