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Frequently Asked Questions About De-coding Pictures on the IBLCE Exam

Of course IBLCE exam-takers fret about the picture part of the exam. Those who have “been there, done that” have seen how daunting it can be. Those who are taking the exam for the first time have probably heard re-certifiers describe–in vivid detail, despite the passage of 10 years since their last exam–how anxious and bewildered they felt about it!

One thing is clear: Whether you’re a first-timer or a re-certifier, if you’re taking the IBLCE exam, you’re going to need some strategy to wrestle with the pictures. (That’s why I developed my “Picture Perfect” course, and why I’ve taught it dozens of times over the past several years.) Read on for the most frequently-asked questions I’ve heard about the exam’s pictures.

Is the IBLCE exam pictures-only?
The first part of the IBLCE exam is text-only. The second part has about 75-100 or more images. In my last exam, I faced 102 images. Sometimes the “images” are not photos but diagrams, charts, or drawings. However, the vast majority of the images are clinical photos, or—as many exam-takers say—“skin.” The entire exam consists of 175 questions. That means that your ability to correctly answer 50 percent or more of the exam will rely on your ability to de-code  images.

What will you see?
When you’re taking Part 2 of the IBLCE exam, you’ll be looking at mothers and babies, healthy and ill, from a few minutes after birth until about 2 years old. This includes plenty of variations of normal. You’re looking at equipment (e.g., tube-feeding devices), gizmos (e.g., pacifiers) lesions (“sores”), behaviors (e.g., an older infant feeding himself), processes (e.g., hand expression), and more.

How do you decipher “sore” nipples or “sore” breasts?
Unfortunately, I can’t cover this broad topic in one blog post. (I do provide a lot of information in the new workbook, though!) But here are the “big four” clues that I used while writing the workbook: size, shape, color, location. Of these, I would say location is often the most important.

Here’s an example: A yeast infection can be anywhere. But unless the “thing” is present on the nipple, it’s highly unlikely to be yeast if the characteristic color, shininess and texture isn’t present on the nipple as well as the areola. An exception would be if you see cracking and characteristic yeast signs at the nipple/areolar junction.

Here’s another one: Mastitis will cause redness—which can be anywhere on the breast —but it is frequently located in the upper, outer quadrant of the breast. And, mastitis is rarely bilateral, so if you see redness on both breasts, strongly consider another explanation.

Here are several others: A cleft of the lip is always on the upper lip. A natal tooth is always in the lower alveolar ridge. A torticollis is on the right side in 75 percent of the cases. True, you’ll need to know more than this to pick the right answer, but often, knowing location might help you to at least eliminate some of the options.

How do you distinguish between normal, variations of normal, and abnormal?
Again, this is a huge topic! But let’s say the photo shows small breasts and the question asks what impact it will have on the baby or on milk production. Pause before you say “no problem.” Is this micromastia, or hypoplasia? The former has little or no clinical impact; the latter may have a huge impact. Are the breasts symmetrical? Do the nipples and areolae look “proportionate” to them? What is the shape of the breasts? You’ll want to go a little further than the obvious in decoding these images!

How do you tell if it’s a scar—or something else?
Maybe you see a “scar” around the areola. Is this line a scar, or just an indentation? If the line has “railroad tracks,” you can bet that’s evidence of sutures that held the incision together. But if it’s smooth, it’s probably an indentation of from a breast shell, clothing, or something else.

How do you tell if it’s a birth mark—or child abuse?
Yeah, this is a hairy one, isn’t it? Anyone credentialed in healthcare is obligated to report signs of child abuse, so this is fair game for the IBLCE exam. Here, location is of little importance; both abusive marks and birth marks can be anywhere. But a Mongolian slate blue mark is flat, and it does not change colors within a few days. A bruise IS likely to be swollen above the skin’s surface, changes color as it heals, and often has the distinctive shape of the item that caused it.

What I’ve given you here is only the tip of the iceberg. But I hope it will help you to start looking critically at the clues that are in the photo. You still have time to get my workbook at a special price, (or packaged with the Breastfeeding Atlas, 6th edition) and there, you can use the narrative, paper-and pencil match-up and many other written exercises to cement your knowledge, and even blast through the post-test questions at the end of every chapter!

How prepared do you feel for the IBLCE exam?

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