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NO.1 A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the
adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost
weight recently. His eyes had been photographed by a community ophthalmologist 1 week
previously. A photograph of the right fundus is shown (see image).
Investigations:
haemoglobin A1c104 mmol/mol (20-42)
What is the most likely explanation for the retinal appearance?
A. retinitis pigmentosa
B. drusen
C. macular oedema
D. preproliferative diabetic retinopathy
E. benign choroidal naevus
Answer: E

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NO.2 A 61-year-old woman was referred to the blood pressure clinic because of refractory
hypertension. One year previously, her blood pressure, urea and electrolytes had been normal. Her
current therapy included verapamil modified-release 240 mg daily and doxazosin 16 mg daily.
On examination, she was 1.63 m tall and weighed 90 kg with an elevated waist to hip ratio. Her blood
pressure was 182/94 mmHg supine.
Investigations:
serum sodium137 mmol/L (137-144)
serum potassium2.8 mmol/L (3.5-4.9)
serum creatinine79 umol/L (60-110)
plasma renin activity (after 30 min supine)<1.1 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)<135 pmol/L (135-400)
What is the most appropriate investigation?
A. 24-h urine to assess free cortisol:cortisone ratio
B. repeat renin and aldosterone concentrations after stopping verapamil for 2 weeks
C. overnight dexamethasone suppression test
D. analysis of the SCNN1B and SCNN1G genes
E. 24-h urinary electrolytes
Answer: C

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