Before starting a patient on hydroxychloroquine, which baseline assessment is essential?

• A. Serum electrolytes
• B. Complete metabolic profile
• C. Eye exam
• D. Chest X-ray

Answer: (C)

Before initiating treatment with hydroxychloroquine, it is crucial to conduct a baseline eye examination. Hydroxychloroquine is often used in the management of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus, but it has potential ocular side effects, particularly retinal toxicity over prolonged use. This toxicity can lead to irreversible vision loss if not monitored carefully.

The baseline eye exam helps to ensure that the patient does not have any pre-existing retinal conditions or risk factors that could be exacerbated by hydroxychloroquine. Regular eye exams are also recommended throughout the duration of treatment to detect any early signs of toxicity. This practice is essential, especially considering that some of the side effects may not present until the patient has been on the medication for a significant period.

While other assessments, such as monitoring serum electrolytes or conducting a metabolic profile, are important in managing the patient's overall health, they are not as specific to the concerns associated with hydroxychloroquine. A chest X-ray can be used for various conditions but is not routinely required before starting hydroxychloroquine. Thus, the baseline eye exam stands out as the essential assessment prior to the initiation of this medication.