IBCLC Exam
QUESTIONS AND
ANSWERS 2023
What is the first question to consider when helping a breastfeeding mother with a
medication question?
A) What is the relative infant dose of the medication?
B) What is the protein binding of the medication?
C) What is the molecular weight of the medication?
D) Is the medication really necessary to take now? - ANSWER D
Which drug property results in more transfer of the drug into the mother's milk?
A) Molecular weight >800 Daltons
B) High protein binding
C) High lipid solubility
D) Low maternal plasma concentration - ANSWER C
When it comes to medications and breastfeeding, drugs with a shorter half-life are
preferred. How many half-lives until it is generally considered that the drug is eliminated
from the system?
A) 3
B) 5
C) 7
D) 9 - ANSWER B
If a woman is given 80 mg of a drug to treat a urinary tract infection - and the drug has a
half-life of 3 hours - how much will be left in her system after 3 half-lives?
A) 40 mg
B) 20 mg
C) 10 mg
D) 5 mg - ANSWER C
,What is considered a high enough molecular weight that the medication will be too big
to easily get into the breast milk compartment?
A) 200 Daltons
B) 300 Daltons
C) 400 Daltons
D) More than 800 Daltons - ANSWER D
Drugs can be highly bound to albumin, a large protein in the blood circulation, and
therefore too big to get into the breast milk space. What percentage of protein binding is
considered high and therefore preferred?
A) 40%
B) 60%
C) 80%
D) >90% - ANSWER D
While most drugs are compatible with breastfeeding, a few are not. Which type of drug
is usually contraindicated for breastfeeding?
A) Antibiotic
B) Antidepressant
C) Chemotherapy
D) Diabetic therapy - ANSWER C
A Relative Infant Dose (RID) of _____ indicates compatibility with breastfeeding.
A) <10% ANSWER A) <10%
B) >10% -
A good resource to use to figure out if a medicine is compatible with breastfeeding is:
A) The Physician Desk Reference (PDR)
B) The medicine package insert
C) Google
D) LactMed - ANSWER D) LactMed
In Hale's Medications and Mothers' Milk, which lactation risk category is the safest?
A) L1
B) L2
C) L4
D) L5 - ANSWER A
In Hale's Medications and Mothers' Milk, what lactation risk category does a medication
go into if there is absolutely no published data about the medication, even if it is
considered safe?
A) L2
B) L3
C) L4
D) L5 - ANSWER B
,In which lactation risk category in Medications and Mothers' Milk is this the
recommendation: "The drug is contraindicated in women who are breastfeeding an
infant."
A) L2
B) L3
C) L4
D) L5 - ANSWER D) L5
Many antibiotics are safe for the breastfeeding mother to take. However, caution needs
to be taken with this antibiotic, ________, about which Hale's Medications and Mothers'
Milk says, "This antibiotic can be extremely toxic, particularly in neonates, and should
not be used for trivial infections."
A) Ampicillin
B) Chloramphenicol
C) Gentamicin
D) Metronidazole - ANSWER B) Chloramphenicol
Plasma levels of most topical and ophthalmic preparations are virtually nil and are not
likely to produce milk levels at all.
A) True
B) False - ANSWER A) True
Some drug pumping systems exist in the alveolar cell (the cells that line the milk sac).
For example, iodine is readily pumped into the milk compartment. Therefore, any form
of radioactive iodine should be avoided while breastfeeding.
A) True
B) False - ANSWER A) True
Although there are many exceptions, in general, _______ of the maternal dose finds its
way into the milk and, subsequently, to the baby. ***(Do not confuse this with Relative
Infant Dose)
A) <1%
B) 5%
C) 10%
D) 12.5% - ANSWER A
What is the AVERAGE volume of milk consumed per 24 hours by a breastfed baby
around age 2-4 weeks?
A) 550-600ml (18-20oz)
B) 650-700ml (21.5-23oz)
C) 750-800 ml (25-26.5oz)
D) 850-900ml (28-30oz) - ANSWER C
Which statement about the effect of human milk on the child's immune system would be
MOST important to medical students?
A)Human milk stimulates the baby to begin making his own SIgA and other antibodies.
, B)Exclusively breastfed babies have a poorer response to immunizations.
C) The mother's own milk provides passive immunity between placentally acquired
immunity and autonomous immune protection.
D)The breastfed baby is at higher risk of infection because he relies on the mother's
immune protection during breastfeeding - ANSWER C
Which component of preterm milk is proportionally higher than in term milk?
A) Protein
B)Lactose
C)Phosphorus
D)Iron - ANSWER A
Which is the MOST APPROPRIATE suggestion for a pregnant woman concerned about
eating well enough for her own body growth and her developing baby?
A)Take prenatal vitamins every day
B)Eat fruits, vegetables, and protein-rich food 5 times a day
C)Plan your meals and snacks so you can eat every few hours
D)Plan to gain 25-35 pounds by the end of your pregnancy - ANSWER D
A 3-week-old exclusively breastfed baby with a strong family history of allergy has a
severe reaction the first time he is fed with a cow's milk-based formula. The MOST
LIKELY explanation for this is that the:
A)baby was sensitized by intact cow's milk proteins that passed into the mother's milk
B)baby was given a bottle of formula in the hospital nursery
C)mother consumed large amounts of dairy products during pregnancy
D)allergic reaction was more likely due to the latex in the bottle nipple than the cow's
milk - ANSWER C
Which of the following components of human milk has the MOST immunological
importance?
A)Interferon
B)Fibronectin
C)Lactoferrin
D)Secretory IgA - ANSWER D
Which of the following protective components of milk is destroyed by freezing?
A)Lysozyme
B)Lymphocytes
C)Secretory IgA
D)Lactoferrin - ANSWER B
According to studies of breastfed babies in an industrialized society, which of the
following feeding patterns most closely approximates that of an exclusively breastfed 3-
month-old baby?
A)4-6 feeds per day, total 60 minutes or more
B)6-8 feeds per day, total 100 minutes or more
QUESTIONS AND
ANSWERS 2023
What is the first question to consider when helping a breastfeeding mother with a
medication question?
A) What is the relative infant dose of the medication?
B) What is the protein binding of the medication?
C) What is the molecular weight of the medication?
D) Is the medication really necessary to take now? - ANSWER D
Which drug property results in more transfer of the drug into the mother's milk?
A) Molecular weight >800 Daltons
B) High protein binding
C) High lipid solubility
D) Low maternal plasma concentration - ANSWER C
When it comes to medications and breastfeeding, drugs with a shorter half-life are
preferred. How many half-lives until it is generally considered that the drug is eliminated
from the system?
A) 3
B) 5
C) 7
D) 9 - ANSWER B
If a woman is given 80 mg of a drug to treat a urinary tract infection - and the drug has a
half-life of 3 hours - how much will be left in her system after 3 half-lives?
A) 40 mg
B) 20 mg
C) 10 mg
D) 5 mg - ANSWER C
,What is considered a high enough molecular weight that the medication will be too big
to easily get into the breast milk compartment?
A) 200 Daltons
B) 300 Daltons
C) 400 Daltons
D) More than 800 Daltons - ANSWER D
Drugs can be highly bound to albumin, a large protein in the blood circulation, and
therefore too big to get into the breast milk space. What percentage of protein binding is
considered high and therefore preferred?
A) 40%
B) 60%
C) 80%
D) >90% - ANSWER D
While most drugs are compatible with breastfeeding, a few are not. Which type of drug
is usually contraindicated for breastfeeding?
A) Antibiotic
B) Antidepressant
C) Chemotherapy
D) Diabetic therapy - ANSWER C
A Relative Infant Dose (RID) of _____ indicates compatibility with breastfeeding.
A) <10% ANSWER A) <10%
B) >10% -
A good resource to use to figure out if a medicine is compatible with breastfeeding is:
A) The Physician Desk Reference (PDR)
B) The medicine package insert
C) Google
D) LactMed - ANSWER D) LactMed
In Hale's Medications and Mothers' Milk, which lactation risk category is the safest?
A) L1
B) L2
C) L4
D) L5 - ANSWER A
In Hale's Medications and Mothers' Milk, what lactation risk category does a medication
go into if there is absolutely no published data about the medication, even if it is
considered safe?
A) L2
B) L3
C) L4
D) L5 - ANSWER B
,In which lactation risk category in Medications and Mothers' Milk is this the
recommendation: "The drug is contraindicated in women who are breastfeeding an
infant."
A) L2
B) L3
C) L4
D) L5 - ANSWER D) L5
Many antibiotics are safe for the breastfeeding mother to take. However, caution needs
to be taken with this antibiotic, ________, about which Hale's Medications and Mothers'
Milk says, "This antibiotic can be extremely toxic, particularly in neonates, and should
not be used for trivial infections."
A) Ampicillin
B) Chloramphenicol
C) Gentamicin
D) Metronidazole - ANSWER B) Chloramphenicol
Plasma levels of most topical and ophthalmic preparations are virtually nil and are not
likely to produce milk levels at all.
A) True
B) False - ANSWER A) True
Some drug pumping systems exist in the alveolar cell (the cells that line the milk sac).
For example, iodine is readily pumped into the milk compartment. Therefore, any form
of radioactive iodine should be avoided while breastfeeding.
A) True
B) False - ANSWER A) True
Although there are many exceptions, in general, _______ of the maternal dose finds its
way into the milk and, subsequently, to the baby. ***(Do not confuse this with Relative
Infant Dose)
A) <1%
B) 5%
C) 10%
D) 12.5% - ANSWER A
What is the AVERAGE volume of milk consumed per 24 hours by a breastfed baby
around age 2-4 weeks?
A) 550-600ml (18-20oz)
B) 650-700ml (21.5-23oz)
C) 750-800 ml (25-26.5oz)
D) 850-900ml (28-30oz) - ANSWER C
Which statement about the effect of human milk on the child's immune system would be
MOST important to medical students?
A)Human milk stimulates the baby to begin making his own SIgA and other antibodies.
, B)Exclusively breastfed babies have a poorer response to immunizations.
C) The mother's own milk provides passive immunity between placentally acquired
immunity and autonomous immune protection.
D)The breastfed baby is at higher risk of infection because he relies on the mother's
immune protection during breastfeeding - ANSWER C
Which component of preterm milk is proportionally higher than in term milk?
A) Protein
B)Lactose
C)Phosphorus
D)Iron - ANSWER A
Which is the MOST APPROPRIATE suggestion for a pregnant woman concerned about
eating well enough for her own body growth and her developing baby?
A)Take prenatal vitamins every day
B)Eat fruits, vegetables, and protein-rich food 5 times a day
C)Plan your meals and snacks so you can eat every few hours
D)Plan to gain 25-35 pounds by the end of your pregnancy - ANSWER D
A 3-week-old exclusively breastfed baby with a strong family history of allergy has a
severe reaction the first time he is fed with a cow's milk-based formula. The MOST
LIKELY explanation for this is that the:
A)baby was sensitized by intact cow's milk proteins that passed into the mother's milk
B)baby was given a bottle of formula in the hospital nursery
C)mother consumed large amounts of dairy products during pregnancy
D)allergic reaction was more likely due to the latex in the bottle nipple than the cow's
milk - ANSWER C
Which of the following components of human milk has the MOST immunological
importance?
A)Interferon
B)Fibronectin
C)Lactoferrin
D)Secretory IgA - ANSWER D
Which of the following protective components of milk is destroyed by freezing?
A)Lysozyme
B)Lymphocytes
C)Secretory IgA
D)Lactoferrin - ANSWER B
According to studies of breastfed babies in an industrialized society, which of the
following feeding patterns most closely approximates that of an exclusively breastfed 3-
month-old baby?
A)4-6 feeds per day, total 60 minutes or more
B)6-8 feeds per day, total 100 minutes or more
