••• Chapter 40^ Pediatric and Adolescent Gynecology^399
❍ Under what circumstances is it indicated to give post-exposure prophylaxis for HIV?
(1) High-risk behavior in the assailant.
(2) Multiple assailants.
(3) Mucosal lesions on the assailant.
(4) Vaginal or anal penetration.
(5) Ejaculation on mucous membranes.
❍ What is the most common cause of breast asymmetry in an adolescent?
Normal variation in the development of the breasts is the most common cause of asymmetry, with 25% of cases
persisting to adulthood. Biopsy should almost always be avoided in prepubertal girls or during early puberty, to
avoid causing potentially irreversible damage to the breast bud.
❍ What is the usual presentation of mastalgia in an adolescent?
Cyclic breast pain that is often most severe during the luteal phase of the menstrual cycle. Symptoms might also
include mild breast swelling or palpable nodularity in the upper outer quadrants, consistent with fibrocystic changes.
❍ What are the characteristic findings in benign mammary ductal ectasia in an adolescent?
(1) Bloody or dark-brown nipple discharge.
(2) Dilation of mammary ducts.
(3) Periductal fibrosis and inflammation.
(4) Breast mass.
❍ Describe the four types of female genital cutting or circumcision.
(1) Type I: Excision of the prepuce with or without removal of all or part of the clitoris.
(2) Type II: Removal of the clitoris and part or all of the labia minora.
(3) Type III: Removing part or all of the external genitalia and sewing together the remaining edges to leave a
small neo-introitus (infibulation).
(4) All other forms, such as burning, pricking or scraping.
❍ What are the criteria that would allow an Institutional Review Board to waive the requirement for parental
permission in research involving adolescents?
(1) Only minimal risk is involved.
(2) Waiving parental permission does not adversely affect the welfare of the adolescent.
(3) Research could not practically be done without a waiver.
(4) Subjects will be provided with pertinent information after participation.
❍ In which areas of adolescent research may parental permission be waived?
(1) STDs.
(2) Birth control use.
(3) High-risk sexual behavior.
(4) HIV prevention.
(5) Pregnancy.
(6) Family planning.