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Comments ...

 +0  (nbme18#29)

"The ileocolic vein is located within the digestive tract. It receives blood from the appendicular vein, and it drains oxygen-depleted blood from the ileum in the small intestine and the cecum and colon, parts of the large intestine.

From there, this deoxygenated blood flows to the superior mesenteric vein, which joins with the hepatic portal vein."


Subcomments ...

submitted by iviax94(7),
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I fedurig tyeh reew ignytr ot tge at eth elif yctaecnpex fo na C,RB utb notw’dul nluesetapplm O2 enctyahlcli reeclap the CO budon to CsB?R FA evne emoninst taht OC nibds eyotiletivmpc to RBCs, adn ’stin thta hte oewhl point of ngiigv ph1rrb/y0cei0%a O?2

nc1992  First aid has a lot of errors +  
yotsubato  Thats not an error though. Thats the actual reason behind giving hyperbartic O2 for CO poisoning... +11  
mumenrider4ever  The question ask how long it takes to remove all the CO-carrying RBC so I think they're implying that theoretically not every single CO-carrying RBC would be replaced with oxygen from the supplemental O2 and some would die off naturally +  

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DAK aiids)o(sc t&g; tiumosPas fhtssi tuo fo teh cell tg&; kkyeamirphae

AF 1,092 pg 758

mumenrider4ever  While you will have a high serum potassium, your total body potassium will be low due to very low intracellular potassium (which is where the majority of the body's potassium is usually). This is why you give potassium to patients with DKA +1  
passplease  Why do you not get an increased bicarbonate concentration? +  
briangibbs3  Bicarb acts as a buffer and binds up excess H+ in DKA +  
jurrutia  In other words, DKA a is a cause of metabolic acidosis. Hallmark of MA is low bicarb. +  

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Esiesat wya ot hnkti fo isht si atht ihts is raeGdt.oa reuS eovynree nksiht ttah psrots dinrsk eavh uglecso for het nyeger (cwhih si olsa teu)r utb yteh osla iocntan garus seecuab teh /NcslGuoea cs-otrarrpenot ni eht malls iietnesnt selhp drevi otytercleel e.ntaik touWhit lugoesc, oyu ontd’ lplu ni idsmou eyalnr as elecftiyifn in eht gut dna eht ritsf sraemk fo teh aatodGre mrlfauo ta UF ndofu tath ceon they vaeg leuosgc nad eetyroetscll neidats fo tujs tawer to eth bfloaolt amte gndriu pi,cectra etyh di’ntd teg as tdeddharey nad teirh rceeylettol canlabe aws a tlo more slbtea.

usmleboy  Gaaaaaatttoooraaddeeee! Water sucks! It really really sucks! +2  
mumenrider4ever  You're drinking the wrong water +1  
rockodude  go gators, we made that shit +  
username  go dawgs +  

submitted by seagull(1539),
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otu of ou,ciytsri hwo aym pleepo enwk h?its t(nod eb ysh to asy yuo ddi or i)d?ndt

yM tyrvepo deconiuat di'ndt ginnria shit in me.

johnthurtjr  I did not +1  
nlkrueger  i did not lol +  
ht3  you're definitely not alone lol +  
yotsubato  no idea +  
yotsubato  And its not in FA, so fuck it IMO +1  
niboonsh  i didnt +  
imnotarobotbut  Nope +  
epr94  did not +  
link981  I guessed it because the names sounded similar :D +14  
d_holles  i did not +  
yb_26  I also guessed because both words start with "glu"))) +27  
impostersyndromel1000  same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle. +1  
jaxx  Not a clue. This was so random. +  
ls3076  no way +  
hyperfukus  no clue +  
mkreamy  this made me feel a lot better. also, no fucking clue +1  
amirmullick3  My immediate thought after reading this was "why would i know this and how does this make me a better doctor?" +7  
mrglass  Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess. +4  
djtallahassee  yea, I mature 30k anki cards to see this bs +4  
taediggity  I literally shouted wtf in quiet library at this question. +1  
bend_nbme_over  Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol +21  
drschmoctor  Is it biochemistry? Then I do not know it. +5  
snoochi95  hell no brother +1  
roro17  I didn’t +  
bodanese  I did not +  
hatethisshit  nope +  
jesusisking  I Ctrl+F'd glucosamine in FA and it's not even there lol +  
batmane  i definitely guessed, for some reason got it down to arginine and glutamine +2  
waterloo  Nope. +  
monique  I did not +  
issamd1221  didnt +  
baja_blast  Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic. +1  
amy  +1 no idea! +  
mumenrider4ever  Had no idea what glucosamine was +  
feeeeeever  Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing +1  
surfacegomd  no clue +  
schep  no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle +  
kernicteruscandycorn  NOPE! +  
chediakhigashi  nurp +  
kidokick  just adding in to say, nope. +  
flvent2120  Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least +1  

submitted by nwinkelmann(292),
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I dnufo hits hwne yrngit ot seuddnntra wyh aeciedsnr NO cedsua aehcshade: Nertrtisii/tsnate aer a yevr onmcom hehdaace dan aeimgrin ofdo errigtgs M(be)DW and asrie crniit xedio eeslvl. hHig lveels fo icrtni oxeid are aisdocsate twih agrinmie ).Sd(uyt dsehHaeac dna msginerai rea slao yver noommc in adeimtsocni ttha stoob cintri oxdie, hscu a gaariv ydt(s,)u but ti si uneacrl hwy this haepsp.n The nriaiogl sthpyoesih saw ahtt iitrnc dxieo eesacsirn bolod vlssee zsie nda rgtigser a iamg,iern tub eth rgaiav sudty dna hestor ovrspdeid hsi.t eNerw dstseui on itinrc odiex sshow that ti aensceisr eht peeitdp CR)(GP tath is isrconeedd slbsepreion for iriegrgntg rnimgiase dSt(uy) faret arienecss in fiam.otnnialm saueceB iirnct iexdo is aisodstcae cneiegronu maanmtiniolf ,seiessad s'it kiylel thta ahacshdee dan engrsiami fmro ctrini doiex are a rnniwga ings fo htis aoltnnamimfi .yS)dut(

heT eearcshr si ysalcliab ttsnagi htat etnsiatr eiars nircti xeoid sleelv dan gihh irtnic oxdei lseelv acsrneie mnfaimtnaloi adn ehehasdca nda eamsir.ign ,reHowev eth aetcx naores hwy hsti hepsnpa is .nwonukn


taediggity  Goljan and FA mentioned this as Monday Disease for people who worked in industries that heavily used nitrates, where they would build tolerance during the week and then get a headache when they went back to work on Monday +4  
nootnootpenguinn  Just to add to this- one of the side effect of NG when given to patients with MI is "massive headache"! That's how I the question right! +  
mumenrider4ever  This is similar in how triptans induce vasoconstriction which is used to treat migraines +  

submitted by wishmewell(33),
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nI ym niionpo hsti is dikna uedr sa an nilita i.cnato if eth npsreo tcieusnno to og akbc to hte pco,ti I douwl asy nhgvai a crhpoeean owuld d.kih wyh gttenInrruip eht eniatpt hiwt a orme rnatelu picto stni hte eswnra

wishmewell  NVM! i read the question again. The patient has visited already 4 times with cheif complains regarding sexual organs in a short period of time. According to FA page 262 (2018) at this point a chaperone should be added, if this doesnt help then the patient needs to be forwarded to another physician. +1  
groovygrinch  Can someone explain why " Tell the patient that it is common for patients to fantasize about their physicians" is wrong? +5  
mumenrider4ever  @groovygrinch I don't think it's normal for patients to have sexual fantasies about their physicians lol +8  
abcdefbhiximab  @groovygrinch lmao +1  
kindcomet  im dying of laughter +  
jurrutia  Switching to a neutral subject doesn't "address the problem". Never refer, always address the problem. +  

submitted by iguzman2(3),
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nA'tre 1M otrcprees ndofu ni the brnia nad are lsnoepbirse ofr mnooit sesnsc?ik

m-ice  M1 receptors are for sure the major muscarinic receptor type found in the CNS, but M3 receptors are the muscarinic subtype involved in vomiting controlled by the CNS. This is definitely a random fact, but I think they also wanted you to eliminate all other options. Targeting the sympathetic system (options A and B) won't make a difference. NMDA receptors are a major receptor throughout the CNS, but they're not a target of antihistamines, and neither are serotonin receptors. We know that antihistamines target histamine and muscarinic receptors, but the H2 histamine receptor is responsible for gastrin secretion in the stomach, so the answer must be antagonism of M3 receptors. +5  
dorsal_vein  ^ First generation antihistamines definitely antagonize serotonin receptors within the CNS, which can cause weight gain and increase appetite. However, this plays little role in motion sickness. +12  
mumenrider4ever  That is confusing because scopolamine (anti-muscarinic used to treat motion sickness) is an M1 receptor antagonist +2  
pelparente  So according to amboss scopolamine is a nonspecific antiemetic. I think Sketchy probably just confused everyone. +2  
osteopathnproud  I had @m-ice logic down to H2 and M3, then from base knowledge, I was like H2 gastrin secretion or M3 contraction of smooth muscle like bladder... stomach stuff is for me so H2... I do not know how you can get this question without knowing that M3 has to do with motion sickness +  

submitted by mamed(15),

What is the neoplastic chondrocytes filling lacunes?

mumenrider4ever  I think that's a chondrosarcoma (tumor of malignant chondrocytes, found in the pelvis, proximal femur and humerus, FA 2020 pg. 465) +1  

Contraction atelectasis occurs when local or generalized fibrotic changes in the lung leads to collapsed alveoli. It can an occur after radiation therapy, necrotizing pneumonia, or granulomatous disease

submitted by mousie(216),
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eadR ph...o.tma.a. thecarp 1 p 5 on l"elc e"dtha ateLui eiqcvf rcinosse ruscoc ni bianr aticnrf ( pcryotoleti smyzene ormf giiamlclro leslc lifiuqy het in)bra ap&m; bssAces tpirotol(cye sneyemz form neplrsihtou yuqifli setius [in this aces nrapmuyol rcmenhy)paa] mpa&; tcprtsaaeini ma(es nt)ihg

mumenrider4ever  Also talked about under liquefactive necrosis on pg. 209 FA 2020 +3  
lokotriene  UW: 302 & 9989 are both great for representing/explaining this. +  
tekkenman101  pancreatitis is fat saponification not liquefactive according to FA. +  

submitted by tissue creep(112),
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lMid uciaednj tihw sreindeac ugedjuonactn ni na elrod eolwfl is ddcereaes eUalPtfrgcnuenyalsros-uDr catvtiiy. uarilcPrtayl ni tcnexto fo etssrs (ca)oepyemtnpd

pg32  Went with hepatitis because of his recent surgery. Seen problems like this before where recent surgery means they were given inhaled anesthetic that can cause hepatotoxicity/hepatitis. That, along with the elevated AST/ALT and unconjugated bilirubinemia (signifying liver losing its ability to conjugate bilirubin due to inflammation) made me pick hepatitis. Why is that wrong? +  
suckitnbme  @pg32 AST/ALT are only slightly elevated. The patient also is not particularly symptomatic. He's really not that sick. Hepatoxicity is also most associated with halothane which is no longer used in the US. It would be a different story if the patient had surgery done in a different country (as is common in Uworld questions on this) +5  
mumenrider4ever  I don't know why NBME uses ALT/AST reference ranges from 8-20 u/L when the reference ranges for uworld are 8-40 u/L. So maybe his liver enzymes aren't really elevated since they're below 40 +4  
cheesetouch  Can someone refute 'surgical trauma'? +  
cancelstep  Appendix is pretty far anatomically from the bile ducts. Also damage to bile ducts should cause direct hyperbilirubinemia since there's no problem with conjugation versus Gilbert syndrome which causes impairment of UGT +4  

submitted by tinydoc(231),
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pNaetouhicr nPai fetra reskto is lrcntea tPso tkeros apin eymnroSd

dcueas by aaortcrllante ahcltiam inlosse

gP. 405 1AF9

chandlerbas  agreed! more specifically damage to the VPL +6  
docshrek  Pg. 403 FA 19. +  
baja_blast  Both commenters above got the page wrong; it's FA 2019 p. 503. +4  
teepot123  looooool ^ what were the odd of both being wrong +  
mumenrider4ever  Pg. 515 FA 2020 +  
bbr  503 in 2019 Interesting that its seen in 10% of strokes. Starts with allodynia ---> neuropathic pain. +  

submitted by beeip(124),
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ta"iEryotxc ianom c"iasd rrsfee to ltta,gueam ewihl cigenB"oi" rtlapnpyea ersref ot ystor,nei het rpceruros AA ot deopanim adn p.oreni

sahusema  Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft +10  
mumenrider4ever  FA 2020 pg. 239 +3  

submitted by madojo(176),
  • CholecystokinIn is secreted from the I cells of the duodenum and jejunum.
  • Gastrin is released from the G cells of the antrum of the stomach.
  • IF is secreted by the stomach and absorbed in the terminal ileum with B12.
  • Pepsin is secreted from the chief cells of the stomach and plays a role in protein digestion.
  • Secretion of VIP increases intestinal water and electrolyte secretion by acting on the parasympathetic ganglia
nobody  PAGE 365 FA 2019 +1  
mumenrider4ever  FA 2020 pg. 371 +  

submitted by niboonsh(355),
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i ogt hsit tqseinuo gtrih utb why ocdulnt it eb kgino la?ibbo

nor16  and why no therapy, i.e. cognitive training` +  
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +3  
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +  
tryntofigritout  Because this is a western medicine test. Even though it has shown great protection against AD and memory protection, this test won't allow that. I initially clicked on ginko but thought to myself... na this test doesn't accept an eastern idea. so clicked on the one I know they wanted me to say, and I got it right. ha +6  
mumenrider4ever  Wikipedia says "Gingko extract has also been studied in Alzheimer's disease, but there is no good evidence that it has any effect." +3  

submitted by usmleuser007(395),
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  1. lHo(oeom saisbsdt tlnoci):tg itnWhi het rtisf efw ntuesim fo ruijy,n
    1. a epelttlnis eth lodob ginbe ot cistk ot eht urjiden .stei
    2. ishT aivstteac eth lesat,tple ingacsu a wef hignts ot pep.hna
    3. yeTh nacghe tnoi na rshomuaop ,eaphs orem tieslbau orf tigtcol,n dan hyte lerseea cimelcah nalgiss to temporo conilgt.t
    4. siTh teslrsu in het ctnvaitoai ,rfbfin io chiwh osmrf a hsme nda atcs as g"el"u ot dnib pelesttal ot chae .thoer
    5. Tish sakme  lhotatc at versse ot gupl eht break in eth boldo vlesse, gitwenn/enopvrilsg rfhtreu [nbde6]i[eg.]5l

  2. ltfnom:imnaIa ugiDnr shit sa,phe gamdade dan edda elslc era lcerdea otu, golan htwi ataibcer nda hetor onphgtsae or rei.bds
    1. hTsi ahsnpep urhoght eth ceposrs ,spfhtgyioocoas  eewhr witeh ooldb slcel ""eat sderbi yb eguilnfgn ti .
    2. -vdldeetiPeretal gtowrh o efaratrsc eesdelar toni eth udnow ttah saecu eht romiagitn dan ivisidno of slcle gdnuir eth pflvroiiteear a.phse

  3. ioPnaeiolrrft otghrw( of wne esisu)t: nI iths nlpenpsa,gshdrltoensg,uieaeoec oiinsgl itg oni, aoaan r, uoissftotiemna oeizntill,ihtaaeip and nduwo aotroctcnni r.couc
    1. In i,gneossagnei surlvaac ohaiellendt llecs rmfo wen dloob sv.esles
    2. nI palbfarsiio dan nrioaalungt iestus rbfointas,sflobomgi ra wrto and rmof a w,en pcai etalrsoeuvarnliorllx Mt)xE( ariCm yb tgeexrcin nlelgcao c eai.obnrnniftd
    3. u,ncetoryrnCl thpii-iaelatnliozere of het eimdiserp occurs, in ai eiclltwehhhpi rfcseetlaip relol dan c'rla'w otpa teh duwno ebd, godipvnri vcreo orf hte wen tsi.esu
    4. nI dnowu ei  obastdnobsfea,csycocrnolrtretaim eht zsie of hte wuond yb giripgpn the wduon gedse dan icgcntroatn ugins a ihcsmeman hatt esesrebml thta ni otmohs usemcl lcles.
    5. ehWn het 'cslle soelr aer ecols ot eolcpmt,e needndeu lcels pri onpousgdest.oa
  4. ntoruaitMa gnoi)lm:e(der Druign oatitmunar adn ,lrnogdeeim

    1. caoellgn is enalrigde lnago nsoteni es,nil dan esllc ttha are on neorgl ededen era dmrveeo by pgmrrdaemo ellc ,tdahe posora.sp oit

  5. eatoimAxppr mtsie fo the fdnieetfr pheass of nduow 0lhig1hn i,wae][t addef ievntslra grmniak btalsusnait novaait,ir eigpndden iyalmn on downu zsei nad nhglaie ,indicntsoo but eiagm sedo ont uendilc oarjm ammrienspti htta ancccureo ish od.wsnu
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +  

submitted by benzjonez(45),
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AF 2108 p. 069. pSuctse rehlraut ryjuin if blodo is eesn at het thleraru ea.muts ahmciseMn of psirtoroe etrulrah rjyniu = cvipel tcra,uerf cwhih ew ese in siht iatnep.t trealrhU tzhtoctnaereiai is iyleraetvl ercdnoatcdina.ti

hyperfukus  thank you! +  
baja_blast  Understood, but is there anything in the question that rules out BPH specifically? I honed in on the words "most likely" and saw he was 60. I guess I overthought it but I'd appreciate any insight as to what if anything in the Q makes that definitively wrong. +  
daddyusmle  I think the question stem, with the trauma and fractures, points you in the direction of membranous urethral trauma. Pelvic fractures are more associated with urethra damage than prostate damage, although they're right next to each other, and I can see why someone would choose prostate hypertrophy. Also, I'm not sure if bleeding is associated with BPH. +  
mumenrider4ever  FA 2020 pg. 627 +2  
nio5021  could someone explain why urethral stricture is incorrect? +  
nio5021  According to mayo clinic, strictures can be caused by trauma to pelvis as well. Would strictures be more likely if this patient had some sort of procedure done? +  
eghafoor  @nio5021: "Trauma to the anterior urethra is often from straddle injuries. This can occur with a sharp blow to the perineum. This type of trauma can lead to scars in the urethra ("urethral stricture"). These scars can slow or block the flow of urine from the penis. Trauma to the posterior urethra almost always results from a severe injury. In males, posterior urethral trauma may tear the urethra completely away below the prostate" Source:,of%20urine%20from%20the%20penis. +  
eghafoor  The key for this question was recognizing that the pelvis was fractured = unique only to posterior urethral injuries (FA 2020 p. 627), and after was to realize that you'd have an urethral disruption/tear +  

submitted by neonem(568),
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rMoeinhp si a mu pidoio intgsao - neo svradee feeftc of opisido is smat clle aiuarldtnengo ahtt is eee-EInpdntdgin. aeRlese of tsmniaeih si knai to na anhpltiaaccy oieactnr tg&-;- ,upstrrii tc.e

sympathetikey  Never had heard of that one. Just a good guess. Thanks! +  
yb_26  IgE-independent mast cell degranulation can also be caused by radiocontrast agents, some antibiotics (vancomycin) +7  
temmy  it was a u world question +  
mambaforstep  FA 2019 pg 400 +  
mannywillsee  i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +  
mannywillsee  i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +1  
mambaforstep  under mast cells "IgE-independent mast cell degran"! FA 2019 pg 400 +  
mumenrider4ever  Uworld QID 11852 talks about this Also FA 2020 pg. 408 (under mast cells) +  

submitted by hyperfukus(76),
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Asol reotanh eky is ti ssay ralonm prnapigea irgl neo fo eht nihtsg otbau eth IAS si htta ehty od teg nscreoayd ulsexa rsgli ont'd loko mrloan t'hedy be sothr adn yubsbt no oobsb fat cekn etc

covid2019  I'm confused that they said she appeared "normal". I thought AIS would mean the patient has very scant pubic hair / underarm hair. Wouldn't this be abnormal in a 17 year old? Should have Tanner stage 5 hair.... +  
mumenrider4ever  FA2020 (pg. 639) describes AIS as "Defect in androgen receptor resulting in normal-appearing female (46,XY DSD)" so I assume they're talking about general outwards appearance +1  
lola915  You do get breasts because patient has build up of testosterone that is aromatized into estrogen. No axillary or pubic hair because that requires testosterone. +  
lovebug  THX. SEE AIS (FA19 pg,625) +  

submitted by usmleuser007(395),
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sA pre 1A)F tyatf ntotrfilaini )2 llualecr llgninoaob 3) etlnaevu enoirssc

hyperfukus  thanks u saved me time in looking that up :) +  
violethall11  Those are for non-alcoholic fatty liver disease. Definitely missing some info in the question stem, however, I believe that the whole point is that the individual is NOT an usual alchoholic . +  
mumenrider4ever  FA2020 pg. 391 +  

submitted by m-ice(339),
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hsTi oyb has srcdlo,noaaphai hwchi is uacdes yb na atlsmuooa tadoinmn tanmtuoi ni lbatsbFroi torGwh trFoac prReeoct 3. FFG ligsngina is deeend ofr peropr agartleic fn,nociut dan owitthu it, teh gnlo nbose fo het dyob iwll tno ogrw useecba teh gohrtw leapt (deam fo ecnhryoso)tdc sdoe ont fucni.not Hwovr,ee osben thta nrdgoeu sbmmeanour tcisaiiof,ons like eht esnbo fo the e,hda iwll ogrw om.arlnyl Tsih tssleru ni eht etpanti ghvani otrsh xemtsireiet tihw a moanrl sezi rnktu nda rgeal eadh ievlreat ot eht lm.bsi

mumenrider4ever  Small edit, achondroplasia is due to constitutive activation (not inactivation) of FGFR3, which inhibits chondrocyte proliferation +9