Gynaecological oncology: vulval intraepithelial neoplasia: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological oncology: vulval intraepithelial neoplasia

Sample item

A 30-year-old smoker has multiple pigmented raised vulval lesions, and biopsy shows high-grade squamous intraepithelial lesion (usual type VIN) associated with HPV 16. Which treatment is suitable for limited multifocal disease?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Topical imiquimod or laser ablation, with excision of suspicious areas

Usual-type VIN is HPV-related, affects younger women, and is often multifocal. Treatment includes local excision, laser vapourisation or topical imiquimod, preserving anatomy and function, with long-term follow-up for recurrence. Differentiated VIN is HPV-independent, associated with lichen sclerosus and TP53 mutations, and progresses to cancer more rapidly, so it is excised.

Option by option

  • A. Systemic chemotherapy

    Chemotherapy is not used for VIN.

  • B. Observation without treatment

    Untreated high-grade VIN can progress.

  • C. Radical vulvectomy

    Radical vulvectomy is excessive for pre-invasive disease.

  • D. Topical imiquimod or laser ablation, with excision of suspicious areas (correct)

    Correct. Conservative local therapy suits usual-type VIN.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Topical imiquimod or laser ablation, with excision of suspicious areas. Usual-type VIN is HPV-related, affects younger women, and is often multifocal.

Why is "Systemic chemotherapy" not the answer?

Chemotherapy is not used for VIN.

Why is "Observation without treatment" not the answer?

Untreated high-grade VIN can progress.

Why is "Radical vulvectomy" not the answer?

Radical vulvectomy is excessive for pre-invasive disease.

What concept does this question test?

It tests Gynaecological oncology: vulval intraepithelial neoplasia in OBG. Treatment includes local excision, laser vapourisation or topical imiquimod, preserving anatomy and function, with long-term follow-up for recurrence. Differentiated VIN is HPV-independent, associated with lichen sclerosus and TP53 mutations, and progresses to cancer more rapidly, so it is excised.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological oncology: vulval intraepithelial neoplasia?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.