{"metadata":{"generator":"Captivate","generatorVersion":"10.0.1","schemaVersion":"","author":"eviQ Education","title":"eQuiz - Clinical management","description":"project description","email":"eviqed@eviq.org.au","website":"https://education.eviq.org.au/","tags":"","thumbnail":"","source":"assets","durationInFrames":1284,"frameRate":30,"totalSlides":15,"width":1280,"height":800,"responsive":false,"scalable":false,"launchFile":"index_scorm.html"},"contentStructure":[{"id":"si16725","class":"TODO::Senthil","roles":{}},{"id":"si15398","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7002","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7013","class":"TODO::Senthil","title":"Clinical management  ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7039","class":"TODO::Senthil","title":"Version 1|March 2018 ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7024","class":"TODO::Senthil","roles":{}},{"id":"si7026","class":"TODO::Senthil","roles":{}},{"id":"SS_start_btn_1","class":"TODO::Senthil","instance":"SS_start_btn_1","title":"eQuiz ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7104","class":"TODO::Senthil","title":"eQuiz ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7123","class":"TODO::Senthil","title":"eQuiz ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Slide4531","class":"Normal Slide","instance":"","thumbnail":"","children":["si16725","si15398","si7002","si7013","si7039","si7024","si7026","SS_start_btn_1","si7104","si7123"],"roles":{"slide":{"durationInFrames":147},"navigation":{"navid":"Slide4531"}}},{"id":"si16733","class":"TODO::Senthil","roles":{}},{"id":"si7578","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7593","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7602","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7613","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7622","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si7642","class":"TODO::Senthil","roles":{}},{"id":"si7644","class":"TODO::Senthil","roles":{}},{"id":"SmartShape_2","class":"TODO::Senthil","instance":"SmartShape_2","title":"Before attempting this eQuiz, it is strongly recommended you review the associated eLearning guide.  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Advise the patient of present to the department immediately and advise the treating oncologist.\r","index":"Not implemented","score":{"weight":10}}}},{"id":"si17561","class":"TODO::Senthil","instance":"Button_43","title":" ","roles":{"click":{"subtype":"reviewModeBack","question":"Slide17695q3","for":"Slide17695q3"},"textData":{}}},{"id":"si17573","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"reviewModeBack","question":"Slide17695q3","for":"Slide17695q3"},"textData":{}}},{"id":"si17585","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"reviewModeBack","question":"Slide17695q3","for":"Slide17695q3"},"textData":{}}},{"id":"si17615","class":"TODO::Senthil","instance":"Button_44","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide17695q3","for":"Slide17695q3"},"textData":{}}},{"id":"si17627","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide17695q3","for":"Slide17695q3"},"textData":{}}},{"id":"si17639","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide17695q3","for":"Slide17695q3"},"textData":{}}},{"id":"si17439","class":"TODO::Senthil","instance":"SmartShape_61","title":"Well done!  The patient has reported symptoms consistent with grade 2 gastrointestinal toxicity associated with the use of an immune checkpoint inhibitor. Assessment is required to confirm the toxicity and initiate treatment if required to ensure the toxicity does not escalate.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide17695q3"},"textData":{}}},{"id":"si17458","class":"TODO::Senthil","instance":"SmartShape_62","title":"Not quite.   The patient has reported symptoms consistent with grade 2 gastrointestinal toxicity associated with the use of an immune checkpoint inhibitor. Assessment is required to confirm the toxicity and initiate treatment if required to ensure the toxicity does not escalate.   Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide17695q3"},"textData":{}}},{"id":"si17477","class":"TODO::Senthil","instance":"SmartShape_63","title":"You must answer the question before continuing. ","roles":{"click":{"subtype":"button","question":"Slide17695q3"},"textData":{}}},{"id":"Slide17695","class":"Question Slide","instance":"","thumbnail":"","children":["si17696","si17738","SmartShape_59","SmartShape_60","si17365","si17380","si17391","si17402","si17561","si17573","si17585","si17615","si17627","si17639","si17477"],"roles":{"slide":{"durationInFrames":90},"navigation":{"navid":"Slide17695"},"question":{"interactionId":"17302","quizId":377,"title":"Multiple Choice","text":"You ask the patient follow-up questions to determine the severity of the symptoms and determine appropriate action. \r\rThe patient tells you that the diarrhoea has worsened today and this morning they have already experienced 4 episodes of diarrhoea. The patient has taken anti-diarrhoeals to no resolve. The patients has not noticed any blood in their stools. The patient also mentions that their husband has been unwell with food poisoning and would like to know if this could be the cause.\r\rHow do you respond?\r","ikc":false,"type":"graded","interactionType":"choice","ramdomized":true,"correctAnswers":["3"],"score":{"weight":10,"penalty":0}}}},{"id":"si16753","class":"TODO::Senthil","roles":{}},{"id":"si15532","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"textData":{}}},{"id":"SmartShape_12","class":"TODO::Senthil","instance":"SmartShape_12","title":"Clinical management ","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"textData":{}}},{"id":"si10810","class":"TODO::Senthil","instance":"Text_Caption_28","roles":{}},{"id":"si10692","class":"TODO::Senthil","instance":"Text_Caption_19","title":"Which if the following symptoms may indicate an endocrine immune related adverse event? (select all that apply) ","roles":{"textData":{}}},{"id":"si10703","class":"TODO::Senthil","instance":"Text_Caption_20","title":" ","roles":{"textData":{}}},{"id":"si10707","class":"TODO::Senthil","instance":"Text_Caption_21","title":"Unexplained weight loss, increased heart rate, increased sensitivity to heat. ","roles":{"textData":{}}},{"id":"si10707","class":"TODO::Senthil","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"answer":{"title":"dummy title","index":-1,"score":{}}}},{"id":"si10703_a","class":"TODO::Senthil","roles":{"answer":{"title":"Unexplained weight loss, increased heart rate, increased sensitivity to heat.\r","index":"Not implemented","score":{"weight":10}}}},{"id":"si10714","class":"TODO::Senthil","instance":"Text_Caption_22","title":" ","roles":{"textData":{}}},{"id":"si10718","class":"TODO::Senthil","instance":"Text_Caption_23","title":"Fatigue, increased sensitivity to cold, decreased heart rate, unexplained weight gain. ","roles":{"textData":{}}},{"id":"si10718","class":"TODO::Senthil","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"answer":{"title":"dummy title","index":-1,"score":{}}}},{"id":"si10714_a","class":"TODO::Senthil","roles":{"answer":{"title":"Fatigue, increased sensitivity to cold, decreased heart rate, unexplained weight gain.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si10725","class":"TODO::Senthil","instance":"Text_Caption_24","title":" ","roles":{"textData":{}}},{"id":"si10729","class":"TODO::Senthil","instance":"Text_Caption_25","title":"Vision changes, head ache, excessive thirst, increased urine output. ","roles":{"textData":{}}},{"id":"si10729","class":"TODO::Senthil","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"answer":{"title":"dummy title","index":-1,"score":{}}}},{"id":"si10725_a","class":"TODO::Senthil","roles":{"answer":{"title":"Vision changes, head ache, excessive thirst, increased urine output.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si10736","class":"TODO::Senthil","instance":"Text_Caption_26","title":" ","roles":{"textData":{}}},{"id":"si10740","class":"TODO::Senthil","instance":"Text_Caption_27","title":"Diarrhoea, vomiting, muscle and joint pain. ","roles":{"textData":{}}},{"id":"si10740","class":"TODO::Senthil","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"answer":{"title":"dummy title","index":-1,"score":{}}}},{"id":"si10736_a","class":"TODO::Senthil","roles":{"answer":{"title":"Diarrhoea, vomiting, muscle and joint pain.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si10936","class":"TODO::Senthil","instance":"Button_6","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide11016q4","for":"Slide11016q4"},"textData":{}}},{"id":"si10948","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide11016q4","for":"Slide11016q4"},"textData":{}}},{"id":"si10960","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide11016q4","for":"Slide11016q4"},"textData":{}}},{"id":"si10766","class":"TODO::Senthil","instance":"SmartShape_6","title":"Well done!  All of the above may be symptoms of endocrine toxicity as the result of immune checkpoint inhibitor treatment. Endocrine toxicities include hypothyroidism, hyperthyroidism, hypophysitis, adrenal insufficiency and diabetes mellitus.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"textData":{}}},{"id":"si10785","class":"TODO::Senthil","instance":"SmartShape_7","title":"Not quite.   All of the above may be symptoms of endocrine toxicity as the result of immune checkpoint inhibitor treatment. Endocrine toxicities include hypothyroidism, hyperthyroidism, hypophysitis, adrenal insufficiency and diabetes mellitus.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"textData":{}}},{"id":"si10804","class":"TODO::Senthil","instance":"SmartShape_13","title":"You must answer the question before continuing. ","roles":{"click":{"subtype":"button","question":"Slide11016q4"},"textData":{}}},{"id":"Slide11016","class":"Question Slide","instance":"","thumbnail":"","children":["si16753","si15532","SmartShape_12","si10692","si10707","si10718","si10729","si10740","si10936","si10948","si10960","si10804"],"roles":{"slide":{"durationInFrames":90},"navigation":{"navid":"Slide11016"},"question":{"interactionId":"10642","quizId":377,"title":"Multiple Choice","text":"Which if the following symptoms may indicate an endocrine immune related adverse event?\r(select all that apply)\r","ikc":false,"type":"graded","interactionType":"choice","ramdomized":true,"correctAnswers":["1","2","3","4"],"score":{"weight":10,"penalty":0}}}},{"id":"si16765","class":"TODO::Senthil","roles":{}},{"id":"si16104","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button","question":"Slide16061q5"},"textData":{}}},{"id":"SmartShape_45","class":"TODO::Senthil","instance":"SmartShape_45","title":"Clinical management ","roles":{"click":{"subtype":"button","question":"Slide16061q5"},"textData":{}}},{"id":"SmartShape_69","class":"TODO::Senthil","instance":"SmartShape_69","title":"You may wish to refer to the eviQ Pembrolizumab metastatic melanoma treatment protocol and the eviQ hypersensitivity reaction resource to assist you in answering this question. ","roles":{"click":{"subtype":"button","question":"Slide16061q5"},"textData":{}}},{"id":"si15855","class":"TODO::Senthil","instance":"Text_Caption_133","roles":{}},{"id":"si15737","class":"TODO::Senthil","instance":"Text_Caption_124","title":"You are administering the first infusion of pembrolizumab to a patient for treatment of metastatic melanoma. Twenty minutes into the infusion you check on the patient and notice that they have some reddening up their right arm. Upon questioning the patient states that their skin is itching and upon closer inspection appears raised in some areas. The patient’s pulse, blood pressure, temperature, and oxygen saturation are normal. The patient complains of no other symptoms. What should you do? ","roles":{"textData":{}}},{"id":"si15748","class":"TODO::Senthil","instance":"Text_Caption_125","title":" ","roles":{"textData":{}}},{"id":"si15752","class":"TODO::Senthil","instance":"Text_Caption_126","title":"Continue with the infusion at the current infusion rate and treat the rash with topical ointment. ","roles":{"textData":{}}},{"id":"si15748_a","class":"TODO::Senthil","roles":{"answer":{"title":"Continue with the infusion at the current infusion rate and treat the rash with topical ointment.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si15759","class":"TODO::Senthil","instance":"Text_Caption_127","title":" ","roles":{"textData":{}}},{"id":"si15763","class":"TODO::Senthil","instance":"Text_Caption_128","title":"Stop the infusion and do not consider a rechallenge. ","roles":{"textData":{}}},{"id":"si15759_a","class":"TODO::Senthil","roles":{"answer":{"title":"Stop the infusion and do not consider a rechallenge.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si15770","class":"TODO::Senthil","instance":"Text_Caption_129","title":" ","roles":{"textData":{}}},{"id":"si15774","class":"TODO::Senthil","instance":"Text_Caption_130","title":"Call a medical emergency. ","roles":{"textData":{}}},{"id":"si15770_a","class":"TODO::Senthil","roles":{"answer":{"title":"Call a medical emergency.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si15781","class":"TODO::Senthil","instance":"Text_Caption_131","title":" ","roles":{"textData":{}}},{"id":"si15785","class":"TODO::Senthil","instance":"Text_Caption_132","title":"Decrease the infusion rate and monitor the patient closely. Consider premedication with antihistamines for future doses. ","roles":{"textData":{}}},{"id":"si15781_a","class":"TODO::Senthil","roles":{"answer":{"title":"Decrease the infusion rate and monitor the patient closely. Consider premedication with antihistamines for future doses.\r","index":"Not implemented","score":{"weight":10}}}},{"id":"si15981","class":"TODO::Senthil","instance":"Button_32","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide16061q5","for":"Slide16061q5"},"textData":{}}},{"id":"si15993","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide16061q5","for":"Slide16061q5"},"textData":{}}},{"id":"si16005","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide16061q5","for":"Slide16061q5"},"textData":{}}},{"id":"si15811","class":"TODO::Senthil","instance":"SmartShape_46","title":"Well done!  The patient’s symptoms are consistent with a mild or moderate infusion related reaction. The patient is not displaying signs of an anaphylactic reaction. If a severe reaction is suspected stop the infusion and notify a medical officer.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide16061q5"},"textData":{}}},{"id":"si15830","class":"TODO::Senthil","instance":"SmartShape_47","title":"Not quite.   The patient’s symptoms are consistent with a mild or moderate infusion related reaction. The patient is not displaying signs of an anaphylactic reaction. Decreasing the rate of the infusion and close monitoring is advised.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide16061q5"},"textData":{}}},{"id":"si15849","class":"TODO::Senthil","instance":"SmartShape_48","title":"You must answer the question before continuing. ","roles":{"click":{"subtype":"button","question":"Slide16061q5"},"textData":{}}},{"id":"Slide16061","class":"Question Slide","instance":"","thumbnail":"","children":["si16765","si16104","SmartShape_45","SmartShape_69","si15737","si15752","si15763","si15774","si15785","si15981","si15993","si16005","si15849"],"roles":{"slide":{"durationInFrames":90},"navigation":{"navid":"Slide16061"},"question":{"interactionId":"15687","quizId":377,"title":"Multiple Choice","text":"You are administering the first infusion of pembrolizumab to a patient for treatment of metastatic melanoma. Twenty minutes into the infusion you check on the patient and notice that they have some reddening up their right arm. Upon questioning the patient states that their skin is itching and upon closer inspection appears raised in some areas. The patient’s pulse, blood pressure, temperature, and oxygen saturation are normal. The patient complains of no other symptoms. What should you do?\r","ikc":false,"type":"graded","interactionType":"choice","ramdomized":false,"correctAnswers":["4"],"score":{"weight":10,"penalty":0}}}},{"id":"si16757","class":"TODO::Senthil","roles":{}},{"id":"si15550","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button","question":"Slide12297q6"},"textData":{}}},{"id":"SmartShape_19","class":"TODO::Senthil","instance":"SmartShape_19","title":"Clinical management ","roles":{"click":{"subtype":"button","question":"Slide12297q6"},"textData":{}}},{"id":"si12091","class":"TODO::Senthil","instance":"Text_Caption_64","roles":{}},{"id":"si11973","class":"TODO::Senthil","instance":"Text_Caption_55","title":"You are performing the baseline assessment of a patient who is prescribed to receive their first cycle of induction combined ipilimumab and nivolumab therapy for the treatment of metastatic melanoma. The patient mentions that they suffer from rheumatoid arthritis and are currently managing this with non-steroidal anti-inflammatories. The patient also takes prednisolone during acute flare ups. What action should you take? ","roles":{"textData":{}}},{"id":"si11984","class":"TODO::Senthil","instance":"Text_Caption_56","title":" ","roles":{"textData":{}}},{"id":"si11988","class":"TODO::Senthil","instance":"Text_Caption_57","title":"Note this on the assessment form and continue with the assessment. If there are no other issues continue with administering the infusion. Relay this information to the treating doctor when you have time. ","roles":{"textData":{}}},{"id":"si11984_a","class":"TODO::Senthil","roles":{"answer":{"title":"Note this on the assessment form and continue with the assessment. If there are no other issues continue with administering the infusion. Relay this information to the treating doctor when you have time.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si11995","class":"TODO::Senthil","instance":"Text_Caption_58","title":" ","roles":{"textData":{}}},{"id":"si11999","class":"TODO::Senthil","instance":"Text_Caption_59","title":"Rheumatoid arthritis is an autoimmune disease. Immune checkpoint inhibitor treatment may worsen autoimmunity and may not be suitable for this patient. Organise a review with the treating doctor prior to beginning the infusion. ","roles":{"textData":{}}},{"id":"si11995_a","class":"TODO::Senthil","roles":{"answer":{"title":"Rheumatoid arthritis is an autoimmune disease. Immune checkpoint inhibitor treatment may worsen autoimmunity and may not be suitable for this patient. Organise a review with the treating doctor prior to beginning the infusion.\r","index":"Not implemented","score":{"weight":10}}}},{"id":"si12006","class":"TODO::Senthil","instance":"Text_Caption_60","title":" ","roles":{"textData":{}}},{"id":"si12010","class":"TODO::Senthil","instance":"Text_Caption_61","title":"Ensure the patient has not taken prednisolone recently. These can supress immune activity and work against the immune checkpoint inhibitor treatment. If the patient hasn’t taken this recently continue with the infusion. ","roles":{"textData":{}}},{"id":"si12006_a","class":"TODO::Senthil","roles":{"answer":{"title":"Ensure the patient has not taken prednisolone recently. These can supress immune activity and work against the immune checkpoint inhibitor treatment. If the patient hasn’t taken this recently continue with the infusion.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si12017","class":"TODO::Senthil","instance":"Text_Caption_62","title":" ","roles":{"textData":{}}},{"id":"si12021","class":"TODO::Senthil","instance":"Text_Caption_63","title":"Continue with the assessment and the infusion. Immune checkpoint inhibitor therapy is not contraindicated for this patient. ","roles":{"textData":{}}},{"id":"si12017_a","class":"TODO::Senthil","roles":{"answer":{"title":"Continue with the assessment and the infusion. Immune checkpoint inhibitor therapy is not contraindicated for this patient.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si12217","class":"TODO::Senthil","instance":"Button_13","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide12297q6","for":"Slide12297q6"},"textData":{}}},{"id":"si12229","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide12297q6","for":"Slide12297q6"},"textData":{}}},{"id":"si12241","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide12297q6","for":"Slide12297q6"},"textData":{}}},{"id":"si12047","class":"TODO::Senthil","instance":"SmartShape_20","title":"Well done!  Rheumatoid arthritis is an autoimmune disease. Immune checkpoint inhibitor treatment may worsen autoimmunity and may not be suitable for patients with a history or auto-immune conditions. It is important to ensure that the prescribing doctor is aware of auto-immune conditions, these patients may still be able to be treated and autoimmune flare ups managed as required.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide12297q6"},"textData":{}}},{"id":"si12066","class":"TODO::Senthil","instance":"SmartShape_21","title":"Not quite.   Rheumatoid arthritis is an autoimmune disease. Immune checkpoint inhibitor treatment may worsen autoimmunity and may not be suitable for patients with a history or auto-immune conditions. It is important to ensure that the prescribing doctor is aware of auto-immune conditions, these patients may still be able to be treated and autoimmune flare ups managed as required.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide12297q6"},"textData":{}}},{"id":"si12085","class":"TODO::Senthil","instance":"SmartShape_22","title":"You must answer the question before continuing. ","roles":{"click":{"subtype":"button","question":"Slide12297q6"},"textData":{}}},{"id":"Slide12297","class":"Question Slide","instance":"","thumbnail":"","children":["si16757","si15550","SmartShape_19","si11973","si11988","si11999","si12010","si12021","si12217","si12229","si12241","si12085"],"roles":{"slide":{"durationInFrames":90},"navigation":{"navid":"Slide12297"},"question":{"interactionId":"11923","quizId":377,"title":"Multiple Choice","text":"You are performing the baseline assessment of a patient who is prescribed to receive their first cycle of induction combined ipilimumab and nivolumab therapy for the treatment of metastatic melanoma. The patient mentions that they suffer from rheumatoid arthritis and are currently managing this with non-steroidal anti-inflammatories. The patient also takes prednisolone during acute flare ups. What action should you take?\r","ikc":false,"type":"graded","interactionType":"choice","ramdomized":false,"correctAnswers":["2"],"score":{"weight":10,"penalty":0}}}},{"id":"si16759","class":"TODO::Senthil","roles":{}},{"id":"si15559","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button","question":"Slide13313q7"},"textData":{}}},{"id":"SmartShape_25","class":"TODO::Senthil","instance":"SmartShape_25","title":"Clinical management ","roles":{"click":{"subtype":"button","question":"Slide13313q7"},"textData":{}}},{"id":"si13107","class":"TODO::Senthil","instance":"Text_Caption_96","roles":{}},{"id":"si12967","class":"TODO::Senthil","instance":"Text_Caption_83","title":"You are performing a pre-administration assessment of a patient and note that the patient appears to have raised levels of AST. The latest AST results indicate levels 3.0 x baseline. Bilirubin levels are normal and consistent with baseline. Your physical assessment of the patient indicates some loss of appetite and occasional nausea.  What action should you take? ","roles":{"textData":{}}},{"id":"si12978","class":"TODO::Senthil","instance":"Text_Caption_84","title":" ","roles":{"textData":{}}},{"id":"si12982","class":"TODO::Senthil","instance":"Text_Caption_85","title":"Note this on the assessment form and continue with the infusion. Bilirubin levels are normal so there is no risk that the patient is experiencing hepatotoxicity. ","roles":{"textData":{}}},{"id":"si12978_a","class":"TODO::Senthil","roles":{"answer":{"title":"Note this on the assessment form and continue with the infusion. Bilirubin levels are normal so there is no risk that the patient is experiencing hepatotoxicity.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si12989","class":"TODO::Senthil","instance":"Text_Caption_86","title":" ","roles":{"textData":{}}},{"id":"si12993","class":"TODO::Senthil","instance":"Text_Caption_87","title":"Note this on the assessment form and start the infusion. Ask the medical officer to review the patient when they have time. ","roles":{"textData":{}}},{"id":"si12989_a","class":"TODO::Senthil","roles":{"answer":{"title":"Note this on the assessment form and start the infusion. Ask the medical officer to review the patient when they have time.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si13022","class":"TODO::Senthil","instance":"Text_Caption_92","title":" ","roles":{"textData":{}}},{"id":"si13026","class":"TODO::Senthil","instance":"Text_Caption_93","title":"Note raised AST on the assessment form and call for a medical review. This patient is showing some signs of hepatotoxicity and requires review before an infusion is started. ","roles":{"textData":{}}},{"id":"si13022_a","class":"TODO::Senthil","roles":{"answer":{"title":"Note raised AST on the assessment form and call for a medical review. This patient is showing some signs of hepatotoxicity and requires review before an infusion is started.\r","index":"Not implemented","score":{"weight":10}}}},{"id":"si13033","class":"TODO::Senthil","instance":"Text_Caption_94","title":" ","roles":{"textData":{}}},{"id":"si13037","class":"TODO::Senthil","instance":"Text_Caption_95","title":"Call a medical emergency. ","roles":{"textData":{}}},{"id":"si13033_a","class":"TODO::Senthil","roles":{"answer":{"title":"Call a medical emergency.\r","index":"Not implemented","score":{"weight":0}}}},{"id":"si13233","class":"TODO::Senthil","instance":"Button_20","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide13313q7","for":"Slide13313q7"},"textData":{}}},{"id":"si13245","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide13313q7","for":"Slide13313q7"},"textData":{}}},{"id":"si13257","class":"TODO::Senthil","title":"Submit ","roles":{"click":{"subtype":"submit","question":"Slide13313q7","for":"Slide13313q7"},"textData":{}}},{"id":"si13063","class":"TODO::Senthil","instance":"SmartShape_27","title":"Well done!  Raised AST or ALT with or without raised bilirubin can indicated hepatotoxicity. A medical review should be undertaken prior to the infusion being initiated.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide13313q7"},"textData":{}}},{"id":"si13082","class":"TODO::Senthil","instance":"SmartShape_28","title":"Not quite.   Raised AST or ALT with or without raised bilirubin can indicated hepatotoxicity.  A medical review should be undertaken prior to the infusion being initiated.  Click anywhere to continue. ","roles":{"click":{"subtype":"button","question":"Slide13313q7"},"textData":{}}},{"id":"si13101","class":"TODO::Senthil","instance":"SmartShape_29","title":"You must answer the question before continuing. ","roles":{"click":{"subtype":"button","question":"Slide13313q7"},"textData":{}}},{"id":"Slide13313","class":"Question Slide","instance":"","thumbnail":"","children":["si16759","si15559","SmartShape_25","si12967","si12982","si12993","si13026","si13037","si13233","si13245","si13257","si13101"],"roles":{"slide":{"durationInFrames":90},"navigation":{"navid":"Slide13313"},"question":{"interactionId":"12917","quizId":377,"title":"Multiple Choice","text":"You are performing a pre-administration assessment of a patient and note that the patient appears to have raised levels of AST. The latest AST results indicate levels 3.0 x baseline. Bilirubin levels are normal and consistent with baseline. Your physical assessment of the patient indicates some loss of appetite and occasional nausea.  What action should you take?\r","ikc":false,"type":"graded","interactionType":"choice","ramdomized":false,"correctAnswers":["2"],"score":{"weight":10,"penalty":0}}}},{"id":"si16767","class":"TODO::Senthil","roles":{}},{"id":"si16663","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button","question":"Slide16620q8"},"textData":{}}},{"id":"SmartShape_49","class":"TODO::Senthil","instance":"SmartShape_49","title":"Clinical management ","roles":{"click":{"subtype":"button","question":"Slide16620q8"},"textData":{}}},{"id":"si16414","class":"TODO::Senthil","instance":"Text_Caption_144","roles":{}},{"id":"si16296","class":"TODO::Senthil","instance":"Text_Caption_135","title":"You are asked to perform the first education session for a patient who is prescribed to receive their first dose of nivolumab for lung cancer. The patient has previously received radiotherapy for treatment of their lung cancer. The patient asks you what side effects they may expect.   How do you respond? (select all that apply) ","roles":{"textData":{}}},{"id":"si16307","class":"TODO::Senthil","instance":"Text_Caption_136","title":" ","roles":{"textData":{}}},{"id":"si16311","class":"TODO::Senthil","instance":"Text_Caption_137","title":"Explain that the patient should look for signs of pneumonitis including a new or worsening cough, shortness of breath and wheezing. 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