A fictional 63-year-old on combination checkpoint inhibitors presents with increasing diarrhoea, abdominal pain and reduced oral intake.
Listen for the assumption.
This is probably treatment-related, so I will prescribe symptomatic treatment and send the patient home.
What must be assessed before calling it uncomplicated toxicity?
Severity, hydration, abdominal signs, infection and other causes. I will contact oncology and use the immune-toxicity pathway with gastroenterology input when needed.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Increasing stool frequency over baseline
- Abdominal pain and reduced intake
- Recent combination immune-checkpoint therapy
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Ask about blood, fever, severe pain and fluid intake; assess for complications and arrange tests under the toxicity pathway.
Treatment interruption and immunosuppression are grade-specific decisions. Do not publish a universal steroid or biologic regimen.
I will hand over therapy type, symptom trajectory, infection work-up, hydration and oncology advice.
What must remain explicit.
- Follow the current oncology immune-toxicity protocol.
- Escalate severe pain, bleeding, fever, dehydration or systemic instability.
- Avoid unqualified antidiarrhoeal or immunosuppressive advice.
Where reasoning fails.
- Assuming a benign adverse effect
- Missing infection
- Ignoring hydration or abdominal examination
Possible ICI colitis: agent/regimen [details], stool/pain [trajectory], hydration [status], infection work-up [status] and oncology plan [name].
Which feature would stop you from managing this as routine diarrhoea?