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Profiles narrow base FHIR resources for a specific use case. Extensions add fields the base spec doesn't have. Implementation Guides bundle profiles + value sets + examples.
A *profile* is a StructureDefinition that constrains a base FHIR resource: which fields are required, which value sets they bind to, what extensions are allowed.
An *extension* adds a typed field outside the base spec. Identified by URL.
An *Implementation Guide (IG)* is a bundle of profiles + value sets + capability statements + examples for a specific use case (US Core, DaVinci PAS, mCODE, etc.).
Validation: use $validate operation on a profile-supporting server or run HL7 Validator locally.