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: Elevated glucose levels in obese individuals are often due to insulin resistance. Insulin resistance occurs when the body's cells do not respond effectively to insulin, leading to decreased glucose uptake. This results in elevated blood glucose levels. Diabetic acidosis (choice A) is a complication of uncontrolled diabetes characterized by high blood ketone levels, not directly related to obesity. Glucose intolerance (choice B) refers to the body's inability to regulate blood glucose levels efficiently but is not specific to obesity. Insulin deficiency (choice D) is characteristic of type 1 diabetes, where the body does not produce enough insulin, which is distinct from insulin resistance seen in obesity.

Correct Answer: C

Rationale: Leydig cells are found in the testes and are responsible for producing testosterone, a crucial male sex hormone. This hormone is essential for the development of male reproductive organs, secondary sexual characteristics, and sperm production. Oestrogen is primarily produced by the ovaries in females. Androgen binding globulin is a protein that binds to testosterone in the bloodstream but is not produced by Leydig cells. Semen is produced by the accessory glands in the male reproductive system, not by Leydig cells. Therefore, the correct answer is C: Testosterone.

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: 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: 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: D

Rationale: The correct answer is D because synthesis of thyroid hormones (T3 and T4) occurs by the coupling of iodinated tyrosine residues on thyroglobulin within thyroid follicles. Thyroglobulin acts as a precursor for thyroid hormone synthesis. Choices A, B, and C are incorrect because thyroid hormone synthesis does not occur in parafollicular cells, extracellularly in plasma, or require cholesterol for the coupling of iodinated tyrosine residues on thyroglobulin.

Correct Answer: C

Rationale: The correct answer is C: Bi-temporal hemianopia. Pituitary adenoma compressing the optic chiasm typically leads to bi-temporal hemianopia due to compression of the crossing fibers from the nasal visual fields. This results in loss of peripheral vision in both temporal visual fields. A: Bilateral inferior visual field deficits and B: Bilateral superior visual field deficits are less likely as they are not typical patterns associated with optic chiasm compression. D: Right homonymous hemianopia is incorrect as it is not associated with compression of the optic chiasm by a pituitary adenoma.

Correct Answer: C

Rationale: Rationale: 1. GnRH directly binds to pituitary receptors. 2. GnRH specifically targets gonadotroph cells to release LH and FSH. 3. CRH and ACTH are related to stress and adrenal function, not reproductive hormones. 4. Tremor is unrelated to pituitary hormone regulation. Summary: Gonadotrophin releasing hormone (GnRH) is the correct answer as it directly stimulates the release of LH and FSH from the pituitary gland. Other choices are incorrect as they are not involved in the regulation of reproductive hormones.