All of the following are associated with increased levels of total T4 in the plasma with a normal free T4 except:

Correct Answer: A

Rationale: The correct answer is A: Cirrhosis. In cirrhosis, there is a decrease in the binding proteins for T4, leading to decreased total T4 levels in the plasma. Pregnancy, euthyroid sick syndrome, and familial excess thyroid binding globulin are all conditions associated with increased total T4 levels due to various physiological changes. In pregnancy, there is an increase in thyroid hormone production to support fetal development. Euthyroid sick syndrome is a condition where there is a decrease in binding proteins, leading to an increase in free T4 levels but normal total T4 levels. Familial excess thyroid binding globulin causes an increase in total T4 levels due to excessive binding proteins.

Correct Answer: A

Rationale: The correct answer is A: Acute pancreatitis. Hyperparathyroidism is not typically associated with acute pancreatitis. Hyperparathyroidism is characterized by excessive production of parathyroid hormone, leading to increased calcium levels in the blood. Nephrocalcinosis, palpable neck swelling, and pseudogout are commonly seen in hyperparathyroidism due to the effects of elevated calcium levels on the kidneys, parathyroid glands, and joints, respectively. Acute pancreatitis, on the other hand, is more commonly associated with gallstones, alcohol consumption, or certain medications, rather than hyperparathyroidism.

Correct Answer: B

Rationale: The correct answer is B: Dry skin. In hypothyroidism, the thyroid gland does not produce enough thyroid hormone, leading to decreased metabolism. This can result in several symptoms, including dry skin due to reduced sweat gland activity. Hyporeflexia (A) is not a common symptom of hypothyroidism. Oily skin (C) is more commonly associated with hyperthyroidism, where thyroid hormone levels are elevated. Excessive hair growth (D) is not typically seen in hypothyroidism; instead, hair loss is a common symptom.

Correct Answer: C

Rationale: Step-by-step rationale: 1. Tertiary hyperparathyroidism occurs due to prolonged secondary hyperparathyroidism in response to chronic renal failure. 2. In chronic renal failure, impaired kidney function leads to reduced activation of vitamin D and impaired calcium regulation. 3. Persistent hypocalcemia triggers the parathyroid glands to overproduce parathyroid hormone, leading to tertiary hyperparathyroidism. 4. Rickets (choice A) is associated with vitamin D deficiency, pseudohypoparathyroidism (choice B) is a genetic disorder, and malabsorption syndrome (choice D) affects nutrient absorption, but they are not commonly linked to tertiary hyperparathyroidism.

Correct Answer: B

Rationale: The correct answer is B: Chronic pancreatitis. Hypoglycemia is not typically associated with chronic pancreatitis as it is more related to pancreatic insufficiency and impaired glucose regulation. A: Glycogen storage disease can lead to hypoglycemia due to the inability to properly release stored glucose. C: Galactosaemia can cause hypoglycemia due to the impaired breakdown of galactose into glucose. D: Post-gastrectomy can lead to hypoglycemia due to rapid glucose absorption and altered hormonal responses.

Correct Answer: C

Rationale: The correct answer is C: Myxoedema. Myxoedema is associated with hypothyroidism, not SIADH. Guillain-Barre syndrome, subacute bacterial endocarditis, and bronchogenic carcinoma are all conditions that can lead to SIADH due to various mechanisms. Guillain-Barre syndrome can cause SIADH through autonomic dysfunction, endocarditis through the release of inflammatory cytokines, and bronchogenic carcinoma through production of ectopic ADH. Therefore, myxoedema is the only incorrect choice as it does not typically lead to SIADH.

Correct Answer: A

Rationale: Aldosterone increases potassium excretion by promoting the reabsorption of sodium and water in the kidneys, leading to potassium excretion. This helps maintain electrolyte balance. Other choices are incorrect because aldosterone does not directly increase water loss, is released in response to low blood volume, and is deficient in Addison's disease.

Correct Answer: C

Rationale: The correct answer is C: Glucose-6-phosphatase deficiency. This enzyme is essential for gluconeogenesis and glycogenolysis, so its deficiency leads to fasting hypoglycemia. Galactosaemia (A) can cause hypoglycemia due to impaired galactose metabolism. Insulinoma (B) results in excess insulin production causing hypoglycemia. Systemic carnitine deficiency (D) can lead to hypoglycemia by impairing fatty acid oxidation, but it does not directly cause fasting hypoglycemia as seen in Glucose-6-phosphatase deficiency.

Correct Answer: A

Rationale: The correct answer is A: Adrenaline. In injury to the adrenal cortex, adrenaline is least affected because it is primarily synthesized and secreted by the adrenal medulla, not the adrenal cortex. Cortisol, aldosterone, and androstenedione are hormones produced by the adrenal cortex. In adrenal cortex injury, the secretion of cortisol, aldosterone, and androstenedione would be significantly affected due to the damage to the adrenal cortex, leading to hormonal imbalance and related symptoms. Therefore, option A is the correct answer as it is not primarily secreted by the adrenal cortex and would be least affected in this scenario.