A 57-year-old with epigastric discomfort has lost 6 kg unintentionally. What does NICE NG12 advise?
Answer and explanation
Correct answer: A. Refer for urgent upper gastrointestinal endoscopy on the suspected cancer pathway
- Step 1: Weight loss with upper abdominal symptoms at age 55 or over is a red flag.
- Step 2: NICE advises direct-access endoscopy under the suspected cancer pathway.
Answer
Refer for urgent upper gastrointestinal endoscopy on the suspected cancer pathway.
Why not the others: A stool culture and faecal calprotectin, followed by dietary advice from the practice: Stool culture will not assess the stomach. A trial of omeprazole with review in a year, with no endoscopy unless symptoms return: Delay risks missing cancer. Reassurance that mild weight loss is normal at his age and a review in six months: Weight loss is not normal.
Practise more Common presentations and prescribing.
Free questions with an explanation for every one, and full timed PLAB 1 (GMC, international medical graduates) mock tests.
More Common presentations and prescribing questions
- An adult has a sore throat. FeverPAIN is 4. What does NICE advise?
- A non-pregnant woman aged 30 has uncomplicated lower urinary tract infection with no allergies and eGFR 90. Which first-line treatment is re…
- A 40-year-old has low back pain with new urinary retention and saddle numbness. What is the right action?
- A 73-year-old woman has new temporal headache, jaw claudication and ESR 90 mm/h. What is the correct immediate management?
- A 66-year-old man on sertraline is prescribed regular ibuprofen for knee pain. What is the main risk and the sensible precaution?
- A 59-year-old man has iron deficiency anaemia with ferritin 8 micrograms/L and no obvious cause. What is the most appropriate next step?