CLC Exam 2024 Updated and Correct
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What are green/shiny stools a sign of? - CORRECT ANSWER--sign of overproduction leading
to less fat in milk, faster digestion causing not enough time for lactase to digest the lactose in
milk. An improved latch could allow for more fat flow
Signs of oversupply - CORRECT ANSWER-Rapid weight gain in infant, unsettled baby after
feeding, recurrent plugged ducts and mastitis, painful feedings, voluminous (huge volumes of)
stools- often green & shiny
What causes nipple pain? - CORRECT ANSWER-Improper latch--> need lactation support to
help with proper latch on, good seal
True/false: baby should be pulled into breast. - CORRECT ANSWER-False! Do not pull baby
into breast, let baby tilt head back for optimal latch. Hand on back of baby's head can interfere
baby's interoral function by restricting the movement of the cranio-cervical spine--> causes
nipple trauma. Make sure crook of arm in cradle position does not block baby from being able to
fully tilt back.
Should a latch be symmetric or asymmetric? - CORRECT ANSWER-Asymmetric! A baby
should form a teat with breast tissue underneath the nipple as part of a latch
What is a symmetric latch - CORRECT ANSWER-Not a good latch, causes nipple damage
Asymmetric latch - CORRECT ANSWER-Optimal attachment to the breast, where the baby's
lips are not centered in relationship to the areolar, but rather vertically off-centered with the
baby's chin and lower lip closer to the edge of the areola than the baby's upper lip. A baby should
form a teat with breast tissue underneath the nipple as part of a latch
Do nipple creams work? - CORRECT ANSWER-Continued questions of effectiveness, fear of
ingestion by baby
Should a frenotomy be suggested for tongue tie? - CORRECT ANSWER-No study was able to
report that frenotomy led to better long term breastfeeding
,Tongue tied breastfeeder - CORRECT ANSWER--complete feeding assessment and suggest
ways to optimize latch.
-refer onward for diagnosis (have PCP diagnose TT)
-provide support
What is a fissure straight down the nipple evidence of? - CORRECT ANSWER-A symmetric
latch. Top lip needs to have good seal, moist part of lip should be touching nipple, can roll out
top lip, to reduce injury during BF
Is there a deep latch with nipple stretching? - CORRECT ANSWER-If nipple not stretched
deeply into mouth, less oxytocin flows, less fat is in mix. With less fat, milk digested quicker =
not enough time for baby to make enough lactase to digest lactose in milk.
What to do for oversupply? - CORRECT ANSWER-Decrease additional stimulation/milk
removal if possible
Consider block feeding (only nursing on one side only per feeding)
Watch for mastitis
Try australian posture (mother down under, baby on top)
Consider donating to milk bank
Consult with HCP for medical dx
How many mL considered oversupply? - CORRECT ANSWER-normal milk production = 750-
1000 mL/day
Thrush during BF - CORRECT ANSWER-painful for mother & baby.
may be visible or may not (whiteness that can't be wiped off)
-mother will have itchy, flaky, shiny skin
-candida not found inside the ducts or milk
Treatment of candida on breast - CORRECT ANSWER--nystatin first line
-flucanizole second line
-throw out all yeast vectors (pacifiers sterilize breast pumps)
-flucanazole oral capsules may be used to clean yeast vectors due to the biofilm created on
pacifiers by candida
What to do if antifungal treatment for yeast doesn't work? - CORRECT ANSWER-Not candida
infection!
Reynaud's Phenomenon - CORRECT ANSWER--vasospasm of nipple, recognized by triple
color sign: from white--> blue--> raspberry or bicolor sign white --> raspberry.
,pain is extreme and spasmodic (not continuous)
-this happens after feeding once baby's mouth comes off nipple has vasospasm, feels like
frostbite
treatment of reynauds - CORRECT ANSWER--prevent/decrease cold exposure
-avoid vasoconstrictive drugs such as caffeine and hypertensive drugs, nicotine
-can use nifedipine or calcium channel blocker
Nipple pain and poor milk transfer that is persistent despite optimal latch - CORRECT
ANSWER--can use nipple shield as a test to see if baby exerting too much pressure?
-OT involvement
-in rare cases baby have a strong sucking vacuum as measured by a pressure transducer or nipple
shield
Clogs/plugs - CORRECT ANSWER-Palpable lumps of milk within the lumen or duct system,
usually not visible. Solids dont get absorbed...could be too tight of a bra slowing flow of milk
what to do for clogs/plugs - CORRECT ANSWER-Encourage massage using side of hand and
warm compresses. Do double nursing by doubling up on side of clog to push it out. point baby's
chin toward clog
See PCP if clog hasnt moved in 24-48 hours or systemic symptoms of inflammation (flu like s/s)
When to call PCP for clog/plug - CORRECT ANSWER-If plug hasn't moved in 24-48 hrs or
systemic signs of inflammation (flu like s/s)
Causes of clogs/plug - CORRECT ANSWER-too tight nursing bra
what is a bleb - CORRECT ANSWER-small white spots on the face of the nipple that look like
milk-filled blisters. one duct opening is usually covered
what does a bleb feel like - CORRECT ANSWER-painful stabbing pinpoint pain
how to get rid of blebs - CORRECT ANSWER-Same as clog treatment. Sometimes need t be
lanced by HCP
Common mastitis - CORRECT ANSWER--can be non-infective or infective
-blocked ducts from engorgment, hurried feedings, nipple shield (pressure will build until milk
sneaks out of space, body reacts to this like invader)
, causes of common mastitis - CORRECT ANSWER--tight bra (look for indentation of breast
straps)
-use of breast shell or nipple shell
-attachment difficulties
-anemia in the mother
-tongue tie in baby (ineffective milk emptying)
s/s common mastitis - CORRECT ANSWER-systemic- fever, ill, malaise, redness, pain, one
inflamed breast
What bacteria causes infective mastitis - CORRECT ANSWER-Staphylococcus
tx common mastitis - CORRECT ANSWER-NSAIDS first line but make sure diagnosed by PCP
-must keep pumping/breastfeeding to keep milk flowing. keeps breasts soft/comfortable to avoid
abscess development
Abscess on breast - CORRECT ANSWER-Localized areas of pus and necrotic tissue that can
develop with a breast infection
•Can develop in the subcutaneous, intramammary, retromammarylayers
•Symptoms include pain, swelling, redness, fever, increased WBC count, palpable mass
-pocket of pus forms in the breast
-from untreated mastitis
Antibiotics for mastitis? - CORRECT ANSWER-Usually for double mastitis, not generally
proscribed for one breast common mastitis. If treatment uneffective consider anemia, ductal or
inflammatory breast cancer
Double mastitis - CORRECT ANSWER-EMERGENT AND UNCOMMON- tissue of both
breasts inflamed.
organism cause of double mastitis - CORRECT ANSWER-strep -potentially fatal, whole body
inflammation, sepsis
-not a problem with milk
signs of inflammatory breast cancer - CORRECT ANSWER-- breast tissue is red, warm, has
orange peel (peau d'orange), pitting appearance on skin surface
- breast mass may or may not be present
