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Bladder cancer — MCCQE Part 1 MCQ

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ModerateBlood in UrineBladder cancerMCCQE Part 1

66-year-old man with smoking history presents with painless visible haematuria. Urinalysis confirms blood without infection. Which of the following is the most appropriate next step?

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Correct answer: A — Arrange cystoscopy and upper-tract imaging

Arrange cystoscopy and upper-tract imaging is best because visible painless haematuria in an older smoker requires malignancy evaluation. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Do not repeatedly treat culture-negative haematuria as UTI.

Reference: Canadian Urological Association haematuria guidance