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IMF-025-01-0001-en	Chromosomal sex is fixed at fertilisation. Why does that not settle gonadal and anatomical sex, and what does this imply for assessment?	Gonadal and anatomical differentiation depend on gene expression and hormone action, so variation can arise at chromosomal, gonadal, hormonal, receptor or anatomical levels; assessment must be precise and respectful, not based on appearance.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0002-en	How does testicular development direct internal and external differentiation, and what happens when its products are absent?	The developing testis produces anti-Mullerian hormone and androgens that direct differentiation; in their absence, ovarian and female tract development proceeds through alternative pathways.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0003-en	What hypothalamic change initiates puberty, and how does it produce secondary sexual characteristics?	Pulsatile gonadotropin-releasing hormone activity, restrained in childhood, increases and drives luteinising and follicle-stimulating hormones; the resulting gonadal steroids produce secondary sexual characteristics, growth and bone maturation.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0004-en	How do theca and granulosa cells cooperate to produce oestradiol in the ovarian follicle?	Theca cells supply androgens, and granulosa cells, in follicles recruited by follicle-stimulating hormone, convert those theca-derived androgens to oestradiol.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0005-en	How can rising oestradiol both restrain gonadotropins and trigger ovulation?	Early in the rise it exerts negative feedback, but sustained high levels switch to positive feedback, generating the luteinising-hormone surge that triggers ovulation and luteinisation.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0006-en	Without pregnancy, what sequence leads from the corpus luteum to menstrual shedding?	The corpus luteum regresses, progesterone and oestradiol fall, spiral arteries constrict, and the functional endometrium sheds.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0007-en	In the testis, how are the roles of luteinising hormone and follicle-stimulating hormone divided?	Luteinising hormone stimulates Leydig-cell testosterone production, while follicle-stimulating hormone together with intratesticular testosterone supports Sertoli cells and spermatogenesis; inhibin contributes feedback.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0008-en	What distinguishes the neural control of erection from that of ejaculation?	Erection depends mainly on parasympathetic nitric-oxide signalling with smooth-muscle relaxation, arterial inflow and venous occlusion, whereas ejaculation uses sympathetic and somatic pathways.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0009-en	Why should sexual dysfunction be assessed by separate domains rather than one label?	It may arise from vascular, neurological, endocrine, medication, pain, psychological, relational or structural factors, so desire, arousal, orgasm, ejaculation, pain, fertility and satisfaction are assessed separately.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0010-en	Why is human chorionic gonadotropin needed in early pregnancy?	It preserves the corpus luteum, and therefore its steroid output, until placental steroid production is established.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0011-en	Why is the placenta described as an active organ rather than a passive filter?	Its exchange depends on flow, surface area, membrane properties, metabolism and gradients, and it produces chorionic gonadotropin, progesterone, oestrogens, placental lactogen and other signals.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0012-en	How does the character of bleeding help distinguish placental separation before birth from placenta praevia?	Placental separation before birth causes painful bleeding with fetal compromise, whereas implantation over the cervical opening (praevia) typically causes painless bleeding.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0013-en	Red-cell mass rises in pregnancy. Why does physiological haemodilution still occur?	Plasma volume expansion exceeds red-cell expansion, so concentration falls even though red-cell mass has increased.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0014-en	Why can lying supine reduce circulation late in pregnancy?	The uterus compresses the veins in the supine position, reducing venous return.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0015-en	Why does pregnancy produce a mild respiratory alkalosis with low bicarbonate?	Progesterone increases ventilation, lowering carbon dioxide, and bicarbonate falls with it.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0016-en	Why is the usual creatinine value lower in pregnancy?	Glomerular filtration and renal blood flow rise in pregnancy, which lowers the usual creatinine value.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0017-en	Why does insulin resistance rise later in pregnancy, and how does gestational diabetes arise from it?	It preserves nutrients for the fetus; pancreatic secretion normally compensates, and gestational diabetes results when that compensation fails.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0018-en	What keeps the fetal shunts (ductus venosus, foramen ovale, ductus arteriosus) open before birth?	High pulmonary vascular resistance and low placental resistance maintain the shunts that route blood around the liver and lungs.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0019-en	At birth, what closes the foramen ovale and what promotes ductal closure?	Lung expansion lowers pulmonary resistance and cord clamping raises systemic resistance, so rising left atrial pressure closes the foramen ovale functionally; oxygen and reduced prostaglandins promote ductal closure.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0020-en	What positive feedback strengthens contractions during labour?	Cervical stretch and oxytocin reinforce each other, so stretch increases oxytocin-driven contraction, which increases stretch.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0021-en	How is bleeding normally limited after placental separation, and why is uterine atony therefore a major cause of postpartum haemorrhage?	Uterine contraction compresses the vessels and limits bleeding; an atonic uterus fails to contract, so the vessels are not compressed and bleeding continues.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0022-en	Why does full milk secretion begin only after placental delivery?	Oestrogen and progesterone promote breast development in pregnancy but restrain full secretion; their fall after placental delivery permits prolactin-driven synthesis.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0023-en	Why are long-acting reversible contraceptive methods highly effective?	They reduce dependence on the user, which is what makes them highly effective.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending
IMF-025-01-0024-en	Why does the timing of drug exposure in pregnancy change the kind of harm it can cause?	Early exposure may disrupt organ formation, whereas later exposure can affect growth, physiology, labour or neonatal adaptation.	Integrated Medical Foundations; chapter 25, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: b8cc410f10e2155219dfe9ee44fde86a776bbc78eb17a49843456168c69e97c2; editorial review pending	imf lang::en chapter::025 module::025-01 review::pending