IBCLC EXAM: Maternal Pathology Exam questions and answers 2024 already graded A+

Hypoplasia/ Amastia abnormally shaped breasts with insufficient glandular tissue -widely spaced -asymmetric -pt may have had breast augmentation to correct appearance -few breast changes during pregnancy -no engorgement postpartum -possible connection to thyroid disease -low supply likely -monitor infant growth -counseling necessary -may improve with subsequent pregnancies -utilize pumping/galactogogues Galactorrhea spontaneous lactation, milk production post weaning -d/t medications or health problem Hyperprolactinemia elevated prolactin levels -d/t hypo or hyperthyroidism, psychosis/anxiety meds, renal failure, pituitary/uterine/ovarian tumors Pitting edema excessive swelling -d/t breast abscess, cancer, malignant condition: peau d'orange, trauma to breast, inflammation of breast, obstruction of milk ducts/glands, benign breast lump/cyst Candidiasis (thrush) yeast infection, likely candida -d/t nipple trauma, mastitis, antibiotic use, vaginal yeast infection, contraceptives, steriods -passed between mom and baby: treat both -thrush can cause gassy/fussy baby -mother c/o nipple/areolar pain, burning and radiating through breast -areola appears shiny pink -use good cleaning techniques -don't stop breastfeeding -tx with nystatin/diflucan -keep nipples dry, use clean breast pads, expose breasts to sunlight, decease sugar and dairy Vasospasm/Raynaud's stinging, tingling, burning with triphasic color changes: white/blue/red -triggered by emotional stress, cold; infants who clench, chew, bite the nipple -initiate let down before putting baby to breast -feed on less tender side first, ensure good positioning -avoid cold, apply heat, cover nipples, avoid caffeine, nicotine -use ibuprofen, nifedipine, compress end of nipple -more common with: scleroderma, lupus, rheumatoid arthritis, arteriosclerosis, pulmonary hypertension Engorgement Normal: fullness when tissues swell from milk "coming in." Pathologic: hard, tight, shiny, red, painful, unable to extract milk, can be aggravated by mismanagement of breastfeeding -at risk for permanent damage to alveolar cells -affects letdown and milk transfer -tx with breastfeeding often, warmth (if able to express milk), hand expression, massage, reverse pressure softening, cold compresses (if cannot express milk), cabbage leaves -avoid restrictive clothing Plugged duct tender sot or lump on breast from duct blocked by milk, localized pain, low grade fever, and flu like sx -d/t missed feedings, restrictive clothing, pressure on breasts -frequent feedings, hand massage, positioning baby's mouth in direction of duct, warmth, ibuprofen, decreasing saturated fat intake -can become mastitis Milk blister also called bleb, caused by a blocked nipple pore, painful -soak nipple in warm water and express -sterile needle extraction Mastitis swollen, tender, red, infected breast, generally bacterial cause. flu like sx, fever >101, breast throbbing, red streaks -often from poor breastfeeding technique, milk stasis: engorgement, plugged duct, fatigue, stress -tx with antibiotics, ibuprofen, milk removal, moist heat, bed rest, fluids, may need to culture milk if recurrent -usually occurs in 1st few weeks of breastfeeding Abscess advanced/untreated mastitis, local collection of pus without an opening for drainage -same sx and indications as mastitis -tx by lancing it and draining it -fluid cultured to determine antibiotic therapy -may still breastfeed Galatocele benign cyst containing milk, found in ducts of breast. Smooth, movable lump -continue to feed -dx with ultrasound -tx possible aspiration and surgery Duct ectasia "periductal mastitis" causes bilateral, multiduct, multicolored, intermittent, sticky nipple discharge. similar sign/sx to yeast: burning, itching, pain, swelling. may mimic cancer -breastfeeding can aggravate the condition, but is not contraindicated Fibrocystic breasts palpable irregularities in breast tissue -respond to menstrual cycle -continue to breastfeed Nausea r/t milk ejection reflex nausea with let down -disappears on own -increase fluid intake, snack often Dysphoric milk ejection reflex abrupt negative emotions before and during milk release -medications that increase dopamine may help -in extreme cases: mother can decrease supply in order to make her let downs less frequent Oversupply (hyperlactation) excessive milk volume -baby may choke, pull away, feed frequently, act colicky, explosive watery bowel movements. Foremilk can cause digestive/respiratory disorders -may be mistaken for food allergies or GERD -at risk for plugged ducts, mastitis, abscesses -dx with test weights -tx with block feedings, pumping some milk off first, pharmacologic management Nipple trauma/soreness normal for first week postpartum -may be d/t oral anomalies in infant, improper use of equipment, no buccal fat pads in infant -tx with positioning and attachment assistance, evaluate; nipple shape, flanges, vacumn on pump. Apply colostrum, anti-bacterial ointment on nipples, cold cloths, start feedings with less sore breast -if no improvement: 1-2 days nipple rest with expression used to preserve breastfeeding, skin to skin. Breast surgery -inquire about surgery -observe location of scars -ask about nipple sensitivity -teach mother how to assess normal feeding -test weights -hand expression, observe pumping -counsel about supplementation -allow mother to verbalize emotions