EMQs in Clinical Medicine.pdf - Peshawar Medical College

136 Orthopaedics and rheumatology
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A patient complains of grossly swollen gums.
Monitoring kidney function is important as a result of the adverse effects
of nephrotoxicity and hyperkalaemia. Note that a dose-dependent
increase in serum urea and creatinine is seen during the first few weeks
of treatment.
Gum hypertrophy is also a recognized adverse effect of phenytoin and
calcium channel blockers.
A patient taking an intramuscular DMARD presents with an itchy erythematous
rash covering the whole body.
Exfoliative dermatitis is a medical emergency. Such a widespread inflammation
of the skin can have severe complications, including hypothermia,
fluid loss, hypoalbuminaemia and ‘capillary leak syndrome’
(inflammatory cytokine cascade mediates vascular leakage and oedema
in major organs). Sulphonamides can also give rise to this presentation
in some individuals.
A 65-year-old woman patient presents with gross irreversible
retinopathy.
Retinopathy associated with hydroxychloroquine is irreversible and so
regular ophthalmological monitoring is required.