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Suspected Scaphoid Fracture — UKMLA MCQ

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MediumEmergency MedicineSuspected Scaphoid FractureUKMLAMRCEM SBAMRCGP AKTPARA

A 52-year-old woman reported visible haematuria during a culture-confirmed urinary infection. Her dysuria resolved after susceptibility-guided treatment and a repeat culture is negative. Two weeks later she has another episode of painless visible haematuria. Examination is unremarkable. What is the most appropriate next action?

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Correct answer: C — Suspected cancer pathway referral for bladder cancer

She is over 45 and has visible haematuria recurring after successful treatment of a proven urinary infection. NICE advises a suspected cancer pathway referral for bladder cancer in this situation. The negative repeat culture and absence of dysuria make recurrent infection less likely, and empirical antibiotics would delay appropriate assessment. Routine ultrasound alone is not an adequate substitute for the urgent urological pathway, through which suitable upper-tract imaging and cystoscopy can be arranged. Urine cytology should not be used in primary care as a gatekeeper to referral. The crucial distinction is recurrence after the infection has been successfully treated.

Reference: NICE NG12, bladder cancer recommendation 1.6.4. https://www.nice.org.uk/guidance/ng12/chapter/1-recommendations-organised-by-site-of-cancer