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: C

Rationale: Step-by-step rationale: 1. Anorexia nervosa can affect both males and females. 2. Therefore, it is not exclusively in females. 3. Hypokalaemia, primary amenorrhea, and low FSH and LH are commonly associated with anorexia nervosa. 4. Choice C is incorrect as anorexia nervosa can affect individuals of any gender.

Correct Answer: B

Rationale: Excess prolactin causes gynaecomastia due to its stimulatory effect on breast tissue growth in males. Prolactin inhibits the release of testosterone, leading to an imbalance in sex hormones and breast tissue development. Acromegaly is caused by excess growth hormone, not prolactin. Early menopause is unrelated to prolactin levels. Anaemia is typically not associated with prolactin excess. Thus, gynaecomastia is the most appropriate outcome of excess prolactin.

Correct Answer: C

Rationale: Rationale for choice C (FSH) being correct: 1. FSH stimulates Sertoli cells in the testes. 2. Sertoli cells produce androgen binding globulin (ABG). 3. ABG binds to testosterone, regulating its availability. 4. FSH indirectly influences testosterone levels via ABG production. Summary of incorrect choices: A. LH stimulates Leydig cells to produce testosterone, not Sertoli cells. B. GnRH regulates the release of FSH and LH but does not directly stimulate ABG production. D. Oxytocin is not involved in the regulation of Sertoli cells or ABG production in males.

Correct Answer: D

Rationale: Step-by-step rationale: 1. Gynaecomastia is a known side effect of spironolactone, digitalis, and cimetidine. 2. Rifampicin is not associated with gynaecomastia. 3. Rifampicin is an antibiotic used to treat tuberculosis and other infections. 4. The mechanism of action of rifampicin does not involve hormonal changes that could lead to gynaecomastia. Summary of incorrect choices: - A: Spironolactone is a potassium-sparing diuretic that can cause gynaecomastia. - B: Digitalis (digoxin) can lead to gynaecomastia as a side effect. - C: Cimetidine, an H2 receptor antagonist, is also known to cause gynaecomastia.

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.

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: C

Rationale: The correct answer is C: Oxytocin. The anterior pituitary gland produces several hormones, including adrenocorticotropic hormone (A), growth hormone (B), and thyroid-stimulating hormone (D). Oxytocin is actually produced by the posterior pituitary gland, not the anterior pituitary. Oxytocin is responsible for uterine contractions during childbirth and milk ejection during breastfeeding. Therefore, C is the correct answer as it is not produced by the anterior pituitary unlike the other hormones mentioned.

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.