IBCLC Certification Exam

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(IBCLC) Certification Exam

1.What week gestation does the breast begin to develop in utero?: *4th*

week of gestation

2.Where does the primitive milk streak develop: Bilaterally from the

axilla to the groin

3.By the 5th week gestation the milk streak becomes what?: Mammary

Milk Ridge (or milk line) 4.Thickening and inward growth into the chest wall continues during

what weeks gestation?: *7-8* weeks gestation

5.Between weeks 12 and 16 gestation specialized cells differentiate into

what?: Smooth muscles of the nipple and areola

6.What forms the mammary pit?: Lactiferous ducts and their branches

open into a shallow epithelial depression

7.What failure creates an inverted nipple?: When the Mammary pit

fails to elevate

8.What is witches milk?: After birth, a neonate's mammary tissue

(under the influence of maternal hormones) might recreate colostral like fluid 9.At what age do the primary and secondary ducts grow and divide and

form the terminal end buds that become the alveoli?: 10-12 years old

(puberty)

10.When does *complete* development of mammary function occur?:

During pregnancy

11.What is superficial fiscia?: Fibrous tissue beneath the skin

12.Where is the breast located?: In the superficial fascia between the

*2nd rib and 6th ICS*

13.What are the two major divisions of the breast?: Parenchyma and

Stroma 1 / 4

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14.What makes up the Parenchyma?: Ducts, lobes, and aveoli

15.What are alveoli?: Small sacs where milk is secreted

16.What makes up the Stroma?: Connective and fat tissue, blood

vessels, nerves, and lymphatics.

17.What is Cooper's Ligament?: Suspensory ligament that are the

fibrous con- nections between the inner side of the breast skin and pectoral muscles. Help to shape the breasts 2 / 4

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18.What does the nipple contain?: 15-25 milk ducts, smooth muscle

fibers, sebaceous and apocrine sweat glands, and dense innervations of sensory nerve endings

19.How many milk ducts does the nipple contain?: 15-25

20.What are Montgomery Tubercles?: Sebaceous glands in the areola

sur- rounding the nipple

21.What do the Montgomery Tubercles secrete?: *Oily secretions* (lipoid

fluid) to keep the areola and the nipple lubricated and protected

22.What 2 arteries supply blood to the breast (60% / 30%)?: Internal

mammary artery (60%) and lateral thoracic artery (30%) 23.Where does the lymphatic system of the breast drain excess fluids

from tissue space, bacteria and cast off cells?: Auxiliary lymph node

24.Where do the nerves of the breast branch from?: 4th, 5th, and 6th

inter- costal nerve

25.What nerve supplies the greatest amount of *sensation* to the areola?:

- *4th* intercostal nerve

26.What part of the breast is most sensitive?: The areola followed by

the general skin of the breast, and then the nipple which is least sensitive.

27.What percent of breast milk is *carbohydrates*?: Approximately 7%

28.What are the six infant behavioral "states": *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 29.Milk components that protect the infant/lactating breast actively bind , preventing their passage through the permeable infant -

: pathogens

gut mucosa

30.How does the infant get the antibodies produced by mom?:

antibodies are produced in moms blood, targeted *SIgA* which is transported across the mammary secretory cells and released in the 3 / 4

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milk.

31.What is sIgA?: Immunoglobulin A is an antibody that coats mucosal

surfaces to prevent adherence and penetration by pathogens

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