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Neurology
FA complete review part 2 Anatomy and Physiology
| Question | Answer |
|---|---|
| Which medulla nucleus coordinates the vomiting center? | Nucleus tractus solitarius (NTS) in the medulla |
| Which areas or zones send to NTS in medulla? | 1. Chemoreceptor trigger zone (CTZ) 2. GI tract via vagus nerve 3. Vestibular system 4. CNS |
| Where is the CTZ located? | Within area postrema in 4th ventricle |
| CTZ and adjacent vomiting center nuclei receive input form 5 major receptos: | 1. Muscarinic (M1), 2. Dopamine (D2), 3. Histamine (H3), 4. Serotonin (5-HT), 5. Neurokinin (NK-1) |
| What muscarinic receptor is associated with the CTZ and vomiting centers nuclei? | M1 |
| Which receptor antagonists are used to treat chemotherapy-induced vomit? | 5-HT3, D2, and NK-1 receptors |
| Which two of the five antagonists are sued to motion sickness and hyperemesis gravidarum? | M1 and H1 receptors |
| M1 and H1 antagonists are used to treat? | Motion sickness and hyperemesis gravidarum |
| Serotonin, D2, and NK-1 antagonists are used to treat: | Chemotherapy-induced vomiting |
| What important physiologic center is located in the NTS in the medulla? | Vomiting center |
| The sleep cycle is regulated by the _______________ rhythm. | Circadian rhythm |
| The Suprachiasmatic nucleus of hypothalamus ---> | Drives the sleep cycle with regulates the circadian rhythm. |
| What is controlled by the Circadian rhythm? | Nocturnal release of ACTH, prolactin, melatonin, norepinephrine |
| What regulates Suprachiasmatic nucleus (SCN)? | Environment (light) |
| Which gland releases melatonin? | Pineal gland |
| SCN --(+)---> NE release ==> | Pineal gland which releases melatonin |
| What are the two stages of Sleep physiology? | Rapid-eye movement (REM) and non-REM |
| What substances and drug types are associated with a decrease in REM sleep and delta wave sleep? | Alcohol, benzodiazepines, and barbiturates |
| What happens to REM sleep with increase norepinephrine? | Decrease REM sleep |
| A patient with decreased REM sleep and a decreased delta wave is often associated to consumption of : | Alcohol, benzodiazepines, and barbiturates |
| Which type of medications are proven to help for night terrors? | Benzodiazepines |
| Which sleep disorder conditions are treated with Benzodiazepines? | Night terrors and sleepwalking |
| What is the MOA of benzodiazepines ahta aid in treating Night terrors and sleepwalking? | Decreased N3 and REM sleep |
| What are the main sleep stages? | 1. Awake (eyes open/closed) 2. Non-REM sleep (N1, N2, and N3) 3. REM sleep |
| Which is the description for the awake with eyes open sleep stage? | Aleer, active mental concentrations |
| What is the associated EEG waveform of the Awake with eyes open of the sleep stages? | Beta waves |
| Which sleep stages have Beta waves in the EEG? | 1. Awake (eyes open) 2. REM sleep |
| Alpha waves of EEG are associated with which sleep stage? | Awake (eyes closed) |
| What are the subdivisions of Non-REM sleep? | Stage N1, Stage N2, and Stage N3 |
| Which non-REM sleep is the largest or with the largest percentage? | Stage N2 |
| What is the description of Stage N1 of sleep? | Light sleep |
| Which stage of sleep is described as "light sleep"? | Stage N1 |
| What are the associated EEG waveforms of Non-REM Stage N1? | Theta waves |
| (+) Theta waves on EEG. | Stage N1 |
| Which sleep stage accounts for approximately 75% of all sleep cycle? | Non-REM sleep |
| Description of N2 stage of Non-REM sleep | Deeper sleep that Stage N1; bruxism occurs |
| Which sleep stage is associated with Bruxism? | Stage N2 |
| What is Bruxism? | Teeth grinding |
| EEG waveform of Non-REM stage N2 sleep | Sleep spindles and K complexes |
| (+) Sleep spindles and K complexes on EEG | Non-REM sleep stage N2 |
| Which stage has the deepest non-REM sleep? | Stage N3 |
| Which EEG waveform has the lowest frequency and highest amplitude? | Delta wave |
| Associated waveform of Stage N3 of sleep? | Delta wave |
| Slow-wave sleep? | Stage N3 |
| What is the description of non-REM sleep Stage N3? | Deepest non-REM sleep; associated with sleepwalking, night terrors, and bedwetting |
| Which conditions are associated with non-REM Stage N3 sleep? | 1. Sleepwalking 2. Night terrors 3. Bedwetting |
| Loss of motor tone, increased brain oxygen use, and increase variable pulse and BP, and elevated ACh | Description of REM sleep |
| What physiological conditions are associated REM sleep? | - Dreaming - Nightmares - Penile/clitoral tumensce |
| Which sleep stage may present with penile erection? | REM sleep |
| Which mood disorder is associated with increased REM sleep but decreased REM latency? | Depression |
| What accounts for the extraocular movements in REM sleep? | Activity of PPRF |
| What is the PPRF? | Paramedian Pontine Reticular formation/ conjugate gaze center. |
| How often does REM sleep occur? | Every 90 minutes, and duration increases through the night |
| REM sleep associated EEG waves | Beta waves |
| Dreams happen during __________________ sleep. | REM |
| Major relay for all ascending sensory information except olfaction | Thalamus |
| Which are the nuclei of the Thalamus? | 1. Ventral Postero-Lateral nucleus 2. Ventral Postero-Medial nucleus 3. Lateral geniculate nucleus 4. Medial geniculate nucleus 5. Ventral lateral nucleus |
| The VPL and VPM nucleus are part of the _________________. | Thalamus |
| Which ascending sensory information does not relay in the Thalamus? | Olfactory |
| What is the input of the Ventral Posterolateral nucleus of the Thalamus? | Spinothalamic and dorsal columns/ medial lemniscus |
| The Spinothalamic and dorsal columns and medial lemniscus is the input of the: | Ventral Posterolateral nucleus of the Thalamus |
| What is sensed by the VPL nucleus of the Thalamus? | Vibration, Pain, Pressure, Proprioception, Light touch, and temperature. |
| What is the destination of of the sensory information coming from the VPL nucleus of thalamus? | Primary somatosensory cortex |
| Which thalamic nucleus have as destination the Primary somatosensory cortex? | VPL and VPM nuclei |
| What is the input of the Ventral posterolateral nucleus of the thalamus? | Trigeminal and gustatory pathway |
| What are the sensation of the VPM nuclei of the thalamus? | Face sensation and taste |
| Which hypothalamic nucleus is damaged if there is decreased sensation of the face and taste? | Ventral Postero-Medial nucleus |
| Input Trigeminal and gustatory pathway. Thalamic nucleus? | Ventral Postero-Medial nucleus |
| What is the input of the Thalamic lateral geniculate nucleus? | CN II, Optic chiasm, and Optic tract |
| Associated thalamic nucleus of the CN II, optic chiasm, and optic tract? | Lateral geniculate nucleus |
| What is sensed by LGN of the thalamus? | Vision |
| Vision associated ________ _________ nucleus of the thalamus | Lateral geniculate nucleus |
| What is the destination of the Lateral geniculate nucleus sensory input? | Calcarine sulcus |
| The Calcarine sulcus receives sensory information of which Thalamic nucleus? | Lateral geniculate nucleus |
| Medial geniculate nucleus receives input from the: | Superior olive and inferior colliculus of tectum |
| What senses the Medial geniculate nucleus sensory fibers? | Hearing |
| Hearing is sense by the ____________ nucleus of the thalamus | Medial geniculate nucleus |
| What is the destination of the sensor pathways that relay by the Medial geniculate nucleus? | Auditory cortex of temporal lobe |
| Associated destination of the MGN of the thalamus? | Auditory cortex of temporal lobe |
| The ventral lateral nucleus has input of : | Basal ganglia and cerebellum |
| The Ventral lateral nucleus senses ________________ functions. | Motor |
| What is the final destination of the sensory information relayed in the thalamus ventral lateral nucleus? | Motor cortex |
| What is the Limbic system? | Collection of neural structures involved in emotion, long-term memory, olfaction, behavior modulation, and ANS function |
| What does the Limbic system consists of? | Hippocampus, Amygdala, Mammillary bodes, anterior thalamic nuclei, cingulate gyrus, and entorhinal cortex. |
| What neurological structure or system is made up of the hippocampus, amygdala, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, and entorhinal cortex? | Limbic system |
| The limbic system is responsible for: | 1. Feeding, 2. Fleeing, 3. Fighting, 4, Feeling, 5. Sex (fucking) |
| What are the famous 5 F's of the limbic system? | Feeding, fleeing, fighting, feeling, and Fukcing (sex) |
| List of Dopaminergic pathways: | 1. Mesocortical 2. Mesolimbic 3. Nigrostriatal 4. Tuberoinfundibular |
| What are the "negative"symptoms associated with Dopamine? | Anergia, apathy, and lack of spontaneity |
| A decreased in which dopaminergic pathway lead to development of negative symptoms? | Mesocortical |
| Decreased activity in the mesocortical dopaminergic pathway --> | "negative" symptoms |
| Antipsychotic drugs have a limited effect on which dopaminergic pathway? | Mesocortical |
| Increased activity in the Mesolimbic dopaminergic pathway lead to: | Development of "positive" symptoms |
| What are the positive symptoms associated with Dopamine? | Delusions and hallucinations |
| Which dopaminergic pathway represents the primary target of the antipsychotic drugs? | Mesolimbic |
| Inhibition of the mesolimbic dopaminergic pathway lead to: | Decrease positive symptoms in Schizophrenia |
| Dopaminergic pathways are altered by which drugs? | Antipsychotics |
| Which two features alter the Dopaminergic pathways? | Drugs (antipsychotics) and movement disorders (Parkinson disease). |
| What is the major dopaminergic pathway in the brain? | Nigrostriatal |
| Decreased activity of this dopaminergic pathway leads to the development of Extrapyramidal symptoms? | Nigrostriatal |
| What are the Extrapyramidal symptoms? | Dystonia, Akathisia, parkinsonism, and tardive dyskinesia |
| Which Dopaminergic pathway is most affected by drugs and movement disorders? | Nigrostriatal |
| Disorder that leads to an undeveloped or nonfunctional Nigrostriatal dopaminergic pathway will present clinically be the development of: | Extrapyramidal symptoms |
| Which Dopaminergic pathway is associated with libido, sexual function, galactorrhea and gynecomastia in men? | Tuberoinfundibular |
| A decrease activity in the Dopaminergic Tuberoinfundibular pathway leads to a ____________________ in prolactin. | Increase |
| Hyperprolactinemia may be due to damage to which dopaminergic pathway? | Tuberoinfundibular |
| What are the results of decrease activity in the Tuberoinfundibular pathway? | Hyperprolactinemia which leads to decreased libido, sexual dysfunction, galactorrhea, and gynecomastia in men. |
| Functions of the Cerebellum: | 1. Modulates movement 2. Aids in coordination and balance |
| What are the 2 inputs of the Cerebellum? | 1. Contralateral cortex via middle cerebellar peduncle 2. Ipsilateral cerebellar peduncle from spinal cord |
| What i the contralateral input of the cerebellum? | Cortix via middle cerebellar peduncle |
| What is the is ipsilateral input of the cerebellum? | Proprioceptive information via inferior cerebellar peduncle form the spinal cord |
| Output of the Cerebellar cortex: | Purkinje cells --> deep nuclei of cerebellum ----> contralateral cortex via superior cerebellar peduncle |
| Which cerebellar peduncle is used output information from the cerebellar cortex? | Superior cerebellar peduncle |
| What cells are involved in the output of information form the cerebellar cortex? | Purkinje cells |
| Cerebellar Purkinje cells are always _________________. | Inhibitory |
| True or False. Cerebellar Purkinje fibres are stimulatory and inhibitory. | False; Always and only inhibitory |
| What is the deep nuclei out of the cerebellum? | Dentate, Embolofrm, Globose, and Fatigal |
| Direction of output for the cerebellum deep nuclei output? | Lateral to medial |
| What is affected by LATERAL lesions to the cerebellum? | Voluntary movement of the extremities |
| What is a common symptom of a cerebellum lateral injury? | Propensity to fall toward ipsilateral side |
| A person falls has a tendency to fall to the right side, and has difficulty moving arms on command. Dx? | Right side cerebellum injury |
| What are the medial structures of the Cerebellum? | Vermis, fastigial nuclei, and floculonodular lobe |
| What clinical features of a medial cerebellar lesion? | 1. Truncal ataxia 2. Nystagmus 3. Head tilting |
| Lateral of Medial lesions to the cerebellum cause bilateral motor deficits affecting axial and proximal limb musculature? | Medial |
| What structures, medial or lateral cerebellum, in order to show wide-based cerebellar gait? | Medial |
| Modulates movement and aids in coordination and balance. | Cerebellum |
| The contralateral cortex input of the cerebellum is via the: | Middle cerebellar peduncle |
| Function of middle peduncle of cerebellum | Provide input to the contralateral cortex of the cerebellum |
| Function of the Inferior cerebellar peduncle? | Provide input concerning ipsilateral proprioception |
| Which structure is important in voluntary movements and making postural adjustments? | Basal ganglia |
| What type of input is received by the Basal ganglia? | Cortical input |
| Provides negative feedback to cortex to modulate movement. | Basal ganglia |
| What type of feedback is provided by the Basal ganglia? | Negative feedback to cortex to modulate movement |
| Putamen + Caudate = | Striatum |
| What composes the Striatum? | Putamen and Caudate |
| What provides the motor part of the Striatum? | Putamen |
| Which component of the Striatum provides the cognitive features? | Caudate |
| Lentiform = | Putamen + globus pallidus |
| Putamen and the Globus pallidus, compose the ________________, of the basal ganglia. | Lentiform |
| If the putamen is added to the caudate, it then makes up the _______________. | Striatum |
| Lentiform = Putamen + _____________________. | Globus pallidus |
| Which, D1 or D2, is the direct pathway in the basal ganglia? | D1 |
| Which is the inhibitory pathway of the basal ganglia, D1 or D2? | D2 |
| What is another way to refer to the Direct pathway of the Basal ganglia? | Excitatory |
| What is another form to refer to the Indirect pathway of the Basal ganglia? | Inhibitory |
| SNc input stimulate the striatum, stimulating the release of GABA, which inhibits GABA release from the GPi, disinhibiting the thalamus via the GPi. | Direct (excitatory) pathway of the basal ganglia |
| The direct pathway of the Basal ganglia, stimulates the striatum which causes ---> | Striatal release of GABA |
| What is the overall result of the direct pathway of the basal ganglia? | Increase motion |
| Which pathway of the basal ganglia is designed to decrease motion? | Indirect (inhibitory) pathway |
| Which structure stimulates the striatum in both, the indirect and direct pathways of the basal ganglia? | SNc (Substantia nigra) |
| How does dopamine causes increased motion by acting on the Basal ganglia pathways? | Binding to D1 to stimulate the excitatory pathway, and D2, by inhibiting the inhibitory pathway |
| Inhibition of the inhibitory pathway leads to increased movement | Dopamine binding to D2 receptor in the Basal ganglia |
| Which areas of the brain are located in the Frontal lobe? | - Primary motor - Premotor cortex - Frontal eye field - Prefrontal association area - Broca area |
| The Sylvian fissure borders with brain lobes? | Frontal lobe and Temporal lobe |
| On which brain lobe is the Wernicke area located? | Temporal lobe |
| Which important area or brain region is located at the Occipital lobe of the brain? | Primary visual cortex |
| Which lobe would be affected if there is traumatic damage to the Primary visual cortex? | Occipital lobe |
| On which brain lobe is the Primary auditory cortex located? | Temporal lobe |
| Which are the gyri and areas associated with the Parietal lobe? | - Primary somatosensory gyrus - Somatosensory association cortex |
| What association area is located in the anterior part of the Temporal lobe of the brain? | Limbic association area |
| Which areas and cortex are located in the Temporal lobe of the brain? | Limbic association area, Wernicke area, and Primary auditory cortex. |
| What is the "Homunculus"? | Topographic representation of motor ans sensory areas in the cerebral cortex |
| Which is the Homunculus presented with a "distorted appearance"? | Due to certain body regios being more richly innervated and thus having increased cortical representation |
| Brain perfusion relies strongly on ____________________. | Autoregulation |
| Cerebral perfusion is primarily driven by: | P CO2 |
| At what point is PO2 also a modulator of cerebral perfusion? | Severe hypoxia |
| What is the pressure gradient by which cerebral perfusion is based on? | Between mean arterial pressure (MAP) and ICP |
| A decrease on BP has what effect on cerebral perfusion pressure? | Decreased cerebral perfusion pressure |
| A decrease or increase on ICP will result in a decrease on CPP (cerebral perfusion pressure)? | Increase in ICP |
| Therapeutic hyperventilation: | 1. Decreases Partial CO2 (PCO2), which leads to ---> 2. Vasoconstriction, ---> 3. Decrease in cerebral blood flow which causes: 4. Decreased ICP |
| In order to achieve physiological decrease of ICP, the patient can be instructed to modified his/her breathing in what way? | Hyperventilate |
| What does the hyperventilation causes to the levels of PCO2 in the brain vasculature? | Decreases PCO2 with causes vasoconstriction |
| What is a possible reason to apply therapeutic hyperventilation? | Treat acute cerebral edema unresponsive to other interventions |
| CPP = (mathematical equation) | MAP - ICP |
| What is the difference of MAP -ICP? | Cerebral perfusion pressure |
| What does a CPP = 0, indicate? | No cerebral perfusion leading to brain death |
| When can hypoxemia cause an increase in CPP? | Only if P O2 is < 50 mm Hg |
| CPP is directly proportional to PCO2 until? | PCO2 is > 90 mm Hg. |
| Which cerebral artery supplies the anteromedial surface of the cortical brain? | Anterior cerebral artery |
| What is irrigated by the Middle cerebral artery? | Lateral surface of the cortical brain |
| Which cortical surfaces of the brain are supplied by the Posterior cerebral artery? | Posterior and Inferior surfaces |
| Watershed areas of the brain: | 1. Between the ACA and MCA 2. Between the PCA and MCA 3. Between the Superficial and deep vascular territories of the MCA |
| What condition affects the brain watershed areas? | Severe hypotension |
| What are the symptoms of damage of watershed areas by severe hypotension? | - Proximal upper and lower extremity weakness - Higher order visual dysfunction |
| What are the expected clinical signs of watershed zone damage if the internal border zone was damaged? | Proximal upper and lower extremity weakness |
| What is clinically seen in damgate to the watershed area formed between the PCA and MCA border zone? | Higher order visual dysfunction |
| What is the Circle of Willis? | System of anastomoses between anterior and posterior blood supplies to brain. |
| Which arteries form the anterior circulation of the brain? | ACA, ICA, and MCA |
| PCA, Basilar artery, and the Vertebral artery make up the _______________ circulation of the brain. | Posterior |
| The Lenticulostriate arteries branch off the ___________. | MCA |
| What are the Dural venous sinuses? | Large venous channel that run through the periosteal and meningeal layer of the dura mater |
| What is the function of the dural venous sinuses? | 1. Drain blood from cerebral veins and, 2. Receive CSF from arachnoid granulations |
| Into which important venous body do dural venous sinuses drain? | Internal jugular vein |
| The internal jugular vein receives drainage from: | The dural venous sinuses |
| What is the main clinical presentation of a patient with a Venous sinus thrombosis? | Increased ICP |
| What are the common clinical signs of increased ICP? | Headache, seizures, papilledema, and focal neurological defects |
| Serious complication of venous sinus thrombosis? | Venous hemorrhage |
| What are the associated hypercoagulable states that increase risk for venous sinus thrombosis development? | Pregnancy, OCP use, and factor V Leiden |
| Which is the main location of CSF return via the arachnoid granulations? | Superior sagittal sinus |
| Anatomically, wheres is the Cavernous sinus located with respect to the Sphenoparietal sinus? | Posteriorly |
| Which dural venous sinus is the the most superior? | Superior sagittal sinus |
| On which lobe of the brain is the Confluence of the sinuses located? | Occipital lobe |
| What are the ventricles that make up the CNS ventricular system? | Lateral ventricles, Third ventricle, and the Fourth ventricle |
| In the ventricular system, arrange from the most superior to the inferior the ventricles involved: | Lateral ventricles, Third Ventricle Fourth Ventricle |
| What structure is between the 3rd and 4th Ventricles? | Cerebral aqueduct of Sylvius |
| Which structure connects the 3rd ventricle with the Lateral ventricle? | Interventricular foramina of Monro |
| Which foramina connect or serve as conducts between the 4th Ventricle and the Subarachnoid space? | 1. Foramina of Luschka 2. Foramen of Magendie |
| Which is the medial foramina that allows 4th ventricle CSF to reach the subarachnoid space? | Foramen of Magendie |
| Foramina of Luschka, is it Lateral or Medial? | Lateral |
| What makes the CSF? | Choroid plexuses located in the lateral and fourth ventricles |
| Where are the choroid plexuses located? | Lateral and Fourth ventricles |
| What structures reabsorb the CSF from the Foramina of Luschka and Magendie? | Arachnoid granulations, which then drain into the dural venous sinuses |
| CSF in the arachnoid granulations is drain into the: | Dural venous sinuses |
| Which are the 4 Cranial nerves above the Pons? | I, II, III, and IV |
| Which 4 CNs exit the pons? | V, VI, VII, and VIII |
| Which 4 cranial nerves are in the medulla? | IX, X, XI, and XII |
| Which cranial nerve nuclei are MEDIAL ? | III, IV, VI, and XII |
| What is common in CNs 3, 4, 6, and 12? | Nuclei are medial |
| Actions or roles of the Pineal gland: | 1. Melatonin secretion 2. Circadian rhythms |
| The circadian rhythm and melatonin secretion are actions performed by the __________ ___________. | Pineal gland |
| What is the function of the Superior colliculi? | Direct eye movements to stimuli or objects of interests |
| The inferior colliculi is involved in __________________. | Auditatory |
| Where are the nuclei of the cranial nerves? | In tegmentum portion of brain stem |
| Which CN nuclei are located in the midbrain? | III and IV |
| Which cranial nerve nuclei are located in the Pons? | CN V, VI, VII, and VIII |
| What structure is known to divide the lateral nuclei from the medial nuclei of the cranial nerves? | Sulcus limitans |
| Cranial nerve LATERAL nuclei = | Sensory (alar plate) |
| Cranial nerve MEDIAL nuclei = | Motor (basal plate) |
| CN nerves in the medulla: | CN IX, X, XII |
| Which cranial nerve's nucleus in in the Spinal cord? | CN XI |
| Associated foramina of the Anterior cranial fossa? | Cribriform plate |
| Which cranial nerve goes through the Cribriform plate? | CN I |
| What structures (nerve/artery) pass through the Optic canal? | CN II and Ophthalmic artery |
| Which foramen is used by the CN II? | Optic canal |
| Which canal is used by the Ophthalmic artery? | Optic canal |
| What are the associated foramina of the Middle Cranial fossa? | 1. Optic canal 2. Superior orbital fissure 3. Foramen Rotundum 4. Foramen Ovale 5. Foramen Spinosum |
| What cranial nerves are known to pass through the Superior orbital fissure? | CN II, IV, VI, and V1. |
| Which foramen is used by CN V2? | Foramen Rotundum |
| Which foramen is used by CN V3? | Foramen Ovale |
| Foramen Rotundum provides passage to which cranial nerve? | CN V2 |
| Foramen Ovale is used by which cranial nerve? | CN V3 |
| What structure goes through the Foramen Spinosum? | Middle meningeal artery |
| The MMA uses which middle cranial fossa foramen? | Foramen spinosum |
| Anterior cranial fossa is through the | Ethmoid bone |
| Which cranial fossa is associated with "through sphenoid bone"? | Middle cranial fossa |
| Through temporal or occipital bone. Cranial fossa? | Posterior cranial fossa |
| What are the foramina associated with the Posterior cranial fossa? | - Internal auditory meatus - Jugular foramen - Hypoglossal canal - Foramen magnum |
| What cranial nerves go through the Internal auditory meatus? | CN VII and CN VIII |
| Which foramen is used by cranial nerves VII and VIII in the Posteror cranial fossa? | Internal auditory meatus |
| Damage to the Jugular foramen will probably damage which cranial nerves and vein? | CN 9, 10, 11, and Jugular vein |
| What foramen is used by Cranial nerve XII? | Hypoglossal canal |
| What structures traverse by the Foramen magnum? | 1. Brain stem 2. Spinal root of CN XI 3. Vertebral arteries |
| Which foramen is used in the Posterior cranial fossa by the Brain stem and Vertebral arteries? | Foramen magnum |
| What is the associated cranial nerve that goes through the Foramen Magnum? | Spinal root of CN XI |
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rakomi
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