IBCLC Exam 1 Questions With Correct Answers

What week gestation does the breast begin to develop in utero? - Answer *4th* week of gestation Where does the primitive milk streak develop - Answer Bilaterally from the axilla to the groin By the 5th week gestation the milk streak becomes what? - Answer Mammary Milk Ridge (or milk line) Thickening and inward growth into the chest wall continues during what weeks gestation? - Answer *7-8* weeks gestation Between weeks 12 and 16 gestation specialized cells differentiate into what? - Answer Smooth muscles of the nipple and areola What forms the mammary pit? - Answer Lactiferous ducts and their branches open into a shallow epithelial depression What failure creates an inverted nipple? - Answer When the Mammary pit fails to elevate What is witches milk? - Answer After birth, a neonate's mammary tissue (under the influence of maternal hormones) might recreate colostral like fluid At what age do the primary and secondary ducts grow and divide and form the terminal end buds that become the alveoli? - Answer 10-12 years old (puberty) When does *complete* development of mammary function occur? - Answer During pregnancy What is superficial fiscia? - Answer Fibrous tissue beneath the skin Where is the breast located? - Answer In the superficial fascia between the *2nd rib and 6th ICS* What are the two major divisions of the breast? - Answer Parenchyma and Stroma What makes up the Parenchyma? - Answer Ducts, lobes, and aveoli What are alveoli? - Answer Small sacs where milk is secreted What makes up the Stroma? - Answer Connective and fat tissue, blood vessels, nerves, and lymphatics. What is Cooper's Ligament? - Answer Suspensory ligament that are the fibrous connections between the inner side of the breast skin and pectoral muscles. Help to shape the breasts What does the nipple contain? - Answer 15-25 milk ducts, smooth muscle fibers, sebaceous and apocrine sweat glands, and dense innervations of sensory nerve endings How many milk ducts does the nipple contain? - Answer 15-25 What are Montgomery Tubercles? - Answer Sebaceous glands in the areola surrounding the nipple What do the Montgomery Tubercles secrete? - Answer *Oily secretions* (lipoid fluid) to keep the areola and the nipple lubricated and protected What 2 arteries supply blood to the breast (60% / 30%)? - Answer Internal mammary artery (60%) and lateral thoracic artery (30%) Where does the lymphatic system of the breast drain excess fluids from tissue space, bacteria and cast off cells? - Answer Auxiliary lymph node Where do the nerves of the breast branch from? - Answer 4th, 5th, and 6th intercostal nerve What nerve supplies the greatest amount of *sensation* to the areola? - Answer *4th* intercostal nerve What part of the breast is most sensitive? - Answer The areola followed by the general skin of the breast, and then the nipple which is least sensitive. What percent of breast milk is *carbohydrates*? - Answer Approximately 7% What are the six infant behavioral "states" - Answer *Crying* *Active alert*=fussy *Quiet alert*=ready to play *Drowsy*= irreg. breathing, heavy eyes *Active sleep*= eye movement under lids, twitching *Quiet sleep*= reg resp. relaxed, diff. to wake Milk components that protect the infant/lactating breast actively bind ______, preventing their passage through the permeable infant _____ _____ - Answer pathogens gut mucosa How does the infant get the antibodies produced by mom? - Answer antibodies are produced in moms blood, targeted *SIgA* which is transported across the mammary secretory cells and released in the milk. What is sIgA? - Answer Immunoglobulin A is an antibody that coats mucosal surfaces to prevent adherence and penetration by pathogens What are the most common food allergies? - Answer 1. Cow's milk protein 2. Eggs 3. Peanuts 4. Tree nuts 5. Fish 6. Shellfish 7. Soy 8. Wheat What are the common symptoms of food allergies? - Answer 1. Eczema 2. Hives 3. Digestive or respiratory problems (e.g. mucus or blood in the stool) The infant uses their _____ to draw in the nipple and ____ it in the mouth - Answer Lips Stabilize Weak lip tone is also called? - Answer *Hypotonic lips* result in the inability to seal lips around the breast impacting the amount of suction created What is a sucking blister? What are 2 things it can be caused by? - Answer friction abrasions resulting from *retracted lips or a labial frenulum* that restricts the lips from flanging What does weak lip tone look like? - Answer Milk spilling, smacking sound (breaking suction), infant tires faster due to increased work of the feedings even though they aren't efficient feedings Things to look for when assessing the lips: - Answer Seal Tone Stretchy labial frenulum No breaks in suction No milk spilling What do fat deposits in the cheeks help provide? - Answer *structural support* to stabilize nipple in the mouth Does low/weak tone cause the infant to have higher or lower levels of suction? - Answer lower levels of suction What does Hypotonia mean? - Answer Low tone What does it mean if an infant has thin cheeks due to reduced fat pads? - Answer That the infants intraoral space is larger than normal, forcing them to create a larger vacuum to generate and sustain suction. So the *work for a feeding increases* What does the dancer's hand help with? - Answer Cheek stability What does the jaw provide stability for? - Answer Tongue, lips, and cheeks Almost all babies have ___ jaws - Answer receding Preterm infants usually have jaw instability because of what 2 things? - Answer Low muscle tone Immature muscles What is micrognathia? - Answer abnormally receding chin (can happen in certain breach positions) What is Pierre Robin Syndrome? - Answer Severe micrognathia ( receding chin) that can obstruct the airway How do you help with nipple pain if a baby has a receding jaw? - Answer *Tip the infants head in a slightly extended position* to bring the chin closer to the breast Abnormally wide jaw excursions can cause a ____ in ____ - Answer *break* in *suction* What are some methods to help during a feeding with an abnormality in the jaw? - Answer 1. provide *external support with a finger* placed under the jaw to help with distance of jaw excursions 2. *Position infant so head* is extended up to help lower jaw extend to breast 3. find a *position that is comfortable for mom* and baby to help with jaw stability How does the tongue create negative pressure with a baby is latched? - Answer The tongue should be able to lift freely and lift the mothers nipple against the hard palate so with each drop of the tongue, the oral cavity gets larger and creates negative pressure When assessing the tongue you should look for all of the following: - Answer 1. shape 2. restrictions 3. position 4. abnormalities True or false: an infant who is struggling with a fast flow will break suction on their own - Answer True! How does the palate get shaped in utero? - Answer The tongue pressed against it Bubble palates result from what? - Answer Tongue Tie. The tongue is not able to extend all the way to the middle of the palate due to the restriction. So where the tongue is anchored, you will feel a bubble on the palate What is the job of the hard palate during a feeding? - Answer It opposes the tongue helping to *compress the nipple and maintain its position in the mouth* What are Epstein's pearls? - Answer They are small, round, white cysts that are found on the ridge of the hard palate or gums and they usually go away within 2 months (do not affect BF) Epstein's Pearls can sometime be mistaken for what? - Answer teeth or thrush What is a partial or incomplete cleft lip? - Answer Small gap or indentation of the lip What is the difference between a unilateral and bilateral complete cleft lip? - Answer Unilateral refers to 1 side, bilateral refers to both sides and complete means that it continues into the nose. What is an incomplete cleft palate? - Answer A "hole" in the roof of the mouth, usually as a cleft soft palate *D* What is a complete cleft palate? - Answer Soft and hard palate, possibly including a gap in the jaw Why does a cleft palate make BF more difficult? - Answer Because the infant is unable to seal the oral cavity to create suction What is a submucosal cleft? - Answer A defect in the closure of the shelves behind the hard palate. These are hard to identify because a *thin layer of skin grows over the hole* How do you identify a submucosal cleft? - Answer *By shining a light on the palate*-it reveals a translucent area What is a bifurcated uvula and what does it usually indicated? - Answer A forked uvula that usually reveals a cleft defect What does nasal regurgitation usually indicate? - Answer Cleft palate What position helps a prevent nasal regurgitation and aspiration? - Answer sitting up right What are Alveoli? - Answer Small cavity in breast lined with lactocytes What is a lactocyte? - Answer Milk producing cell What are the cranial nerves and what is the acronym? - Answer I. Olfactory-smell II. Optic-sight III. Oculomotor-movement of the eye IV. Trochlear- movement of the eye up and down V. Trigeminal- muscle of mastication* VI. Abducens- moves the eye away from the center of the body VII. facial-moves the muscles of the face* VIII. auditory (vestibulocochlear) hearing and equilibrium IX. Glossopharyngeal- taste, sensation in the pharynx* X. Vagus-larynx and pharynx* XI. Spinal accessory-muscles of the neck and shoulder* XII. Hypoglossal-muscles of the tongue* "On Old Olympus' Towering Top A Fin and German Vend Some Hops" What does the sternohyoid muscle do? - Answer Depresses the hyoid and larynx what does the Omohyoid muscle do? - Answer Depresses the Hyoid What does the Thyrohyoid muscle do? - Answer Raises and changes the form of the larynx What is the buccinator and masseter muscles and what do they do? - Answer *Sucking pads that consist of fatty tissue in the cheek* that provide stability of the nipple during sucking What is the lingual frenulum? And if it is short, more posterior or anterior what does it cause? - Answer Strip from floor of the mouth to the midline under the surface of the tongue. Can cause *tongue tie* What is the labial frenulum and if it is short or extends what does it cause? - Answer Membrane that attaches the lips to the gum ridge. if it is short or attaches to the papilla it can cause a *lip tie* What is the oropharnyx? - Answer Area between the elevated soft palate and epiglottis Where do the estuation tubes originate? - Answer Nasopharynx What does the oral anatomy consist of? (5 things) - Answer Nose, mouth, pharynx, airways, and esophagus From birth-6 months the ____ ____ and _____ are close in proximity - Answer Soft palate and epiglottis From birth-6 months that oral cavity is long or short? - Answer short What happens to the oral cavity between 6-12 months? - Answer The oral cavity *elongates* vertically. Soft palate and epiglottis are no longer close in proximity, and now the larynx must elevate farther to allow the epiglottis to fully seal during a swallow