American Board of Internal Medicine (ABIM) Certification Practice Exam

What is typically the initial test for diagnosing bladder cancer?

1. CT urogram

2. Ultrasound

3. Cystoscopy with biopsy

4. Urinalysis

The correct answer is: Cystoscopy with biopsy

Cystoscopy with biopsy is considered the initial standard for diagnosing bladder cancer because it allows for direct visualization of the bladder's interior lining. This procedure is essential for identifying any suspicious lesions or growths that may be indicative of cancer. During cystoscopy, a thin, flexible tube equipped with a camera is inserted through the urethra into the bladder, enabling the clinician to see abnormalities and obtain tissue samples for histological examination. While imaging techniques like CT urogram or ultrasound may help in assessing the urinary tract and detecting larger masses, they do not provide definitive diagnoses of bladder cancer by themselves. Urinalysis can detect blood in the urine and other abnormalities, but it is not specific to bladder cancer and cannot confirm a diagnosis. Therefore, cystoscopy with biopsy is the most definitive initial test to accurately diagnose bladder cancer and guide further management.