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: 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: B

Rationale: The correct answer is B: Weight loss. Hypothyroidism is characterized by an underactive thyroid gland, leading to a decreased metabolic rate. This typically results in weight gain, not weight loss. Choices A, C, and D are all associated with hypothyroidism. Loss of libido can occur due to hormonal imbalances, cardiac failure can result from the decreased metabolic rate affecting the heart, and organic psychosis can be a symptom of severe untreated hypothyroidism.

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: A

Rationale: The correct answer is A: Diarrhea. Addison's disease is a condition where the adrenal glands do not produce enough hormones. Diarrhea is not a typical symptom of Addison's disease. The characteristic features include fatigue, weakness, weight loss, dizziness (B), hyperpigmentation, low blood pressure, dehydration (D), and skin changes like dermatitis is common (C). Therefore, diarrhea does not align with the typical symptoms of Addison's disease.