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<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic<|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l- Physiological: growing infants, puberty 2- Cirrhosis of liver 3- Klinefelter's syndrome 4- Testicular cancer 5- Chronic renal failure 6- Hyperthyroidism 7- Drugs: spironolactone, CCB, ketoconazole<|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome<|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger and toes, Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia<|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. This condition is due to IgG antibodies binding to the TSH receptor B. This condition associated with multinodular goiter C. This condition associated with pernicious anemia and high T3, T4 D. This condition in long tern can lead to osteoporosis E. This condition can be t•eated with radioactive iodine<|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy<|im_end|>