RNC-NIC Hematology & Hyperbilirubinemia

Question 1

A term neonate at 36 hours of life has a total serum bilirubin (TSB) of 13 mg/dL, placing it in the high-intermediate risk zone on the Bhutani nomogram. Which intervention is most appropriate?

Accepted Answer

Repeat TSB in 4-6 hours and monitor the trajectory closely

Answer

Initiate intensive phototherapy immediately

Answer

Perform exchange transfusion

Answer

Discharge with pediatric follow-up in one week

Question 2

Which form of bilirubin is considered neurotoxic in the neonate because it can cross the blood-brain barrier?

Accepted Answer

Unconjugated (indirect) bilirubin

Answer

Conjugated (direct) bilirubin

Answer

Delta bilirubin

Answer

Urobilirubin

Question 3

A 3-day-old neonate exhibits lethargy, hypotonia, a high-pitched cry, and opisthotonus (arching). These findings are most consistent with which complication of severe hyperbilirubinemia?

Accepted Answer

Acute bilirubin encephalopathy (kernicterus)

Answer

Neonatal sepsis

Answer

Hypoglycemia

Answer

Hypocalcemia

Question 4

A positive direct antiglobulin test (DAT/direct Coombs test) in a neonate most strongly suggests which condition?

Accepted Answer

ABO incompatibility or Rh hemolytic disease of the newborn

Answer

Physiologic jaundice

Answer

Breast milk jaundice

Answer

Gilbert syndrome

Question 5

Physiologic jaundice in a healthy term neonate typically becomes visible on which day of life?

Accepted Answer

Days 2-3

Answer

Day 1

Answer

Days 5-7

Answer

Day 10

Question 6

Which laboratory value defines polycythemia in the neonate?

Accepted Answer

Central venous hematocrit of 65% or greater

Answer

Hemoglobin greater than 18 g/dL

Answer

Platelet count greater than 450,000/mm³

Answer

White blood cell count greater than 30,000/mm³

Question 7

A 28-week preterm neonate on day 21 of life has a hemoglobin of 7 g/dL with associated tachycardia and poor weight gain. Which intervention is most appropriate?

Accepted Answer

Packed red blood cell (PRBC) transfusion

Answer

Iron supplementation alone

Answer

Erythropoietin administration without transfusion

Answer

Vitamin K injection