RNC MNN EXAM 2026 LATEST UPDATE QUESTIONS AND
CORRECT VERIFIED ANSWERS ALREADY GRADED A+
*CHARGE* - ANS-- Coloboma malformation: ranges from coloboma of the iris w/o visual
impairement to anopthalmos; retinal coloboma is most common
- Heart disease (i.e. TOF, PDA, DORV w/ AV canal, VSD, ASD, right-sided aortic arch)
- Atresia of the choanae (membranous or bony); may be associated w/ cleft life and palate
- Retarded growth and development and/or CNS malformations, may include Pierre-Robin
- Genital anomalies, hypogonadism
- Ear anomalies, deafness
*Beckwith-Wiedemann Syndrome* - ANS-- usually a sporadic occurrence; the gene is located
at 11p15.5
- most common defects: macroglossia, omphalocele, macrosomia, ear creases
- also large fontanels, prominent occiput, large kidneys w/ renal medullary dysplasia,
pancreatic hyperplasia, cryptorchidism
- often present w/ polycythemia and/or hypoglycemia
*VA(C)TER(L) - ANS-- Vertebral anomalies, VSD
- Anal atresia w/ or w/o fistula
- Cardiac anomalies (VSD)
- Tracheosophageal fistula
- Esophageal atresia
- Renal anomalies, single umbilical artery, radial dysplasia
- Limb abnormalities
,*Pierre-Robin sequence* - ANS-- early mandibular hypoplasia syndrome --> results from
hypoplasia of the mandibular area prior to 9 weeks of development, allowing the tongue to
be posteriorly located and impairing the closure of the posterior palatal shelves
- defects include micrognathia, glossoptosis (tongue is normal size but too big for small jaw),
cleft soft palate
- results in airway obstruction leading to hypoxia, cor pulmonale, FTT, cerebral impairment
- *position prone so tongue can fall forward*
*autoregulation* - ANS-- maintenance of constant cerebral blood flow despite swings in blood
pressure or alterations of anything that affects cerebral blood flow (i.e. pH, potassium,
hypoxemia, osmolarity, calcium)
*harlequin sign* - ANS-- normal reflection of an immature autonomic nervous system in a
newborn
*signs of VP shunt infection or blockage* - ANS-- irritability
- vomiting
- increasing head size
- lethargy
- changes in feeding patterns
- bulging fontanels
- fever
*spina bifida occulta* - ANS-- type of neural tube defect that involves the vertebral bone and
is invisible
*meningocele* - ANS-- type of neural tube defect that involves the protrusion of the
meninges
,*myelocele* - ANS-- type of neural tube defect that involves the exposure of the internal
surface of the spinal cord or nerve roots
*myelomeningocele* - ANS-- type of neural tube defect that involves the spinal cord and
meninges exposed through the skin and onto the surface of the back
*myeloschisis* - ANS-- type of neural tube defect that involves large areas of the spinal cord
without covering
Duchenne-Erb palsy - ANS-- type of brachial plexus injury that involves Cervical Nerves 5 and 6
--> upper arm paralysis
- affected arm is abducted and internally rotated, elbow is extended, arm is pronated, wrist is
flexed ("waiter's tip" position)
- asymmetric Moro, normal grasp
Klumpke's paralysis - ANS-- type of brachial plexus injury that involves Cervical Nerve 6 to
Thoracic Nerve 1 (lower arm paralysis)
- very rare
- no grasp in affected hand
grading of intracranial hemorrhage - ANS-- Grade I: germinal matrix hemorrhage
- Grade II: partial filling of lateral ventricles w/o ventricular dilation
- Grade III: intraventricular hemorrhage w/ ventricular dilation
- Grade IV: parenchymal involvement or extension of blood into the cerebral tissue itself
subdural hemorrhages - ANS-- caused by tears of cerebral veins or venous sinuses, w/ bleeding
over the cerebral hemispheres
, - *large head in combination w/ a small birth canal* --> birth trauma
- vaginal breech delivery, malpresentation, instrumentation
- may present normally or w/ subtle seizes, focal seizures on day 2-3, hemiparesis, dilation or
poorly reactive pupil on the same side as the bleed
- head CT or MRI
*essential criteria for hypoxic ischemic encephalopathy (HIE)* - ANS-- *must meet all 4 criteria
to be diagnosed*
1) evidence of a metabolic acidosis in fetal umbilical cord arterial blood obtained at delivery (pH
<7 and base deficit = 12 mmol/L)
2) early onset of severe or moderate neonatal encephalopathy in infants born at 34 weeks of
gestation or more
3) cerebral palsy of the spastic quadriplegic or dyskinetic type
4) exclusion of other identifiable etiologies such as trauma, coagulation disorders, infectious
conditions, or genetic disorders
HIE criteria that collectively suggest an intrapartum timing (within close proximity to labor and
delivery, e.g. 0-48 hrs) but are nonspecific to asphyxial insults - ANS-- a sentinel (signal) hypoxic
event occurring immediately before or during labor
- a sudden and sustained fetal bradycardia or absence of fetal heart rate variability in the
presence of persistent, late, or variable decels --> usually after a hypoxic sentinel event when
the pattern was previously normal
- APGAR 0-3 beyond 5 min.
- onset of multisystem involvement w/in 72 hours of birth
- early imaging study showing evidence of acute nonfocal cerebral abnormality
CORRECT VERIFIED ANSWERS ALREADY GRADED A+
*CHARGE* - ANS-- Coloboma malformation: ranges from coloboma of the iris w/o visual
impairement to anopthalmos; retinal coloboma is most common
- Heart disease (i.e. TOF, PDA, DORV w/ AV canal, VSD, ASD, right-sided aortic arch)
- Atresia of the choanae (membranous or bony); may be associated w/ cleft life and palate
- Retarded growth and development and/or CNS malformations, may include Pierre-Robin
- Genital anomalies, hypogonadism
- Ear anomalies, deafness
*Beckwith-Wiedemann Syndrome* - ANS-- usually a sporadic occurrence; the gene is located
at 11p15.5
- most common defects: macroglossia, omphalocele, macrosomia, ear creases
- also large fontanels, prominent occiput, large kidneys w/ renal medullary dysplasia,
pancreatic hyperplasia, cryptorchidism
- often present w/ polycythemia and/or hypoglycemia
*VA(C)TER(L) - ANS-- Vertebral anomalies, VSD
- Anal atresia w/ or w/o fistula
- Cardiac anomalies (VSD)
- Tracheosophageal fistula
- Esophageal atresia
- Renal anomalies, single umbilical artery, radial dysplasia
- Limb abnormalities
,*Pierre-Robin sequence* - ANS-- early mandibular hypoplasia syndrome --> results from
hypoplasia of the mandibular area prior to 9 weeks of development, allowing the tongue to
be posteriorly located and impairing the closure of the posterior palatal shelves
- defects include micrognathia, glossoptosis (tongue is normal size but too big for small jaw),
cleft soft palate
- results in airway obstruction leading to hypoxia, cor pulmonale, FTT, cerebral impairment
- *position prone so tongue can fall forward*
*autoregulation* - ANS-- maintenance of constant cerebral blood flow despite swings in blood
pressure or alterations of anything that affects cerebral blood flow (i.e. pH, potassium,
hypoxemia, osmolarity, calcium)
*harlequin sign* - ANS-- normal reflection of an immature autonomic nervous system in a
newborn
*signs of VP shunt infection or blockage* - ANS-- irritability
- vomiting
- increasing head size
- lethargy
- changes in feeding patterns
- bulging fontanels
- fever
*spina bifida occulta* - ANS-- type of neural tube defect that involves the vertebral bone and
is invisible
*meningocele* - ANS-- type of neural tube defect that involves the protrusion of the
meninges
,*myelocele* - ANS-- type of neural tube defect that involves the exposure of the internal
surface of the spinal cord or nerve roots
*myelomeningocele* - ANS-- type of neural tube defect that involves the spinal cord and
meninges exposed through the skin and onto the surface of the back
*myeloschisis* - ANS-- type of neural tube defect that involves large areas of the spinal cord
without covering
Duchenne-Erb palsy - ANS-- type of brachial plexus injury that involves Cervical Nerves 5 and 6
--> upper arm paralysis
- affected arm is abducted and internally rotated, elbow is extended, arm is pronated, wrist is
flexed ("waiter's tip" position)
- asymmetric Moro, normal grasp
Klumpke's paralysis - ANS-- type of brachial plexus injury that involves Cervical Nerve 6 to
Thoracic Nerve 1 (lower arm paralysis)
- very rare
- no grasp in affected hand
grading of intracranial hemorrhage - ANS-- Grade I: germinal matrix hemorrhage
- Grade II: partial filling of lateral ventricles w/o ventricular dilation
- Grade III: intraventricular hemorrhage w/ ventricular dilation
- Grade IV: parenchymal involvement or extension of blood into the cerebral tissue itself
subdural hemorrhages - ANS-- caused by tears of cerebral veins or venous sinuses, w/ bleeding
over the cerebral hemispheres
, - *large head in combination w/ a small birth canal* --> birth trauma
- vaginal breech delivery, malpresentation, instrumentation
- may present normally or w/ subtle seizes, focal seizures on day 2-3, hemiparesis, dilation or
poorly reactive pupil on the same side as the bleed
- head CT or MRI
*essential criteria for hypoxic ischemic encephalopathy (HIE)* - ANS-- *must meet all 4 criteria
to be diagnosed*
1) evidence of a metabolic acidosis in fetal umbilical cord arterial blood obtained at delivery (pH
<7 and base deficit = 12 mmol/L)
2) early onset of severe or moderate neonatal encephalopathy in infants born at 34 weeks of
gestation or more
3) cerebral palsy of the spastic quadriplegic or dyskinetic type
4) exclusion of other identifiable etiologies such as trauma, coagulation disorders, infectious
conditions, or genetic disorders
HIE criteria that collectively suggest an intrapartum timing (within close proximity to labor and
delivery, e.g. 0-48 hrs) but are nonspecific to asphyxial insults - ANS-- a sentinel (signal) hypoxic
event occurring immediately before or during labor
- a sudden and sustained fetal bradycardia or absence of fetal heart rate variability in the
presence of persistent, late, or variable decels --> usually after a hypoxic sentinel event when
the pattern was previously normal
- APGAR 0-3 beyond 5 min.
- onset of multisystem involvement w/in 72 hours of birth
- early imaging study showing evidence of acute nonfocal cerebral abnormality
