The Gold Standard Line

Question:
WITHOUT LOOKING IT UP: According to the WHO’s “Guidelines on HIV and Infant Feeding” (2010), who should decide whether HIV-infected mothers should be counseled primarily to breastfeed with an antiretroviral intervention or to avoid all breastfeeding?
A. National and sub-national health authorities
B. Individual health counselors
C. Religious leaders of the mother’s faith
D. The mother’s family

Answer:
The correct answer here is “A.”
Guidelines on HIV and Infant Feeding is available online.

The relevant passage, in a section entitled “Setting national or sub-national recommendations for infant feeding in the context of HIV” reads:
“National or sub-national health authorities should decide whether health services will principally counsel and support mothers known to be HIV-infected to either:
- breastfeed and receive ARV interventions, or,
- avoid all breastfeeding,
as the strategy that will most likely give infants the greatest chance of HIV-free survival.
This decision should be based on international recommendations and consideration of the:
- socio-economic and cultural contexts of the populations served by maternal and child health services;
- availability and quality of health services;
- local epidemiology including HIV prevalence among pregnant women; and,
- main causes of maternal and child under- nutrition and infant and child mortality.”

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Question:
WITHOUT LOOKING IT UP: For infants with cleft lip and palate, or cleft palate: Research indicates that obturators have what sort of effect on breastfeeding efficacy, breastfeeding effectiveness, and infant weight gain?
A. Significant increase
B. Significant decrease
C. No impact

Answer:
The answer here is “C.”
You’ll want to look at the Academy of Breastfeeding Medicine’s Guidelines for Breastfeeding Infants with Cleft Lip, Cleft Palate, or Cleft Lip and Palate (Protocol #17).

Here’s the relelvant passage (but see the source for more on the research the committee looked at): “Breastfeeding outcomes may be affected by the use of feeding plates (which obturate some of the cleft and attempt to “normalize” the oral cavity for feeding)46 or presurgical orthopedics (prosthesis to reposition the cleft segments prior to surgery). These are collectively referred to as “obturators” for this report. There was strong (Level I) evidence that obturators do not facilitate feeding or weight gain in breastfed babies with a CLP,45 and that they do not improve the infant’s rate of bottle feeding.46 There was moderate evidence (Level II-2) obturators do not facilitate suction during bottle feeding.23 This is because obturators do not facilitate complete closure of the soft palate against the walls of the throat during feeding. Contradictory evidence exists, supporting the use of obturators to facilitate breastfeeding in infants with a CP or CLP, but it is from much weaker sources (Level II-3, and Level III descriptive and case studies, and expert opinion).29,39,51,53,59–66″

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Question:
CONSIDER THIS: The mother of a 7 month old child has been diagnosed with mastitis. She reports that her physician has prescribed Keflex and told her she must wean immediately. After hearing her story, you decide the BEST response is:
A. “Apparently he doesn’t know that weaning is the WORST thing to do now.”
B. “Keflex has long been established as safe during breastfeeding, so there is no reason to wean.”
C. “I can talk to him and point him to the latest information on Keflex and breastfeediing.”
D. “Tell him you aren’t willing to wean, and ask for where he got his information.”

Answer:
The correct answer is “C.” This is the only answer that helps the mother move towards problem-solving without undermining the physician’s authority. Taking this on as an advocate for the mother, and treating it as a discussion point with a colleague, is the BEST way to go.

“A” acknowledges that weaning is, quite possibly, the worst thing to do now because it would increase the likelihood of milk stasis. However, this is not an appropriate response because it undermines the physician’s authority.

“B” recognizes that Keflex has a history of being safe for the breastfed infant, and we might assume that there is no reason to wean because of it. However, this approach also undermines the doctor. Without talking to him, we cannot know how he came to assess the risk/benefit in this situation.

“D” makes assumptions about the mother (she has not said she is unwilling to wean). Also, demanding that the doctor name his sources of information is not a likely way to achieve problem-solving.

Good sources of information about breastfeeding and medication interactions are: Hale’s Medications and Mother’s Milk and the Drugs and Lactation Database from the National Institutes of Health.

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Question:
WITHOUT LOOKING IT UP: When should complementary foods be introduced to the breastfed infant?
A. 3 months
B. 6 months
C. 8 months
D. 9 months

Answer: The best source for answering this question is the Global Strategy for Infant and Young Child Feeding, from WHO and UNICEF.

The relevant passage:
“As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.”

Although six month old infants will take in only small amounts of “solid” food initially, they should be introduced at this time to meet the infant’s changing needs. The answer here is B.

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Question:

WITHOUT LOOKING IT UP: The tissue from below the nose to the upper lip is called which of the following?
A. antecubitalfossa
B. incisivepapilla
C. philtrim
D. uvula

Answer: The answer is C. Normally, the philtrum is grooved, but in fetal alcohol syndrome it is flat. A pronunciation guide is here: http://www.forvo.com/word/philtrum/
A. is commonly known as the crook of the elbow.
B. is the flap of tissue just behind the front teeth.
D. hangs down at the soft palate.

While this question is unlikely to appear as-is on the IBLCE exam, knowing this information may help you figure out a more complicated question.

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Question:
WITHOUT LOOKING IT UP: Bradycardia in a newborn means that the baby’s heart rate is which of the following?
A. less than 100
B. 100-120
C. 121-140
D. 141-160
E. greater than 160

Bradycardia is “A,” less than 100 beats per minute. This is the time-honored definition of the medical term.

“B,” while a lower heart rate that most newborns have, is not considered bracycardia.

“C” and “D” are both within the normal range for newborn heart rate.

A heart rate of greater than 160 beats per minute, “E,” is father than normal in a newborn. This would be called tachypnea.

Of course, this question is unlikely to be included in the IBLCE exam as-is, but knowing this information may help you decode a more complex exam item.

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Question:
WITHOUT LOOKING IT UP: “Extra” nipples would be correctly referred to by all of the following terms EXCEPT:

A. ectopic nipples
B. hypermastia
C. supernumerary nipples
D. polythelia

Answer:
The correct answer is B. “Hyper” means “excessive,” while “mastia” means “breast tissue.” Breast tissue is not the same as nipple.

All of the other terms could be used for “extra nipples.” How can you tell?

“Ectopic” is from the Greek word “ektopos,” which means “out of place.” Therefore, “ectopic nipple” can be used to describe an extra nipple that exists somewhere other than the usual place on the breast.

“Supernumerary” means “more than the usual number,” and in this context it is being used to describe nipples.

“Poly” means “many” and “thelia” means “nipple.”

While this question is unlikely to appear as-is on the IBLCE exam, knowing this information may help you figure out a more complicated test item.

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