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IMF-041-02-0001-en	Why does a combination of fatigue, rash, a positive antibody and a raised inflammatory marker not by itself establish an autoimmune syndrome?	Each is common and they need not share one mechanism; a convincing syndrome links specific features to objective tissue injury, a plausible immune pathway and a compatible time course while testing alternatives.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0002-en	Why is self-tolerance multilayered, and how may genetic susceptibility act on it?	No single checkpoint is perfect, so several layers are needed; genetic susceptibility may alter several weak checkpoints rather than act through one deterministic gene.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0003-en	Why is it useful to name the effector mechanism of autoimmune injury, as with antiphospholipid antibodies?	Effectors differ: antiphospholipid antibodies promote thrombosis rather than classic vessel-wall inflammation, and naming the mechanism predicts which laboratory, biopsy and treatment signals are meaningful.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0004-en	Why is antinuclear antibody unhelpful in people without compatible features and for tracking lupus activity?	Although sensitive for lupus, it has limited positive predictive value without compatible features, and repeating it rarely measures disease activity.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0005-en	What question should be settled before ordering an autoantibody test, and why?	Which organ assessment or treatment would change if it is positive and what a negative would exclude, because indiscriminate broad panels yield weak positives in low-probability people and contradictory results.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0006-en	In lupus nephritis, why should falling complement and rising double-stranded-DNA antibody not alone set treatment intensity?	They support activity only in some patients and should not overrule a stable kidney phenotype; biopsy shows class, activity, scar and alternatives so treatment matches salvageable inflammation.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0007-en	Why can a normal creatinine be falsely reassuring in lupus kidney disease?	Proteinuria and an active sediment can progress while creatinine stays normal, and in a patient with little muscle mass the fall in filtration is underestimated.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0008-en	Why is the behaviour of lupus anticoagulant described as paradoxical?	It prolongs phospholipid-dependent clotting assays in the laboratory while increasing thrombosis risk in vivo.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0009-en	In scleroderma renal crisis, why is angiotensin-converting-enzyme inhibition continued despite an early creatinine rise?	When the diagnosis fits, renin-driven vascular injury otherwise progresses, so inhibition is started promptly and continued.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0010-en	Why is inflammatory myopathy followed by serial power measurement rather than creatine kinase alone?	The disease is recognised through loss of power, so weakness of neck flexion, shoulder and hip movement, finger flexion, swallowing, cough and respiration is measured serially.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0011-en	Why can imaging and temporal-artery biopsy for giant-cell arteritis be arranged without delaying glucocorticoids?	Ultrasound, arterial imaging and temporal-artery biopsy retain diagnostic value for a period after treatment, so treatment of threatened visual ischaemia need not wait.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0012-en	In suspected alveolar haemorrhage, why are cultures and imaging obtained before and after immunosuppression begins?	Lung opacity and anaemia arise from both infection and haemorrhage, so specimens and imaging around the start of treatment are needed to tell them apart.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0013-en	Why is Strongyloides exposure history checked before high-dose corticosteroids?	Because Strongyloides hyperinfection in a patient given high-dose corticosteroids can be fatal.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending
IMF-041-02-0014-en	During treatment, why must clinicians neither reflexively escalate immunosuppression nor wait for complete certainty?	Escalating without new specimens and anatomy can worsen the true cause, yet waiting during visual loss, alveolar haemorrhage, renal crisis or mesenteric ischaemia causes irreversible damage.	Integrated Medical Foundations; chapter 41, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ab9c4f373aa858fa312f932067bdda8eb9fde92f9a627b6ea4ef91dfed593885; editorial review pending	imf lang::en chapter::041 module::041-02 review::pending