skip to main content

Visible haematuria requiring parallel urological and endometrial cancer assessment — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardHematuriaVisible haematuria requiring parallel urological and endometrial cancer assessmentMSRA

A 61-year-old woman presents with two episodes of painless visible haematuria over 10 days. She is postmenopausal and also reports 4 weeks of persistent watery vaginal discharge. She has no dysuria, frequency, fever, loin pain, weight loss, vaginal bleeding or recent urinary instrumentation. A correctly collected midstream urine sample shows 3+ blood, negative nitrites and leucocytes, and no significant growth on culture. Her eGFR is 78 mL/min/1.73 m². Full blood count shows haemoglobin 104 g/L, white cell count 6.9 × 10⁹/L and platelets 286 × 10⁹/L. What is the most appropriate management today?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Arrange suspected cancer pathway referral for bladder and renal cancer and urgent direct-access ultrasound to assess for endometrial cancer

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

She requires parallel urgent investigation. At age 61, visible haematuria without evidence of urinary tract infection meets NICE criteria for suspected cancer pathway referral for both bladder and renal cancer. A negative culture and absence of pyuria make empirical antibiotic treatment inappropriate and should not delay referral. A separate NICE criterion also applies: women aged 55 years or over with visible haematuria plus a low haemoglobin level should be considered for urgent direct-access ultrasound to assess for endometrial cancer. Her persistent unexplained watery vaginal discharge increases the importance of not attributing all findings to a urinary cause. The ultrasound is an additional investigation, not an alternative to urological cancer referral. B misses the specified urgent endometrial assessment. C under-triages the urological presentation: routine urology referral is not appropriate for unexplained visible haematuria in someone aged over 45. D is attractive because infection can cause haematuria, but culture and dipstick findings do not support this. E delays evaluation despite meeting urgent referral criteria.

Reference: NICE NG12: Suspected cancer: recognition and referral — recommendations organised by site of cancer (Last updated 15 April 2026) — https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer