B&HL Anatomy Exam Review

1. Name the 5 phases of lactation:

1. mammogenesis

2. lactogenesis I

3. lactogenesis II

4. galactopoiesis

5. involution

2. When does breast development begin?: by the 4th or 5th week of gestation when two parallel primitive milk streaks develop from axilla to groin on the trunk of the embryo

3. What weeks of gestation does the mammary ridge or milk line develop?: by the 5th week of embryonic life

4. What develops during weeks 12-16 of gestation?: areola and nipple develop;

as well as the tree-like pattern forming alveoli

5. What develops in weeks 32-40 gestation?: lobular alveolar structures containing colostrum develop

6. Is it normal for a neonate's mammary tissue to secrete colostral milk for as long as 3-4 weeks? If so, what is it called?: Yes (witch's milk) (galactorrhea)

7. At puberty what 5 hormones influence breast growth in a girl?:

1. estrogen

2. prolactin

3. luteinizing hormone

4. follicle stimulating hormone

5. growth hormone

8. Buds develop into new branches and small ductules of areolar buds, which later become the alveoli in the mature female breast, also known as:                 : terminal ductule lobular units

9. complete development of mammary function occurs when?:

only in preg- nancy, when the breasts increase in size and the nipple pigment darkens

10. New budding of structures continues until about age            : 35 years old

11. Each cluster of secretory cells of an alveolus is surrounded by

                  , a contractile unit responsible for eject- ing milk into the ductules.: myoepithelial cells

12. the basic unit of the mature glandular (mammary) tissue are the

                    .: alveoli

13. Ducts grow inward from the ectodermal layer and canalize by          weeks' gestation.: 32 weeks'

14. The ducts are lined with                                                        

                     near

the nipple, with columnar epithelium at more distal areas, and with highly vascular                     tissue.: stratified squamous epithelium; connective

15. the alveolus is a: milk-secreting unit

16. The alveolus (milk-secreting unit) is made up of single layer of epithelial cells that is surrounded by supporting structures:

1.

2.

3.: 1. myoepithelial cells

2. contractile cells for milk ejection

3. connective tissue

17. Milk is secreted into the                                           , where it is stored until the letdown reflex triggers the myoepithelial cells to contract and eject the milk: alveolar lumina

18. in each breast, there are         -            interwoven lobes, each containing between        and     alveoli.: 15-25 ; 10 and 100

19. The nerve supply of the breast is derived from the        to the        inter- costal nerves.: 2nd - 6th

20. The          intercostal nerve penetrates the posterior aspect of the breast and supplies the greatest amount of sensation to the nipple and areola.: 4th

21. if the lowermost nerve branch is severed, the mother will lose sensation to the nipple and areola. Which nerve are they describing?: 4th intercostal nerve

22. Milk ducts are small, superficial, easily compressed, and increase in diameter at                                 .: milk ejection

23. The nipple and areola contain erectile                      muscle.: smooth

24. The size of the areola increases significantly in the first few days post- partum, especially on day     with lactogenesis.: day 3

25. average diameter of the areola is          cm.: 6.4

26. average diameter of the erectile portion of the nipple is          cm and the length is        cm.: 1.6 cm, 0.7 cm

27. Within the areola lie Mongomery's tubercles, which consist of mammary milk glands and sebaceous glands; together they are called                                                                                                                                                                                  

                .: areolar glands

28. TRUE/FALSE- the left breast is often larger than the right: TRUE

29. Polymastia: multiple breast tissue

30. polythelia or supernumerary nipples: multiple nipples

31. Occasionally polythelia is associated with                and                                                                                                                                                                                                 

anomalies.: kidney and urinary tract anomalies

32. In pregnancy, nipple growth is related to serum                      levels.: pro- lactin

33. In pregnancy, areolar growth is related o serum                                          .-

: placental lactogen

34. lactogenesis is: transition from pregnancy to lactation

35. growth and proliferation of the ductal tree and further formation of lob- ules characterize the             half of pregnancy.: first

36. In the            half of pregnancy, secretory activity accelerates and the acini or alveoli become distended by accumulating colostrum: second

37. lactogenesis stage I- from         to day        postpartum: midpregnancy to day 2 postpartum

38. lactogenesis stage II- from         -           to day          postpartum: day 3 to day 8

39. galactopoiesis- from           to              : day 9 to beginning of involution

40. involution- from                   : average 40 days after last breastfeeding

41. During full lactation, the passage of substances between alveolar cells is stopped by a gasketlike protein structure called                    , which joins the epithelial cells tightly to one another.: desmosome

42. Involution two step process:: 1. death of the secretory epithelium

2. replacement by adipocytes

43. Delayed lactogenesis II has been associated with maternal                                                                                                                                                                                  

and maternal                                                    .: obesity; infant seperation

44. progesterone inhibits                                .: prolactin

45. Prolactin is secreted by the                                                               

                                    .: anterior pituitary gland

46. A group of peptides including                                 ,                               , and

              , sitmulate the release of prolactin.: angiotensin II, gonadotropin-re- leasing hormone (GnRH), and vasopressin

47. During galactopoiesis, the                                is dependent upon milk removal for lactation to continue.: hypothalamus

48. When milk secretion shifts from endocrine to autocrine control. prolactin secretion continues to be controlled by the                                      .: hypothal- amus

49. Prolactin levels remain elevated throughout the first                months postpartum in women who breastfeed at regular intervals.: 6 months

50. During                   , the hypothalamus is dependent on milk removal for lactation to continue.: Galactopoeisis

51. When the nipple is stimulated and milk is removed from the breast,

the hypothalamus inhibits the release of                        , a prolactin-inhibiting factor; this drop in                           stimulates the release of prolactin and promotes milk production.: dopamine; dopamine

52. Prolactin concentration in blood doubles in response to suckling and peaks approximately 45 minutes after the beginning of a breastfeeding ses- sion.:

53. If a mother does not breastfeed, prolactin levels usually reach non-preg- nant levels by day       post partum.: 7

54. Milk prolactin concentration is lower than its concentration in blood plasma and is highest in early transitional milk and foremilk rather than hind milk.:

55. Milk prolactin levels are about the same between the left and right breasts and are highest in the morning.:

56. Multiparous women had a greater number of mammary gland receptors for prolactin.:

57. The number of prolactin receptors, rather than the number of prolactin in serum. (multiparous babies gain weight faster than primip babies):

58. Cortisol is a                                                     : Glucocorticoid

59. Cortisol acts synergistically on the mammary system in the presence of

                                  .: prolactin

60. TRUE/FALSE Prolactin is also present in breastmilk.: TRUE

61. Glucocorticoids are hormones secreted by the adrenal glands that help to regulate water transport across the cell membranes during lactation.:

62. A high cortisol level is associated with a delay in

                                                                  .: lactogenesis

63. Thyroid stimulatig hormone (TSH) promotes                                                                                                                                                                                  

                             and lactation through a permissive rather than regulatory role.: mammary growth and lactation

64. Prolactin Inhibiting Factor (PIF) stimulates                                releases and inhibits prolactin secretions (dopamine agonist).: dopamine

65. NIpple stimulation and milk removal suppresses PIF and dopamine, caus- ing prolactin levels to rise and the breast to produce milk.:

66. Drugs such as domperidone, metocloporamide, phenothiazines, and re- serpine derivatives increase breastmilk production because they inhibit

                .: Prolactin inhibiting factor

67. In response to suckling, release of the posterior pituitary hormone oxy- tocin causes the milk-ejection reflex (MER) or letdown, a contraction of the myoepithelial cells surrounding the alveoli necessary for the removal of milk from the breast.:

68. The uterus not only contracts during breastfeeding, but also continues to contract rhythmically for as long as            minutes after the feeding.: 20

69. When exposed to stress, lactating women have been found to have lower levels of ACTH, cortisol, glucose, and norepinephrine compared to nonlactating women.:

70. Lactation shifts from endocrine control (hormone driven) to autocrine control (milk removal driven).:

71. An autocrine feedback mechanism, the feedback inhibitor of lactation

(FIL) appears to locally control milk synthesis.:

72. Galactopoiesis is the maintenance of the established milk production.:

73. It is the quantity and quality of infant suckling or milk removal that governs breastmilk synthesis.:

74. Galactorrhea is the spontaneous secretion of milk from the breast under nonphysiological circumstances.:

75. Thyrotoxicosis, certain drugs (reserpine, methyldopa, phenothiazines, antipsychotics), and the use of intrauterine devices containing copper can trigger abnormal milk secretion.:

76. In some women, galactorrhea is a symptom of a larger problem of

                                                  ; in addition to spontaneous milk secretion, these women may complain of amenorrhea, difficult in becoming pregnant, and lack of libido.: hyperprolactinemia

77. Hypoplasia (lack of breast tissue) signified by a wide space between breasts (intramammary space), a short breast that has a dog-eared appear- ance (high inframammary fold), and thin, tubular breasts are anatomic "red flags" associated with                                      lactation.: insufficient lactation

78. lateral incision in the vicinity of the cutaneous branch of the                                                                                                                                                                                  

                     made during breast augmentation or reduction surgery may mean severed innervation of the nipple to areola.: fourth inter- costal nerve

79. surgery on the breast, especially if it involves an incision at the areolar margin, is likely to interfere to some degree with milk production.:

80. An increase in breast size, swelling, and tenderness usually indicates adequately functioning breast tissue responsive to hormonal changes.:

81. significant scarring of the dermis and epidermis may result in

1.

2.

3.: 1. reduced maternal sensation when the infant suckles

2. minimal tissue elasticity, requiring the mother to alter the baby's position at the breast

3. reduced milk ejection if a nipple has been surgically reconstructed

82. What makes up the stroma?: connective tissue, fat tissue, blood vessels, nerves, and lymphatics

83. what makes up the parenchyma?: ducts, lobes, and alveoli

84. what does the nipple contain?: 15-25 milk ducts, smooth muscle fibers, sebaceous and apocrine sweat glands, and dense innervations of sensory nerve endings

85. what are montgomery tubercles?: sebaceous glands in the areola sounding the nipple

86. What artery(s) supply blood to the breast?: Internal mammary artery (60%)

and lateral thoracic artery (30%)

87. what are the common symptoms of food allergies?: 1. Eczema

2. Hives

3. Digestive or respiratory problems (e.g. mucus or blood in the stool)

88. 5 S's for breast assessment: 1. symmetry

2. size

3. shape

4. surgery

5. scars (supernumerary nipples)

89. All of the following accurately describe oxytocin EXCEPT:

a, it is secreted by the anterior pituitary b. it is secreted by the posterior pituitary

c. it is the primary hormone that regulates milk ejection

d. it causes the epithelial cells of the alveoli to contract: A. it is secreted by the anterior pituitary

90. The alveolus contains two types of cells; these are the:

a. myoepithelial cells and the secretory cells b. myoepithelial cells and the squamous cells c. secretory cells and the squamous cells

d. squamous cells and the stem cells: a. myoepithelial cells and the secretory cells

91. Which of the following will suppress the release of oxytocin?

a. infant suckling the breast b. hearing the infant cry

c. ice on the nipples

d. consuming a warm drink: c. ice on the nipples

92. The sucking reflex could be correctly described as:

a. elicited by tactile or chemical stimulation of the palate b. elicited by tactile or chemical stimulation of the tongue c. present beginning around the 34th week of gestation

d. disappearing around 6 months of life: a. elicited by tactile or chemical stimu- lation of the palate

93. Negative pressure exerted by the infant's mouth on the nipple/areola primarily:

a. draws milk out of the breasts

b. reduces the resistance of the sucking fat pads

c. holds the nipple/areola in place: c. holds the nipple/areola in place

94. During the first 20 minutes of suckling, you could say that serum prolactin levels:

a. somewhat decrease from baseline b. more than double from baseline

c. more than triple from baseline: b. more than double from baseline

95. From day 4 to day 20, the grams of lactose in human milk:

a. increase, which increases milk supply; concentration is about the same b. increase, which increases milk supply; concentration also increases

c. increase, which increases milk supply; concentration decreases

d. decrease, which increases milk supply; concentration is about the same-

: a. increase, which increases milk supply; concentration is about the same

96. A more acid gut environment would:

a. inhibit the growth of normal flora b. inhibit the growth of acidophilus c. promote the growth of lactobacilli

d. promote the growth of clostridia: c. promote the growth of lactobacilli

97. Lysozyme is an:

a. ion

b. enzyme

c. interferon

d. immunoglobulin: b. enzyme

98. A concentration of lactose increase:

a. milk volume increases and sodium concentrations decrease b. milk volume increases and sodium concentrations increase c. milk volume decreases and chloride levels decrease

d. milk volume decreases and chloride levels increase: a. milk volume increas- es and sodium concentrations decrease

99. Long-chain polyunsaturated fatty acids are essential for:

a. soft, nonmalodorus stools

b. retinal and neural tissue development c. glucose synthesis and stabilization

d. bilirubin transport and excretion: b. retinal and neural tissue development

100. Bioactive factors in human milk include all EXCEPT:

a. glucoconjugates b. nucleotides

c. triglycerides

d. cytokines: c. triglycerides

101. Which two deficiencies would be most likely to occur in a lactating woman?

a. calcium and zinc

b. calcium and phosphorus c. magnesium and zinc

d. potassium and zinc: a. calcium and zinc

102. A mother with CMV gave birth to a baby who weighed 1427 grams at birth. She wants to know if it is okay to breastfeed. Which of the following would be your BEST response?

a. reassure her that breastfeeding is not contraindicated for CMV. b. talk with her and her doctor about some possible precautions

c. initiate breastfeeding only after the infant has had the HBIG vaccine. d. gently inform her that breastfeeding is strictly contraindicated in this case.: b. talk with her and her doctor about some possible precautions (There are no recommendations against breastfeeding by mothers who are

CMV-seropositive. However, infants born <30 weeks gestational age and <1500g who acquire CMV from breast milk may be at risk of developing a late-onset sepsis-like syndrome.)

103. The natural-killer (NK) cells are:

a. non-specific white cells to fight disease b. specific white cells that fight disease

c. red cells that destroy disease

d. red cells that prevent disease: a. non-specific white cells to fight disease

104. To help a mother who has Hepititis B, you should:

a.teach her how to prepare formula for her infant b. make sure her infant has been given the HBIG

c. make sure her prescribed antibiotic is safe during breastfeeding

d. tell her to freeze her milk for 72 hours before giving it: b. make sure her infant has been given the HBIG

105. When choosing a breast shell for a woman with flat nipples, you would choose the style with which of the following characteristics?

a. a smaller hole b. a lager hole

c. a cotton insert: a. a smaller hole

106. You might describe an obturator as:

a. used for newborns with Down Syndrome b. used for older infants with autism

c. a semi-soft prosthesis for a cleft palate

d. a semi-soft prosthesis used after a mastectomy: c. a semi-soft prosthesis for a cleft palate

107. Carbohydrates in human milk include all of the following:

a. glycopeptides b. lactoferrin

c. lactose

d. oligosaccharides: b. lactoferrin

108. Which of the following is normally present in the fetus, but not normal in an infant 3 or 4 days old?

a. foramen magnum b. foramen ovale

c. mastoid fontanelle: b. foramen ovale

109. Which of the following drugs is used to treat engorgement in the non- lactating mothers?

a. desinex (chlortrimazole)

b. dostinex (cabergoline)

c. dovonex (calcipotriene)

d. lactinex (lactobacillus): b. dostinex (cabergoline)

110. Which is the MOST APPROPRIATE suggestion for a pregnant woman concerned about eating well enough for her own body growth and her developing baby?

a. take prenatal vitamins every day

b. eat fruits, vegetables, and protein-rich foods 5 times a day

c. plan your meals and snacks so you can eat every few hours

d. plan to gain 25 to 35 pounds (11.4 to 15.9kg) by the end of your pregnan- cy.: d. plan to gain 25 to 35 pounds (11.4 to 15.9kg) by the end of your pregnancy.

111. A researcher is studying breastfeeding incidence in two neighbring community prenatal clinics In one clinic, a new videotape is used to teach breastfeeding; the other clinic continues to use an older videotape. At the follow-up, both clinics report similar increases in breastfeeding initiation. The MOST LIKELY reason for this is:

a. that all instructional videotapes are equivalent b. the Hawthorne effect

c. that changing the videotape had no effect d. the Nedelsky effect: b. the Hawthorne effect

112. When does the mammary secretory glandular tissue develop?

a. during puberty

b. some development occurs with each menstrual period c. in the first trimester of pregnancy

d. during pregnancy and the early weeks postbirth: d. during pregnancy and the early weeks postbirth

113. What process is primarily responsible for the increase in breast size

(volume) during pregnancy?

a. increase in fatty stores in the breast b. development of the duct system

c. growth of secretory epithelial cells

d. growing uterus triggers ribcage expansion: c. growth of secretory epithelial cells

114. Which fetal structure may remain open or be reopened by excessive infant crying?

a. ductus venosus

b. ductus arteriosus c. foramen ovale

d. portal sinus: c. foramen ovale

115. Which prenatal breast condition is MOST LIKELY to affect lactation?

a. no leaking of colostrum by the third trimester b. flat nipples

c. no change in pigment of the nipple and areola

d. no change in breast size pregnancy: d. no change in breast size pregnancy

116. Your client is a pregnant 38-year old woman who had breast reduction surgery through use of the inferior pedicle technique 10 years ago, after having breastfed two children for about 1 year each. She had low milk production with each of the children. What is the likelihood of a full milk production for the new baby?

a. high because of the surgical technique used b. high because of her two previous lactations

c. unlikely because of the type of breast reduction surgery

d. unlikely because of the length of time since reduction: b. high because of her two previous lactations

117. Which of the following maternal prenatal factors is MOST LIKELY to interfere with initiation of breastfeeding?

a. cesarean surgery

b. magnesium sulfate administered during labor c. intravenous hydration during labor

d. history of failed breastfeeding in previous pregnancy: a. cesarean surgery

118. During a difficult birth, a baby sustained damage to the hypoglossal nerve. What is the MOST LIKELY effect on breastfeeding? The baby would be:

a. unable to maintain latch at breast

b. unable to move tongue to collect milk c. unable to swallow

d. unable to grasp breast with mouth/lips: b. unable to move tongue to collect milk

119. Pooling or collection of fluid between the skin and cranial bones of the infant's head is called:

a. caput succedaneum b. cephalhematoma

c. periosteal swelling

d. hydrocephalus: a. caput succedaneum

120. Which medication given to a laboring woman is MOST LIKELY related to newborn sucking problems?

a. magnesium sulfate b. fentanyl

c. propofol

d. penicillin: b. fentanyl

121. Which of the following effects is MOST LIKELY to occur following ad- ministration of epidural narcotic drugs given to the laboring woman?

a. delayed onset of lactogenesis b. longer second stage of labor

c. increased risk of cesarean birth

d. increased risk for forceps or vacuum-assisted birth: a. delayed onset of lactogenesis

122. The MOST important consequence of adding fortifiers to human milk given to premature babies is:

a. better long-term bone mineralization

b. increased risk of allergic reaction from bovine protein in fortifiers c. increased iron transport

d. decreased gut transit time: b. increased risk of allergic reaction from bovine protein in fortifiers

123. Which factor is MOST LIKELY to put a premature infant at risk of evap- orative water loss?

a. lower brown fat reserves

b. immature thyroid control of metabolic rate c. relatively large skin surface area

d. poor insulin response leading to hyperglycemia: c. relatively large skin surface area

124. Which nutrient is most difficult for premature babies to digest?

a. carbohydrates b. proteins

c. fats

d. minerals: c. fats

125. Mothers of twins are MOST likely to experience which of the following circumstances?

a. premature birth b. cesarean birth

c. intrauterine growth retardation

d. insufficient milk supply: a. premature birth

126. Which of the following developmental processes is MOST interrupted by premature birth?

a. central nervous system development b. gut maturation

c. deposition of fat

d. hearing and taste: a. central nervous system development

127. Sodium is higher than normal in breastmilk when:

1.

2.

3.: 1. initiation of lactation

2. involution

3. pregnancy

128. What are the 2 types of mastitis?: cellulitis and adenitis

129. cellulitis mastitis is :: thought to involve the interlobular connective tissue that has been infected by the introduction of bacteria through cracked nipples TX= antibiotics

130. adenitis mastitis is:: the breast ducts are presumably blocked, and the clinical symptoms are less severe.

131. Breastmilk composition changes during a breast infection. Elevated lev- els of              &                 caused by the temporary opening of the normally

tight junctions between secretory cells in the paracellular pathways cause the breastmilk to taste salty.: salt and chloride

132. What breastmilk components rise during breast infection?: 1. sodium

2. chloride

3. sIgA

4. lactose

5. lactoferrin

133. What percentage of breast infections develop into abscesses?: 5-10%

134. For small breast abscesses (3cm or less) the recommended first line of tx is:: fine-needle aspiration, single or repeated, preferanly under ultrasound

135. For large breast abscesses (larger than 3cm) the recommended first line of tx is:: percutaneous suction catheter can be placed for 3 to 7 days

136.                          infections present with complaints of deep, dull aching breast pain during or after feedings, breast tenderness with deep touch, bilateral pain, and burning.: bacterial

137. Mothers with suspected S. aureus infection should be tx with oral an- tibiotics such as                     ,            , or                  ). These agents are more effective in preventing mastitis development and reducing pain.: cephalexin, amoxicillin, or dicloxicillin

138. What type of breast cancer/disease resembles nipple eczema?: Paget's disease

139. What is tx for eczema?: topical corticosteroid ointments

140. To diagnose                           phenomenon acurrately, symptoms of cold stimuli, classic triphasic color change (white, blue, and red), or biphasic color change (white and blue) must be present.: Raynaud's

141. Tx for Raynaud's includes:

1.

2.

3.

4.: 1. avoiding cold temperatures

2. keeping the breasts and nipples warm

3. avoiding vasoconstrictive drugs

taking nifedipine 30 to 60 mg/day for 2 weeks

142. What is thrush?: yeast infection that causes white coating inside the mouth. CANDIDIASIS

If patch falls off, can bleed or be very red most common in infants under 2 mos

if fever, most likely dif. type of infection report immediately

thrush sb reported to superior as needs medical treatment (not overly dangerous) USE GOOD HYGIENE

143. What symptoms are signs of thrush?: rapidly developed extremely sore nipples, burning or itching, and burning, shooting, or stabbing nipple pain that radiates to the chest wall

144. What are prime sites for Candida infections to grow on the body?

1.

2.

3.: 1. infant's mouth and anal area

2. mother's breasts (nipples and areola)

3. mother's vagina

145. What tx does the ABM recommend for thrush?: nystatin should be first choice for tx of thrush

146. What 3 recommendations does the ABM suggest?: 1. Topical azole anti- fungal ointment or cream (miconazole and clotrimazole also inhibit the growth of Staphylococcus (bacteria) on nipples

2. Nystatin suspension or miconazole oral gel for infant's mouth.

3. Gentian violet (less than 0.5% aqueous solution) may be used daily for no more than 7 days. Longer durations and higher concentrations may cause ulcerations and skin necrosis.

147. 1. What is a galactocele?

2. When does it often occur?: 1. milk-filled cyst in the lactating breast- most common benign lesion of the lactating breast

2. more frequently occur after cessation of bf when milk is retained and becomes stagnant within the breast

148. What is an intraductal papilloma?: An intraductal papilloma is a wart-like lump that develops in one or more of the milk ducts in the breast. It's usually close to the nipple, but can sometimes be found elsewhere in the breast. Intraductal papilloma is a benign (not cancer) breast condition.

149. When does rusty pipe syndrome occur in lactation?: during the early stages of lactation; thought to be caused by increased vascularization of rapidly developing alveolae, which are easily traumatized, resulting in blood escaping into breast secretions

150. bright red bleeding from the breast in the absence of nipple soreness or cracking indicates that the mother should be assessed for the possibility of an                                                                .: intraductal papilloma

151. It is recommended to refer the mother to a physician for evaluation for breast cancer if:

1.

2.

3.: 1. any mass that shows no decrease in size after 72 hours of tx

2. afebrile mastitis-like symptoms that are unresolved after a course of antibiotics

3. recurrent mastitis or plugged ducts that appear at the same location

152. True or False

All chemotherapeutic drugs cross into the milk.: true

153. True or False

Women receiving chemotherapy for breast cancer or any other cancer should not breastfeed.: true

154. True or False

There is neither an increase nor a decrease in incidence of breast cancer in breastfed daughters of women who have had breast cancer.: true

155. Mastitis is usually treated with                    or                          that covers Staphylococcus aureus for 6 to 10 days.: penicilinase-resistant penicillin or cephalosporin

156. Which method of family planning would MOST INTERFERE with breast- feeding?

a. tubal ligation

b. progestin-only oral contraceptives c. intrauterine devices

d. natural family planning (periodic abstinence): b. progestin-only contracep- tion

157. This mother's condition has persisted for 2 weeks despite correcting the baby's positioning and latch. What is the MOST LIKELY strategy to resolve this condition?

a. apply a nipple shield during feeds to protect the area

b. massage some expressed milk into the area to speed healing c. coat the area with a thick ointment to prevent scab formation

d. rinse the area with clean water, then apply an antifungal ointment: d. rinse the area with clean water, then apply an antifungal ointment

158. A mother is adamant about not wanting to breastfeed or provide her pumped milk or to obtain donor human milk. She asks which manufactured formula would be next safest for her baby. Your BEST suggestion is:

a. soy-based liquid b. goat's milk

c. cow's milk-based protein

d. cow's milk-based liquid: d. cow's milk-based liquid

cow's milk(bovine) formulas are safer than the other options listed. Soy products contain no lactose and are not recommended for general use. Powdered formulas are never sterile and may be contaminated with pathogenic bacteria. Goat's milk is deficient in folic acid and other nutrients needed by human infants.

159. An adopting mother is exploring maternal factors that may influence her ability to induce lactation. Which of the following factors or conditions is MOST LIKELY to reduce her chances of inducing lactation?

a. clinical depression b. milk anemia

c. polycystic ovary syndrome

c. hypertension: c. polycystic ovary syndrome

160. A bf mother of a 3-week old baby needs oral surgery for an abscessed tooth. Her dentist is concerned that the anti-inflammatory drug he plans to prescribe may appear in her milk and cause problems for her baby. Which of the following statements is TRUE?

a. anti-inflammatory drugs cause severe bleeding in breastfed babies b. most drugs appear in high concentrations in milk

c. breastfeeding will retard healing of her surigcal incision

d. anti-inflammatory drugs are generally compatible with breastfeeding: d. anti-inflammatory drugs are generally compatible with breastfeeding

161. If a newborn needs to undergo a painful procedure, which pain-manage- ment strategy is MOST LIKELY to be effective during the procedure?

a. snug swaddling b. breastfeeding

c. skin-to-skin

d. oral sucrose: b. breastfeeding

Bf has been shown to be the most effective pain relief strategy for minor painful procedures. Human milk alone may be pain relieving, even without direct breast- feeding.

162. During the colostral phase of lactation, drugs taken by the mother can more easily pass into the breastmilk because:

a. colostrum is more concentrated than mature milk

b. the intracellular spaces between lactocytes are wide

c. the mother has a larger blood volume immediately postpartum

d. the mother's kidneys do not clear drugs as quickly immmediately postpar- tum: b. the intracellular spaces between lactocytes are wide

163. Why do the breastfed baby's stools become firmer over time, even before the addition of solid foods?

a. casein incresaes in proportion to whey over time

b. there is less liquid in proportion to minerals in the milk over time

c. breastmilk supplies inadequate fluids over time, necessitating adding other drinks

d. they baby perspires more using more of the liquid in milk for metabolism-

: a. casein incresaes in proportion to whey over time

164. A mother is concerned because her 3-week old exclusively bf baby suddenly became very fussy in the evenings. Her bf pattern did not change, and the baby is otherwise healthy. Which recently added item in her diet is MOST LIKELY to be related to her baby's reaction?

a. lemonade b. herbal tea

c. green vegetables

d. vitamin supplements: b. herbal tea

( herbal teas may contain substances that exert a pharmacological effect on the baby)

165. A mother is uncertain about providing her own milk for her preterm baby and has been told that her milk helps nerve development. Which sensory system is MOST compromised by the absence of human milk?

a. olfactory (smell)

b. auditory (hearing)

c. gustatory (taste)

d. visual (sight): d. visual (sight)

The visual system is the last sensory system to develop during gestation and therefore the most affectced by preterm nutrition. Human milk makes a significant different in visual development of the preterm infant, partly because of fatty acid profiles.

166. A mother calls you complaining of breast pain. Her breasts are hot, hard, "knotty", and painful to the touch. She is 3 days postpartum.The FIRST

suggestion you should give her is:

a. don't worry, your breasts will feel better in 24 hours b. use a nipple shield during feedings

c. express or pump at least every 2-3 hours until the lumps are gone

d. restrict your fluid intake: c. express or pump at least every 2-3 hours until the lumps are gone

( The mother is experiencing milk stasis and inflammation, a common event on day

3. Removal of milk to support ongoing lactogenesis is the top priority.)

167. You are working with a baby who has a unilateral cleft of the hard palate. The MOST APPROPRIATE strategy to suggest is:

a. try nursing lying down to see whether your breast will fill the cleft b. gradually reduce your milk production while you switch to formula

c. hand-express after every attempted nursing session, and give the milk by cup

d. if the baby can latch, try feeding in upright positions to avoid nasopha- ryngeal reflux: d. if the baby can latch, try feeding in upright positions to avoid nasopharyngeal reflux

168. When selecting a device to assist bf, which is the MOST IMPORTANT

principle to consider?

a. use a device authorized by your employer b. select the least expensive device

c. use the least intervention for the shortest time

d. obtain informed consent from both parents: c. use the least intervention for the shortest time

169. An obese mother's baby weighed 6lbs 12oz at birth; 6lbs 4oz at dis- charge on day 2, and 6lbs 14oz on a day 4 checkup. She is relieved, because obesity may have which effect on lactation?

a. reduced prolactin response to sucking

b. overactive letdown response that overwhelms the baby

c. suppressed milk synthesis because of excess lipid tissue in the breast d. overproduction because of excess blood glucose: a. reduced prolactin response to sucking

(obesity is associated with reduced prolactin response to suckling in the early days of lactation. Prolactin response to suckling is more important for milk production in the first postpartum week than it is later in lactation.)

170. A pregnant woman taking an anti seizure medication was advised to not bf her first two children because of the medication. She is being encouraged to bf this third child by her neurologist. What is the MOST SUPPORTIVE

information you should share with her now?

a. your neurologist must know what he's talking about, so following his advice is wise.

b. your milk has many components that foster and support brain growth, even if some medication is in the milk

c. you followed the best advice at the time with your other children, so do not feel guilty

d. your milk's nutritional properties are not changed by the medication that might be present: b. your milk has many components that foster and support brain growth, even if some medication is in the milk

(brain growth in infants is the most common concern when mother is taking any psychoactive medication, and antiseizure medications considered compatible with bf.

171. A mother stopped pumping milk for her premature baby 48 hours ago, and now her breasts are painfully full of milk. Your FIRST action to reduce her discomfort should be to:

a. suggest she stand in a warm shower to trigger a letdown response b. put cold cloths on her breasts to reduce inflammation

c. help her massage and express some milk

d. apply a breast binder to suppress lactation: c. help her massage and express some milk

(the first strategy is always to help the mother with self-care skills. Gentle hand expression and massage should help the milk to start moving and require no equipment or devices.)

172. Which relationship between postpartum depression and bf is MOST COMMON?

a. depression precedes bf cessation

b. bf cessation can lead to depression c. depression is not related to bf

d. depressed mothers should not bf: a. depression precedes bf cessation

173. You are counseling the mother of a baby born at 36 weeks' gestation who says her infant is quite sleepy. She calls her infant a snacker, which she describes as her infant waking up to feed approximately every 1-2 hours and promptly falling asleep at the breast. What should be your NEXT suggestion for this mother?

a. apply a cold washcloth to the baby's back during bf to stimulate him

b. keep the baby skin-to-skin, without swaddling blankets, to maintain his temperature during feeds

c. follow the infant's cues and bf as often as he requests, including letting him sleep at the breast

d. to break this cycle, pump and feed your expressed milk instead: b. keep the baby skin-to-skin, without swaddling blankets, to maintain his temperature during feeds

(late preterm infants may fall asleep if they are slightly chilled, due to inherent thermal instability. Skin-to-skin contact is the best way to maintain thermal stability and maintain alertness.

174. Sexual assault has a pervasive, negative effect on women's health and well-being. It can also influence her experience as a new mother. In a 2013 article in Breastfeeding Medicine, of the following impacts, Kendall-Tackett et al. found that breastfeeding had which impact on the effects of sexual assault?

a.no effect on women's experiences

b. increased their risk of postpartum depression

c. breastfeeding lessened their risk of sleep problems

d. reduced their overall sleep quality: c. breastfeeding lessened their risk of sleep problems

(breastfeeding particularly exclusive breastfeeding downregulates the mother's stress system, improves her sleep, and lowers her risk of depression.)

175. During a home visit on the 2nd day post partum, you learn that a baby has not yet passed a meconium stool. Your FIRST action should be to:

a. assess the baby's skin turgor and reflexes, documenting your findings b. inform the baby's primary care provider of your findings

c. reassure the parents that delayed passing of meconium is normal

d. show the parents how to safely feed infant formula: b. inform the baby's primary care provider of your findings

(The code of professional conduct states that a LC required to "inform an appro- priate person or authority if it appears that the health or safety of a client or a colleague is at risk" the LCs scope of practice alone does not include a medical assessment of the baby.)

176. A woman who took phenobarbital (carbamazepine) during pregnancy to control seizures wants to exclusively breastfeed. Which of the following infant signs is MOST LIKELY to be related to this drug transferring to her milk and should be reported to the primary care provider?

a. facial rash

b. sedation or drowsiness c. vomiting or spitting up

d. fussiness, excessive crying: b. sedation or drowsiness

(sedation or drowsiness is the most likely infant reaction to an anticonvulsant drug taken during breastfeeding. other signs include poor suck, poor weight, or jaundice; all should be reported to the child's physician)

177. An exclusively bf baby needs surgery that must be performed under anesthesia. How long must bf be withheld before administration of anesthe- sia?

a. 30 minutes b. 2 hours

c. 4 hours

d. 6 hours: c. 4 hours

(the current ABM recommendation for a breastfed baby undergoing general anes- thesia is to withhold breastfeeding and breastmilk for 4 hours. The most serious consequence of nonfasting is pulmonary aspiration, and even breastmilk can be problematic.

178. Which drug property results in MORE transfer of the drug into mother's milk?

a. milk:plasma ratio <1.0 b. molecular weight >300 c. high protein binding

d. lipid solubility: d. lipid solubility

(lipid solubility facilitates transfer of drugs into mother's milk)

179. What age is the highest risks for SIDS?: 2-4 months of age

180. Which family planning (contraceptive) method is MOST COMPATIBLE

with breastfeeding?

a. progestin-only oral contraceptives

b. "combined" hormonal contraceptives c. barrier methods

d. emergency contraceptives: c. barrier methods

181. Which of the following drug properties results in MORE transfer into milk?

a. low pH

b. highly protein bound c. high milk:plasma ratio

d. low lipid solubility: c. high milk:plasma ratio

(drugs with high milk"plasma ratio readily transfer into milk and my even accumu- late in milk.)

182. Which type of bacteria are MOST DANGEROUS for the newborn?

a. anaerobic bacteria in the gut

b. enterococcal bacteria in the feces

c. staphylococcus epidermis on the skin

d. aerobic bacteria on the mucous membranes: d.

aerobic bacteria require oxygen and are more potentially harmful than anaerobic bacteria, which do not require oxygen. the mucous membranes are the most common route for infections of the newborn

183. Which component of human milk is MOST IMPORTANT in preventing neonatal septicemia?

a. lysozyme in colostrum b. SIg antibodies

c. oligosaccharide receptor analogues d. lactoferrin protein: b.

SIgA plays a powerful role in preventing neonatal septicemia

184. What effect does at least 7 mos of bf have on urinary tract infections? a. higher risk of infections unless water is given, because less urine is produced by the breastfed child

b. lower risk of infection for up to 2 yrs because of SIgA antibodies and lactoferrin in milk

c. no difference in the risk of infection after supplements and family foods are started

d. no difference in boys, but bf girl have increased risk after 6 months pf breastfeeding: b.

SIgA and lactoferrin in milk and human milk's anti-inflammatory and anti-infective properties

185. Banking of donated human milk has been practiced since the early

1900s. Which factor is MOST IMPORTANT in dispensing banked donor milk?

a. being financially able to afford its purchase b. acquiring a prescription from the physician c. being under the age of 3

d. socio-economic status of the family: b.

donor milk is dispensed by prescription only, especialy in the US. Regardless of the amount of milk available, its use is prioritized (ranked) according to severity of need by recipient.

186. The UNICEF/WHO Ten steps to successful bf (BFHI) includes which one of the following steps?

a. train all maternity staff with 3 hours of bf education

b. give only breastmilk to premature infants under 37 weeks' gestation c. use at-breast supplements for supplementing breastfed infants

d. encourage feeding on cue for all parents regardless of feeding method: d. feeding "on cue" is step 8 and applies to all babies, especially bf babies. It is also described as "encourage unrestricted breastfeeding"

187. Which description of oral function of the baby during bf is the MOST IMPORTANT?

a. sense of taste and smell of milk

b. pressure of the breast against the oral tissues

c. tactile sensation of breast filling the infant's mouth d. ability of infant to control shape of breast: c.

tactile sensation of the breast in the mouth ("mother in the mouth") is a critical part of imprinting and emotional and psychological development. The oral experience of bf is pleasurable and normal. The infant controls and molds the shape of the breast in its mouth.

188. What is the MOST IMPORTANT function of lactose in human milk?

a. supplies of 40% of infant's energy needs

b. aids absorption of phosphorus and manganese

c. protects the gastrointestinal tract from pathogens d. supports the CNS and cognitive development: d. CNS development is highly linked to lactose in human milk

choices a & c are also accurate. lactose aids absorption of calcium and iron

189. A mother asks which manufactured formula would be next safest for her baby. Your BEST suggestion is:

a. soy-based liquid b. goat's milk

c. cow's milk-based powdered d. cow's milk-based liquid: d.

cow's milk (bovine) formulas are safer than the other options listed.

Soy products contain no lactose and are not recommended for general use. Powdered formulas are never sterile and may be contaminated with pathogenic bacteria.

Goat's milk is deficient in folic acid and other nutrients needed by human infants.

190. Which of the following components of human milk protects the baby by binding nutrients needed by pathogens in the baby's gut?

a. lactoferrin b. lysozyme c. mucins

d. oligosaccharides: a.

lactoferrin binds to iron, which starves pathogenic bacteria of the iron needed to proliferate

191. Which component of human milk is active against at least 40 tumors?

a. alpha-lactalbumin b. beta-lactoglobulin c. lactoferrin

d. gangliocides: a.

human alpha-lactalbumin (HAMLET) in laboratory experiments was found to inac- tivate at least 40 forms of tumors

beta-lactoglobulin is not found in human breast milk

192. A breastfeeding mother with type 1 diabetes melliltus (IDDM) is at increased risk for which of the following conditions?

a. insufficient milk supply b. mastitis

c. oversupply

d. plugged milk ducts: b.

maternal IDDM increases the risk of infections in general, including breast infec- tions

193. You are helping a woman who has a documented allergy to dairy prod- ucts (cow's milk). Which of the following foods would provide many of the nutrients contained in dairy products?

a. rice and potatoes

b. almonds and cashews c. spinach and onions

d. corn tortillas soaked in lime: d.

this choice has high levels of dietary calcium

194. At what point during gestation does the mammary ridge form?

a. 4-5 weeks

b. 14-15 weeks c. 24-25 weeks

d. 34-25 weeks: a. 4-5 weeks

195. A mother was given 40 mg of a drug with a half-life of 4 hours. How much of the drug is left in her system after 4 half-lives have elapsed?

a. 20mg b. 10mg c. 5mg

d. 2.5mg: d.

196. Cholecystokinin (CCK), which is released by sucking, has which of the following effects?

a. arousal b. satiety

c. agitation

d. depression: b.

197. What's the MOST IMPORTANT difference between pasteruized donor milk and mother's own milk?

a. specific specificity b. allergy prevention c. bioavailability

d. potential HIV exposure: d.

pasteurized donor milk does not transmit the HIV virus. Pasteurization kills the HIV

virus and other pathogens that may be present in milk.

198. What is a clinically appropriate use of a nipple shield?

a. feels like the breast in the baby's mouth

b. therapeutic changes in the baby's oral-motor response c. enhances milk transfer in some babies with weak suck d. extends duration of bf: c.

in premature babies, a thin silicone nipple shield was found to increase transfer of milk

199. Which of the following is an example of mutual interdependency during breastfeeding?

a. baby's gut closure occurs around the time he is ready for solid foods b. mother's milk contains environmental chemicals, triggering baby's im- mune system

c. skin contact during bf helps regulate baby's temperature

d. sucking at breast triggers release of gut hormones in mother and baby: a. The timing of gut closure and developmental readiness for complementary foods is one example of mutual interdependency.

200. A lactating mother noticed two raised bumps on her areola that drip milk when her baby is nursing on the other breast. These bumps are MOST LIKELY:

a. Montgomery glands b. milk duct pores

c. warts

d. insect bites: b.

milk ducts sometimes terminate on the areola, causing milk to be released during the MER. This is a normal breast configuration.

201. During bf, how long does the nipple extend beyond its resting length?

a. one-quarter resting length (25%)

b. half again (50%)

c. twice its length (100%)

d. it does not extend at all (0%): c.

202. Which muscle is responsible for closing the lips around the nipple or other object?

a. masseter b. temporal

c. orbicularis oris

d. internal pterygoid: c.

203. Which property of maternal medications INCREASES the amount of the drug that gets to the bf baby via breastmilk?

a. short half-life

b. no active metabolites c. high oral absorption

d. high gut destruction: c. drugs that are highly absorbable via oral ingestion more easily transfer to breastmilk

204. A mother has been having migraine headaches and asks about various remedies and their effect on her nursing 3 week old. The remedy MOST LIKELY to affect her baby is:

a. acetaminophen

b. an herbal preparation c. a homeopathic remedy

d. a caffeinated beverage: d.

caffeine is highly fat soluble and therefore easily transfers to milk

205. A bf mother must receive a radioactive isotope for diagnostic testing. How long should she wait before bf her baby again?

a. 5 days

b. 48 hours

c. 5 half-lives

d. she must completely wean:

c. after 5 half-lives have passed, approximately 98% of the drug or isotope has been eliminated. Each drug or isotope has a specific half-life.

206. Which nutritional recommendation is MOST RELEVANT to a bf mother?

a. drink a large glass of water whenever she breastfeeds b. avoid spicy or gas-producing foods

c. increase her caloric intake to make enough milk d. follow her usual dietary practices: d.

mothers' dietary practices have very little effect on lactation

207. Why is human milk often a bluish-white color?

a. the whey:casein ratio of human milk is 80:20 b. the whey:casein ratio of human milk is 20:80 c. secretory IgA is a blue color

d. human casein does not bind calcium: a.

notes: the casein portion binds calcium and scatters light and therefore appears white

notes: the whey portion of soluble components is slightly blue

notes: cow's milk has a whey: casein ratio of ~20:80 which means the high portion of casein causes the white opaque color of cow's milk

208. Where is MOST of the glandular tissue of the breast located?

a. deep in the breast, close to the chest wall

b. clustered on the distal ends of the milk ducts

c. interspersed throughout the breast fairly evenly d. within a 30-mm radius of the nipple base:

d. a large portion (70%) of the glandular tissue is located within a 30-mm radius of the nipple, according to recent ultrasound studies

209. The risk of which of the following maternal reproductive cancers is MOST INCREASED in women who do not breastfeed after pregnancy? a. cervical cancer

b. premenopausal breast cancer c. ovarian cancer

d. endometrial cancer: b.

the risk for premenopausal breast cancer is higher in women who do not breast- feed/lactate after pregnancy.

210. What is the MOST LIKELY number of milk ducts terminating on the nipple?

a. fewer than 6 b. 9 or 10

c. 15 to 20

d. more than 20: b.

211. Which milk expression method(s) would be your FIRST recommenda- tion for a mother whose 37-week-gestation baby is hospitalized in a neonatal intensive care unit?

a. hand express, starting at 24 hours after birth

b. hand expression within 1 hour then add a hospital-grade pump c. double-pump with an adjustable-speed hospital-grade pump

d. single-pump with a wide-diameter, flexible-flange pump: b. hand expression within 1 hour then add a hospital-grade pump

212. Which method of family planning is MOST LIKELY to interfere with bf?

a. progestin-containing medications b. estrogen-containing medications c. cervical cap or diaphragm