Class Notes Part 3 ⭐

Nervous System

Each half of cerebrum is hemisphere.

Brainstem: Central core of the brain—contains midbrain, pons and medulla Spinal cord: Main pathway for ascending and descending fiber tracts that connect brain to spinal nerves.

Hypothalamus: Major respiratory center with basic function control and coordination

Dermatome: a sensory unit of the skin that is innervated by a single spinal nerve.

Stroke: Stroke is also the most common cause of adult disability. The fifth most common cause of death in the United States.

Tremor: the body's involuntary, rhythmic shaking or trembling.

Ears

Dizziness: A general feeling of lightheadedness, unsteadiness, or faintness. Vertigo: spinning sensation. Often linked to inner ear problems

Tympanic Membrane (TM): Also called the eardrum.

Method of cleaning ear canal is to soften cerumen with a warmed solution of mineral oil and hydrogen peroxide. Do not irrigate if history or examination suggests perforation or infection.

Some adults may show scarring, which is a dense white patch on TM, a sequela of repeated ear infections.

Middle Ear: Contains tiny ear bones, or auditory ossicles: malleus, incus, and stapes.

Inner ear: Contains the bony labyrinth, which holds sensory organs for equilibrium and hearing. Not accessible to direct examination.

Labyrinth: Feeds the brain with information to brain about body’s position in space (Equilibrium). If labyrinth ever becomes inflamed, it feeds wrong information to brain, creating a staggering gait and vertigo.

• Conductive hearing loss: mechanical dysfunction of external or middle ear Physical Obstruction.
• Sensorineural (or perceptive) hearing loss:  signifies pathology of inner ear, cranial nerve VIII, or auditory areas of cerebral cortex, the issue is not mechanical. Rather electric or quemical.
• Mixed hearing loss: combination of conductive and sensorineural types in the same ear

Otosclerosis is a common cause of hearing loss in young adults (20 to 40 years old). Presbycusis: type of hearing loss that occurs with aging, even in people living in quiet environment, is sensorineural not conductive. • Darwin’s tubercle: a small painless nodule at the helix; this is a congenital variation and not significant

Otoscope: To look inside the ear.

Ophthalmoscope: To look inside the eye (retina, optic disk and blood vessels.

• Weber Test:
• Measures: If hearing loss is one-sided (and whether it’s conductive or sensorineural).
• Normal → sound same in both ears.
• Conductive loss → sound louder in bad ear.
• Sensorineural loss → sound louder in good ear.
• Rinne Test:
• Measures: The relationship of Air Conduction (AC) vs Bone Conduction (BC).
• Checks: If the ear conducts sound better through air (normal) or bone (conductive loss).

Nose:

Anterior part of septum holds a rich vascular network, Kiesselbach’s plexus, most common site of nosebleeds.

Lateral walls of each nasal cavity contain three parallel bony projections: superior, middle, and inferior turbinate.

Sinuses drain into middle meatus, and tears from nasolacrimal duct drain into inferior meatus.

Paranasal sinuses: air-filled pockets within the cranium

Epistaxis: medical term for a nosebleed.

Nasal stuffiness and epistaxis may occur during pregnancy

Nasal patency: Air goes thru both nostrils, we cover one at the theme and ask pt. to breath in.

Mouth

• Palate: arching roof of mouth divided into two parts
• Hard palate: anterior part made up of bone. white with irregular transverse rugae
• Soft palate: posterior part, an arch of muscle that is mobile. Pink, smooth.
• Uvula: free projection hanging down from middle of soft palate
• Is inspected to check function of CN X (Vagus)

During pregnancy gums can bleed with tooth brushing.

Dysphagia: difficulty swallowing.

Hoarseness: an abnormal voice change that makes your voice sound weak, breathy, or raspy, often caused by colds, infections, or vocal cord irritation from overuse.

CNIII Raises eyelid and constrictions of pupil.

Mydriasis: Dilation of pupil.

Miosis: Constrictions of pupil.

Ptosis: Eyelid is like half down.

Mental Status (So far this is disorganized)

Aphasia: Aphasia is a true language disorder in which the ability to understand or produce speech is impaired. It represents a disturbance in higher-level language processing, leading to problems with word choice, comprehension, or both.

Dysphonia: Dysphonia is a voice disorder caused by disease of the larynx, resulting in difficulty or discomfort when speaking. The voice often sounds hoarse, strained, or whispered, with abnormal pitch or volume, although articulation and language remain intact.

Dysarthria: Dysarthria is an articulation disorder that occurs when poor muscle control affects the production of speech. Words may sound distorted, slurred, or difficult to understand, but the person’s language skills—including grammar, word choice, and comprehension—are preserved.

Types of Aphasia:

Global Aphasia: Most severe; speech and comprehension absent or minimal. Repetition, reading, and writing also impaired.

Broca’s Aphasia (Expressive): Understands language but speech is nonfluent, effortful, short phrases. Communication hard.

Wernicke’s Aphasia (Receptive): Fluent, effortless speech but makes no sense; comprehension poor.

Depression: Persistent sadness and loss of interest ≥2 weeks.

Anxiety: Nervousness/worry with no clear cause.

Fear: Worry due to known cause (e.g., spiders).

Irritability: Easily annoyed or impatient.

Euphoria: Exaggerated, abnormal happiness.

Generalized Anxiety Disorder (GAD): Constant, excessive anxiety most of the time.

Agoraphobia: Fear of open or public places where escape feels hard.

Posttraumatic Stress Disorder (PTSD): After trauma; intrusive memories, hypervigilance, avoidance.

Obsessive-Compulsive Disorder (OCD): Obsessions = unwanted thoughts; Compulsions = repetitive behaviors to reduce anxiety.

Delirium: Acute, reversible confusion with disorientation, illusions, poor memory, agitation, inattention.

Dementia: Chronic, progressive cognitive decline (memory, judgment, orientation) with consciousness intact.

Thought Process Abnormalities

• Blocking: Sudden stop in thought, can’t finish a sentence.

Example: “Forgot what I was going to say.”

• Neologism: Making up a new word that only has meaning to the person.

Example: “I’ll have to turn on my thinkilator.”

• Confabulation: Making up events to fill memory gaps.

Example: Describes a walk around the hospital, though he never left his room.

• Circumlocution: Using a phrase instead of the actual word.

Example: “The thing you open the door with” instead of “key.”

• Circumstantiality: Gives too many details and delays the point.

Example: “When was my surgery? Well I was 28, living with my aunt, she had psoriasis that year, the heat was bad…”

• Loosening associations: Jumps from one unrelated topic to another without noticing.

Example: “My boss is angry… I saw that movie Lassie… she kept trying to land the airplane…”

• Flight of ideas: Rapidly skips from one topic to another; speech flows fast.

Example: “Take this pill? The pill is blue. I feel blue. (sings) She wore blue…”

• Word salad: Random, jumbled words that make no sense.

Example: “Beauty, red-based five, pigeon, the street corner, sort of.”

• Perseveration: Repeats words or actions over and over.

Example: “I’m going to lock the door, lock the door… lock the door.”

• Echolalia: Repeats another person’s words, often mocking.

Example: Nurse: “Take your pill.” Patient: “Take your pill. Take your pill.”

• Clanging: Chooses words by sound (rhymes/puns), not meaning.

Example: “My feet are cold. Cold, bold, told. The bell tolled for me.”

Thought Content Abnormalities

Phobia: A strong, persistent, irrational fear of an object or situation. The person feels compelled to avoid it.

Examples: fear of cats, dogs, heights, or enclosed spaces.

Hypochondriasis: Excessive worry about health without real evidence. The person believes normal sensations or minor symptoms mean serious illness.

Example: thinking every ache or sign means cancer.

Obsession: Unwanted, repetitive thoughts or impulses that feel intrusive and senseless. Logic cannot remove them from the mind.

Examples: repeated violent thoughts, fear of contamination by shaking hands.

Compulsion: Repetitive, purposeful behaviors done to reduce anxiety or prevent imagined danger. The person feels driven to perform them.

Examples: constant handwashing, checking locks repeatedly, counting, or touching objects.

Delusions: Firm, false beliefs that are irrational and resistant to evidence.

• Grandiose delusion: Believing you are a famous or powerful figure.
• Persecutory delusion: Believing others are “out to get me.”

Perception Abnormalities

Hallucination: False sensory experiences with no external stimulus. Can involve any sense: hearing voices (auditory), seeing things (visual), feeling sensations (tactile), or smelling/ tasting things not present.

Illusion: Misinterpreting a real external stimulus.

Example: folds in bedsheets look like moving creatures.

Eating Problems

Anorexia Nervosa: Distorted body image with intense fear of gaining weight, leading to self-starvation.

Bulimia Nervosa: Recurrent episodes of binge eating followed by purging (self-induced vomiting or laxatives).

Binge Eating Disorder: Repeated episodes of uncontrollable overeating within a short time, followed by feelings of guilt or distress.

Mood and Affect Abnormalities

Flat Affect (Blunted Affect): A lack of emotional response. The person shows no expression of feelings; voice is monotonous and face immobile, regardless of topic.

Depression: A sad, gloomy, dejected mood. Can occur after stressful events, illness, or certain times (like holidays or rainy weather). Temporary situations improve quickly, but persistent sadness signals clinical depression. Example: “I don’t enjoy anything anymore.”

Depersonalization (Loss of Ego Boundaries): A loss of sense of identity. The person feels estranged from themselves, perplexed about who they are or whether they exist. Examples: “I don’t feel real.” “I feel like I’m not really here.”

Elation: A state of joy, optimism, and overconfidence, often with increased activity. Normal at times but can also be a pathologic sign of mania. Example: “I’m feeling very happy.”

Euphoria: An excessive sense of well-being, inappropriately cheerful or elated given the circumstances. Suggests a pathologic mood. Examples: “I’m high.” “I feel like I’m flying.” “I feel on top of the world.”

Anxiety: Feelings of worry, unease, or apprehension due to anticipation of danger, but the source is vague or unknown. Examples: “I feel nervous and high-strung.” “I worry all the time.”

Fear: Similar to anxiety but tied to a known external danger. Example: fear of flying in airplanes.

Irritability: Being easily annoyed or provoked. A minor stimulus may “set the person off.”

Rage: A furious, uncontrolled state of anger. Often expressed as violent behavior toward self or others.

Ambivalence: Holding two opposing emotions toward the same idea, object, or person. Example: loving and hating someone at the same time.

Lability: Rapid shifts in emotion. The person may go from euphoric to tearful to angry in quick succession.

Inappropriate Affect: Emotional expression that does not match the content of speech. Example: laughing while discussing a serious medical condition like a biopsy.