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 +6  (nbme23#20)

The puborectalis muscle, which is one of the muscles that comprise the pelvic floor and plays an important role in both fecal continence and defecation, is tonically contracted and maintains the anorectal angle at rest.

here is a picture: https://www.123rf.com/photo_46940875_stock-vector-the-rectum-and-anus-showing-the-puborectalis-muscle-part-of-the-levator-ani-used-for-the-control-of-.html

gh889  How do you differentiate this from hypertonicity of the internal anal sphincter?
gh889  nvm. im dumb lol
qball  Uworld Q ID 17004

 +5  (nbme23#29)

Lomustine ia an alkylating nitrosourea compound used in chemotherapy. Alkylating agents crosslink DNA.

Cyclophosphamide metabolizes into a phosphoramide mustard. Phosphoramide mustard forms DNA crosslinks both between and within DNA strands

Cholchicine and Vinblastine work on microtubules

Methotrexate and 5-FU both work on purine metabolism.

Cytosine arabinoside interferes with the synthesis of DNA. Its mode of action is due to its rapid conversion into cytosine arabinoside triphosphate, which damages DNA when the cell cycle holds in the S phase (synthesis of DNA). Rapidly dividing cells, which require DNA replication for mitosis, are therefore most affected.

smc213  To clarify Methotrexate (inhibits dihydrofolate reductase) and 5-FU (inhibits thymidylate synthase) in the Pyrimidine synthesis pathway. 6-MP inhibits Glutamine PRPP amidotransferase in the PURINE synthesis pathway

Subcomments ...

submitted by sympathetikey(618),

Believe this question is referring to Visceral Leishmaniasis.

gabeb71  The give away is the Fever, Pancytopenia, and Hepatosplenomegaly after being bitten by an insect and developing the sore. +2  
tallerthanmymom  I got this question directly after the other visceral leishmania question and it made me second guess everything I thought I knew. +  
qball  Don't forget they like to infect macrophages. +  

submitted by lfsuarez(114),

This patient presents with a small cell carcinoma which is very common for para neoplastic syndromes. In this case the cancer is causing SIADH. Demeclocyline is a tetracycline antibiotic that is also used to treat SIADH

gabeb71  To add to ^ It is widely used (though off-label in many countries including the United States) in the treatment of hyponatremia (low blood sodium concentration) due to the syndrome of inappropriate antidiuretic hormone (SIADH) when fluid restriction alone has been ineffective. Physiologically, this works by reducing the responsiveness of the collecting tubule cells to ADH. The use in SIADH actually relies on a side effect; demeclocycline induces nephrogenic diabetes insipidus (dehydration due to the inability to concentrate urine). +12  
qball  And for you Sketchy people Demeclocycline is in GI/Endocrine ADH one with the bicycle and that "vaptans" are first line. +  

PTH is increased because serum calcium is low. Because PTH is increased, phosphorous is decreased. The woman in unable to absorb vitamin D (a fat soluble vitamin), so calcitriol is decreased (no vitamin D for the kidney to activate into calcitriol).

gabeb71  What does this have to do with the Celiac Sprue? +1  
medpsychosis  I believe they were explaining the reason for the mentioned "mild osteopenia" in the pt presentation. +  
meningitis  No, I think this person got confused with another question about celiac sprue, PTH, Calcitriol, and Vit D (it was an arrow type question). +  
diabetes  explanation for decreased bone density . +