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82 Cards in this Set
- Front
- Back
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What are the two general functions of the brain stem?
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arousal-mood setter
autonomic policeman |
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what are the neutransmitter systems within the brainstem?
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serotonin
ACh dopamine noradrenaline |
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where are the serotonergic neurones located in the brainstem?
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raphe nuclei
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Where are the ACh neurones located in the brainstem?
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BRF ACh groups
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what are the functions of serotonin in the BRF?
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behaviour
mood (depression) aggression pain blood flow control |
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What are the functions of ACh in the BRF?
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arousal
memory (attention) ANS control pain dreamer |
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Where are the dopaminergic neurones located in the BRF?
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substantia nigra, ventral tegmental area
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where do the dopaminergic neurones of the BRF connect to?
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forebrain
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What are the functions of dopamine in the BRF?
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behaviour regulation
focus pleasure/motivation |
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where are the noradrenergic neurones located in the BRF?
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locus coeruleus
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what are the functions of noradrenaline in the BRF?
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ANS control
pleasure/motivation blood flow control neuroplasticity global attention |
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what do medullary chemoreceptors sense?
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low pH
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where are the central chemoreceptors located?
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retrotrapezoid nucleus in the caudal pons/rostral medulla
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What are the motor cells of the brainstem?
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pontine nuclei
red nucleus substantia nigra |
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what are the two general functions of the BRF?
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arousal-mood stter (samples the somatic/visceral worlds to set forebrain activity)
autonomic policeman (monitors somatic/visceral world to influence crucial reflexes) |
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What neurotransmitter system of the brainstem RF does not connect all over the brain?
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dopamine (it only connects to the forebrain)
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What are the three types of fibres in a nerve?
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motor, sensory and autonomic
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T/F.. a nucleus may use many nerves, but a nerve may not use any nuclei
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False. A nucleus may use many nerves AND a nerve may use many nuclei
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What are the functions and fibres of the oculomotor nerve?
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motor eye and parasympathetic eye
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What are the functions and fibres of facial nerve?
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motor face, taste, sensory ear, para glands
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What are the functions and fibres of trigeminal nerve?
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sensory head and motor mastication
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What are the functions and fibres of glossopharyngeal nerve?
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sensory thorax, taste, motor pharynx, para glands
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What are the functions/nerves of vagus?
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sensory thorax/gut, taste, para thorax/gut, motor pharyx/larynx
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What are the functions/nerves of CN XII?
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motor pharyx/larynx/palate
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What are the functions/nerves of CN XII?
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motor tongue
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Which cranial nerve nuclei are somatic motor?
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III (motor eye)
IV (motor eye) VI (motor eye) XII (motor tongue) |
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Which cranial nerve nuclei are autonomic?
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Edinger-Westphal (CN III, para eye)
Sup salivary (VII, para glands) Inf Salivary (IX, para glands) Dorsal motor X (X, para thorax/gut) |
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Which cranial nerve nuclei are for taste?
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Rostral solitary tract (VII, IX, X)
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Which cranial nerve nuclei are visceral sensory?
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Caudal solitary tract (IX, X - sensory gut/thorax)
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Which cranial nerve nuclei are visceral motor?
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V motor (mastication)
VII motor (face) Nucleus ambiguous (IX [pharynx], X [pharynx/larynx], XI [pharynx, palate, larynx]) |
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Which cranial nerve nuclei are somatic sensory?
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CN V: principal V, spinal tract V, mesencephalic V (sensory head)
CN VII: principal V, spinal V (sensory ear) |
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Which cranial nerve nuclei are involved in special senses?
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vestibular/cochlear (VIII, hearing and equilibrium)
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What happens to facial muscles with upper motor neurone lesion above VII (motor) nucleus?
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upper and lower facial muscle loss
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If lower facial muscles are affected only, what part of the corticobulbar tract is affected?
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VII nerve below the nucleus (lower motor neurone lesion)
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T/F.. the pons plays an essential role in regulating breathing, blood pressure, and other functions such as swallowing and vomiting
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False. the medulla oblongata does these things. The pons replays signals from cerebellum to the forebrain and regulates breathing
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What is the major factor driving breathing?
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blood C02 level
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Describe phrenic nerve activity during breathing?
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it gradually increases in activity during inspiration then suddently terminates with no activity during expiration
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How is inspiration initiated in the respiratory centre on the brain?
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there is an increase of neuronal firing in this centre connecting to other neurones in the cervical, and upper spinal cord which in turn innervate the inspiratory muscles
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What regulates the rate and depth of inspiration?
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1. inputs to the respiratory centre signially ing the PCO2, pH and PO2 of the arterial blood
2. afferent (sensory) inputs from receptors in the lung 3. inputs arising from higher centres of the brain, such as t he motor cortex |
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What respiratory control centres are located in teh dorsum of the pons?
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pneumotaxic centre and apneustic centre
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What respiratory control centres are located in the medullary respiratory centre?
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Pre-Botzinger complex
dorsal and ventral respiratory groups |
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What respiratory group consists mainly of inspiratory neurones?
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dorsal respiratory group
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What respiratory group fires during expiration?
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ventral respiratory group (as it contains both inspiratory and expiratory neurons)
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Where are the central chemoreceptors located?
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in the retrotrapezoid nucleus (RTN) in caudal pons/rostral medulla
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What gene is mutated in congenital cetral hypoventilation syndrome and what does it do?
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Phox2b gene - when mutated there is no respiratory response to increased CO2, but normal respiratory response to exercise and arousal
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Which nerve and receptors and responsible from the Hering Breuer reflex?
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vagus nerve and pulmonary stretch receptors
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WTF is the Hering-Breuer reflex?
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a protective mechanism against overinflation of the lungs and minimises work of breathing (inhibits inspiration via pneumotaxic centre in pons upon pulmonary stretch)
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WTF are rostral venterolateral medullary sympathetic premotor neurons?
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project directly to the sympathetic preganglionic neurons in the spinal cord
are tonically active, maintaining sympathetic activity and resting blood pressure receive inputs from peripheral receptors and from cardiovascular nuclei in pons, midbrain and forebrain are a critical component in cardiovascular reflex pathways and baroreflex |
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The rostral venterolateral medullary premotor sympathetic neurons regulate general vascular bed.. T/F
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False. they have subgroups regulating specific vascular beds
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What is CT Xray?
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Xrays transmitted through an object and collected by detectors
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What is MRI?
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radio frequencies used to excite tissue in the presence of a strong magnetic field creating resonance frequencies
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What contrast is used in CT and MRI respectively?
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CT - iodine
MRI - gadolinium |
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What is T1 MRI?
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fat is bright, CSF is black
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What is T2 MRI?
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CSF is bright, fat is often black
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What is flair MRI?
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CSF is black, however bound water is bright
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What is diffusion MRI?
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infarcted tissue is bright
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Where is the catheter inserted in neuroangiography and what is it used for?
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insert in femoral artery to to carotid
allows for the visualisation of vessels |
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What physiological imaging is useful for cellularity, haemodynamics and metabolism respectively?
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Diffusion weighted imaging (cellularity)
Perfusion weighted imaging (haemodynamics) MR spectroscopy and PET (metabolism) |
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Where do 75% of strokes occur?
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MCA
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Looking at acute stroke, how many CTs in the first 3 and 6 hours will be normal?
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over 80% in 3 hours
60% in 6 hours |
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In acute stroke, what are the first changes in CT due to?
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changes in the water content of the brain due to evolving cytotoxic oedema
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What do the earliest changes seen on CT in acute stroke look like?
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loss of grey-white junction
loss of definition of basal ganglia, insular ribbon, internal capsule hyperdense MCA sign cerebral oedema mass effect (sulcal effacement, vetricular distortion) |
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Why is CT important in acute stroke?
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to rule out haemorhage and prescribe thrombolytic therapy
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What are the earliest changes seen on MRI with acute stroke?
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diffusion restriction within 30 mins of event
swelling of grey matter and increased signal intensity on T2 and FLAIR (cytotoxic oedema) loss of intravascular flow voids |
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What are subacute stroke changes seen on CT?
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increased mass effect in first 3 days (CT shows wedge shaped infarct involving both grey and white matter)
haemorrhagic transformation occuring 1-14 days following infarction |
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What causes most haemorrhagic strokes?
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sudden reperfusion of damaged tissues
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What does watershed infarction look like on CT?
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on an axial plane of cerebral ctx, it is in an X shape across midline
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What is primary prevention?
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protecting healthy people from developing a disease or experiencing an injury in the first place
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What is secondary prevention?
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the goal is to halt or slow the progress of disease in its earliest stages
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What is tertiary prevention?
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goals include preventing further physical deterioration and maximising quality of life
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What is primary prevention in stroke?
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assess based on absolute risk of CVD in 5 years
apply to people aged 45 to 74 (and indigenous peoples aged >35) |
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What is secondary prevention in stroke?
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Assess absolute risk
Modify risk factors with intensity based on absolute risk |
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How many strokes are there in Australia per year?
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60,000
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Which age group has 50% of strokes?
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those > 75 years
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Why is stroke prognosis poor?
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it is fatal
it recurs frequently old people have other conditions alongside stroke |
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what predicts stroke survival?
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basline Barthel Index <20/20
severe coma incontinence previous TIA (ex-)smoker age recurrent stroke |
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What constitutes tertiary stroke prevention?
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clinical guidelines (Stroke Foundation)
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What patients do rehabilitation stroke units accept?
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after a delay of 7 days
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How less likely of death or institutionalisation is a stroke sufferer in a stroke unit vs general medical ward?
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25% reduction
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What is the equation for numbers needed to treat?
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1/absolute risk reduction% x 100
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What is the standard duration of a TIA?
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1-30 mins
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What is the commonest extracranial site for atherosclerosis?
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internal carotid near common carotid bifurcation
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