RNC-NIC COMPREHENSIVE STUDY
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ The form of circulating bilirubin that places the infant at the highest risk for
kernicterus is:.
Answer: Indirect, free bilirubin is not attached to albumin and easily crosses
the blood-brain barrier, potentially resulting in signs of kernicterus.
◍ polycythemia in newborn.
Answer: hematocrit >65%seen in the first few hours or days of lifepossible
symptoms -altered mental status -poor feeding -plethora (excessive blood in
circulatory system or one organ or one area) -acrocyanosis
-hyperbilirubinemia
◍ Hemophilia A.
Answer: Hemophilia A has a normal or prolonged partial thromboplastin
time and a normal prothrombin time and platelet count. Factor VIII is
deficient.
◍ ABO incompatibility.
Answer: ABO incompatibility affects babies when mothers have blood
group O and the babies have blood group A or B (seen as antigens)Mom
will make antibodies and attack fetal RBCs by maternal anti-ab
antibodiesProtects against fetal RH disease because of rapid destruction of
fetal A/B cells, preventing RH antigen exposureWhile it occurs more
frequently than Rh isoimmunization (partially because of the use of
RhoGAM for Rh), the hemolytic disease is less severe.
◍ Isoimmunization and Rh isomminuzation (incompatibility).
Answer: Production by an individual of antibodies against constituents of
, the tissues of another individual of the same speciesIf fetal Rh-positive
blood leaks into the Rh-negative mother's circulation, her body may respond
by making antibodies to destroy the Rh-positive erythrocytes.
◍ RH Incompatibility and amniocentisis.
Answer: Because an amniocentesis can cause minute amounts of fetal red
blood cells to enter the maternal circulation, maternal antibodies (IgM and
IgG) can result if the mother is Rh negative and the baby is Rh positive.
◍ Neonatal autoimmune thrombocytopenia.
Answer: Neonatal alloimmune thrombocytopenia has a similar
pathophysiology to Rh incompatibility.It occurs when maternal platelets
come into contact with fetal platelets containing an antigen lacking in the
mother. Maternal antibodies cross the placenta and coat the fetal
platelets—primarily on subsequent pregnancies.The maternal platelet count
is normal. Neonatal partial thromboplastin time and prothrombin time are
normal. Treatment of neonatal alloimmune thrombocytopenia includes
giving the baby washed maternal platelets, which are free of the platelet
antigen.
◍ Breastmilk Jaundice presentation, value, cause, treatment.
Answer: Breast milk jaundice occurs after 4 to 7 days of life and is related to
two substances found in the maternal breast milk that interfere with bilirubin
conjugation and increase the resorption of bilirubin from the intestine,
resulting in increased indirect bilirubin. The resulting level of total bilirubin
is often between 12 and 20 mg/dl. In breast milk jaundice, stopping feeding
breast milk for 24 to 48 hours will decrease the level of the total bilirubin by
50%
◍ Grade II IVH.
Answer: Grade II is an intraventricular hemorrhage without ventricular
dilation.
◍ Grade III IVH.
Answer: blood within the ventricles and associated dilation of the ventricle.
,◍ Grade IV IVH.
Answer: blood within the ventricles and an echogenic focus within the
periventricular tissue.
◍ Bicarb administration time and associated risks from rapid infusion.
Answer: Rapid infusions of sodium bicarbonate may result in elevations of
carbon dioxide, causing a rapid dilation of cerebral blood vessels, which
could lead to intracerebral hemorrhage. Therefore infusing sodium
bicarbonate at 4.2% concentration over 30 minutes will avoid a rapid
infusion of a hyperosmolar solution.
◍ myelomeningocele position and treatment.
Answer: The infant should be positioned in the prone kneeling
position.Initial delivery room management is to protect the lesion by
covering with sterile gauze moistened with warm sterile saline solution.
◍ Klumpe Paralysis.
Answer: Klumpe paralysis exhibits swelling in the shoulder and
supraclavicular fossa, which can be accompanied by clavicle fracture. Due
to intrinsic muscle involvement of the hand, there is a clawlike appearance.
There will be no grasp of the affected hand.
◍ Signs and symptoms of sublgeal hemorrhage.
Answer: Infants may present with signs of shock, which include a rapidly
falling hematocrit, hypovolemia, pallor, hypotension, tachycardia,
tachypnea, and hypotonia.
◍ Residuals feeding normal.
Answer: -Feeding tube is aspirated every 2-4 hours-Incompletely digested
aspirates of less than 50% of the previous feedings, OR 2 to 4mL/kg may be
normal
◍ Residuals feedings abnormal.
Answer: >50% of amount of feeding given in 3hrOr 2-4mL/kg
◍ Abnormal residual in 24 hour interventions.
Answer: Consider infection screenDiscard residualHold feedings
, ◍ Glucose is the primary.
Answer: Source of energy
◍ Long Chain fatty acids (fats).
Answer: Essential for brain development
◍ HIE Candidates.
Answer: Candidates for therapeutic hypothermia must be greater than or
equal to 36 weeks' gestation and less than 6 hours of age.
◍ Neonatal meningitis.
Answer: Meningitis is most often associated with late-onset sepsisE.
ColiGroup B. Strep
◍ Most apparent type of anomilies associated with Kerniticus.
Answer: Auditory abnormalities are most apparent in kernicterus because
the auditory pathway is the neuronal system most sensitive to bilirubin.
◍ Microcephaly causes.
Answer: Microcephaly may be caused by teratogens, including abuse of
street or prescription drugs, alcohol, and/or viral infection under the
TORCH (toxoplasmosis, syphilis, rubella, CMV or herpes) spectrum.
◍ Physiologic Jaundice.
Answer: -Never visible in first 24 hours of life-Rapid progressive increase in
TSB concentration from 2 mg/dl to 5 to 6 mg/dl between 4 days of
life.-Does not exceed 15mg/dl
◍ TORCH Infection.
Answer: Congenital cytomegalovirus (CMV; TORCH spectrum)
manifestations include intrauterine growth restriction, jaundice, purpura,
hepatosplenomegaly, microcephaly, seizures, intracerebral calcifications,
chorioretinitis, and progressive sensorineural hearing loss.Submit
◍ Hirschbrung testing.
Answer: abdominal x-rayContrast EnemaAnorectal ManometryRectal
Biopsy
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ The form of circulating bilirubin that places the infant at the highest risk for
kernicterus is:.
Answer: Indirect, free bilirubin is not attached to albumin and easily crosses
the blood-brain barrier, potentially resulting in signs of kernicterus.
◍ polycythemia in newborn.
Answer: hematocrit >65%seen in the first few hours or days of lifepossible
symptoms -altered mental status -poor feeding -plethora (excessive blood in
circulatory system or one organ or one area) -acrocyanosis
-hyperbilirubinemia
◍ Hemophilia A.
Answer: Hemophilia A has a normal or prolonged partial thromboplastin
time and a normal prothrombin time and platelet count. Factor VIII is
deficient.
◍ ABO incompatibility.
Answer: ABO incompatibility affects babies when mothers have blood
group O and the babies have blood group A or B (seen as antigens)Mom
will make antibodies and attack fetal RBCs by maternal anti-ab
antibodiesProtects against fetal RH disease because of rapid destruction of
fetal A/B cells, preventing RH antigen exposureWhile it occurs more
frequently than Rh isoimmunization (partially because of the use of
RhoGAM for Rh), the hemolytic disease is less severe.
◍ Isoimmunization and Rh isomminuzation (incompatibility).
Answer: Production by an individual of antibodies against constituents of
, the tissues of another individual of the same speciesIf fetal Rh-positive
blood leaks into the Rh-negative mother's circulation, her body may respond
by making antibodies to destroy the Rh-positive erythrocytes.
◍ RH Incompatibility and amniocentisis.
Answer: Because an amniocentesis can cause minute amounts of fetal red
blood cells to enter the maternal circulation, maternal antibodies (IgM and
IgG) can result if the mother is Rh negative and the baby is Rh positive.
◍ Neonatal autoimmune thrombocytopenia.
Answer: Neonatal alloimmune thrombocytopenia has a similar
pathophysiology to Rh incompatibility.It occurs when maternal platelets
come into contact with fetal platelets containing an antigen lacking in the
mother. Maternal antibodies cross the placenta and coat the fetal
platelets—primarily on subsequent pregnancies.The maternal platelet count
is normal. Neonatal partial thromboplastin time and prothrombin time are
normal. Treatment of neonatal alloimmune thrombocytopenia includes
giving the baby washed maternal platelets, which are free of the platelet
antigen.
◍ Breastmilk Jaundice presentation, value, cause, treatment.
Answer: Breast milk jaundice occurs after 4 to 7 days of life and is related to
two substances found in the maternal breast milk that interfere with bilirubin
conjugation and increase the resorption of bilirubin from the intestine,
resulting in increased indirect bilirubin. The resulting level of total bilirubin
is often between 12 and 20 mg/dl. In breast milk jaundice, stopping feeding
breast milk for 24 to 48 hours will decrease the level of the total bilirubin by
50%
◍ Grade II IVH.
Answer: Grade II is an intraventricular hemorrhage without ventricular
dilation.
◍ Grade III IVH.
Answer: blood within the ventricles and associated dilation of the ventricle.
,◍ Grade IV IVH.
Answer: blood within the ventricles and an echogenic focus within the
periventricular tissue.
◍ Bicarb administration time and associated risks from rapid infusion.
Answer: Rapid infusions of sodium bicarbonate may result in elevations of
carbon dioxide, causing a rapid dilation of cerebral blood vessels, which
could lead to intracerebral hemorrhage. Therefore infusing sodium
bicarbonate at 4.2% concentration over 30 minutes will avoid a rapid
infusion of a hyperosmolar solution.
◍ myelomeningocele position and treatment.
Answer: The infant should be positioned in the prone kneeling
position.Initial delivery room management is to protect the lesion by
covering with sterile gauze moistened with warm sterile saline solution.
◍ Klumpe Paralysis.
Answer: Klumpe paralysis exhibits swelling in the shoulder and
supraclavicular fossa, which can be accompanied by clavicle fracture. Due
to intrinsic muscle involvement of the hand, there is a clawlike appearance.
There will be no grasp of the affected hand.
◍ Signs and symptoms of sublgeal hemorrhage.
Answer: Infants may present with signs of shock, which include a rapidly
falling hematocrit, hypovolemia, pallor, hypotension, tachycardia,
tachypnea, and hypotonia.
◍ Residuals feeding normal.
Answer: -Feeding tube is aspirated every 2-4 hours-Incompletely digested
aspirates of less than 50% of the previous feedings, OR 2 to 4mL/kg may be
normal
◍ Residuals feedings abnormal.
Answer: >50% of amount of feeding given in 3hrOr 2-4mL/kg
◍ Abnormal residual in 24 hour interventions.
Answer: Consider infection screenDiscard residualHold feedings
, ◍ Glucose is the primary.
Answer: Source of energy
◍ Long Chain fatty acids (fats).
Answer: Essential for brain development
◍ HIE Candidates.
Answer: Candidates for therapeutic hypothermia must be greater than or
equal to 36 weeks' gestation and less than 6 hours of age.
◍ Neonatal meningitis.
Answer: Meningitis is most often associated with late-onset sepsisE.
ColiGroup B. Strep
◍ Most apparent type of anomilies associated with Kerniticus.
Answer: Auditory abnormalities are most apparent in kernicterus because
the auditory pathway is the neuronal system most sensitive to bilirubin.
◍ Microcephaly causes.
Answer: Microcephaly may be caused by teratogens, including abuse of
street or prescription drugs, alcohol, and/or viral infection under the
TORCH (toxoplasmosis, syphilis, rubella, CMV or herpes) spectrum.
◍ Physiologic Jaundice.
Answer: -Never visible in first 24 hours of life-Rapid progressive increase in
TSB concentration from 2 mg/dl to 5 to 6 mg/dl between 4 days of
life.-Does not exceed 15mg/dl
◍ TORCH Infection.
Answer: Congenital cytomegalovirus (CMV; TORCH spectrum)
manifestations include intrauterine growth restriction, jaundice, purpura,
hepatosplenomegaly, microcephaly, seizures, intracerebral calcifications,
chorioretinitis, and progressive sensorineural hearing loss.Submit
◍ Hirschbrung testing.
Answer: abdominal x-rayContrast EnemaAnorectal ManometryRectal
Biopsy
