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Alzheimer's disease — UKMLA MCQ

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MediumMental Health & PsychiatryAlzheimer's diseaseUKMLAMRCGP AKTMRCP Part 1

A 58-year-old woman has a persistent change to looser bowel habit and lower abdominal discomfort. Examination is unremarkable, haemoglobin is normal, and she is clinically stable. Quantitative FIT returns 18 micrograms of haemoglobin per gram of faeces. What is the most appropriate next step?

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Correct answer: B — Refer using a suspected colorectal-cancer pathway

Her symptoms meet the pathway for quantitative FIT, and a result of 18 micrograms Hb/g is above the NICE referral threshold of 10 micrograms/g. She should be referred on the suspected colorectal-cancer pathway. Normal haemoglobin and examination do not exclude cancer. The threshold is not 100 micrograms/g, and antibiotics are not a prerequisite. Safety-net and consider referral despite a lower FIT when symptoms remain strongly concerning, because FIT supports rather than replaces clinical judgement.

Reference: NICE. NG12 Suspected cancer: recognition and referral, colorectal recommendations. https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer