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However buy generic paxil 40 mg line, counseling concerning warm-ups, stretches, and a graded increase in exercise intensity can help prevent musculoskeletal problems as a side effect of exercise. A 50-year-old woman presents for a follow-up visit to discuss the laboratory results from her annual physical examination and a treatment plan. Her total serum cholesterol level is 260 mg/dl, which is up from 200 mg/dl the previous year. Her blood pressure is 140/100 mm Hg, which is up from 135/90 mm Hg; she weighs 165 lb, a gain of 12 lb from the previous year. Results from other tests and her physical examination are normal. She is postmenopausal and has been receiving hormonal replacement therapy for 2 years. You discuss her increased lipid levels and increased blood pressure in the context of her weight gain and dietary habits. When asked about her dietary habits, she says that she has heard that putting salt on food causes high blood pressure. She asks if she should stop putting salt on her food because her blood pressure is high. How would you describe for this patient the relationship between sodium and hypertension? Tell her that reducing sodium intake usually leads to significant reduc- tions in blood pressure ❏ B. Tell her that reducing intake of sodium and fats while increasing intake of fruits, vegetables, and whole grains usually leads to significant reduc- tions in hypertension ❏ C. Explain to her that decreasing sodium is only important in elderly patients ❏ D. Tell her that research studies are unclear about the role of sodium in hypertension ❏ E. Explain to her that antihypertensive medication is effective in reducing hypertension, making sodium reduction unnecessary Key Concept/Objective: To understand current evidence that supports the relationship between sodium and hypertension The Dietary Approaches to Stop Hypertension (DASH) trial1 demonstrated that the combi- nation of eating fruits, vegetables, and whole grains along with reducing fat and sodium levels can lower systolic blood pressure an average of 11. Reductions in dietary sodium can contribute to substantial reductions in the risk of stroke and coronary artery disease.
Some of the reticular formation include the caudal portion of the pon- exiting ﬁbers of CN VI may be seen as the nerve emerges tine reticular formation buy discount paxil 20mg on-line, which also contributes to the pon- anteriorly, at the junction of the pons and medulla. CN VII: The motor neurons of the facial nerve The fourth ventricle is very large but often seems nucleus, supplying the muscles of facial expression, are smaller because the lobule of the cerebellar vermis, called located in the ventrolateral portion of the tegmentum. As the nodulus (part of the ﬂocculonodular lobe, refer to explained, the ﬁbers of CN VII form an internal loop over Figure 54), impinges upon its space. The MLF is found the abducens nucleus (see Figure 48). Also present is the actual section through this level of the pons. The intracerebellar (deep cerebel- Figure 6 and Figure 7). The auditory ﬁbers synapse in the lar) nuclei are also found at this cross-sectional level and dorsal and ventral cochlear nuclei, which will be seen in are located within the white matter of the cerebellum the medulla in a section just below this level (see also (discussed with Figure 56A and Figure 56B). Superior 4th ventricle Lateral Cerebellar peduncles: Inferior Spinal t. Medial lemniscus Facial nerve (CN VII) Vestibulocochlear Trapezoid body nerve (CN VIII) Abducens nerve (CN VI) Superior olivary complex Cortico-spinal ﬁbers Pontine nuclei FIGURE 66C: Brainstem Histology — Lower Pons © 2006 by Taylor & Francis Group, LLC 190 Atlas of Functional Neutoanatomy THE MEDULLA 67C). The fourth ventricle lies behind the tegmentum, separating the medulla from the cerebellum (see Figure FIGURE 67, FIGURE 67A, 20B). The roof of this (lower) part of the ventricle has choroid plexus (see Figure 21). CSF escapes from the FIGURE 67B, AND FIGURE 67C fourth ventricle via the various foramina located here, and then ﬂows into the subarachnoid space, the cisterna magna This part of the brainstem has a different appearance from (see Figure 18 and Figure 21). They contain the cortico-spinal of the medulla, with the cerebellum attached. This speci- ﬁbers that have descended from the motor areas of the men shows the principal identifying features of the cortex and now emerge as a distinct bundle (see Figure medulla, the pyramids ventrally on either side of the mid- 45 and Figure 48).