IBCLC EXAM STUDY

IBCLC EXAM IBLCE

Quantitative Research

research that is based on numbers, numerical data collection and analysis of the numbers. Quantitative with the letter N = numbers

Mean

the average number

Median

the middle number

mode:

the number that occurs most frequently

range

the difference between the lowest and the highest number.

finding the range

find the highes number and find the lowest number, then subtract one from the other

determine th emean, median, mode and range for this set of numbers:

6, 15, 15, 18, 20, 23, 43

Mean: 140 divided by 7 = 20

Median: 18

Mode: 15

Range: 43 take away 6 = 37

What are the stages in the continuum of human milk?

Colostrum, transitional milk and mature milk

What does LLAMAS Pee Gold stand for?

L - Living Cells

L- Lactoferrin

A- Secretory IgA

M- Microbiome

A- Vitamin A

S- Sugars (HMOS) Human milk oligosaccharides

P- Protien

G- Growth factors

What is the yellow color of colostrum due to?

Beta-carotene - a product of vit A

Approx how many living cells per mL does colostrum maintain?

5 million cells per mL (decreases 10 feld in mature milk)

What are the two main types of white blood cells in human milk?

macrophages and lymphocytes

What makes up the majority of the white blood cells at 90%

Macrohages

What is the job of a macrophages?

these cells engulf and absorb pathogens.

what makes up 10% of white blood cells in human milk?

Lymphocytes

What is lactoferrin?

lactofierrin in colostrum binds and transports iron. It offers protection agains infection by keeping iron away form pathogens. Pathogens need iron to be able to grow and multiply

what is secretory IgA?

immuniglobin (anitbody) in human milk. and key player in the first days of life.

What is 15-40 times higher in the first 24 hrs than during any other stage of lactation?

Secretory IgA

what is Secretory IgA responsible for in the infants gut?

coats the gut, sealing off enrty points for potential pathogens. It acts like a varnish.

Breast milk is not sterile liquid. True or false

true

Colostrum is high in what vitamin which gives it the yellow color?

Vitamin A

what is the role of Vitamin A in colostrum?

provides more immune protection to the infant

What are a family of structurally diverse carbohydrates that are highly abundant in and unique to human milk?

HMOs

List 3 benefits of HMO

1. Prebiotics

2. Serve as decoy receptors that prevent pathogens from attaching to the infant mucosal surfaces

3. participate in the production of Salic acid which is essential for brain development and cognition

How many HMOS have been discovered

200

Milk protien is made up of two types of protein. what are they?

Whey and caesin

What is the ratio of whey and casein in proteins in colostrum?

90:10 (easy for digestion)

What is the ratio of whey and casein in proteins in mature milk?

60:40

What is the whey:casein ratio in cow’s milk?

20:80

What promotes gut cell closure in a infants digestive system?

Growth Factors

List two examples of growth factors

TGF-B and colony stimulation factor

True or false: Colostrum has higher concentration of fat and lower concentration of lactose and protien

false - it has a higher concentration of protein and lower in fat and lactose

What is the average colostrum produced in the first 24hrs of life?

37 mL with a capacity of 7mL

by day 3, what is the average 24-hour production and stomach capacity of a newborn?

408mL and stomach capacity increasing to 27mL per feed

By day of life 5, what is the total daily production of human milk? What is the infant’s stomach capacity equaling?

705 mL and 57 mL per feed

_________________ occurs when postpartum hemorrhage (blood loss) with significant hypotension (low blood pressure) leads to infarction (death) of the anterior pituitary gland. Prolactin is one of the hormones affected.

Sheehan Syndrome

Name some risk factors for delayed lactogenesis

AMA

C-birth

diabetes type 1 & 2

Labor: long stage 2 (pushing)

obestity / elevated BMI

PCOS

infertility

primiparity

retained placenta

sheehan syndrom

surgery: breast augmentation

what hormone does the placenta produce to block prolactin on the lactocyte?

Progeterone

The time at which mothers report that their milk comes in is highly variable and ranges from ______ hours after birth, with an average of _____hours

38-98; 50-59

Colostrum is under _______ control. Mature milk is under _________ control.

Endocrine (hormonal); autocrine (local control)

the concentration of lactose is lower or higher in in colostrum when compared with more mature milk?

lower

______________ is when a woman uses hand expression to express colostrum several times a day often starting at around 36 weeks’ gestation

Antenatal milk expression

1)The secretion of colostrum begins at approximately how many weeks’ gestation?

A) 16 weeks

B) 26 weeks

C) 32 weeks

D) 36 weeks

A) 16 weeks

2. The primary function of colostrum is a protective one. One way colostrum protects the newborn is by coating the infant’s gut which blocks pathogens from adhering to the cells and gaining entry into infant’s system.

A) True

B) False

A) true

3. In the first 24 hours after birth, the average amount of colostrum produced is:

A) 27 mL

B) 37 mL

C) 47 mL

D) 57 mL

B) 37mLs

4. As compared to mature human milk, colostrum contains:

A) Higher concentrations of lactose

B) Higher concentrations of fat

C) Higher concentrations of protein

D) Lower concentrations of growth factors

c) higher concentrations of protien

5. When are levels of human milk secretory IgA the highest?

A) The levels are constant throughout lactation

B) In the first 24 hours after birth

C) When the baby reaches 6 months of age when it is time to add solid foods

D) At the end of the first year of the baby’s life

B) in the first 24 hours after birth

6. Human milk oligosaccharides (HMOs):

A) Serve as a prebiotic (food) to for the “good” bacteria in the baby’s gut

B) Serve as decoy receptors to prevent pathogens from attaching to the infant’s mucosal surfaces

C) Team up with good bacteria to produce sialic acid that helps grow the brain

D) All of the above

D) all of the above

7. Human milk is a sterile product.

A) True

B) False

b) false

8. The main immunoglobulin (antibody) found in human milk is:

A) IgA (in the form of secretory IgA)

B) IgE

C) IgG

D) IgM

A) IgA

9. The whey to casein ratio in colostrum is:

A) 90:10

B) 60:40

C) 50:50

D) 20:80

A) 90:10

10. Colostrum contains approximately 5 million living cells per mL. Which type cell makes up 90% of the white blood cells found in colostrum?

A) Lymphocytes

B) Eosinophils

C) Basophils

D) Macrophages

A) Lymphohcytes

11. The time when a woman’s milk “comes in” is highly variable but the average time is:

A) 24-26 hours

B) 36-39 hours

C) 50-59 hours

D) 72-75 hours 

c) 50-59 hours

12. Following the birth of the baby, the delivery of the placenta leads to a drop in:

A) Cortisol

B) Insulin

C) Progesterone

D) Prolactin

c) Progesterone

13. Medications taken by the mother pass more easily into colostrum than mature milk because of the gaps between lactocytes. These gaps are tightened up by the time mature milk is produced.

A) True

B) False

a) true

14. Colostrum does contain fat, just not as much as mature milk.

A) True

B) False

A) true

impact of milk on MS

43% chance of decreasing relapse if breastfeeding 2m+

What is the average weaning age for children internationally?

4 years

What is the international BF recommendation for parents that are HIV positive and how are those different thant he recommendation in high-resources countries?

WHO recommendes for poeple who have HIV and are on ART should BF for at least 12 months. The CDC states, for mothers on ART with a sustained undetectable HIV viral load during and after pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero and generally recommend not breastfeeding.

What are the safe sleep 7 guidelines?

• No smoking: The parent and anyone else in the home should not smoke 

• Sober: The parent should be sober and not taking any medications that could impair their judgment 

• Breastfeeding: The parent should be breastfeeding the baby 

• Healthy baby: The baby should be full-term and healthy 

• Baby on back: The baby should be placed on their back to sleep, not on their stomach or side 

• Safe surface: The sleeping surface should be firm and flat, and free of soft items like pillows, toys, and blankets 

• Safe environment: The sleeping space should be free of cords and strings that could be a choking hazard

What are the recommendations for feeding infants and young children according to the WHO Code

• Infants should initiate breastfeeding within one hour of birth.

• Infants should be exclusively breastfed for the first six months of life.

• Starting at six months, infants should receive adequate and safe complementary foods while breastfeeding continues up to two years of age and beyond.

What are the 10 rules of WHO International Code of Marketing of Breast-milk Substitutes

1. No advertising of these products to the public.

2. No free samples to mothers.

3. No promotion of products in healthcare facilities.

4. No company mothercraft nurses to advise mothers.

5. No gifts or personal samples to health workers.

6. No words or pictures idealizing artificial feeding, including pictures of infants, on the products.

7. Information to health workers should be scientific and factual.

8. All information on artificial feeding, including the labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding.

9. Unsuitable products, such as condensed milk, should not be promoted for babies.

10. All products should be of high quality and take account of the climate and storage conditions of the country where they are used.

True or False: A pillar of the Baby-Friendly Hospital Initiative is that the designated maternity facility is compliant with the Code.

true

What is Step 1 of the ten steps for Baby Friendly?

Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.

The International Code of Marketing of Breast Milk Substitutes is a set of recommendations to regulate the marketing of:

• Breast-milk substitutes

• Feeding bottles

• Teats (a teat is a nipple)

True or Flase: Recommendation that messages on complementary foods should always include a statement on the need for breastfeeding to continue through 2 years and that complementary foods should not be fed before 6 months

true

true or false: Recommendations that the labels and designs on products other than breast milk substitutes need to be distinct from those used on breast milk substitutes to avoid cross promotion

true

true or flase: Recommendation that any donations to the health care system (including health workers and professional associations) from companies selling foods for infants and young children represent a conflict of interest and should not be allowed

true

true or false: Recommendation that sponsorship of meetings of health professionals and scientific meetings by companies selling foods for infants and young children should not be allowed

true

Which statement about the Baby-Friendly Hospital Initiative is true?

A) It is only for hospitals in the United States.

B) It is only for Australian maternity facilities.

C) It is only for Scandinavian and German maternity facilities.

D) It is an international designation from the World Health Organization (WHO) and UNICEF, so is available worldwide.

D

For an uncomplicated vaginal birth, Step 4 of the Ten Steps to Successful Breastfeeding recommends:

A) Immediate and uninterrupted skin-to-skin contact for the first 30 minutes

B) Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth

C) Begin skin-to-skin contact once the infant has been weighed, examined, and had pictures taken

D) Initiate skin-to-skin contact as soon as possible after the infant has been weighed and examined

B

Step 4 of the Ten Steps to Successful Breastfeeding recommends skin-to-skin contact after birth for:

A) Only infants of mothers who wish to breastfeed

B) Only infants of mothers who wish to formula feed

C) All infants regardless of mother’s feeding choice

D) Only infants born vaginally

C

Skin-to-skin contact after birth is important because it:

A) Promotes bonding

B) Helps breastfeeding

C) Stabilizes the infant’s sugar (glucose) level

D) Regulates the infant’s vital signs including heart rate, respiratory rate and temperature

E) All of the above

E

The Ten Steps, the framework of the Baby-Friendly Hospital Initiative, include:

A) Train all staff, hospital-wide, with 10 hours of lactation education

B) Encourage feeding on cue for all infants regardless of feeding method

C) No availability of infant formula for any infants

D) Directions are given to new parents on the brand of bottle to buy

B

A standard of care in a Baby-Friendly designated hospital is:

A) All staff are competent in teaching hand expression

B) Discharge bags given to the hospital by the formula sales representative for free may be given out to parents at discharge as long as the can of formula is removed

C) Mother and baby room-in 24 hours a day

D) Parents need to bring in their own infant formula

c

Research demonstrates that Baby-Friendly increases breastfeeding rates.

A) True

B) False

C) No research has been conducted on the issue

A

The Ten Steps to Successful Breastfeeding are the framework of the Baby-Friendly Hospital Initiative. Step 1 consists of three parts. Step 1a is about:

A) The Code

B) Infant feeding policy

C) Maternity unit metrics

D) Skin-to-skin contact in the labor and delivery suite

A

When does sudden unexpected post-natal collapse (SUPC) occur?

A) 1/3 in first 2 hours, 1/3 in first 24 hours, 1/3 in first 7 days

B) 1/3 in first 2 hours, 2/3 in first 24 hours

C) 2/3 in first 2 hours, 1/3 in first 24 hours

D) 2/3 in first 2 hours, 1/3 in first 7 days

A

All are risk factors for Sudden Unexpected Post-Natal Collapse except:

A) Skin-to-skin contact with poor positioning

B) Maternal use of cell phone

C) Paternal obesity

D) Mother left alone in delivery room

C

Fill in the blanks. The World Health Organization recommends:

A) Initiating breastfeeding within ______ of birth

B) Exclusive breastfeeding during the first ________ of life,

C) With continued breastfeeding until ________ years or beyond, along with nutritionally adequate and safe complementary foods from the age of six months.

A) 1 hr

B) 24

C) 2 years

The International Code of Breastmilk Substitutes started in:

A) 1981

B) 1991

C) 2001

D) 2010

A

The International Code of Breastmilk Substitutes is

A) A law set by the World Council that all countries must follow

B) A set of recommendations from the World Health Organization for Member States to follow to regulate the marketing of breast-milk substitutes, feeding bottles and teats

C) A proclamation from the United Nations on optimal feeding strategies

D) A Code published by the infant food industry on rules they promise to follow

B

According to the International Code of Marketing of Breastmilk Substitutes (the Code), the marketing of which products are considered a violation?

A) Breast milk storage bags

B) Breast pumps

C) Breast milk substitutes (ie infant formula), feeding bottles and nipples

D) Pasteurized donor human milk

C

15. According to Resolution 69.9 from the World Health Assembly, “follow-up” formula and “growing-up milks” fall under the scope of the Code and should not be promoted.

A) True

B) False

C) There is not such resolution from the World Health Assembly

A

Your colleague on the maternity unit, Dr. Smith, comes into work wearing this badge holder and name label on stethoscope. He tells you he was given these items at a conference he just attended. Are these a violation of the Code?

A) Yes

B) No

A

New parents leaving the maternity unit are given this gift on the day they leave the unit. The formula sales representative provides these gifts to the hospital for free. Is this a violation of the Code?

A) Yes

B) No

A

You are asked to give a Grand Rounds at a neighboring hospital on the Baby-Friendly Hospital Initiative. You are compliant with the Code in your professional life. When you arrive to set up, about a half hour early, a formula sales representative is sitting outside the auditorium where you are giving your talk with his identification clearly showing and he is providing free donuts and coffee. A sign on the table states, compliments of Abbott Laboratories. Is this a violation of the Code and what should you do?

A) It is a violation of the Code but do nothing because you don’t have enough time.

B) It is a violation of the Code. Immediately talk to the department chairperson or the Grand Rounds contact person and share that you cannot give the talk unless the formula representative and his food are removed.

C) It is not a violation of the Code because it is outside the lecture hall. Do nothing.

D) It is not a violation of the Code because the formula representative is giving out free donuts and coffee, not free infant formula samples.

B

A substance that can increase breast milk

Galactagogues

a simple suger that’s a key part of human metabolism and is found in many foods

galagtose

a rare genetis disorder that prevents the body from metabolizing galactose

galactosemia

a benign, milk-filled cyst that developes in the breast when a milk duct becomes blocked

galactocele

In which of the following situations should a mother temporarily express and discard her milk?

A) if she has mastitis

B) after having a mammogram

C) after having radionuclide scan

D) after having dental surgery

c) radionuclide scan

Hypothyroidism symptoms

dry skin, sensitivity to cold, “baby blues: and or depression, fatigue, hair loss, lack of energy, forgetfulness, constipation, increased menstrual frequency and flow, milkd enlargment of the thyroid.

what is the most common form of hypothyroidism?

Hashimoto’s desease

TSH level is high and t3/t4 levels are low

hypothyroidism

TSH level is low and the T3/T4 levels are high

hyperthyroidism

symptoms of hyperthyroidism

racing heart, run down, weight loss, sensitive to heat, diarrhea, decreased menstrual frequency and flow, mild enlargement of the thyroid

Most common form of hyperthyroidism

Grave’s disease

postpartum pituitary infarction

Sheehan’s syndrome

Which of the following findings best describes current research regarding the general risk to breastfed infants from maternal ingestion/absorption of the environmental contaminant polychlorinated biphenyls (PCBs)?

A) not excreted in mother’s milk, and therefore in not a risk to the breastfed infant

B) excreted in mother’s milk, but does not pose a significant risk to the breastfed infant

C) excreted in mother’s milk and therefore poses a significant risk to the breastfed infant

D) water soluble and not stored in body fat, and therefore is not a significant risk to the breastfed infant

C