Correct Answer: D

Rationale: Acromegaly is typically caused by the overproduction of growth hormone (GH) by the pituitary gland. In around 95% of cases, this overproduction is due to the presence of a non-cancerous tumor called a pituitary adenoma. These adenomas are benign, slow-growing tumors that cause the pituitary gland to produce excessive amounts of growth hormone, leading to the characteristic symptoms of acromegaly such as enlargement of the bones and soft tissues.

Correct Answer: A

Rationale: Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia in newborns. This condition is due to a deficiency of enzymes in the adrenal gland that are necessary for the production of cortisol. As a result, the body produces excess androgens (masculinizing hormones), leading to abnormal genital development in females. The external genitalia may appear ambiguous, with features of both male and female genitalia. This condition can be detected through newborn screening and confirmed through further hormonal and genetic testing. Treatment involves hormone replacement therapy to normalize hormone levels and surgery may be required to reconstruct the genitalia.

Correct Answer: D

Rationale: Blood calcium levels are primarily regulated by the actions of parathyroid hormone (PTH) and Vitamin D. Vitamin D plays a crucial role in maintaining calcium balance in the body by promoting the absorption of calcium from the intestines. When blood calcium levels are low, Vitamin D works to increase absorption of calcium to raise the levels back to normal. Therefore, elevated blood calcium levels are commonly associated with excess Vitamin D intake or conditions that increase Vitamin D levels, such as hypervitaminosis D.

Correct Answer: D

Rationale: Persistent muscular weakness is characteristic of myxoedema, which is severe hypothyroidism. Myxoedema can lead to general weakness and fatigue, as thyroid hormones play a crucial role in controlling metabolism and energy production in the body. Other symptoms of myxoedema include cold intolerance, weight gain, dry skin, and hair loss. Conn's syndrome (hyperaldosteronism) is characterized by hypertension and low potassium levels, not persistent muscular weakness. Acromegaly is a condition resulting from excess growth hormone production, leading to enlarged body parts and metabolic changes but not specifically muscular weakness. Hyperparathyroidism is associated with high levels of parathyroid hormone, which can lead to bone weakening and calcium imbalance, but it is not typically a primary cause of muscular weakness.

Correct Answer: B

Rationale: The earliest changes observed by ophthalmoscope in background retinopathy of diabetes is typically the presence of microaneurysms. These are small dilations of retinal capillaries due to weakening of the vessel walls caused by diabetes-induced damage. Microaneurysms are a hallmark sign of diabetic retinopathy and are often the first visible sign on retinal examination. Other changes in diabetic retinopathy, such as venous dilatation, increased capillary permeability, and arteriovenous shunts, may develop later in the disease process as it progresses.