Source / episode info

• **Episode:**391
• **Title:**Divine Intervention Episode 391 – USMLE Step 2CK/3 Rapid Review Series 75
• **Published:**2022-05-19
• Source:Episode page

One-liner

This episode provides a rapid review covering the clinical manifestations of lung cancer paraneoplastic syndromes, emergency management of postpartum hemorrhage, nephrotoxic effects of anti-hypertensives (ACEi/ARBs), acute cardiac rhythm recognition and treatment protocols, HIV vaccine guidelines, and common causes of small bowel obstruction.

High-yield summary

• Small Cell Lung Cancer (SCLC): Highly associated with paraneoplastic syndromes: SIADH (Hyponatremia), Hypercalcemia (PTHrP), Hypokalemic Metabolic Alkalosis, and LEMS (proximal weakness).
• Postpartum Hemorrhage (PPH): The most common cause is uterine atony; risk factors include polyhydramnios, large baby (>9 lbs), and diabetes. First line treatment is uterine massage followed by Oxytocin.
• ACE Inhibitors/ARBs: Use with caution in bilateral renal artery stenosis (RAS) due to efferent arteriolar dilation, which decreases glomerular filtration rate (GFR). They are also useful for treating peripheral edema associated with CCB use by dilating veins.
• V-Tachyarrhythmias: Wide complex tachycardia requires immediate triage: stable/with pulse -> MateriaRate; unstable/pulseless -> Unsynchronized Cardioversion (Defibrillation). Defibrillable rhythms include V-fib and pulseless V-tach.
• HIV Vaccines: Live attenuated vaccines are contraindicated if the CD4 count is < 200 cells/mm³. The intranasal influenza vaccine should never be given, regardless of CD4 count.
• Anti-cholinergic Side Effects: Drugs like TCAs and first-generation low-potency antipsychotics (e.g., Chlorpromazine) cause Anti-H1 (sedation), Anti-1 (orthostatic hypotension), and Anti-muscarinic effects.

Learning objectives

• Differentiate the clinical presentations of various lung cancer types, particularly recognizing paraneoplastic syndromes associated with SCLC.
• Master the immediate management protocols for postpartum hemorrhage, identifying primary causes and first-line pharmacological interventions.
• Analyze drug interactions involving RAAS blockade (ACEi/ARBs) in patients with pre-existing renal artery stenosis.
• Apply advanced cardiac life support principles to wide complex tachyarrhythmias, distinguishing between stable and unstable presentations.
• Recall contraindications for live attenuated vaccines in immunocompromised patients (e.g., HIV).