pNlseioaa si ewn eissut wtgorh atth si gaeduulret,n lreerivrbsei, nad ooonna.llmc

yinCtaoll acn eb edeimntder yb al-pugehp6ts-cooseh rseedhoeadyng GD)(6P ymenze isomorsf. PDG6 si -lnikdXe.

*rFo roem miftnoriaon ekchc otu C.h 3 isNepaoal in omPatah

eervF ;tg-& lrue tuo letf rractlvnuie iluafer M ST-XPM rpspaxiyhlo ;-t&g erlu uot inPousctmeys iivy noKrcideej psrtalannt btu on CBRC/WB ni eiunr >- uler out sntlptnaar jctroieen

ivanLeg MCV nad plactayi ciuemmacoyrtb sa eth iangerinm wot tipnos.o MCV is mero ekilly ni a ttpannsrla e.tniapt

LV tseoppd ong,iwrk rpseersu cedakb pu onit mpul .ccuirti Pmlu uciicrt rhugloy si amed of 3 "rtsp"a - het ,iarpelcisal naiiirttlste ,caesp nad the olveil.a

nI icocdgneria cosk,h het xaert dloob neiasresc lpriyaacl aiydcrsttoh srpusere, gnirivd uidfl tnoi eht lattiiisnter p.ceas mraCodep ot teh oal,lvei eth litetrinasit paecs wno hsa more ldiuf t(hsu ermo tenasiiittlr isyotchtrda usrrseep adn essl iontocc ersruesp deu to raiot fo iudfl to n,eortip) and sa a etslur fo sith baaingnulnc fo r,fsoec uldif sevom tino hte vaoliel &;--tg lmpryuaon daeem.

eaPg 2 has a aretg cturepi

epw/s:1)99-c37p.6rijr(.o//hita12wtn00/1a4n8S6cifteglw-6o0dl/

weoeNrh ahve I nbee aelb to fdni why hte lhel sith si a nt.hig

A gbi nihtg eerh too is gnctnioi ttha eth ALP is cdes.adere tbseatlosO iiaytcvt si damsuere yb obne PLA. I ikhtn atth asw teh nmia sufco erhe dan not htta uoy reessincayl ened to onkw eth BA1FC nege .uomatint

uYo can sosrc uto the otp ehetr sawrne ehci,sco B,C.A, uYo wnot eb rnbgrosaieb nayhitgn in eth TPC in f'nnacsoi osem.drny kLginoo ta imopk,aelayh moa,hyrnaitep and omtoehpphpiyhasa now. akpolmiHyea a'ctn eb rcotrec ecsbaue eevn guhtoh apumssoti is ltso it will eb orebeabsdr at eht ratel thcki dngsaeicn oolp dan fi hatt ntdose emak sesen, teh obyd wlil sutdja rof olw mresu tmuaispos tbu catgtiainv teh H/K++ pmup no cells. It it'sn erptimhanayo csabuee at the lolcgtncie dctu ncpiralip ,slcel obeoirprnast llwi crcou. iTsh aelves teapsphhohaoymip as eht rroccet dna olny aesrwn coie.hc

nsseiMes itntmasou nlvevoi a tencluodie isntstoutibu etginruls ni ndhagec amoin dsa.ci oteimmeSs eth fstcefe of esemissn mtsitnuao amy be oynl prtpanea edrnu arntcei ervmntlneoain tsin;oocndi chus smesnise tsmnitaou are dclela aintodlncio oitmsa.nut ynMa mssnseei saittmnou ulerst in otepsirn hatt are ltsli ncotauf,lni ta atesl ot some .egered

sl,oA all eth oreht esnwsra dluow brlyabpo aevle oyu hwit etrehi a telragy tdaelre ro o-uanolnntnifc npi.treo

anistt'eP ymotmpss ngabe 30 nmi raetf nwiogm waln .ei.( ratef gidno pshyclai ai.i)ytvct He sah revsee schet pain dna is o,loc lmc,yam atecorphid.i eH has ceadriens rapomuyln taryre upssrree nad iadencser tlef ilatra sep.urers Tknae aegrthe,olt tihs is diagronicec hoksc.

Ciedicarngo cshok si a athre pmpu reblomp -- the VL ti'sn gorkw.ni

When eth V,L 'nsit ,gikrnwo ti eusacs a bcka up in eht etriinodc speoipto ot how oodbl ymlonlar soflw. ereeh,rfTo lodob illw ackb pu in eth .usnlg

shiT ssecua asrdienec lylpricaa yahoctridst peerrsus ;t-g&- tihs drevis more udifl iotn eht siimrtueintt g;-t-& stih uesasc iesedracn iitlistaenrt tyitorcsahd psrresue &g-;t- herte is onw omre diluf tnha olanmr ni het nutttiemiris -;>- htis fftasce hte ronetip ritoa nthiiw the rmtuentsiit ;&-tg- shti euascs eacerdsde asretiinltti tcoconi seerupsr.

heilW the ieeitlmf kisr ni hte gelnrea oltuapinpo si tujs lwoeb %1, ti si %65. in deretfs-gier teresaliv of nittespa dan it irsse ot emro atnh 0%4 in onygtomzoci istnw fo ffedceta oleepp. laAnngziy iclassc etssidu fo eht scngteei fo cpsnhizhreaoi eond as ylera sa in s,1093 iFhsecr udcnleosc ahtt a crncnoacdoe arte orf chsypoiss of uabto 5%0 ni inozmyotcgo itnws eemss ot be a raetlicis i,ettesam hwchi si syaitclnnfgii hrheig ntah ttha in gzdiictyo itnws fo boaut 9–11%0 (o36at#6i.if//smn.PcClp9v3l4ige./c5hnrbnMr/c2me)

sAol rfo estoh of uoy hwo era tyotlal ceesslul elki ,me iayurrn ttcra noubtstiroc = rvtuisotecb .uohparyt

atzlIcneaoro ruiqsree hte aicdci tmevionnren fo the tosahcm ot eb abbsdr.oe elmazpreOo nihitibs eth H+K+/ mpup of teh ,stohamc ryteebh dincsgerea hte tiaicyd fo eht .athcoms So ewhn eht teaptin ktesa arzemolOpe dna croaoItaelzn gete,htor tcIaooaenzlr t'won eb bdbesrao niot the ob.dy taThs' why ti has on ecef.tf

Ist' nmecedrdmoe to keat oneimicsdta at letas 2 uohsr orrpi to tkngia an cditnaa.

F1290A epag :74 Icell- sdesaei inlucnios( clel diaudliipesossic/mose ytep —)dIeirItihen lslamysoo gtoersa irde;dsro ectfde in f1lspceasrrcany-iams-h-Nglpoeotaehuytlons r;ra&r ilrauef of eht lGoig to ophayloethpsr samonen duressie ni(mrfog )hso-eoeaat6mhpps-nn on tloncyirsogep ;&rrar tesrnpoi rea etcsdeer tealcyrarelllux hretar athn evledired to mse.ylosos Reslstu in scearo ifacal eate,rufs vaniglgi ayhpilsape,r eoducdl ,noecsar itrscderte noitj mmeeotsv,n lcwa anhd ifimortes,de sikohoio,yspcsl and ghhi pmasal vselel of yssloloam zy.semen etOfn fatal ni hdoco.lidh

fiiBd ordaict eslups are nees in ritocA sseonist or ritounaigetrg

daiCtro irBut is dareh twhi csasotolesirehr of mconmo aotrcdi rareyt

owlS irnigs eesdreacd mlveou oditcra usepl si ccraaesthiritc of atoirc n.stsoies

nnaoCn vswae rae ense ni opmtecle VA ,cobkl sa rthig lireevtnc nda aairt atnrtcoc d.edlinpyeentn

Dgniur the tasl flah of neacrgnyp niodatli of hte rupep uryianr atctr cna crcuo ued ot mpeonorsisc fo teh eeturrs yb the gniogwr /etrssufuetu nda the alein trsinim.lae ehT ssmeoonirpc of htese si nto llainwgo diulf paegass oitn eht blrddae gsncuia unire luiubpd ni eth dyki,en shti deasl ot oiidlatn of het enkdyi that nsde up uisganc atmpsmcoyit yoshohdepnr.ris itsh nac edn up in itinncoef dan msopstym hcus as hte seon psrteen ni siht aittenp ilke abck pain dan CAV sn.nrdetsee hte ryingc is namily deu ot teh napi auecds yb eht citurnbso.ot dn a tjus sa mieshngto trxa:e ubloed giitpla esehtrtac si a asef nda emlpsi wya fo tgraetin ytscmpaomti dnoeshrrhpyosi fo nncreyag.p

iaochcrT tucd .natesiolr

nGjoal adh a leuterc thta nteenmiod ahtt fI" a tetpina sha haercoaglart, vriewe eyrve udrg t'eerhy aitnkg iensc amyn rudgs cuaes "tcaoaerrhlga.

hTe noly nihgt fo seopslib nraeeecvl ni isth mtsQ-e is htat hes tksae a e,ainciomtd heroetref teh easrnw of "urgd ctf"efe si teh somt lyliek nraose rfo ehr ecraarlta.goh

noo=chrypnohB nneiyropEtaaomrpui x tsdri=or ertcaranbhihlooc rbottiuscno rnesm(gs/iafo dotrbI ia)oypsryn ridstro = agllraeyn uu sriictScsncotounobs pa=hsls etts rof yoipcrl isetssno

neWh eterh is a edafcrrtu bir ti llwi uecsa a amuart oaerxmnptoh wihch cna scaue iar ot ceapse dna eomceb aedtppr eundr eht kins leadgni to etruip.sc

iThs si a ocanndiloti delcla ilpddenscaylcsioai.oar The kdi on Sgrnerat inhsTg twih eht plsi sha het ddseriro. oN loalcr ,soneb too myan thet,e tlorfan sinbgso =;g&t dlindicolaoasrcpyi.eas B1FAC is a gnee hhilgy iatpcdeiml in atlosstobe nc.tfuino

ivyrlAc,co ,irfoavclmic clrciyvaaolv aer unasnoegi asanlg.o Tehy odnureg visnorcneo to acoiyclvr hpmoooetanpsh aiv srivu edecond syaie.kinhtinmde- lel,tUmayti tyeh ibtiihn vairl AND epelmyasro by hacin taoinmnit.re

uattdeM avirl hitienmdy iaskne nac eascu stne.isacre

enWh ndsntaig u,p the dboy nallrymo vciaatste itapcheymst steyms ot oavid osircothtat isnoeytno.ph

tBu icnse ereht si nwo na adiedvit tcfefe fo the oopyohomthecracm nerieac,grds it iwll adle to a nhryetoeispn

:e.(i blouDe anoisocsitntrvoc = ehoP cerdgirsnae + mpShcytaeti smtyse)

itccinA prruupa stulesr mofr oenaxttsrvaia of dbool iotn the dsir.em hTis nnnepoeohm si ude to the isnk opatyhr nda het tflgaryii of eht obdol veslses ni eyllred iv,nddisulia chwih si rxtedaebace by icrohnc uns .eporexus icniAtc prpruau ielsnos era caedlot on pesuoesdnx- r,seaa leki eht sa,mr fcae, dan ekcn.

kinS ahorpty ni ssaotpiremorod is eud to an ltaritonea of ,ceonlagl irialms to htta hwihc si seen in otoprosssi.oe hTis deprncunoo ksin apotyrh csadeu by teh -paonigghot skema the madrel usrlvcaa konewtr ervy eetsivisn ot eth tthsisegl raautm or rahengsi r.ecfo

emynAit ouy vhae a nerpso who sumbp ehtir da,he tges kbac ,pu nad nhte ash seever esuiss or edsi ekil 6 hsuro trael -- yuo veha rfelyuos an edaurlip amhteamo rmof rtloecaian ot hte lidmde NAEINMELG trryea. jo(naGl aelrly miphaeszse ahtt yuo ot'nd wsrce pu nda scelet idlmde .errbeca)l oYu onwk ti has ot be an taealirr aretnolcia cnsei the uadr si itlyhgt aehdedr to eth lsl'uks renni srae.fuc ljoanG dreefrer to ihs ecpenxiere ihwt it sa diennge epirsl ot omveer eth urda ofmr the ;lklsu icpah,rg tub ti srveid eht ntopi .eomh nTniget enes no CT si eeaubsc eht rpledaui amaohtem tgse tcsuk nebwtee het seutru lnie.s nWhe it naasmeg ot aerkb psta one of hte uurste l,sien it si my nunsgdndtirae taht hnte is hnwe uoy get seerev qlease,eu elik hatde ro ahwevtr.e

sA edatst bl,weo eth eLtf csru iberrce swa magaedd ese( awth ti duhols amlynlro olok liek ob.elw) Tsih ntcoinas het pnoirioatslcc ctatr. icSen hte scinocpaltiro artct eutscadse at the ,lmduela ebowl the nridbmia icsteon were' nolgiko ,ta you doluw see tlloatarernaC )Rihtg( icSptsa pmrassieHei

ishT rilg has xeiecres udncide .msaaht It si ont lwel udndseoort wyh it naspeph tbu the sigegrrt ear noger.zdice raymlNol ewhn bahrngtei cusorc rai si knaet ni by hte neso adn eth nslaa aagsessp and iuasenttbr tac to merove dstu nad /myirmduwihaf hte iar. Lailclgyo itsh kmeas the air rnesde TnP.=Rv oS henw ecrnigesi,x triehabng tgohrhu the soen si aedresdec and lepdrace yb rmeo vogsuiro othum eb.garthni sihT nemsa eht rai si tno mudifiedhi adn armdew u.p eTh rai si essl ensde nad eht athsam snue.se Teh tnesoqui okot htis esma lprepinic xpceet dvreseer it yb gniska tahw nelaxetr otoicnnid uoldc elad to eht smaath nad htta ulwod eb cold yrd ai.r

As bcidseedr ni het eniqusto mset, htsi tnuaoitm curcso nhtiwi an inotrn a( gnee mtnseeg cwihh si rceantirsbd RNDN;A]A-&tg[ but not natle.dtrs)a ANR ngcipisl s)zm(nyee rabg RNA dna olo“p i”t; an trinno is uct uot adn teh nsoex on iehret eisd fo teh rntion are ijdna,oed keil shti:

e2nnn—iooxenr—xt1o &;tg= xenoe—1n2ox

il,yyaplcT iths ipsilngc orcsuc ta het vyer gdsee of the tnnior a(wth I eentddo wiht hte “—” .rrhaac)cte tBu ni oru ,sace a muontiat thwnii teh rtinno is scaungi RAN gicsilnp eynzem ot reicneozg a enw :tesi the riscelp tusc ihniwt teh tionnr tdesina( fo ta teh yevr d,eeg as it dlho.)us S,o ew etg thsegiomn that oolks ilke st:ih

on1xe——2ierotnxn

’thTas a ttlalyo dffrnetei RNmA ,lmecloeu nad s'ti iogng ot maek rou ilbgon-β nrtepio loko (and vaeeb)h ylawulf rsne.agt

stivityeSni etsst ear sude ofr si.neegcrn Scctifipyei stets ear edus orf nnmaictroiof ftrea toesivpi cseegnn.sir

tveyniiisSt sttes aer duse ofr gsneei who yanm lopepe yrult ehav the deea.ssi tpyieficciS tsset rea ofr osthe who od nto ahev eth s.seiead

A hlhgyi ivteeniss ttse, nweh ,nevtieag resul UOT iedsaes. A hiylhg ipefcsci st,te nhew itpi,sove serlu NI iesdeas. ,oS a estt ihwt ithw wol nstiiytsiev ncoant elur otu a iees.das A tets hitw wlo ceiiyscpift na'tc rule in see.dias

Teh orodtc nda ettainp antw to ensecr ofr lnooc nercac nad uelr ti uo.t The rotcod olwud anwt a tets thwi ghhi ytetinssivi ot eb laeb to do ahtt. He nwkos ahtt teigtsn reh sotlo orf blodo liwl nto uelr tou eht ilyspsiitob fo cnolo C.A

onlaMhte is cioxt yb two amshscim:en

rF,sti aehntlom can be aaflt ude to sit SCN ndsesrtaep sprieetpro in eht asem enramn as nltoaeh iisgopnon.

S,oedcn ni a sposerc of ni,ttxocioa it si zeitombadle ot icrfom acid via oyddehlfrmea in a opscres iaitntied by het ezmeny llooach ydehogerasedn ni teh ilv.er noealhMt is ncervdeto to lferdaeyohmd vai lcolhao renddyeehosga )A(HD dna ldderayhemfo si rnedeovct ot mrfcio dcai )(tfmraoe iva deheyadl dehonseaygdre D)AL(H.

otFeram is xtoci cubsaee it ibitihns dmanohriitlco ehrtcooycm c sexi,ado nsucgai hpyoixa at hte cllleuar ell,ev and eobamitlc dsacio,is omgan a traievy of rohte aolmtebci c.rabudnsiste

taCoonritca of eth oarat alsed to snedeacri VL orovadle ingcusa LV yprhtperoyh nad a L siax viid.otnae

A aahpdgiyoliclarr ibveils falrid-iu levle gstgessu a erptyt eargl oleisn e,nech( iyaac”)t.rv“ s'htTa ont gngio to eombec oramnl istues nagi.a Sxi tnmhos nolowgilf onosrietlu fo stmpoysm oyu anc extcpe lenhagi ni hte mfor of a sr;ca tath si, ifrssoib btu onyl ni a lnsgie stpo.

iPtneat sha a gmynnaoarioparihc. sotM mmcoon ioclhdhdo rauprinatstleo t.ourm erDeidv mfro mrtnensa of kahetR pochu a(orl e)ot.rdcme tfilaccCiiaon is m.noomc eorlsCethlo lcsastyr ofdun ni trom“o l-”elioki ufldi hiintw mtruo.

A csciyt sallsrpruea ssma ihwt tacsicifnaciol adn nnantcmheee of teh llwa or sdloi rsotnpio in a hicld or dscatoeeln si oltams waaysl a nia.rniaoygmparhco

yaM eb feuosdnc thwi taptiuyri aemanod thb(o acuse elaipbtomr .oeaaini)pmh

hTis is atvrciee myaepoylhitc ra,ve cwhih is ued ot high litadeut or gnlu e.isaesd SOa2 is o,wl dan PEO is er.acsiedn

rotenAh ayw ot crpahapo hte iqtensou si linokgo at hte ooldb eras.m s'tI tptyre anrlmo n(o cgm,yaoeeatsrky on ednceiras rbmenu fo e,ttlapesl no d,ros hnniotg e,blu )ct.e A obdlo smaer fmor a CODP itapetn wlil eb anolm.r stuJ an rdiaecnes bnrmeu of BRsC due to eht ensacdrie EPO idglnea ot deiaencrs bgH.

otnaMtsui ni LM1T-T oln(tilMarihydoc coeednd tRAN ceiueln )1

A comomn umantoti si 323A.G4 nCa etruls ni emuilltp iilrtohcanmod efcneiiescdi and isdceotsaa r.dorsside tI is aetsiosdac ht:iw

• otdhioilnMrac oeypaocahnhlyptme
• tiLcca cosdsiia
• lkerie-Sokt sposidee ASM)E(L

AEMSL si a rrea alodtoricimnh eoirrdsd nonwk to tcffae ynam ptrsa fo het ydob, aecpilleys het vsnorue tsymse adn eht iarn.b topSymms fo ASEML nudicle:

• rRnteruce evsree eshcehada
• cseMul saneewks pm)y(oathy
• rngiaeH ossl
• e-orkliStke oedeissp twhi a sslo fo csu,snonsoscei ur,ezisse dna reoht pbsmolre tgnieacff the reonuvs smeyts.

ecSoru: otidi:whLT.k-kep/s1/gip/rMii/etaTw.n

ntioiasAnridtm of nilliPcnie ofr hisylpSi aym leda to hte eriaeehJHscmrhrxi- arnectoi srouh rtfea tntea.ertm sccOur ued to yslsi fo hecsroiepst (os it can corcu ihtw Bareilor dna opieroistpsLs sa .wlle) Teh enictaor si aredehcraictz yb erevf nda slhi.lc

eTh ailscclas oxnpaatnlie of eht heeerrmxiH rtcaenio si ttah ttetnmera lsretus ni hte nudsde thdae dna rditetcsnou fo rglea urbenms of n,epromsete ihtw eth aielrboint of epnrtio cusotprd nad t.xinso

Tihs npiteta likyle ahs emso morf of prupe ootmr ureonn nlieos ro ieaseds - MUN sinelso era chrteizecaard by ,easwknes neesdacir pdee ntndoe r,lesfexe nad sicastp rpais.es ocflaBne si a -BAGBA tnaiogs ccfesiip to the nailps codr, esud ot aertt emsluc cyisist,atp dtnosyia, adn SM. AB-BGA is a rnG-tioep elpcduo ocertper ocludpe ot Gi, os oigsamn fo tish eotercrp seusac pyithaoalrieporzn fo hte nrsenuo dan ceeddaesr eeasler of tyatriecox utlte.aamg

Al,so yuo hdunl'sto eb esnegi egdra-nno gdamea or reeiadcsn nienr / ydenik osprnsee thwi a iyvprsoelu tyhealh tinaetp hatt ujst vepldedeo tessilane NH.T hTe dyob s'dtoen want ot carsiene irnne hewn ti has HTN. w,erHoev if ouy vaeh s,ssiento eth ydnikse afkre otu aesecub r'hetye ton eitnggt guhoen oflw nad inkth the woelh odby 'inst hte,ire os tyhe tecatvia teh RSAA mstys.e henW yuo geiv tehm na ,IE-AC teh inrne is sillt gnibe crudoepd by hte yikn,ed ti utjs ints' ngebi orvecednt to ogI-isanIenn.it

To anmliteie orhet occs:hie

• He ash erasnecid nrine iictyvat os ouy acn ielenmita irrmyap ssontordilem.a That hsa .cin ,aredetosoln d.ce irn.en
• No signs ro ssx fo u'ssigChn os sht'ta iltdna.eiem
• --exsoy1yl1aBhrd iecicdyefn lwuod sxs ithw het elnigaati. udo'Y aehv ec.d nnrie cyaitvit kdeloert-lnisea(o tfcfese tlils .)reenstp
• lEentaiss :THN dneipxael oabve

0129AF p 375 on ltsirtaGtesnniao lbodo spylpu dna tpyiapcrseamtah initrnnaove:

• oeFgrtu --;&tg icelca artyer, vasgu ovnantniire
• iudgtM -;-tg& S,MA vgaus
• utnigHd -;t&g- IMA, civepl nniarineovt

I oshec tsih leloys besceau it was so amdn iccsfipe

sUe eht rgeyb-WHdrnaei oeiatnuq

1. kaTe het asureq troo of 11,00/6 nad that lwil ivge uyo eht ncfyqreue fo het vieessrec lellae = 04/.1
2. tcCullaae teh nuefeqcyr of eth mdnaoint eellal wiht =,+p1q cwhih si p= .5.079
3. yThe rae etgllni uoy to lutcelaac het enfcryqeu fo eth eisased raerc,ris chhwi si with eht aoqineut .p2q
4. Thye awtn ynol teh essidae aisrercr ni hwhic ldeoetin is rt.sepne oT ltclcaaeu hsit, use eth q uaevl 14/0() adn pmlytlui yb %08 ni thsi doslhu igev oyu 2.0.0
5. na,liFyl caclatule for 2q2 P 5(9(.270.))00= 040. = /25.1

In rroed for a rgud ot be eraedlc yb eht kd,yien it tmsu trfis be dirfleet in eth .llgeriomu rgDsu thiw a hihg VD vahe emor fo teh gurd ni het suites ttha rea not vaalaebli ot ldrfeeti yb eht nik.dey Drgsu hwit hgih rienotp nniibgd twn'o eb eedifrlt het.eri So ouy tanw a urdg whit wol dV nda wlo nnidibg if uyo nwta it dcaeerl vai eth dyskine adn ui.ren

ueten-lheelyMb seatdin celfa mares vleedre romeunus lunphtrseoi tb(u ton ayn nirgsoa)sm. igllaShe si lseosoclr wehn tasndei htwi yemehtnle ;lueb E olic stains lbue twih entmhlyee belu eceasub ti setfnmer cslotea.

This is a very nitpicky question. As I see it, the 3 main concepts tested are:

• This patient has trigeminal neuralgia (sharp, brief, episodic pain in the face), which is caused by a lesion to primary sensory fibers that carry pain sensation from the face.
• Multiple sclerosis, which the patient has, is a demyelinating disease (i.e., it affects white matter).
• The myelinated axons carrying pain sensation from the ipsilateral face enter the brainstem at the level of the pons and then descend (become the spinal tract of the trigeminal). These white matter fibers pass through the pons to synapse on the spinal nucleus of the trigeminal, which is in the medulla (nucleus = gray matter). (picture here). Therefore, a lesion in the white matter (i.e., plaque) in the pons could cause trigeminal neuralgia, and this phenomenon has been observed.

Above the level of the brainstem (thalamus & cerebral cortex), you have second order sensory neurons. Lesions in this part of the circuit are not generally in trigeminal neuralgia. I suppose they also want us to assume that once the spinal tract of the trigeminal enters the medulla, it's not myelinated anymore. I don't think this is completely true, but given the logic described above, pons would still be the better answer.

As people have pointed out, the primary sensory fibers carrying light touch sensation from the face synapse on the chief sensory nucleus in the pons immediately after they enter the pons. This question is not asking about those fibers though.

I got the question wrong too..

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The way I approached the question was to consider what happens 1. When you grow from a baby to a child, and 2. when you grow from a teenager to an older adult. Whatever remained true between both of them was the right answer.

Right answer: The resting BP of a newborn is 65/40 (google), while that of a 1-month old is 95/60. The average adult is higher, with the American Heart Association citing (absurdly, IMO) that "normal" is <120/<80. Nevertheless, the trend is that BP increases as we age, whether we are newborns or old people.

Wrong answers: Development of coronary atherosclerosis: Perhaps due to the American diet it can be argued that the development of atherosclerosis is almost inevitable as you become an older adult. Certainly not true as a baby --> child.

Development of mitral stenosis: Similar reasoning as coronary atherosclerosis; you MAY develop it as an adult (not nearly as common as a buildup of atherosclerotic plaques), but sure, let's say that it can happen. Not true as a baby --> child.

Increased basal heart rate: The opposite is actually true. The basal heart rate of a newborn can easily exceed 150, and that's considered normal. As we age, this heart rate goes down.

Increased cardiac muscle mass: This one was the hardest to work through. It is true that as we age from a baby --> child our heart grows in size. But if we tweak our assumption from before with the American diet, and instead put our patient on a more moderate diet, realistically his heart shouldn't increase in size too much, at least to the point of cardiomegaly.

Increased compliance of arteries: As we become older adults, the compliance of arteries decreases and stiffness increases (careful not to confuse arteries with lungs, which actually do increase in compliance as we age!)

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