Sleeping pulse rate is not increased in:

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: Fine hairs. In secondary hypothyroidism, the pituitary gland fails to produce enough thyroid-stimulating hormone (TSH), resulting in low thyroid hormone levels. Fine hairs (or hair thinning) is a symptom of hyperthyroidism, not hypothyroidism. Normal cholesterol levels (Choice A) are seen in secondary hypothyroidism due to decreased metabolic rate. Menorrhagia (Choice B) can occur due to hormonal imbalances caused by untreated hypothyroidism. Low TSH levels (Choice C) are a characteristic feature of secondary hypothyroidism as the pituitary gland is not producing enough TSH to stimulate the thyroid gland.

Correct Answer: B

Rationale: Thyroid acropathy, also known as thyroid dermopathy, is a skin condition commonly associated with Graves' disease. This autoimmune disorder causes an overactive thyroid gland, leading to high levels of thyroid hormones in the blood. The excess thyroid hormones can trigger changes in the skin, resulting in thyroid acropathy. Subclinical hypothyroidism (choice A) is characterized by slightly elevated TSH levels with normal thyroid hormone levels, not typically associated with thyroid acropathy. Myxoedema (choice C) refers to severe hypothyroidism and is not linked to thyroid acropathy. Medullary carcinoma of the thyroid (choice D) is a type of thyroid cancer and is not known to cause thyroid acropathy. Therefore, the correct answer is B, Graves' disease, as it is the most common condition associated with thyroid acropathy.

Correct Answer: A

Rationale: The correct answer is A because Klinefelter's syndrome is characterized by small, soft testes due to the presence of an extra X chromosome (47, XXY). This leads to hypogonadism and inadequate testosterone production, resulting in underdeveloped testes. Choice B (46, XO) is incorrect as it refers to Turner syndrome. Choice C (upper segment> lower segment) is unrelated to Klinefelter's syndrome. Choice D (Gynaecomastia) is a symptom of Klinefelter's syndrome but not the defining characteristic.

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.