MRCP2-1501

MRCP2-1501

A 25-year-old man with a history of Von Hippel Lindau syndrome presents to his GP for a routine mood review. He has previously been well but has retinal haemangiomas. He is currently taking venlafaxine for improved mood following a recent relationship break down. Despite using mindfulness to control panic attacks, he still experiences palpitations and clamminess.

During the examination, the patient appears alert and in good health. However, his blood pressure is measured at 170/110 mmHg. Fundoscopy reveals no haemorrhages or cotton wool spots, and his visual acuity is 6/6 bilaterally. There are no palpable masses in his abdomen.

The patient’s blood test results show normal levels of Na+, K+, HCO3, urea, and creatinine, but his TSH level is 3.2 mU/l (range 0-4). An ECG reveals large QRS complexes consistent with left ventricular hypertrophy.

What is the most likely explanation for the patient’s symptoms?