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 1: Toxic thyroid adenoma is characterized by a benign tumor in the thyroid gland. Step 2: This tumor produces excessive amounts of thyroid hormones, particularly T3 and T4. Step 3: The tumor arises from the follicular cells of the thyroid gland. Step 4: Choice D accurately describes a toxic thyroid adenoma as a benign tumor producing excessive thyroid hormones from follicular cells. Summary: Choice A is incorrect because it describes autoimmune thyroid disease, not a toxic adenoma. Choice B is incorrect as it describes a malignant tumor, not a benign one. Choice C is incorrect as it describes thyroiditis, not a toxic adenoma.

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: B

Rationale: Correct Answer: B (Rheumatic carditis) Rationale: 1. Rheumatic carditis is a heart condition, which may lead to a decreased cardiac output and subsequently a lower pulse rate during sleep. 2. Anxiety neurosis can lead to increased sympathetic activity, causing an elevated pulse rate during sleep. 3. Pulmonary tuberculosis can cause systemic inflammation and increased metabolic demand, resulting in an elevated pulse rate during sleep. 4. Atropine, a parasympatholytic drug, inhibits the action of the parasympathetic nervous system, leading to an increased pulse rate.

Correct Answer: D

Rationale: The correct answer is D: Thyroxine-binding globulin (TBG). TBG is the primary source of bound T4 in the plasma as it specifically binds to and transports thyroid hormones. This protein has the highest affinity for T4 compared to other plasma proteins. Albumin (A) and gamma globulins (B) can also bind to thyroid hormones, but TBG is the primary carrier. Thyroid peroxidase (C) is an enzyme involved in thyroid hormone production, not in binding T4 in the plasma.