Ibclc Exam 2023 with complete solutions

Embryo and neonate weeks 3-4 - Answer- A primitive milk streak running bilaterally from axilla to groin Embryo and neonate Weeks 4-5 - Answer- Milk streak becomes mammary milk ridge or milk line . Paired breasts develop from this line of glandular tissue Embryo and neonate weeks 7/8 - Answer- Thickening and inward growth into chest wall continue Embryo and neonate weeks 12-16 - Answer- Specialized cells differentiate into smooth muscle of nipple and areola - epithelial cells develop into mammary buds - epithelial branches form to eventually become alveoli Embryo and neonate weeks 15-25 - Answer- Epithelial strips are formed which represent future secretory alveoli - lactiferous ducts and their branches form and open into a shallow epithelial depression known as the mammary pit - the mammary pit becomes elevated forming the nipple and the areola - an inverted nipple results when the pit fails to elevate Embryo and neonate After 32 weeks - Answer- A lumen ( canal ) forms in each part of the branching system Embryo and neonate Near term - Answer- 15-25 mammary ducts form the fetal mammary gland Neonate - Answer- - galactorrhea ( witch's milk ) : secretion of colostral like fluid neonate mammary tissue resulting from influence of maternal hormones - recommended not to express neonatal colostrum because this might lead to mastitis in the newborn Puberty - Answer- 1. Breasts keep pace with general physical growth 2. Growth of the breast parenchyma produces ducts , lobes, alveoli, and surrounding fat pad 3. Onset of menses at 10-12 continues development of the breast - primary and secondary ducts grow and divide . - terminal end buds form , which later become alveoli (small sacs where milk is secreted ) in the mature breast - proliferation and active growth of duct tissue takes place during each period and continues to about 35 years of age Pregnancy breast Development - Answer- 1. Complete development of mammary function occurs only in pregnancy 2. Breast size increases , skin appears thinner , and veins become more prominent 3. Areola diameter increases - Montgomery glands enlarge , and nipple pigment darkens Anomalies in breast Development - Answer- 1. Illnesses, chemo, therapeutic radiation to the chest , chest surgery , or injuries to the chest might affect development 2. Programmed apoptosis ( cell death ) has been suggested as one reason for lower breast cancer rates in bf women Exterior breast - Answer- Located in the superficial fascia ( fibrous tissue beneath skin) between 2nd rib and 6th intercostal space Tail of spence - Answer- Mammary glandular tissue that projects into the axillary region - distinguished from the supernumerary tissue because it connects to the duct system - potential are of milk pooling and mastitis Skin surface of Breast contains - Answer- Nipple, areola, and Montgomery glands Size - Answer- Not related to functional capacity Gives breast it's Shape and size - Answer- Fat composition Size may indicate - Answer- Milk storage potential Nipple - Answer- Conical elevation located slightly below center of areola Average diameter of Nipple - Answer- 1.6cm Average length of Nipple - Answer- 0.7 cm Hoe many milk Duct openings In nipple - Answer- 5-10 Smooth muscle fibers Function as a - Answer- Closure mechanism to keep milk from continuously leaking from the nipple The nipple is Densely innervated With - Answer- Sensory nerve endings What makes the nipple erect when contracted - Answer- Longitudinal inner muscles and outer circular and radial muscles Venostasis - Answer- Slows blood flow and decreases surface area Areola - Answer- Dark pigmented area that surrounds the nipple - elastic like nipple Average diameter Of areola - Answer- 6.4 cm Areola is constructed Of - Answer- Smooth muscle and collagenous , elastic , connective tissue fibers in radial and circular arrangement How does the nipple Aid infant in latching - Answer- Becomes smaller , firmer, and more prominent What happens to Areola in pregnancy - Answer- Darkens and enlarges Where are montgomerys tubercules located - Answer- Around the areola The Montgomery tubercules contain - Answer- Ductal openings of the sebaceous and lactiferous glands and sweat glands What happens to Montgomery glands in pregnancy - Answer- They enlarge and resemble small , raised pimples The Montgomery glands secrete ? - Answer- A substance that lubricates and protects the nipple Some secrete a small amount of milk Secretions of the Montgomery gland may produce ? - Answer- A scent to help the infant locate the nipple Parenchyma are - Answer- Functional parts of the breast Alveoli are ? - Answer- ( acini) are the basic components of the mature mammary gland . Secretory cells in which the milk is produced Lactocytes ( specialized epithelial cells ) that line the interior of the alveolus do ? - Answer- Absorb nutrients , immunoglobulin, and hormones from the mothers bloodstream to compose milk Prolactin receptor sites in the lactocytes Allow? - Answer- Prolactin to be absorbed from the blood and enter into the alveoli to stimulate milk production Myoepithelial cells do what ? - Answer- Encase the alveoli and contact in response to oxytocin to eject milk into ductules How many lobes does the breast contain - Answer- 15-25 that carry the milk through the ductules from the alveoli to the nipple Each lobe contains how many alveoli - Answer- 10-100 in an intricate system of ductules that branch out from the lobes to converge into lactiferous ducts behind the nipple Ultrasound of lobes shows? - Answer- Connections between lobes What do ducts do in response to milk ejection - Answer- Temporarily widen What do ducts do in response to duct drainage - Answer- Narrow What happens to milk that is not removed - Answer- It flows backward up the collecting ducts Lactiferous ducts lead to - Answer- 5-10 openings in the nipple Stroma - Answer- Supporting tissues of the breast Stroma include - Answer- Connective tissue , fat tissue, blood vessels , nerves, and lymphatics Coopers ligaments are - Answer- Suspensory ligaments running vertically through the breast What do coopers ligaments do - Answer- Attach the deep layer of subcutaneous tissue to the dermis layer of the skin The breast is highly - Answer- Vascular What supplies 60%of blood to the breast - Answer- Internal mammary artery What supplies 30%of blood to the breast - Answer- Lateral thoracic artery Blood vessels within the breast do ? - Answer- Enlarge What stimulates growth of the ducts - Answer- Surges of estrogen What causes glandular tissue to expand ? - Answer- Surges of progesterone The lymphatic system collects ? - Answer- Excess fluids from tissue spaces, bacteria, and cast off cell parts The lymphatic system drains where ? - Answer- The axillary lymph nodes mainly Breast innervation derives from mainly where ? - Answer- Branches of the 4th, 5th, and 6th intercostal nerves Where is nerve supply sparse ? - Answer- The innermost parts of the breast The fourth intercostal nerve - Answer- Penetrates the posterior aspect of the breast The 4th intercostal nerve supplies the greatest amount of sensation to the areola where ? - Answer- 4:00 on the left breast and 8:00 on the right breast How many branches does the 4th intercostal nerve divide into - Answer- 5 branches and it becomes more superficial as it reaches the areola The Lowermost branch of the 4th intercostal nerve penetrates the areola where ? - Answer- 5:00 on left breast and 7:00 on the right Trauma to the 4th intercostal nerve might result in - Answer- Some loss of sensation in the breast If the lowermost branch of the 4th intercostal nerve is severed what happens ? - Answer- Loss of sensation to the nipple and areola may result Aberrant sensory or autonomic nerve distributions in the nipple/areola complex could - Answer- Affect milk ejection reflex and secretion of prolactin and oxytocin Trauma or severing of the 4th intercostal nerve could result from - Answer- Breast augmentation or reduction surgery How much does a non pregnant mature breast weigh - Answer- 200g How much does a pregnant near term breast Weigh - Answer- 400-600g How much does a lactating breast weigh - Answer- 600-800g Asymmetry is common . Which breast is often larger - Answer- Left larger than right often Hypermastia - Answer- Presence of an accessory mammary gland - accessory or supernumerary nipple develops along the milk line between the axilla and groin - often prominent during pregnancy and lactation Hypermastia can be associated with - Answer- Renal or other organ system abnormalities What can lactate and undergo malignant changes - Answer- Accessory glandular tissue tissue Hyperthelia - Answer- Nipple without accompanying mammary tissue Hypertrophy - Answer- Abnormally large breast Hypomastia - Answer- Abnormally small breast Hyperplasia - Answer- Overdevelopment of the breast - hyperplastic breast Hypoplasia - Answer- Underdevelopment of the breast - hypoplastic breast Tubular or tuberous shape of because lack of glandular tissue - Answer- Hypoplastic breast Breasts may have large areolas - Answer- Hypoplastic breasts Breast are frequently asymmetric and widely spaced - Answer- Hypoplastic breast What type of breast may present increased risk for insufficient milk - Answer- Hypoplastic breast Poland's syndrome - Answer- Unilateral hypoplasia of the breast combined with hypoplasia of the thorax and pectoral muscle The normal nipple should - Answer- Evert and become protractor when compressed or stimulated What is the range of incidence of poor protractility in primigravid women - Answer- 10-35% Protractility - Answer- Improves during pregnancy - effect on latch is minimal when baby has a large amount of breast tissue Nipple inversion occurs in how many women - Answer- 3% and is usually bilateral A truly inverted nipple does what - Answer- Remains inverted when compressed or stimulated A pseudo inverted nipple does what - Answer- Appears inverted but everts when compressed or stimulated A short shanked nipple does what - Answer- Appears Everted but retracts when compressed or stimulated Common nipple does what - Answer- Protrudes slightly when at rest and becomes more erect and graspable when stimulated - baby can find and pull in mouth and stretch it to the roof of his mouth Flat and or short shanked nipple - Answer- May be soft or pliable and have the ability to ridge so it molds to infants mouth without a problem . The flat nipple may have a short shank which makes it less easy to ridge and the baby to find and grasp . May benefit from a syringe to increase protractility . Retracted nipple - Answer- Most common type of inverted nipple - initially appears graspable - retracts on stimulation making attachment difficult - does respond well to techniques that increase nipple protrusion Inverted nipple - Answer- Truly inverted nipple retracted both at rest and when stimulated. Very uncommon and more difficult for baby to grasp . All techniques used to enhance protractility of breast tissue can be used to improve attachment . Even with nipple retraction baby should be able to latch if mother helps form breast in mouth Bulbous - Answer- Large nipple that may be difficult for baby to grasp Dimpled nipple - Answer- Increases the risk for maceration as the nipple lies enveloped by the areola Midsagittal - Answer- The plane vertically dividing the body through the midline into left and right halves Sagittal - Answer- Any plane that is parallel to the midsagittal line vertically divided body into right and left portions Coronal - Answer- Frontal - any plane dividing body into anterior or posterior Transverse - Answer- Upper and lower portions Ipsilateral - Answer- Pertaining to the same side Contralateral - Answer- Pertaining to the opposite side Alveolus - Answer- A small cavity in the breast - an arrangement of lactocytes around a central Lumen drained by a ductule Process - Answer- Projections on a bone Fontanel - Answer- Junctions of cranial bones covered by a tough membrane Lumen - Answer- The cavity or channel within a tube or tubular organ Temporomandibular - Answer- Opens and closes the jaw . Lateral displacement of the mandible Suture - Answer- A joint that does not move - the bones are united by a thin layer of fibrous tissue Involuntary muscles - Answer- Contraction controlled by autonomic nervous system no willful control Voluntary muscles - Answer- Movement using willful control , central nervous system Visceral smooth muscles - Answer- Found in digestive and respiratory tracts Cardiac / striated muscles - Answer- Involuntary striated muscle - allowing coordination of contraction Skeletal / striated muscle - Answer- Voluntary , striated ; gross and fine motors movements Lymphatic system - Answer- Drains tissue spaces, provides for intercellular waste disposal , and carries absorbed fat in the blood Endocrine system - Answer- Chemical regulator of body functions Occipital bone - Answer- Forms the back and base of the cranium ; contains the foramen magnum through which the spinal cord passes Frontal bone - Answer- Forms the forehead , roof of the nasal cavity , and orbits Parietal bone - Answer- Sides and roof of the cranium Temporal bone - Answer- Sides and base of the cranium ; houses the middle and inner ear structures Sphenoid - Answer- Butterfly shaped bone bridging the other cranial bones internally forming part of the temple floor of the skull ( sella turcica- seat of the pituitary ) nasal septum , posterior walls of orbits Ethmoid bone - Answer- Between the nasal bones and sphenoid ; forms parts of the nasal septum ; walls of orbits Nasal bone - Answer- Upper bridge of nose Vomer bone - Answer- Posterior nasal cavity ; forms a portion of the nasal septum Lacrimal bone - Answer- Anterior , medial wall of the orbit Zygomatic arch - Answer- Prominence of the cheeks and part of the lateral wall and floor of the orbits Palatine - Answer- Posterior cavity between the maxillae and sphenoid Maxilla - Answer- Upper jaw Mandible - Answer- Lower jaw Hyoid bone - Answer- Horseshoe shaped bone suspended from the styloid process of the temporal bone p Choanae - Answer- Posterior nasal apertures paired passages from the nasal cavity to the nasopharynx What does bf do to the choanae - Answer- Widens it unless tongue tie is present Coronal suture - Answer- Line of articulation between the frontal bone and the 2 parietal bones Sagittal suture - Answer- Line of articulation between the 2 parietal bones in the midline Lambdoidal - Answer- Anterior articulation between the occipital and parietal bones Anterior fontanel - Answer- A diamond shaped interval where the frontal angles of the parietal bones meet the 2 separate halves of the frontal bones Posterior fontanel - Answer- A triangular interval at the union of the lambdoid and sagittal sutures Sphenoidal fontanel - Answer- Irregularly shaped interval on either side of the skull Mastoid fontanel - Answer- Interval on either side of the posterior skull Cranial nerve I - Answer- Olfactory : smell cranial nerve 2 - Answer- Optic : sight Cranial nerve 3 - Answer- Oculormotor:innervates external muscles for several movements of the eye Cranial nerve 4 - Answer- Trochlear : innervates muscles that move the eye up and down Cranial nerve 5 - Answer- Trigeminal : three branches : muscles of mastication Cranial nerve 6 - Answer- Abducens: moves the eye away from the center of the body Cranial nerve 7 - Answer- Facial : muscles of facial expression Cranial nerve 8 - Answer- Vestibulocochlear: hearing and equilibrium Cranial nerve 9 - Answer- Glossopharyngeal: taste, sensation in pharynx ( important for swallowing ) Cranial nerve 10 - Answer- Vagus: larynx, pharynx Cranial nerve 11 - Answer- Spinal accessory : muscles of the neck and shoulder Cranial nerve 12 - Answer- Hypoglossal: movements of the tongue How many nerves and muscles must coordinate for swallowing - Answer- 26 muscles and 6 cranial nerves Mouth suckling cranial nerves - Answer- 5 ( sensory - shape: texture ) 7 motor Tongue suckling cranial nerves - Answer- 7, 9 (taste , sensory ) 12 motor Jaw suckling cranial nerves - Answer- 5 ( sensory position of TMJ) 5 motor ; 5 does both sensory and motor Palate swallowing nerves - Answer- 5, 9 ( sensory ) 5,7,9,10 motor Tongue swallowing nerves - Answer- 9 sensory 5,7,12 motor Pharynx swallowing nerves - Answer- 5,9 sensory 9, 10 motor Larynx - Answer- 10 sensory : 9,10 motor Muscles used in mastication and suckling - Answer- Temporalis, Masseter, medial pterygoid , lateral pterygoid, buccinator , orbicularis Oris mentalis Temporalis muscle - Answer- Raises the mandible : closes mouth : draws the mandible backward Masseter muscle - Answer- Closes the jaw Medial pterygoid muscle - Answer- Raises the mandible : closes the mouth Lateral pterygoid - Answer- Brings the jaw forward Buccinator - Answer- Compresses the cheeks and retracts the angle Orbicularis oris - Answer- Closes the lips Mentalis muscle - Answer- Elevates center of lower lip