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IMF-026-02-0001-en	Why do broad hormone panels ordered without a physiological question cause harm?	Without a defined axis and suspected mechanism, they generate incidental abnormalities and contradictory repeat results.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0002-en	Why must the glucocorticoid history include the route of administration?	Inhaled, injected, topical, ocular and intra-articular glucocorticoids can all suppress the adrenal axis, not only oral tablets.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0003-en	What distinguishes true proximal weakness from fatigue, and why does the distinction matter?	True weakness is impaired shoulder or hip power; it supports conditions such as cortisol excess, thyroid disease or myopathy and requires localisation.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0004-en	Which distribution of hyperpigmentation supports high adrenocorticotropic drive, and what does velvety flexural pigmentation suggest?	Diffuse pigmentation in palmar creases, scars, pressure points and mucosa supports high adrenocorticotropic drive; velvety flexural pigmentation suggests insulin resistance but has other causes.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0005-en	Why must biochemical and structural questions about the thyroid be kept separate?	A normal-feeling gland does not exclude functional disease, and a large gland can be euthyroid, so palpation cannot answer the functional question.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0006-en	Why is a normal parathyroid hormone during hypercalcaemia considered inappropriate?	Physiology demands that parathyroid hormone be suppressed when calcium is high, so a value within the printed range signals failed suppression.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0007-en	What should discordant paired hormone results prompt before a rare diagnosis is considered?	Repetition under the same physiological conditions and discussion with the laboratory, since illness, fasting, posture, cycle phase, sleep, stress and exogenous hormones alter both components.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0008-en	Why does an abnormal cortisol screen not by itself justify imaging?	An abnormal screen establishes neither the source nor the imaging target, and dexamethasone suppression can fail through absorption, enzyme induction, non-adherence or cross-reactivity.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0009-en	How can hypokalaemia produce a false-negative aldosterone-renin screen?	Low potassium suppresses aldosterone secretion, lowering the measured aldosterone and masking excess.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0010-en	Irregular menstrual cycles suggest inconsistent ovulation. Why is that not enough for diagnosis?	Irregularity does not identify the cause; pregnancy, energy deficit, polycystic ovarian physiology, prolactin, thyroid disease, perimenopause, medicines and ovarian failure must be separated.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0011-en	Why is consent for intimate examination treated as an ongoing process, and how is silence interpreted?	Consent must be reconfirmed as the examination progresses, for example from external to internal; silence is not consent, and distress or withdrawal should prompt a pause.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0012-en	Why does a human chorionic gonadotropin value above the discriminatory range without an intrauterine sac not prove ectopic pregnancy?	It raises concern, but pregnancy location cannot always be established at one visit, so trends, ultrasound, dates, symptoms and haemodynamic state must be integrated.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0013-en	Why should infertility be assessed in both partners in parallel?	Testing only one partner delays care and can create misplaced blame, since ovulation, sperm, anatomy, timing and age all contribute.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending
IMF-026-02-0014-en	What does it mean for diabetes examination to close actionable loops?	Each finding should change care: a foot-risk category sets education, follow-up, footwear, podiatry or vascular referral, and injection-site findings prompt technique change.	Integrated Medical Foundations; chapter 26, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a9d6a1831b442d5eebaac8ccbc54379daff5f9c81c6d953a498974b5b1ad1785; editorial review pending	imf lang::en chapter::026 module::026-02 review::pending