The following dot products are zero:
$\begin{cases}
\vec{PQ}\cdot\vec{PR}=0 &\quad\text{triangle rect in P}\\
\vec{PM}\cdot\vec{MQ}=\vec{PM}\cdot\vec{MR}=0&\quad(PM)\perp (QR)\text{ and }M\in(QR)\\
\end{cases}$
So we can use vector addition profitably to make these expressions appear:
$\begin{align}PM^2&=\vec{PM}\cdot\vec{PM}\\
&=(\vec{PQ}+\vec{QM})\cdot(\vec{PR}+\vec{RM})\\
&=\underbrace{\vec{PQ}\cdot\vec{PR}}_0+\vec{PQ}\cdot\vec{RM}+\vec{QM}\cdot\vec{PR}+\vec{QM}\cdot\vec{RM}\\
&=(\vec{PM}+\vec{MQ})\cdot\vec{RM}+\vec{QM}\cdot(\vec{PM}+\vec{MR})+\vec{QM}
\cdot\vec{RM}\\
&=\underbrace{\vec{PM}\cdot\vec{RM}}_0+\underbrace{\vec{MQ}\cdot\vec{RM}}_{QM.MR}+\underbrace{\vec{QM}\cdot\vec{PM}}_0+\underbrace{\vec{QM}\cdot\vec{MR}}_{QM.MR}+\underbrace{\vec{QM}\cdot\vec{RM}}_{-QM.MR}\\
&=QM.MR\end{align}$
Note that we used $\ \vec x\cdot\vec y=\lVert x\lVert\times \lVert y\lVert$ when the angle between the two vectors is zero, and opposite when the angle is $180^\circ$.