QuestionSBA
QuestionChoice
Impaired hepatic function isn't listed as a known side effect of hydroxychloroquine. Therefore it doesn't need to be routinely monitored.
50402
d
Liver function tests
QuestionChoice
Hydroxychloroquine can cause a range of haematological disorders such as agranulocytosis, leucopenia and thrombocytopenia. The frequency of these side effects occurring however is unknown, therefore monitoring for them is not recommended.
50400
b
Full blood count
QuestionChoice
Impaired renal function isn't listed as a known side effect of hydroxychloroquine. Therefore it doesn't need to be routinely monitored.
50401
c
Renal function
QuestionChoice
An elevation in cardiac enzymes may suggest some ongoing myocardial ischaemia and can be useful in the general clinical setting on a background of acute chest pain, but is of limited usefulness with respect to starting this drug
50403
e
Troponin
QuestionChoice
Retinopathy is a common side effect of hydroxychloroquine. It is important to ensure that there are no pre-existing issues with the retina prior to starting hydroxychloroquine due to the increased risk of worsening these pre-existing issues. Annual monitoring of the retina is initiated following 5 years of treatment (it can be started earlier if there is an increased risk of retinopathy).
50399
a
Fundus photograph and Optical Coherence Tomography (OCT)
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3663
Taking hydroxychloroquine requires ophthalmological monitoring due to the increased risk of retinal toxicity
Topic
9
Internal Medicine
10134
Case Presentation:  A 34-year-old woman is referred to rheumatology due to ongoing joint pain and facial rashes.  


**PMH** Nil

**DH** NKDA. Ibuprofen 200mg PO QDS

**SH** smokes 10 cigarettes a day (5 pack year history)

**Investigations**

Anti-CCP antibodies: -ve

ANA: +ve

Anti dsDNA antibodies: +ve

Rheumatoid factor: -ve

Based on her symptoms and blood results, she is diagnosed with systemic lupus erythematosus and the decision is made to start hydroxychloroquine sulfate.

Question: Select the most appropriate monitoring option required before initiating hydroxychloroquine sulfate.
a