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IMF-095-02-0001-en	Why is it wrong to say that antibiotic exposure makes a bacterium generate the resistance mutation it needs?	Mutations arise randomly during replication or repair and are then enriched by selection; the drug selects among existing variants rather than directing which mutation appears.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0002-en	How can resistance be selected even when plasma concentrations look adequate?	Exposure differs across tissue, abscess, biofilm, gut, urine and intracellular compartments, and a subtherapeutic concentration at one of those sites can select resistant organisms.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0003-en	Why does reducing antimicrobial use not guarantee that population resistance falls quickly?	Compensatory mutations lower the fitness cost without restoring susceptibility, and resistance can persist because its cost is low or because it is linked to other selected genes.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0004-en	What distinguishes transformation, transduction and conjugation?	Transformation takes up naked environmental DNA, transduction moves bacterial genes inside bacteriophages, and conjugation transfers plasmids or other elements through direct cell contact.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0005-en	Why can use of one antibiotic select resistance to several unrelated drugs?	One plasmid may carry several resistance genes, so selecting for the plasmid with a single drug co-selects every resistance determinant it carries.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0006-en	Integrons are not self-mobile elements, so how do they spread resistance arrays?	They capture gene cassettes at a recombination site and express them from a promoter, and they travel between cells by riding on plasmids or transposons.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0007-en	How can a bacteriophage make its bacterial host more damaging to people?	A temperate phage can integrate as a prophage and confer toxins or other traits, as in selected diphtheria, cholera and Shiga-toxin systems, and induction can release particles and toxins.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0008-en	Why does the presence of a CRISPR-Cas system not guarantee that a strain will resist acquiring resistance plasmids?	CRISPR-Cas gives RNA-guided defence against matching nucleic acids, but mobile elements evolve anti-CRISPR mechanisms and transfer still succeeds when ecological conditions favour it.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0009-en	Why can the name of a beta-lactamase not predict activity against every beta-lactam?	Permeability, porin loss, efflux and additional mechanisms act alongside the enzyme, so the observed phenotype emerges from the whole combination.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0010-en	Give an example showing that a similar resistance phenotype can arise through distinct biology.	Enterococcal vancomycin resistance replaces the terminal cell-wall target chemistry, while intermediate resistance in staphylococci instead involves a thickened cell wall and heterogeneous subpopulations.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0011-en	What distinguishes tolerance, persistence and heteroresistance from inherited resistance?	Tolerance is survival without a raised inhibitory concentration, persistence is a small phenotypic subpopulation surviving transient exposure, and heteroresistance is a resistant minority within an apparently susceptible isolate.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0012-en	Why can a susceptible laboratory result still be followed by treatment failure?	Breakpoints assume standard conditions, so poor source control, limited penetration, impaired immunity, poor adherence or wrong organism identification can defeat an active drug.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0013-en	Why does detecting a virulence gene not prove that the organism caused the current syndrome?	Virulence factors also support colonisation and environmental survival, so their presence describes capacity in some context rather than causation of this illness.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending
IMF-095-02-0014-en	Why is withholding necessary early therapy in severe infection not stewardship?	Stewardship aims to keep treatment effective while reducing unnecessary selection, using narrow agents, optimised dosing, source control, timed review and shorter duration when evidence supports it.	Integrated Medical Foundations; chapter 95, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f774eda9421eda052e758c8ff7088a65f7ce0e15efbb71b69723576fd82cce43; editorial review pending	imf lang::en chapter::095 module::095-02 review::pending