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  <head>
    <title>029-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Higher function, sleep, consciousness, autonomic control">
      <outline text="Cortical organisation">
        <outline text="Association regions integrate modalities and time"/>
        <outline text="Function depends on connectivity as much as tissue">
          <outline text="Strategic lesion disconnects, disproportionate disability"/>
        </outline>
        <outline text="Hemispheres specialised but cooperative">
          <outline text="Language left-dominant in most people"/>
          <outline text="Right: spatial attention, prosody, global context"/>
          <outline text="Dominance probabilistic, so examine, do not assume"/>
        </outline>
      </outline>
      <outline text="Attention and executive control">
        <outline text="Frontoparietal networks with thalamus and brainstem"/>
        <outline text="Attention failure degrades every cognitive test">
          <outline text="Poor recall may be failed encoding, not storage"/>
        </outline>
        <outline text="Prefrontal: working memory, inhibition, rule switching"/>
        <outline text="Orbitofrontal injury: disinhibition, poor judgement"/>
        <outline text="Medial frontal injury: apathy, reduced initiation"/>
        <outline text="Dorsolateral injury: planning, flexibility impaired"/>
        <outline text="Neglect: failure to attend to one side">
          <outline text="Usually right hemisphere injury, left-sided"/>
          <outline text="Not explained by primary sensory loss"/>
          <outline text="Extinction on bilateral stimulation"/>
        </outline>
      </outline>
      <outline text="Language and symbolic functions">
        <outline text="Non-fluent: effortful output, better comprehension"/>
        <outline text="Fluent receptive: empty speech, poor comprehension"/>
        <outline text="Conduction: repetition disproportionately impaired"/>
        <outline text="Dysarthria: motor execution, language intact"/>
        <outline text="Apraxia of speech: articulatory planning"/>
        <outline text="Apraxia: skilled action, not weakness or sensory loss"/>
        <outline text="Agnosia: failed recognition despite sensation"/>
      </outline>
      <outline text="Memory systems">
        <outline text="Working, episodic, semantic, procedural memory"/>
        <outline text="Hippocampal circuits consolidate new declarative memory">
          <outline text="Not a permanent warehouse for all detail"/>
        </outline>
        <outline text="Retrieval reconstructs, so memory is fallible">
          <outline text="Repeated retrieval strengthens and updates"/>
        </outline>
        <outline text="Anterograde versus retrograde amnesia"/>
        <outline text="Frontal: strategies and source monitoring"/>
        <outline text="Confabulation without deliberate deception"/>
      </outline>
      <outline text="Emotion, motivation, and stress">
        <outline text="Amygdala detects salience and learns threat"/>
        <outline text="Dopamine encodes expected versus obtained outcome"/>
        <outline text="Psychiatric symptoms from many causes">
          <outline text="Brain and mind not competing explanations"/>
        </outline>
      </outline>
      <outline text="Sleep architecture">
        <outline text="Circadian timing plus homeostatic pressure"/>
        <outline text="Suprachiasmatic nucleus aligns to light via retina"/>
        <outline text="Melatonin signals night, not an off switch"/>
        <outline text="Slow-wave sleep with reduced sympathetic activity"/>
        <outline text="REM: dreaming, cortical activation, atonia">
          <outline text="Diaphragm and selected muscles spared"/>
        </outline>
        <outline text="Slow-wave earlier, REM later in the night"/>
        <outline text="Deprivation impairs vigilance, judgement, glucose">
          <outline text="Subjective adaptation exceeds objective recovery"/>
        </outline>
      </outline>
      <outline text="Sleep disorders">
        <outline text="Insomnia despite opportunity with daytime effect">
          <outline text="Conditioned arousal outlasts the trigger"/>
          <outline text="Cognitive behavioural therapy targets arousal, timing"/>
          <outline text="Sedatives: dependence, falls, respiratory worsening"/>
        </outline>
        <outline text="Obstructive apnoea: recurrent upper-airway collapse">
          <outline text="Absent sleepiness does not exclude it"/>
          <outline text="Positive airway pressure, weight, devices, surgery"/>
        </outline>
        <outline text="Narcolepsy: REM intrusion, cataplexy"/>
        <outline text="Parasomnias: incomplete state transitions"/>
        <outline text="Restless legs: urge to move, iron, drugs"/>
      </outline>
      <outline text="Consciousness and arousal">
        <outline text="Arousal from brainstem, hypothalamus, thalamus"/>
        <outline text="Coma needs bilateral or arousal-network injury"/>
        <outline text="First: airway, glucose, toxins, seizures, infection"/>
        <outline text="Structural focal versus metabolic symmetric signs"/>
        <outline text="Delirium: acute fluctuating attention failure">
          <outline text="Hypoactive delirium easily missed"/>
        </outline>
        <outline text="Dementia: chronic decline, may coexist"/>
        <outline text="Minimally conscious versus unresponsive wakefulness"/>
        <outline text="Locked-in: conscious, motor output lost"/>
      </outline>
      <outline text="Autonomic organisation">
        <outline text="Preganglionic neurons use acetylcholine"/>
        <outline text="Most sympathetic postganglionic use noradrenaline">
          <outline text="Sweat fibres the exception"/>
        </outline>
        <outline text="Sympathetic and parasympathetic not simple opposites"/>
        <outline text="Baroreceptors adjust sympathetic and vagal output"/>
        <outline text="Standing: vasoconstriction, heart rate, muscle pump"/>
        <outline text="Orthostatic hypotension: volume, drugs, neuropathy"/>
      </outline>
      <outline text="Autonomic failure and emergencies">
        <outline text="Lying and standing pressure and pulse"/>
        <outline text="Autonomic dysreflexia after high cord injury">
          <outline text="Bladder or bowel distension triggers it"/>
          <outline text="Severe hypertension, headache, bradycardia"/>
          <outline text="Sit upright, remove trigger, monitor"/>
          <outline text="Missed: stroke, seizure, cardiac injury"/>
        </outline>
      </outline>
    </outline>
  </body>
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