This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Urinary bladder, Subject name: Surgery
[{'content': 'A 60 year old smoker male patient presents with painless gross hematuria for 1 day. IVU shows 1.2 cm filling defect at the lower pole of infundibulum. Which is the next best investigation to be done? \nSelect and explain. \nA. Cystoscopy, B. Urine cytology, C. USG abdomen, D. DMSA scan', 'role': 'user'}, {'content': 'Answer: A \nExplanation: - 60yr old smoker, hx. of PAINLESS gross hematuria - are findings of CA BLADDER - First investigation to be done is Cystoscopy. Once tumor visualized in cystoscopy, Biopsy done to confirm diagnosis. Urine cytology is done usually for UTI not for Bladder Cancer. A DMSA renal scan is a diagnostic imaging that evaluates the function, size, shape and position of the kidneys and detects scarring caused by frequent infections. BLADDER CANCER: Investigations- IOC for Dx- Cystoscopy + Biopsy- Urinary cytology* To confirm the diagnosis* But location of tumor cannot be identified.- IOC for staging- MRI - Urinary tumor markers* BTA (Bladder tumor antigen)* NMP -22 (Nuclear Matrix Protein)* Lewis- X- antigen* Hyaluronidase* Helpful in diagnosis and for follow up to assist the response of therapy and todetect recurrence', 'role': 'assistant'}]