Urology: haematuria work-up: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Surgery · Urology: haematuria work-up

Sample item

A 64-year-old man who smokes has had one episode of painless gross haematuria. Urine culture is sterile and ultrasound shows normal kidneys. What is the most appropriate next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Flexible cystoscopy

Painless visible haematuria in a smoker is urothelial carcinoma until proven otherwise, and the bladder is the commonest source. Cystoscopy is the key investigation, and the upper tract is evaluated with CT urography. Normal ultrasound does not exclude bladder tumours. Repeated or persistent haematuria should never be dismissed as benign.

Option by option

  • A. Empirical antibiotics for 7 days

    Antibiotics are inappropriate when urine culture is sterile.

  • B. Transrectal prostate biopsy

    Prostate biopsy does not assess the bladder and is not indicated for haematuria alone.

  • C. Flexible cystoscopy (correct)

    Direct visualisation of the bladder mucosa is needed to exclude urothelial cancer.

  • D. Observation and repeat urinalysis in 6 months

    Waiting risks delaying the diagnosis of a possible malignancy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Flexible cystoscopy. Painless visible haematuria in a smoker is urothelial carcinoma until proven otherwise, and the bladder is the commonest source.

Why is "Empirical antibiotics for 7 days" not the answer?

Antibiotics are inappropriate when urine culture is sterile.

Why is "Transrectal prostate biopsy" not the answer?

Prostate biopsy does not assess the bladder and is not indicated for haematuria alone.

Why is "Observation and repeat urinalysis in 6 months" not the answer?

Waiting risks delaying the diagnosis of a possible malignancy.

What concept does this question test?

It tests Urology: haematuria work-up in General Surgery. Cystoscopy is the key investigation, and the upper tract is evaluated with CT urography. Normal ultrasound does not exclude bladder tumours. Repeated or persistent haematuria should never be dismissed as benign.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: haematuria work-up?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.