A 55-year-old man presents with painless hematuria. He has a history of smoking and works in an environment with exposure to industrial chemicals. Urine cytology reveals malignant cells. What is the most likely diagnosis? A) Bladder cancer B) Prostate cancer C) Renal cell carcinoma D) Urethral carcinoma E) Hemorrhagic cystitis Correct Answer: A) Bladder cancer Explanation: Bladder cancer often presents with painless hematuria, particularly in individuals with risk factors like smoking and chemical exposure. The presence of malignant cells on urine cytology strongly suggests this diagnosis. Prostate cancer (B) typically presents with lower urinary tract symptoms (e.g., urinary frequency, weak stream) rather than hematuria. Renal cell carcinoma (C) can present with hematuria but is less commonly associated with painless hematuria and lacks the urine cytology findings seen in bladder cancer. Urethral carcinoma (D) is rare and would more likely cause symptoms like dysuria or obstructive urinary symptoms rather than isolated painless hematuria. Hemorrhagic cystitis (E) can cause hematuria, but it is often associated with pain or irritative voiding symptoms rather than being painless. Key Tips for PLAB 1: ✅ Painless hematuria, history of smoking/chemical exposure = Bladder cancer ✅ Management = Cystoscopy, biopsy, and possible surgical treatment (e.g., TURBT).
