A 60 yr old smoker came with a history of painless gross hematuria for one day. Most logical investigation would be:
Answer is D (Urine microscopy for malignant cytology): Urine microscopy _Pr malgnant cytology is the single best investigation amongst the options provided Painless Gross Haematuria in a 60 year old smoker requires investigation to exclude carcinoma of the bladder. Recommended investigations in individuals greater than 40 years who develop haematuria include: Devita/1-116th Urinary cytologvQ for malignant cells Cvstocopy Imaging of the urinary tract with Intravenous Pyelogram or CT scan Amongst these recommended diagnostic procedures only 'urinary cytology for malignant cell's has been provided amongst the options and hence is the single best answer of choice. USG is not a recommended investigation for eliciting bladder tumours USG by external, transrectal or transurethral route may define moderate size masses but it will not distinguish benign masses from solid masses. Also, it is unlikely to pick up small bladder tumours. It has not been recommended as a first line investigation for eliciting bladder tumours. Routine Urine Microscopy and Plain X-Ray KUB will not give desired / sufficient information.
Urine routine
Plain X ray KUB
USG KUB
Urine microscopy for malignant cytology