QuestionSBA
QuestionChoice
As per new NICE guidance, anybody over the age of 50 with unexplained rectal bleeding should have a FIT test as opposed to a 2 week wait referral, and if positive (more than or equal to 10 nanograms), they should be referred for a colonoscopy within 2 weeks.
10028306
a
Refer to 2-week wait clinic
QuestionChoice
The FOB test was historically used to detect invisible traces of blood, and triage the need for a 2-week wait referral. It has now been replaced by the FIT test. In any case, it is not a useful test in this circumstance - the patient reports passing fresh red blood.
10028309
d
Faecal occult blood (FOB) test
QuestionChoice
The most important diagnosis to consider and exclude in this case is colorectal carcinoma. A faecal calprotectin test may be useful in some cases, however this is not the most appropriate next step. It is important to note that faecal calprotectin can be raised in cases of colorectal carcinoma as well as inflammatory bowel disease, especially when PR bleeding is present.
10028308
c
Faecal calprotectin test
QuestionChoice
This would not be the most appropriate next step for a general practitioner to take. They should refer this patient along the 2-week wait pathway, where the lower GI team will choose the most appropriate investigations (likely a colonoscopy). A CT may be required if a malignancy is found on endoscopy.
10028310
e
CT abdomen pelvis (with contrast)
QuestionChoice
As per NICE guidelines, anybody over the age of 50 with unexplained rectal bleeding should have a FIT test, and if positive (more than or equal to 10 nanograms), they should be referred for a colonoscopy within 2 weeks.
10028307
b
Faecal immunochemistry (FIT) test
QuestionComment
whats the point in doing a FIT when we already know that she's passing blood? 
43334
QuestionComment
The rectal examination was normal. You need to confirm blood loss first
43827
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Cystic Gas
QuestionComment
The FIT test looks for blood in the stool which isn't visible to the naked eye. Meaning blood that is coming form higher up in the GI tract. 
51709
User
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Supraventricular Lion
QuestionComment
well no? anal or rectal cancer will have fresh blood
60933
User
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Sydney Sweeney
User
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ButtMuncher
Concept
Chapter
2693
6050
Lower GI Bleeding
Topic
162
General practice
18059
NICE advise FIT testing in patients over 50 with unexplained rectal bleeding prior to 2 week wait referral
A 54-year-old woman is seen by her GP for a routine diabetes review. During the consultation, she mentions that she has had a few episodes of passing fresh red blood along with her bowel motions.

Other than type 2 diabetes, she has no significant past medical or family history.

On examination, she looks very well. Her abdomen is soft and non-tender with no masses palpable. A rectal examination is normal.

What is the most appropriate next step?
b