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IMF-033-02-0001-en	How does comparing pain on active and passive movement help localise the painful structure, and what limits this?	Pain on active but not passive movement suggests contractile tissue, pain through passive range suggests joint or capsule, but guarding and severe pain blur the distinction.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0002-en	How does joint distribution discriminate rheumatoid arthritis, psoriatic arthritis, gout and spondyloarthritis?	Symmetric metacarpophalangeal and proximal interphalangeal synovitis suggests rheumatoid arthritis, distal interphalangeal disease with nail change psoriatic arthritis, abrupt first metatarsophalangeal inflammation gout, and axial or entheseal disease spondyloarthritis.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0003-en	After limb trauma the limb is warm and pink. Why can important arterial injury still be present?	Collateral flow can keep the limb warm and pink, so asymmetry, expanding haematoma, bruit, neurological deficit or mechanism can still mandate vascular imaging or exploration.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0004-en	What sequence of pressure failure leads from a tight fascial compartment to nerve and muscle ischaemia?	Venous outflow fails first, which raises interstitial pressure further until capillary flow and nerve conduction decline.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0005-en	Why can neither synovial-fluid leukocyte count nor a negative Gram stain rule out septic arthritis?	Fluid appearance and leukocyte count overlap among bacterial, crystal and immune arthritis, and Gram stain lacks the sensitivity to exclude infection.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0006-en	Why does osteoarthritis pain correlate poorly with radiographic change?	Cartilage itself lacks nerves, so pain arises from innervated bone, synovium, capsule, tendon and sensitised neural pathways rather than from the cartilage loss seen on imaging.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0007-en	Why does starting urate-lowering therapy often provoke early gout flares, and how is premature abandonment prevented?	Effective urate lowering gradually dissolves deposits, and starting it mobilises them, provoking flares; prophylaxis and explanation prevent the patient stopping too early.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0008-en	In rheumatoid arthritis, pain persists although swelling and inflammation have resolved. Why is further immunosuppression alone not the answer?	Residual pain may come from fibromyalgia, structural damage, tendon disorder, mood or sleep rather than active synovitis, so these deserve consideration.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0009-en	Why is urine examination essential in systemic lupus erythematosus even without renal symptoms?	Lupus nephritis may be clinically quiet, so proteinuria and active sediment must be sought directly.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0010-en	In scleroderma renal crisis, why is rapid angiotensin-converting-enzyme inhibition continued even as creatinine rises?	Abrupt hypertension with kidney injury defines the crisis, and rapid angiotensin-converting-enzyme inhibition is the central treatment despite rising creatinine.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0011-en	Why is suspected giant-cell arteritis with visual threat treated before biopsy, unlike most vasculitis?	Biopsy is usually obtained before prolonged immunosuppression, but waiting for it in giant-cell arteritis with visual threat can cost sight.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0012-en	Why must drug toxicity, endocrine disease, inherited myopathy, motor-neuron disease and inclusion-body myositis be separated from inflammatory myopathy?	Immunosuppression may not help these conditions and can cause harm.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0013-en	A patient on immunosuppression develops new breathlessness with little fever and low inflammatory markers. Why is infection not excluded?	Scant fever and low markers are not grounds for reassurance, so disease-related lung involvement, opportunistic infection, drug-induced lung injury, thrombosis and heart failure are considered in parallel.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending
IMF-033-02-0014-en	How is treatment success confirmed in immune-mediated musculoskeletal disease, and why not by laboratory values?	By whether standing, walking, work, sleep and self-care have improved, because the goal is the patient's function rather than normalisation of a laboratory marker alone.	Integrated Medical Foundations; chapter 33, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f0aae66dc609d441445037573ba9cc4e6b155131716c654ecba96852f9a9f1fc; editorial review pending	imf lang::en chapter::033 module::033-02 review::pending