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  <head>
    <title>027-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Neural coding, synapses, sensory systems, and pain">
      <outline text="Electrical coding">
        <outline text="Ion gradients and permeability set resting potential"/>
        <outline text="Threshold opens voltage-gated sodium channels">
          <outline text="Inactivation and potassium efflux repolarise"/>
        </outline>
        <outline text="Refractory periods limit frequency and direction"/>
        <outline text="Myelin enables saltatory conduction">
          <outline text="Larger diameter also speeds conduction"/>
        </outline>
        <outline text="All-or-none amplitude, so intensity by rate and recruitment"/>
        <outline text="Rapid adaptation signals change, slow signals duration"/>
      </outline>
      <outline text="Synaptic transmission and integration">
        <outline text="Depolarisation opens presynaptic calcium channels">
          <outline text="Calcium triggers vesicle fusion and release"/>
        </outline>
        <outline text="Ionotropic fast, metabotropic slow and amplified"/>
        <outline text="Inhibition via chloride or potassium conductance"/>
        <outline text="Axon initial segment integrates thousands of inputs"/>
        <outline text="Presynaptic inhibition alters release"/>
        <outline text="Lateral and reciprocal inhibition sharpen contrast"/>
        <outline text="Glutamate excites, GABA inhibits in brain">
          <outline text="Glycine in spinal cord and brainstem"/>
        </outline>
        <outline text="Effect depends on receptor and circuit, not name"/>
      </outline>
      <outline text="Plasticity and glia">
        <outline text="Long-term potentiation and depression">
          <outline text="Receptor trafficking, kinases, genes, structure"/>
        </outline>
        <outline text="Supports learning, also addiction, pain, epilepsy"/>
        <outline text="Astrocytes regulate ions, clearance, blood flow"/>
        <outline text="Oligodendrocytes central, Schwann cells peripheral"/>
        <outline text="Microglia survey, inflame, prune"/>
      </outline>
      <outline text="Sensory organisation">
        <outline text="Small fields and lateral inhibition aid discrimination"/>
        <outline text="Overlapping population codes refine localisation"/>
        <outline text="Cortical maps favour important regions and reorganise"/>
        <outline text="Dorsal columns: touch, vibration, proprioception">
          <outline text="Ipsilateral ascent, cross in medulla"/>
        </outline>
        <outline text="Anterolateral system: pain, temperature, itch">
          <outline text="Cross near spinal entry"/>
        </outline>
        <outline text="Spindles sense length, tendon organs sense tension">
          <outline text="Sensory ataxia worsens without vision"/>
        </outline>
      </outline>
      <outline text="Vision">
        <outline text="Cornea refracts most, lens accommodates"/>
        <outline text="Photoreceptors hyperpolarise in light">
          <outline text="Rods for dim light, cones for acuity and colour"/>
        </outline>
        <outline text="Nasal fibres cross at chiasm">
          <outline text="Each optic tract carries the opposite field"/>
        </outline>
        <outline text="Lesion site predicts field defect pattern"/>
        <outline text="Pupillary pathway diverges before cortex">
          <outline text="Light response kept in cortical blindness"/>
        </outline>
        <outline text="Accommodation: ciliary contraction, lens rounding, convergence"/>
      </outline>
      <outline text="Hearing and balance">
        <outline text="Place coding: high at base, low at apex"/>
        <outline text="Inner hair cells output, outer hair cells amplify"/>
        <outline text="Bilateral central relay">
          <outline text="Unilateral central lesion rarely deafens one ear"/>
        </outline>
        <outline text="Conductive versus sensorineural loss"/>
        <outline text="Canals sense angular acceleration"/>
        <outline text="Utricle and saccule sense linear acceleration and tilt"/>
        <outline text="Sensory mismatch causes vertigo and nystagmus"/>
      </outline>
      <outline text="Taste, smell, and visceral sensation">
        <outline text="Five tastes via ion channels or G proteins"/>
        <outline text="Smell projects to bulb and limbic-linked cortex">
          <outline text="Links odour to memory and emotion"/>
        </outline>
        <outline text="Visceral afferents: stretch, chemistry, ischaemia"/>
        <outline text="Sparse, convergent input makes pain diffuse">
          <outline text="Referred pain follows shared spinal segments"/>
        </outline>
      </outline>
      <outline text="Nociception and pain">
        <outline text="Free nerve endings sense danger"/>
        <outline text="Injury mediators lower thresholds"/>
        <outline text="A-delta sharp and localised"/>
        <outline text="C fibres burning, aching, affective"/>
        <outline text="Pain integrates salience, fear, expectation, control">
          <outline text="Real without proportionate visible damage"/>
        </outline>
        <outline text="Descending control inhibits or facilitates">
          <outline text="Placebo and nocebo use genuine physiology"/>
        </outline>
      </outline>
      <outline text="Pain types and sensitisation">
        <outline text="Peripheral sensitisation lowers thresholds"/>
        <outline text="Central sensitisation amplifies and enlarges fields">
          <outline text="Innocuous input becomes painful"/>
        </outline>
        <outline text="Neuropathic: lesion of somatosensory system"/>
        <outline text="Nociplastic: altered processing without sufficient damage"/>
        <outline text="Treat mechanism and function, not intensity alone"/>
      </outline>
      <outline text="Analgesic principles">
        <outline text="Paracetamol: limited anti-inflammatory action">
          <outline text="Overdose causes hepatic injury"/>
        </outline>
        <outline text="Non-steroidal drugs reduce prostaglandin synthesis">
          <outline text="Bleeding, kidney injury, fluid, cardiovascular harm"/>
        </outline>
        <outline text="Local anaesthetics block sodium channels"/>
        <outline text="Opioids: sedation, respiratory depression, dependence"/>
        <outline text="Neuropathic: antidepressants, channel ligands, topicals"/>
        <outline text="Non-drug care: explanation, activity, sleep, rehab"/>
        <outline text="Multimodal care improves function, limits harm"/>
      </outline>
    </outline>
  </body>
</opml>
