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Midwifery Year 1 MCQ > Anatomy of the Breast and Physiology of Lactation > Flashcards

Anatomy of the Breast and Physiology of Lactation Flashcards

1
Q

The breasts lie over which muscle?

A

The pectoralis major

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2
Q

What extends from the upper outer corner of the breast up into the axilla?

A

The axillary tail of Spence

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3
Q

Why do breasts vary in size?

A

Due to differing amounts of adipose tissue.

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4
Q

What are nipples composed of?

A

Connective tissue.

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5
Q

Describe the surface of the nipple.

A

Nipples are covered in pigmented stratified squamous epithelium, which contain papillae. Papillae allow bundles of unmyelinated nerve endings to lie close to the skin.

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6
Q

What are Montgomery’s tubercles and where can they be found?

A

Montgomery’s tubercles are sebaceous glands that produce sebum to lubricate the nipple. They are found in the areola.

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7
Q

What is the functional substance of the breast, the glandular tissue, also known as?

A

Parenchyma

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8
Q

How is parenchyma arranged?

A

Glandular tissue is arranged in lobes that radiate out from nipple. Each lobe is divided into smaller lobules.

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9
Q

What two things are contained in lobules?

A

Alveoli and ductules.

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10
Q

Where can acini cells (or lactocytes) be found?

A

In each alveolus.

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11
Q

Describe the arrangement of cells in the alveoli.

A

Cells are arranged in a single layer. They rest on the basal lamina and myoepithelial cells.

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12
Q

What is the basal lamina?

A

The basal lamina is the basement membrane dividing the epithelial and stromal parts of breast tissue.

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13
Q

Ducts consist of an inner lining of ____ cells and an outer lining of ____ cells.

A

epithelial

myoepithelial

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14
Q

How many groups of alveoli drain into a small duct?

A

10-100.

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15
Q

Ducts from lobules unit to form what?

A

The main lactiferous duct for each lobe.

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16
Q

What is the stroma?

A

The stroma refers to everything in the breast that is not the functional glandular tissue: connective tissue, adipose tissue, blood and lymph vessels, nerve tissues and surrounding skin.

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17
Q

What holds breasts in position?

A

Suspensory ligaments of Astley-Cooper.

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18
Q

What is the average amount of ducts exiting the nipple?

A

9

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19
Q

What is the ratio of glandular to fatty tissue?

A

2:1

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20
Q

65% of parenchyma is within how many millimetres of the nipple?

A

30mm

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21
Q

List the five developmental stages of breast function.

A
  1. Embryogenesis
  2. Mammogenesis
  3. Lactogenesis
  4. Lactation
  5. Involution
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22
Q

Breasts start to develop on the ventral surface of the body from what week of gestation?

A

4th week

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23
Q

Mammogenesis occurs in two phases, when do these occur?

A

Puberty and pregnancy.

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24
Q

Mammogenesis is not complete until after parturition: true or false?

A

True.

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25
Q

The ovulatory cycle enhances breast growth up until what age?

A

30

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26
Q

Which hormones stimulate the growth of mammary ducts during puberty

A

Oestrogen and growth hormone.

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27
Q

When do the lactiferous ducts and alveoli develop during mammogenesis?

A

In the second half of the menstrual cycle.

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28
Q

What hormone stimulates development of the lactiferous ducts and alveoli in mammogenesis?

A

Progesterone

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29
Q

What are the three stages of lactogenesis?

A

Priming, initiation and maintenance.

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30
Q

When does stage 1 (priming) of lactogenesis occur?

A

During pregnancy.

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31
Q

At how many weeks’ gestation is the breast capable of synthesising milk components?

A

16 weeks

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32
Q

Which hormones contribute to accelerated breast growth in pregnancy?

A

Human placental lactogen, prolactin, human chorionic gonadotrophin, oestrogen and progesterone.

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33
Q

During stage 1 of lactogenesis, which hormone contributes to the development of differentiated secretory alveolar cells?

A

Prolactin

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34
Q

During stage 1 of lactogenesis, which hormone contributes to ductal growth?

A

Oestrogen

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35
Q

During stage 1 of lactogenesis, which hormone contributes to lobular formation and alveolar growth?

A

Progesterone

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36
Q

During stage 1 of lactogenesis, what two things are responsible for suppressing secretory activity?

A

Progesterone and prolactin-inhibiting factor.

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37
Q

Lactogenesis 1 can be considered the transitional milk stage: true or false?

A

False. Walker (2015) defines Lactogenesis 1 as the colostrum stage.

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38
Q

How many millilitres of colostrum is available to the infant on day 0 postpartum?

A

100ml

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39
Q

In the first trimester, what is the percentage increase in blood flow to the breasts?

A

50%.

40
Q

Stage 2 of lactogenesis involves which two maternal reflexes?

A

The milk production reflex and the milk ejection reflex.

41
Q

Stage 2 of lactogenesis is dependent on which three neonatal reflexes?

A

The rooting reflex, the sucking reflex and the swallowing reflex.

42
Q

What three hormones are necessary for initiation of lactation?

A

Prolactin, insulin and hydrocortisone.

43
Q

Why is the anterior pituitary gland no longer inhibited after the birth of the placenta?

A

Because there is an abrupt drop in progesterone, oestrogen and human placental lactogen.

44
Q

Nipple stimulation causes the hypothalamus to inhibit the release of what?

A

Dopamine

45
Q

Why are lower levels of dopamine necessary for stage 2 of lactogenesis?

A

Lower levels of dopamine stimulate the release of prolactin from the anterior pituitary gland.

46
Q

How many hours after birth does the composition of milk rapidly change from colostrum to transitional milk?

A

30-72 hours.

47
Q

When does stage 3 of lactogenesis occur?

A

Approximately 10 days after birth.

48
Q

When is a mature milk supply established?

A

Approximately 10 days after birth.

49
Q

When is lactation the earliest lactation is said to be established?

A

4 weeks after birth.

50
Q

Stage 3 of lactogenesis is reliant on an intact hypothalamic-pituitary axis regulating what?

A

Oxytocin and prolactin

51
Q

Stage 3 of lactogenesis is dependent on what neonatal behaviours?

A

Frequent suckling and removal of milk.

52
Q

Lactation involves two concepts: milk ____ and milk _____.

A

synthesis

production

53
Q

What is milk synthesis?

A

The accumulation of milk within the breast.

54
Q

What is milk production?

A

The volume of milk removed from the breast.

55
Q

When is there an increased synthesis of milk?

A

In the morning, peaking between 8am and midday.

56
Q

Approximately how much milk can an infant remove from the breast?

A

76%

57
Q

List four factors influencing milk synthesis.

A

Frequency of feeds, the time of day, the amount of milk removed, and the storage capacity of each breast.

58
Q

How long is the average period of involution?

A

3 months.

59
Q

Is re-establishment of full lactation possible during involution?

A

Yes.

60
Q

During involution, accumulation of milk in the alveoli and ducts causes what to happen to the epithelial cells?

A

Distension and mechanical atrophy.

61
Q

During involution, accumulation of milk in the alveoli eventually causes what to happen to the alveoli?

A

The alveolar walls rupture.

62
Q

During involution, what happens to the waste cells and glandular debris?

A

Phagocytosis

63
Q

During involution, what happens to the alveolar lining?

A

Alveolar lining changes from a single secretory, to double non-secretory layer.

64
Q

Breasts often remain larger after lactation due to deposition of fat and connective tissue: true or false?

A

True.

65
Q

Describe the changes in milk composition whilst weaning.

A

There are higher levels of fat, sodium and immunoglobulins. There are lower levels of lactose.

66
Q

Why are the breasts vulnerable to infection with abrupt weaning?

A

Because it takes 2 days for immunoglobulin and lactoferrin levels to rise.

67
Q

Feedback Inhibitor of Lactation is found in which component of milk?

A

Whey.

68
Q

Where is Feedback Inhibitor of Lactation produced?

A

It is secreted by the alveolar cells.

69
Q

It is thought that the Feedback Inhibitor of Lactation inhibits secretion of lactose by blocking what?

A

Prolactin

70
Q

If milk accumulates in the breast, the concentration of Feedback Inhibitor of Lactation increases. What effect does this have?

A

It inhibits lactation by reducing the rate of milk synthesis.

71
Q

Where is prolactin produced?

A

In the anterior pituitary gland.

72
Q

Secretion of prolactin is modified by which hormones?

A

Oestrogen and Thyroid Stimulating Hormone

73
Q

What are the prolactin levels at term?

A

150-400ng/ml

74
Q

Prolactin levels are not reliant on infant suckling until when?

A

Approximately day 3 after birth.

75
Q

Describe what happens to prolactin levels during a feed.

A

Prolactin levels rise within 10 minutes of suckling. They peak at 30 minutes. Levels return to base levels within 4 hours of the start of the feed.

76
Q

Prolactin circadian rhythms exist throughout lactation. When are levels highest?

A

At night.

77
Q

In non-breastfeeding mothers, when should their prolactin levels return to normal?

A

Within two weeks of giving birth.

78
Q

Prolactin concentrations are highest in which type of breastmilk?

A

Transitional breastmilk.

79
Q

When absorbed by the neonate, what effect does prolactin have on the intestine?

A

It influences fluid, sodium, potassium and calcium transport.

80
Q

What is dopamine also known as?

A

Prolactin-inhibiting factor.

81
Q

Where is prolactin-inhibiting produced?

A

The hypothalamus

82
Q

What determines whether the hypothalamus produces prolactin-inhibiting factor?

A

Catecholamine levels

83
Q

List three factors that affect prolactin release.

A

Physiological stimuli, pharmacological stimuli, and pharmacological suppressors.

84
Q

According to the prolactin receptor theory, when are the specialised prolactin receptor sites most sensitive?

A

Immediately after the birth of the placenta.

85
Q

According to the prolactin receptor theory, where can the specialised prolactin receptor sites be found?

A

Surrounding the acini cells.

86
Q

According to the prolactin receptor theory, receptor sites that are not primed shut down. What effect does this have?

A

The receptor sites lose their sensitivity to prolactin. If insufficient sites are primed, the resultant milk supply will be lower for the duration of that lactation.

87
Q

When a baby suckles at the breast, _____ impulses pass from the nipple via the ______ to the _____.

A

sensory

spinal cord

brain

88
Q

Sensory impulses from the newborn suckling at the breast stimulates the hypothalamus to produce what?

A

Prolactin-releasing factor.

89
Q

Prolactin-releasing factor stimulates the _____________ to produce ________.

A

anterior pituitary gland

prolactin

90
Q

Prolactin is transported via the _____ to the ______, where it directs _____ cells to produce milk.

A

blood

breast

acini

91
Q

Suckling (possibly via prolactin release) suppresses which three hormones implicated in menstruation and ovulation?

A

Gonadotrophin releasing hormone, luteinising hormone and follicle-stimulating hormone

92
Q

If a mother is exclusively breastfeeding (including at least once at night) and her baby is less than 6 months old, how effective is lactation amenorrhoea as a method of contraception?

A

98% effective.

93
Q

Where is oxytocin produced?

A

The posterior pituitary gland

94
Q

Oxytocin binds to receptors on _____________ cells and to __________ cells in the duct walls, causing ________.

A

myoepithelial

longitudinal

contractions

95
Q

Does the milk ejection reflex increase or decreases intraductal mammary pressure?

A

Increase

96
Q

Describe what happens to oxytocin levels during a feed.

A

Levels rise within one minute of breast stimulation. Levels remain elevated during stimulation due to pulsatile release at one minute intervals. Levels return to baseline within 6 minutes of cessation of stimulation.

Midwifery Year 1 MCQ (10 decks)

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