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IMF-068-02-0001-en	Which questions should precede investigating or treating a new problem in advanced illness, and why?	Ask the likely mechanism, reversible contributors, burden of clarification, time available for benefit, and how results would change management; this prevents both neglect and reflex intervention.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0002-en	Why can a single numerical symptom score not replace narrative assessment?	Suffering has interacting dimensions, as when breathlessness causes panic that intensifies breathlessness, so a score tracks change but not meaning, coping, or fears.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0003-en	Why must cord compression, pathological fracture, or urinary retention be recognised promptly even in advanced disease?	Targeted treatment may rapidly improve comfort or prevent catastrophe.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0004-en	What does repeated use of rescue opioid doses suggest, and why is escalation alone a mistake?	Uncontrolled background pain, predictable incident pain needing anticipatory dosing, or a new cause; escalation without reassessment fails to treat the true mechanism.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0005-en	In a patient on opioids, what should new drowsiness, hallucination, myoclonus, or diffuse pain increased by touch suggest?	Opioid accumulation and neurotoxicity, not only disease progression; review hydration, kidney function, infection, and medicines, then reduce, switch, or trial fluid.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0006-en	Why may a prokinetic help partial obstruction but harm complete mechanical bowel obstruction?	It can aid functional stasis or partial obstruction, but against a complete mechanical block it can worsen colic.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0007-en	Why can facial airflow and upright positioning ease breathlessness independently of oxygen saturation?	Breathlessness correlates imperfectly with saturation, and airflow, posture, pacing, and a calm plan reduce neural threat perception.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0008-en	Why is stacking drugs with similar receptor effects harmful in refractory nausea, and what helps instead?	Stacking increases sedation, hypotension, extrapyramidal reactions, anticholinergic burden, or cardiac risk; combining agents with complementary actions may help.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0009-en	When relatives want prognosis kept from the patient, how should the clinician proceed?	Ask the patient directly and gently how much they wish to know; culture is respected, but the family alone does not decide what the patient is told.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0010-en	What is the intention of proportionate palliative sedation, and how is its depth chosen?	Its intention is relief of intolerable refractory suffering, so the minimum effective depth is titrated to that endpoint rather than to hasten death.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0011-en	Why is intravenous fluid often not the best response to thirst and dry mouth in advanced illness?	These often respond better to mouth care, ice, sips, and saliva substitutes, while fluid can worsen oedema, effusions, secretions, and cannula discomfort.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0012-en	Why are the final days recognised from trajectory and repeated assessment rather than a single sign?	Signs such as bedbound state and minimal intake raise probability only collectively, and reversible sedation, infection, hypercalcaemia, or drug toxicity can mimic dying.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0013-en	What does a decision not to attempt resuscitation leave in place?	It does not stop analgesia, nursing, investigation, or family support; transfer, antibiotics, fluids, oxygen, and admission are each defined separately.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending
IMF-068-02-0014-en	During withdrawal of ventilation, what guides added medication, and what if death does not follow quickly?	Medication is added for observed distress, not a number or the timing of death; if death is delayed, the decision was not necessarily wrong and comfort care continues.	Integrated Medical Foundations; chapter 68, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 7291cc40a47331fab1eeb14d1a8cea2cac033a7d81c70b221a8dcb53a4d4c215; editorial review pending	imf lang::en chapter::068 module::068-02 review::pending