IBCLC EXAM Maternal Pathology Questions With Correct Answers

Hypoplasia/ Amastia - Answer 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 - Answer spontaneous lactation, milk production post weaning -d/t medications or health problem Hyperprolactinemia - Answer elevated prolactin levels -d/t hypo or hyperthyroidism, psychosis/anxiety meds, renal failure, pituitary/uterine/ovarian tumors Pitting edema - Answer 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) - Answer 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 - Answer 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 - Answer 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 - Answer 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 - Answer also called bleb, caused by a blocked nipple pore, painful -soak nipple in warm water and express -sterile needle extraction Mastitis - Answer 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 - Answer 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