Q Fever Endocarditis Monitoring — SCE Infectious Diseases MCQ

Correct answer: C — Arrange retinal-toxicity monitoring earlier than the routine low-risk schedule using OCT and fundus autofluorescence with review after reassessment

The best answer is “Arrange retinal-toxicity monitoring earlier than the routine low-risk schedule using OCT and fundus autofluorescence with review after reassessment”. Renal impairment increases hydroxychloroquine exposure and retinopathy risk, justifying earlier multimodal monitoring rather than reliance on symptoms or visual acuity. “Use visual-acuity testing alone because structural imaging is unnecessary” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Delay all retinal monitoring until 5 full years of exposure regardless of renal impairment” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Replace retinal monitoring with monthly audiometry” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Stop ophthalmic monitoring once a baseline colour-vision test is normal” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement.

Reference: Royal College of Ophthalmologists hydroxychloroquine monitoring guideline: https://www.rcophth.ac.uk/resources-listing/hydroxychloroquine-and-chloroquine-retinopathy-monitoring-guideline/