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  <head>
    <title>026-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Endocrine and reproductive examination and investigation">
      <outline text="Orientation and endocrine history">
        <outline text="Slow, multisystem disorders">
          <outline text="Separate gland disease from drugs, illness, pregnancy"/>
          <outline text="Binding proteins and assay interference"/>
        </outline>
        <outline text="Reproduction adds privacy, consent, trauma-informed care"/>
        <outline text="Time course and function first">
          <outline text="Weight: fat, fluid, muscle, intake, catabolism"/>
          <outline text="Pigmentation, salt craving, stones, ring or shoe size"/>
        </outline>
        <outline text="Weak symptoms gain meaning in coherent clusters"/>
        <outline text="Record every route of medicine and supplement">
          <outline text="Steroids, amiodarone, lithium, opioids, biotin"/>
          <outline text="Can create or conceal endocrine syndromes"/>
        </outline>
      </outline>
      <outline text="General endocrine examination">
        <outline text="Habitus, fat and muscle distribution, voice"/>
        <outline text="Lying and standing pressure when appropriate"/>
        <outline text="Skin: striae, bruises, pigmentation, hirsutism"/>
        <outline text="Proximal weakness: chair rise, arms against resistance"/>
        <outline text="Tremor, reflex relaxation, fields, gait"/>
        <outline text="No single feature proves a diagnosis">
          <outline text="Rounded face, obesity, sparse hair are common"/>
          <outline text="Weigh discriminatory combinations instead"/>
        </outline>
      </outline>
      <outline text="Thyroid and pituitary examination">
        <outline text="Inspect neck at rest and during swallowing"/>
        <outline text="Palpate size, consistency, nodules, nodes">
          <outline text="Bruit only when increased flow suspected"/>
          <outline text="Retrosternal extension compresses despite small neck"/>
        </outline>
        <outline text="Thyroid effects beyond the neck"/>
        <outline text="Graves orbitopathy: acuity, fields, colour, cornea">
          <outline text="Optic neuropathy needs urgent review"/>
        </outline>
        <outline text="Pituitary: confrontation fields, pupils, cranial nerves"/>
        <outline text="Apoplexy: headache with sudden visual change">
          <outline text="Vomiting, hypotension, altered consciousness"/>
        </outline>
        <outline text="Acromegaly: acral, facial, jaw, sleep apnoea"/>
      </outline>
      <outline text="Diabetes and foot assessment">
        <outline text="Glucose patterns, hypoglycaemia, ketosis risk"/>
        <outline text="Foot inspection: callus, deformity, ulcer, footwear"/>
        <outline text="Pulses, temperature, capillary return, ischaemia"/>
        <outline text="Calibrated monofilament for protective sensation"/>
        <outline text="Risk category must lead to action">
          <outline text="Education, footwear, podiatry, vascular review"/>
        </outline>
      </outline>
      <outline text="Reproductive and sexual history">
        <outline text="Neutral language, patient&#x27;s own terms"/>
        <outline text="Do not infer anatomy or risk from identity"/>
        <outline text="Cycle, bleeding, discharge, contraception, safety"/>
        <outline text="Obstetric history: every pregnancy and outcome"/>
        <outline text="Current pregnancy: bleeding, headache, movements"/>
        <outline text="Male history: testes, torsion, androgen use">
          <outline text="Semen varies, repeat abnormal results"/>
        </outline>
      </outline>
      <outline text="Intimate examination">
        <outline text="Indication, explicit consent, privacy, chaperone">
          <outline text="Patient may pause or stop at any time"/>
        </outline>
        <outline text="Speculum visualises vagina, cervix, allows sampling"/>
        <outline text="Bimanual: limited sensitivity for many disorders"/>
        <outline text="Testis: hard intratesticular mass needs urgent ultrasound"/>
        <outline text="Sudden pain with high testis suggests torsion">
          <outline text="Immediate surgical assessment, no low-value tests"/>
        </outline>
      </outline>
      <outline text="Laboratory reasoning">
        <outline text="Define the suspected axis first"/>
        <outline text="Pair target hormone with regulator">
          <outline text="Free thyroxine with thyroid-stimulating hormone"/>
          <outline text="Calcium with parathyroid hormone"/>
          <outline text="Normal regulator may be inappropriate"/>
        </outline>
        <outline text="Confirm unexpected abnormalities">
          <outline text="Timing, fasting, cycle, pregnancy, binding proteins"/>
          <outline text="Biotin, heterophile antibodies, hook effect"/>
          <outline text="Contact laboratory when phenotype conflicts"/>
        </outline>
        <outline text="Dynamic tests assess reserve or suppressibility">
          <outline text="Need pretest probability and validated thresholds"/>
        </outline>
      </outline>
      <outline text="Reproductive and pregnancy investigations">
        <outline text="Pregnancy test detects chorionic gonadotropin">
          <outline text="Never read one number without gestation"/>
          <outline text="Pain, instability, peritonism: ectopic urgency"/>
        </outline>
        <outline text="Amenorrhoea: exclude pregnancy first"/>
        <outline text="Ultrasound shows anatomy, hysteroscopy other questions"/>
        <outline text="Infertility: ovulation, semen, tubes in parallel">
          <outline text="Reserve tests predict stimulation response"/>
        </outline>
        <outline text="Screening estimates risk, diagnosis defines it"/>
      </outline>
      <outline text="Imaging and tissue diagnosis">
        <outline text="Image after biochemical formulation"/>
        <outline text="Ultrasound, resonance, tomography, nuclear roles">
          <outline text="Radiation and nuclear limits in pregnancy"/>
        </outline>
        <outline text="Incidental lesion may be unrelated">
          <outline text="Secretes, compresses, malignant, growing"/>
        </outline>
        <outline text="Pituitary, adrenal: no biopsy without specialist biochemistry"/>
      </outline>
      <outline text="Emergency recognition">
        <outline text="Adrenal crisis, thyroid storm, ketoacidosis"/>
        <outline text="Apoplexy, torsion, ruptured ectopic, haemorrhage"/>
        <outline text="Stabilise and treat before confirmation">
          <outline text="Take critical samples without meaningful delay"/>
        </outline>
      </outline>
    </outline>
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