(Solution guide) 2022 International Board Certified Lactation Consultant (IBCLC) Certification Exam.

(Solution guide) 2022 International Board Certified Lactation Consultant (IBCLC) Certification Exam. Ibclc 2022/ IBCLC Exam A+ Solution Guide Embryo and neonate weeks 3-4 ✓- A primitive milk streak running bilatera ...

(Solution guide) 2022 International Board Certified Lactation Consultant (IBCLC) Certification Exam. 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 . Even with nipple retraction baby should be able to latch if mother helps form breast in mouth Bulbous ✓- Large nipple that may be difficult for baby to grasp Dimpled nipple ✓- Increases the risk for maceration as the nipple lies enveloped by the areola Midsagittal ✓- The plane vertically dividing the body through the midline into left and right halves Sagittal ✓- Any plane that is parallel to the midsagittal line vertically divided body into right and left portions Coronal ✓- Frontal - any plane dividing body into anterior or posterior Transverse ✓- Upper and lower portions Ipsilateral ✓- Pertaining to the same side Contralateral ✓- Pertaining to the opposite side Alveolus ✓- A small cavity in the breast - an arrangement of lactocytes around a central Lumen drained by a ductule Process ✓- Projections on a bone Fontanel ✓- Junctions of cranial bones covered by a tough membrane Lumen ✓- The cavity or channel within a tube or tubular organ Temporomandibular ✓- Opens and closes the jaw . Lateral displacement of the mandible Suture ✓- A joint that does not move - the bones are united by a thin layer of fibrous tissue Involuntary muscles ✓- Contraction controlled by autonomic nervous system no willful control Voluntary muscles ✓- Movement using willful control , central nervous system Visceral smooth muscles ✓- Found in digestive and respiratory tracts Cardiac / striated muscles ✓- Involuntary striated muscle - allowing coordination of contraction Skeletal / striated muscle ✓- Voluntary , striated ; gross and fine motors movements Lymphatic system ✓- Drains tissue spaces, provides for intercellular waste disposal , and carries absorbed fat in the blood Endocrine system ✓- Chemical regulator of body functions Occipital bone ✓- Forms the back and base of the cranium ; contains the foramen magnum through which the spinal cord passes Frontal bone ✓- Forms the forehead , roof of the nasal cavity , and orbits Parietal bone ✓- Sides and roof of the cranium Temporal bone ✓- Sides and base of the cranium ; houses the middle and inner ear structures Sphenoid ✓- 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 ✓- Between the nasal bones and sphenoid ; forms parts of the nasal septum ; walls of orbits Nasal bone ✓- Upper bridge of nose Vomer bone ✓- Posterior nasal cavity ; forms a portion of the nasal septum Lacrimal bone ✓- Anterior , medial wall of the orbit Zygomatic arch ✓- Prominence of the cheeks and part of the lateral wall and floor of the orbits Palatine ✓- Posterior cavity between the maxillae and sphenoid Maxilla ✓- Upper jaw Mandible ✓- Lower jaw Hyoid bone ✓- Horseshoe shaped bone suspended from the styloid process of the temporal bone p Choanae ✓- Posterior nasal apertures paired passages from the nasal cavity to the nasopharynx What does bf do to the choanae ✓- Widens it unless tongue tie is present Coronal suture ✓- Line of articulation between the frontal bone and the 2 parietal bones Sagittal suture ✓- Line of articulation between the 2 parietal bones in the midline Lambdoidal ✓- Anterior articulation between the occipital and parietal bones Anterior fontanel ✓- A diamond shaped interval where the frontal angles of the parietal bones meet the 2 separate halves of the frontal bones Posterior fontanel ✓- A triangular interval at the union of the lambdoid and sagittal sutures Sphenoidal fontanel ✓- Irregularly shaped interval on either side of the skull Mastoid fontanel ✓- Interval on either side of the posterior skull Cranial nerve I ✓- Olfactory : smell cranial nerve 2 ✓- Optic : sight Cranial nerve 3 ✓- Oculormotor:innervates external muscles for several movements of the eye Cranial nerve 4 ✓- Trochlear : innervates muscles that move the eye up and down Cranial nerve 5 ✓- Trigeminal : three branches : muscles of mastication Cranial nerve 6 ✓- Abducens: moves the eye away from the center of the body Cranial nerve 7 ✓- Facial : muscles of facial expression Cranial nerve 8 ✓- Vestibulocochlear: hearing and equilibrium Cranial nerve 9 ✓- Glossopharyngeal: taste, sensation in pharynx ( important for swallowing ) Cranial nerve 10 ✓- Vagus: larynx, pharynx Cranial nerve 11 ✓- Spinal accessory : muscles of the neck and shoulder Cranial nerve 12 ✓- Hypoglossal: movements of the tongue How many nerves and muscles must coordinate for swallowing ✓- 26 muscles and 6 cranial nerves Mouth suckling cranial nerves ✓- 5 ( sensory - shape: texture ) 7 motor Tongue suckling cranial nerves ✓- 7, 9 (taste , sensory ) 12 motor Jaw suckling cranial nerves ✓- 5 ( sensory position of TMJ) 5 motor ; 5 does both sensory and motor Palate swallowing nerves ✓- 5, 9 ( sensory ) 5,7,9,10 motor Tongue swallowing nerves ✓- 9 sensory 5,7,12 motor Pharynx swallowing nerves ✓- 5,9 sensory 9, 10 motor Larynx ✓- 10 sensory : 9,10 motor Muscles used in mastication and suckling ✓- Temporalis, Masseter, medial pterygoid , lateral pterygoid, buccinator , orbicularis Oris mentalis Temporalis muscle ✓- Raises the mandible : closes mouth : draws the mandible backward Masseter muscle ✓- Closes the jaw Medial pterygoid muscle ✓- Raises the mandible : closes the mouth Lateral pterygoid ✓- Brings the jaw forward Buccinator ✓- Compresses the cheeks and retracts the angle Orbicularis oris ✓- Closes the lips Mentalis muscle ✓- Elevates center of lower lip Genioglossus muscle ✓- Depressed and extends / protrudes tongue forward Styloglossus muscle ✓- Draws the tongue upward and backward Stylohyoid ✓- Draws the hyoid and tongue upward Digastric muscle ✓- Raises the hyoid or opens the mouth Mylohyoid muscle ✓- Elevated the hyoid : supports the mouth floor Hypoglossus muscle ✓- Depresses the tongue Geniohyoid ✓- Elevates and draws the hyoid forward Superior longitudinal muscle ✓- Elevates tip and sides of tongue , makes tongue concave Inferior longitudinal muscle ✓- Curls tongue tip downward , makes tongue convex Transverse lingual muscle ✓- Narrows, elongages and protrudes Vertical lingual muscle ✓- Broadens and lengthens tongue Sternohyoid muscle ✓- Depresses the hyoid and larynx Omohyoid muscle ✓- Depresses the hyoid Sternothyroid muscle ✓- Depresses the thyroid cartilage Thyrohyoid ✓- Raises and changes the form of the larynx The oral cavity or mouth is bounded by what ✓- The roof , floor, lips , and cheeks The roof of the mouth consists of what ✓- The Palatine process of the maxilla and the palatine bone ( hard palate ) The roof of the mouth transitions into what ✓- Posteriorly into the soft palate and uvula The floor of the mouth consists of what ✓- Mandible spanned by the mylohyoid, geniohyoid , and front of the digastric muscle What muscle surrounds the lips ✓- Orbicularis oris What muscles define the cheeks ✓- Buccinator and Masseter muscles What helps provide stability for the cheek during sucking and provides lateral borders for the tongue ✓- Sucking pads that consist of fatty tissue encased in the cheek The mandible is ✓- Small and retracted The tongue does what ✓- Fills the entire oral cavity and touches the roof and floor of the mouth as well as the lateral gum lines and cheeks Lingual frenulum ✓- Fold of mucous membrane extending from the floor of the mouth to the midline of the under surface of the tongue , should regress during midgestation Labial frenae ✓- The membranes that attach the lips to the gum ridges , inferiorily and superiority Pharynx ✓- A soft muscular tube at the back of the throat Oropharynx ✓- Composed of the area between the elevated soft palate and the epiglottis Nasopharynx ✓- Section of the pharynx between the nasal choanae and the elevated soft palate : the eustachian tubes originate here Hypopharynx ✓- Extends from base of epiglottis to the cricopharyngeal sphincter Larynx ✓- Gateway to the trachea composed of cartilage suspended by muscles ligaments to the hyoid bone and cervical vertebrae The larynx contains what ✓- The epiglottis and the vocal folds or chords What does the epiglottis do during swallowing ✓- Folds down to cover the airway What do the vocal folds or cords do During swallowing ✓- They close to protect the airway Trachea ✓- Tube that bridges into bronchi leading to each lung Esophagus ✓- A thin muscular tube that extends to the stomach and distends as food is propelled through it by peristaltic motion What does the hard palate do ✓- Assists with positioning and stability of the nipple within the mouth What does the soft palate do ✓- Works with the tongue to create the posterior seal of the oral cavity What does the soft palate do during swallowing ✓- It elevates contacting the pharyngeal walls and closing off the nasal cavity directing the bolus toward the hypopharynx The hard palate should be ✓- Intact and smoothly contoured In utero and after birth the shape of the hard palate ✓- Is contoured by the tongue and it's continual pressure as it rests and moves against the palate Submucous clefts of the soft palate ✓- Cannot be directly visualized High palate ✓- The palate or a portion of the palate is very high altering the shallow saucer shape Wide or flat palate ✓- Reduced arch Narrow palate ✓- Reduced horizontal spread of palate Short and longer palates ✓- Shorter or longer than typical 1 inch from the alveolar ridge ( gum ridge ) to the point where the soft palate folds Channel palate ✓- Midline groove usually from the prolonged presence of orotracheal tubes V shaped arch ✓- A high narrow palate that is narrow anteriorly Bony prominences ✓- Uncommon : more common is an Epstein pearl Epstein pearl ✓- Accumulations of epithelial cells also called a retention cyst located at the juncture of the hard and soft palates Sloped palate ✓- Sudden declines in the normal curve Bubble palate ✓- Concavities of the hard palate confined with a rim Cleft palate ✓- A complete opening in the hard or soft palate resulting from the failure of the primary palate and or palatal shelves to meet and fuse during the 7-8 week of gestation Normal mandible placement is ✓- Upper and lower jaw loosely opposed : both gum ridges in direct opposition Recessed jaw ✓- The lower gum ridge is posterior to the upper gum ridge Micrognathia ✓- An excessively small or posteriorly positioned mandible ; internally the tongue is also posteriorly positioned in relation to the oral cavity What does the tongue do ✓- Brings the nipple into the mouth shaping it and stabilizing its position What happens when the posterior tongue and mandible drop ✓- Negative pressure in the mouth causes milk to flow from the nipple What does the wave of compression from front to back with the tongue do ✓- Exerts positive pressure to initiate swallow moving bolus back into pharynx The tongue forms a central groove in order to ✓- Stabilize the teat and channel fluid toward the pharynx The tongue assists in ✓- Forming a bolus to prep for swallow The tongue is ✓- Soft with a rounded tip The tongue is normally where ✓- The bottom of the mouth with a slight central groove and the tip over the lower gum Tongue tip elevation ✓- The tip of the tongue is in opposition to the upper gum ridge or the palate behind the alveolar ridge Humped tongue ✓- tongue is compressed from front to back Bunched tongue ✓- Compressed in a lateral direction Retracted tongue ✓- Held posteriorly in the mouth behind the inferior alveolar ridge Protruded tongue ✓- The tip rests forward well past the lips Tongue tie or ankyloglossia ✓- A short or tight lingual frenulum What does the rooting reflex cause ✓- Touching or stroking the baby's lips or cheek causes a turning of the head toward the stimulus and opens the mouth ( gape response ) Sucking reflex ✓- A light touch of the nipple or a finger to the lips or tongue initiates the complex movements of the suckle Swallowing is elicited by ✓- A bolus of fluid impacting the sensory receptors of the soft palate and back of the mouth : has both reflexive and voluntary properties triggered at the valeculae in newborns Protrusion reflex ✓- Baby's tongue moves down and foresee grasping and drawing the breast into the mouth Gag reflex ✓- Protects the baby from ingesting items that are too large for the esophagus - elicited in the newborn at the mid tongue area Cough reflex ✓- Mechanism that protects the airway from the aspiration of liquids Scanning ✓- Searching the breasts with the cheeks by moving the head from side to side Stepping reflex ✓- Using the stepping reflex to crawl to the breast Hand movement reflex ✓- Predictable hand movement to stimulate move and shape the breast The breasts are capable of full lactation when ✓- From 16 weeks forward What happens early in the first trimester ✓- Mammary epithelial cells proliferate ductal sprouting and branching are initiated and lobular formation occurs First trimester ✓- Ducts proliferate into fatty pad and ductal ends bud into alveoli First trimester ✓- Increases occur in mammary flow , interstitial water , and electrolyte concentrations First trimester ✓- Mammary blood vessels increase their luminal diameters and form new capillaries around the lobules Third trimester ✓- Secretory cells fill with fat droplets and the alveoli are distended with colostrum Mid pregnancy ✓- Mammary cells become competent to secrete milk proteins but are kept in check by high levels of steroids circulating , particularly progesterone Where do most milk products secreted during pregnancy go ? ✓- They find their way back into the plasma via the leaky junctions (spaces between the mammary alveolar cells ) Lactogenesis is driven by the hormones of the ✓- Endocrine control system What accelerates breast growth ✓- Lactogen , prolactin , and human chorionic gonadotropin What is required for mammary growth and epithelial proliferation during pregnancy ✓- A form of estrogen , 17 beta - estradiol What enhances formation of the lobules during pregnancy ✓- Glucocorticoids What does estrogen do during pregnancy ✓- Increases and stimulates ductal sprouting ✅Continues