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What Comes First … the Photo or the Text?

Brunette woman thinking in front of bookcase.

My course attendees have asked many times, “Should I look at the photo or the text first?” referring to IBCLC® exam questions. I could make an argument for either approach. I’ve spent much of my career with one foot in the clinical camp while the other foot in the academic camp. How I approach a test item depends, to a degree, on what kind of camp I need to be in to answer the question.

How you approach situations in clinical practice sometimes differs from how you would answer a test question. But before you can work as an IBCLC, you must pass the exam!

Remember, historically, the IBCLC exam has used photos for half or more of the test items. It does vary year to year but be prepared to see a large portion of the exam containing clinical photos.

Real-life applications

If I was in front of a patient who had a question about her sore nipples, I would listen to her question and then look at her nipples. Generally, in the real-life clinical setting, I first hear the question posed and then I get to see the situation — whatever it is — myself.

I do not see the patient and say to myself, “I wonder what this problem is?”

I don’t see the nipples or the incision or the lochia or the jaundice first and then say, “Gee, I wonder what she wants to ask me about this?” So, in general, I suspect I’m better at looking at photos after I’ve taken in the question. That gives me a sense of context.

Do what feels comfortable

Ultimately, there is no right or wrong answer here. You can look at the photo first, or you can read the text first. We’re all different kinds of learners, which also means that we’re all different kinds of test-takers.

When I’m taking the IBCLC exam, I sometimes do try to examine the photo first, so that I read the question in the context of the photo.  If I can do that successfully, I’m usually much quicker at answering the question.

The only downside: This approach can backfire on me if I focus on the baby’s nose and discover that the question is about what’s on their forehead!

Personally, reading the question first feels more clinically comfortable for me, and it may improve the accuracy of my initial thinking.


While I don’t think it matters one way or the other, aside from finding what works for you, the biggest suggestion I can offer is to prepare!

I’ve previously gone over the most-commonly asked questions I get about decoding photos on the exam.

This book is heaven sent! If you are pairing it with the Breastfeeding Atlas, it helps you to decode the pictures better and understand the differences and similarities between common issues in lactation! Buy it!!!

-Amazon reviewer

Additionally, I offer an entire course on decoding the photos on the exam that will help you nail the photo questions!

Are you preparing to answer photo questions on the IBCLC exam? Do you look at the photo before or after reading the question during your review?

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