Gynaecological oncology: HSIL management: 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: HSIL management

Sample item

A 32-year-old non-pregnant woman has high-grade squamous intraepithelial lesion on cytology, and colposcopy shows a type 1 transformation zone with a high-grade lesion. What is acceptable management?

AHysterectomyBLarge loop excision of the transformation zone (see-and-treat) with histologyCRepeat cytology in 5 yearsDObservation only

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

The answer and the reasoning

B. Large loop excision of the transformation zone (see-and-treat) with histology

In women with HSIL cytology and a colposcopic high-grade impression, immediate loop excision (see and treat) is acceptable, avoiding the delay and loss to follow-up between biopsy and treatment. It both treats and provides histology, and margins are assessed. Hysterectomy is not first-line for CIN.

Option by option

A. Hysterectomy
Hysterectomy is excessive for CIN.
B. Large loop excision of the transformation zone (see-and-treat) with histology (correct)
Correct. See-and-treat with LLETZ is an accepted option.
C. Repeat cytology in 5 years
Waiting 5 years risks progression.
D. Observation only
High-grade disease should be treated.

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.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Large loop excision of the transformation zone (see-and-treat) with histology. In women with HSIL cytology and a colposcopic high-grade impression, immediate loop excision (see and treat) is acceptable, avoiding the delay and loss to follow-up between biopsy and treatment.

Why is "Hysterectomy" not the answer?

Hysterectomy is excessive for CIN.

Why is "Repeat cytology in 5 years" not the answer?

Waiting 5 years risks progression.

Why is "Observation only" not the answer?

High-grade disease should be treated.

What concept does this question test?

It tests Gynaecological oncology: HSIL management in OBG. It both treats and provides histology, and margins are assessed. Hysterectomy is not first-line for CIN.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: HSIL management?

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.