American Board of Internal Medicine (ABIM) Certification Practice Exam

What should patients with acute ipilimumab toxicity receive?

1. Pain management and hydration

2. Fluid replacement and glucocorticoid therapy

3. Intravenous antibiotics and transfusions

4. Observation and reassurance

The correct answer is: Fluid replacement and glucocorticoid therapy

Patients experiencing acute ipilimumab toxicity should receive fluid replacement and glucocorticoid therapy due to the immune-related adverse effects that can occur with this treatment. Ipilimumab, a CTLA-4 inhibitor used in cancer immunotherapy, can lead to a range of immune-mediated toxicities, which may include colitis, endocrinopathies, and dermatitis, among others. Glucocorticoids are the cornerstone of treatment for these immune-related adverse effects because they help to suppress the exaggerated immune response that ipilimumab promotes. In cases of significant toxicity, such as colitis, high-dose glucocorticoids are often required to reduce inflammation and manage symptoms effectively. Additionally, fluid replacement is essential, especially if the patient experiences dehydration caused by diarrhea or other related issues. Other approaches, such as pain management and hydration, while important in supportive care, do not directly address the underlying immune-mediated toxicity that requires intervention. Likewise, intravenous antibiotics and transfusions are generally not indicated unless there is a secondary infection or other specific complications arising from the toxicity. Observation and reassurance, while important for patient management in certain contexts, will not suffice in addressing the more severe manifestations of ipilimumab toxicity that require active treatment