A 66-year-old man comes to the office because of a 2-day history of intermittent red urine. He has not had flank pain, fever, dysuria, or increased urinary frequency. He has no history of recent trauma. Medical history is remarkable for hypertension and atrial fibrillation. His medications include lisinopril and warfarin. He has smoked one pack of cigarettes daily for 44 years and drinks 2 shots of vodka every day. He works as an operations manager for a large beverage company and frequently travels to Mexico. Abdominal examination shows no abnormalities. Digital rectal examination shows a smooth, normal-sized prostate without any irregularities. Urinalysis is positive for 50 red blood cells/hpf; there are no casts or dysmorphic blood cells. Urine cytology is positive for malignant cells. Renal ultrasonogram reveals normal kidneys. Which of the following is a major risk factor for this patient's current condition?

Question

A 66-year-old man comes to the office because of a 2-day history of intermittent red urine. He has not had flank pain, fever, dysuria, or increased urinary frequency. He has no history of recent trauma. Medical history is remarkable for hypertension and atrial fibrillation. His medications include lisinopril and warfarin. He has smoked one pack of cigarettes daily for 44 years and drinks 2 shots of vodka every day. He works as an operations manager for a large beverage company and frequently travels to Mexico. Abdominal examination shows no abnormalities. Digital rectal examination shows a smooth, normal-sized prostate without any irregularities. Urinalysis is positive for >50 red blood cells/hpf; there are no casts or dysmorphic blood cells.  Urine cytology is positive for malignant cells.  Renal ultrasonogram reveals normal kidneys.  Which of the following is a major risk factor for this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Major risk factors for urothelial cancer of the bladder include age >60, cigarette smoking, and occupational exposure to rubber, plastics, or aromatic amine-containing dyes.  Cyclophosphamide therapy also increases the risk.

A 66-Year-Old Man Comes to the Office Because of a 2-Day