IBCLC 2022 Exam Guide, A+ Solutions

Free Sample: Ibclc 2022/ IBCLC Exam A+ Solution Guide Embryo and neonate weeks 3-4 - A primitive milk streak running bilaterally from axilla to groin Embryo and neonate Weeks 4-5 - Milk streak becomes mammary milk ridge or milk line . Paired breasts develop from this line of glandular tissue Embryo and neonate weeks 7/8 - Thickening and inward growth into chest wall continue Embryo and neonate weeks 12-16 - 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 - 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 - A lumen ( canal ) forms in each part of the branching system Embryo and neonate Near term - 15-25 mammary ducts form the fetal mammary gland Neonate - - 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 - 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 - 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 - 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 - Located in the superficial fascia ( fibrous tissue beneath skin) between 2nd rib and 6th intercostal space Tail of spence - 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 - Nipple, areola, and Montgomery glands Size - Not related to functional capacity Gives breast it's Shape and size - Fat composition Size may indicate - Milk storage potential Nipple - Conical elevation located slightly below center of areola Average diameter of Nipple - 1.6cm Average length of Nipple - 0.7 cm Hoe many milk Duct openings In nipple - 5-10 Smooth muscle fibers Function as a - Closure mechanism to keep milk from continuously leaking from the nipple The nipple is Densely innervated With - Sensory nerve endings What makes the nipple erect when contracted - Longitudinal inner muscles and outer circular and radial muscles Venostasis - Slows blood flow and decreases surface area Areola - Dark pigmented area that surrounds the nipple - elastic like nipple Average diameter Of areola - 6.4 cm Areola is constructed Of - Smooth muscle and collagenous , elastic , connective tissue fibers in radial and circular arrangement How does the nipple Aid infant in latching - Becomes smaller , firmer, and more prominent What happens to Areola in pregnancy - Darkens and enlarges Where are montgomerys tubercules located - Around the areola The Montgomery tubercules contain - Ductal openings of the sebaceous and lactiferous glands and sweat glands What happens to Montgomery glands in pregnancy - They enlarge and resemble small , raised pimples The Montgomery glands secrete ? - A substance that lubricates and protects the nipple Some secrete a small amount of milk Secretions of the Montgomery gland may produce ? - A scent to help the infant locate the nipple Parenchyma are - Functional parts of the breast Alveoli are ? - ( 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 ? - Absorb nutrients , immunoglobulin, and hormones from the mothers bloodstream to compose milk Prolactin receptor sites in the lactocytes Allow? - Prolactin to be absorbed from the blood and enter into the alveoli to stimulate milk production Myoepithelial cells do what ? - Encase the alveoli and contact in response to oxytocin to eject milk into ductules How many lobes does the breast contain - 15-25 that carry the milk through the ductules from the alveoli to the nipple Each lobe contains how many alveoli - 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? - Connections between lobes What do ducts do in response to milk ejection - Temporarily widen What do ducts do in response to duct drainage - Narrow What happens to milk that is not removed - It flows backward up the collecting ducts Lactiferous ducts lead to - 5-10 openings in the nipple Stroma - Supporting tissues of the breast Stroma include - Connective tissue , fat tissue, blood vessels , nerves, and lymphatics Coopers ligaments are - Suspensory ligaments running vertically through the breast What do coopers ligaments do - Attach the deep layer of subcutaneous tissue to the dermis layer of the skin The breast is highly - Vascular What supplies 60%of blood to the breast - Internal mammary artery What supplies 30%of blood to the breast - Lateral thoracic artery Blood vessels within the breast do ? - Enlarge What stimulates growth of the ducts - Surges of estrogen What causes glandular tissue to expand ? - Surges of progesterone The lymphatic system collects ? - Excess fluids from tissue spaces, bacteria, and cast off cell parts The lymphatic system drains where ? - The axillary lymph nodes mainly Breast innervation derives from mainly where ? - Branches of the 4th, 5th, and 6th intercostal nerves Where is nerve supply sparse ? - The innermost parts of the breast The fourth intercostal nerve - Penetrates the posterior aspect of the breast The 4th intercostal nerve supplies the greatest amount of sensation to the areola where ? - 4:00 on the left breast and 8:00 on the right breast How many branches does the 4th intercostal nerve divide into - 5 branches and it becomes more superficial as it reaches the areola The Lowermost branch of the 4th intercostal nerve penetrates the areola where ? - 5:00 on left breast and 7:00 on the right Trauma to the 4th intercostal nerve might result in - Some loss of sensation in the breast If the lowermost branch of the 4th intercostal nerve is severed what happens ? - Loss of sensation to the nipple and areola may result Aberrant sensory or autonomic nerve distributions in the nipple/areola complex could - Affect milk ejection reflex and secretion of prolactin and oxytocin Trauma or severing of the 4th intercostal nerve could result from - Breast augmentation or reduction surgery How much does a non pregnant mature breast weigh - 200g How much does a pregnant near term breast Weigh - 400-600g How much does a lactating breast weigh - 600-800g Asymmetry is common . Which breast is often larger - Left larger than right often Hypermastia - 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 - Renal or other organ system abnormalities What can lactate and undergo malignant changes - Accessory glandular tissue tissue Hyperthelia - Nipple without accompanying mammary tissue Hypertrophy - Abnormally large breast Hypomastia - Abnormally small breast Hyperplasia - Overdevelopment of the breast - hyperplastic breast Hypoplasia - Underdevelopment of the breast - hypoplastic breast Tubular or tuberous shape of because lack of glandular tissue - Hypoplastic breast Breasts may have large areolas - Hypoplastic breasts Breast are frequently asymmetric and widely spaced - Hypoplastic breast What type of breast may present increased risk for insufficient milk - Hypoplastic breast Poland's syndrome - Unilateral hypoplasia of the breast combined with hypoplasia of the thorax and pectoral muscle The normal nipple should - Evert and become protractor when compressed or stimulated What is the range of incidence of poor protractility in primigravid women - 10-35% Protractility - Improves during pregnancy - effect on latch is minimal when baby has a large amount of breast tissue Nipple inversion occurs in how many women - 3% and is usually bilateral A truly inverted nipple does what - Remains inverted when compressed or stimulated A pseudo inverted nipple does what - Appears inverted but everts when compressed or stimulated A short shanked nipple does what - Appears Everted but retracts when compressed or stimulated Common nipple does what - 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 - 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 - 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 - 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 .