Respiratory Distress in Newborn — MCQs

10 questions

In a preterm baby with respiratory distress syndrome, which of the following lipids would be deficient?

What is the most common cause of pneumonia in early onset sepsis in neonates?

A newborn presented with chest retractions, dyspnea, and lethargy. The pediatrician diagnosed the baby with respiratory distress syndrome. This occurs due to the deficiency of:

Which of the following conditions is characterized by the presence of hyaline deposits in alveolar walls?

What is the most appropriate treatment for a clinically significant pneumothorax in a newborn requiring intervention?

Following tests are done for assessing fetal lung maturity. Which of the following test results does not indicate adequate fetal lung maturity?

Failure of rupture of buccopharyngeal membrane leads to?

Uncommon finding in congestive cardiac failure in a newborn -

In triage of school bus accident of children, which one will you attend first and give priority?

Q10

A 20 year old boy is brought to the emergency following a RTA (Road Traffic Accident) with respiratory distress and hypotension. He has subcutaneous emphysema and no air entry on the right side. What is the next best step in the management?

Respiratory Distress in Newborn Indian Medical PG Practice Questions and MCQs

Question 1: In a preterm baby with respiratory distress syndrome, which of the following lipids would be deficient?

A. Cardiolipin
B. Sphingomyelin
C. Phosphatidylinositol
D. Lecithin (Correct Answer)

Explanation: ***Lecithin*** - **Lecithin** (also known as **phosphatidylcholine**) is the primary component of **surfactant** in the lungs, which reduces surface tension and prevents alveolar collapse. - In **preterm babies**, insufficient production of lecithin due to immature lung development leads to **respiratory distress syndrome (RDS)**. *Cardiolipin* - **Cardiolipin** is a major phospholipid found in the **inner mitochondrial membrane**, crucial for oxidative phosphorylation. - Deficiency is associated with mitochondrial disorders like **Barth syndrome**, not primary respiratory distress. *Sphingomyelin* - **Sphingomyelin** is a significant component of **cell membranes** and **myelin sheaths**, important for nerve insulation. - While present in the lungs, its primary role is not in surface tension reduction, and its deficiency is not directly linked to RDS. *Phosphatidylinositol* - **Phosphatidylinositol** is a precursor for various **signaling molecules** and plays a role in cell membrane structure. - While involved in cellular processes, it is not the critical surfactant component whose deficiency causes RDS.

Question 2: What is the most common cause of pneumonia in early onset sepsis in neonates?

A. H influenzae
B. Coagulase positive staph aureus
C. Group B streptococcus (Correct Answer)
D. Listeria

Explanation: ***Group B streptococcus*** - **Group B Streptococcus (GBS)** is the leading cause of **early-onset sepsis** and pneumonia in neonates, typically acquired during passage through the birth canal. - Maternal GBS colonization is a significant risk factor, and GBS can cause **severe respiratory distress** in affected newborns. *H influenzae* - **_Haemophilus influenzae_** is a more common cause of **late-onset sepsis** or pneumonia in infants and children, rather than early-onset neonatal disease. - While it can cause neonatal infections, it is much less frequent than GBS in the early-onset period. *Coagulase positive staph aureus* - **_Staphylococcus aureus_** is a common cause of **nosocomial infections** or late-onset sepsis in neonates, particularly in ventilated or catheterized infants. - It is not the most common pathogen for community-acquired **early-onset neonatal pneumonia**. *Listeria* - **_Listeria monocytogenes_** can cause severe neonatal sepsis and pneumonia, often associated with maternal consumption of contaminated food. - While it is a significant pathogen, it is less common overall than GBS as a cause of early-onset neonatal pneumonia in most regions.

Question 3: A newborn presented with chest retractions, dyspnea, and lethargy. The pediatrician diagnosed the baby with respiratory distress syndrome. This occurs due to the deficiency of:

A. Dipalmitoyl inositol
B. Dipalmitoylphosphatidylethanolamine
C. Lecithin (Correct Answer)
D. Sphingomyelin

Explanation: ***Lecithin*** - **Respiratory distress syndrome (RDS)** in newborns is primarily caused by a deficiency of pulmonary **surfactant**. - **Lecithin (phosphatidylcholine)**, specifically in its dipalmitoyl form (**dipalmitoylphosphatidylcholine or DPPC**), is the main active component of surfactant, constituting ~40-50% of surfactant lipids. - DPPC is crucial for reducing surface tension in the alveoli and preventing their collapse during expiration. - This is the **primary biochemical deficiency** in neonatal RDS. *Dipalmitoyl inositol* - **Inositol** is a sugar alcohol involved in various cellular processes and is present in surfactant as phosphatidylinositol, but it is not a primary functional component. - Deficiency of this compound does not directly lead to **respiratory distress syndrome**. *Dipalmitoylphosphatidylethanolamine* - **Phosphatidylethanolamine (PE)** is a phospholipid found in cell membranes but is not the primary phospholipid responsible for surfactant function. - Note: This is PE, not PC (phosphatidylcholine). While PE is present in surfactant, its deficiency does not specifically cause **neonatal RDS**. *Sphingomyelin* - **Sphingomyelin** is a sphingolipid found in cell membranes and myelin sheaths, but it is not the critical component of pulmonary surfactant. - The **lecithin-to-sphingomyelin (L/S) ratio** is used to assess fetal lung maturity; an L/S ratio >2 indicates mature lungs capable of producing adequate surfactant.

Question 4: Which of the following conditions is characterized by the presence of hyaline deposits in alveolar walls?

A. Asthma
B. Hyaline membrane disease (Correct Answer)
C. Chronic bronchitis
D. Interstitial lung disease

Explanation: ***Hyaline membrane disease*** - This condition is pathologically characterized by the presence of **eosinophilic (hyaline) membranes** lining the distal airspaces, which are composed of fibrin, cellular debris, and necrotic cells [1]. - These **hyaline deposits obstruct gas exchange** and are a hallmark of **acute lung injury** in neonates due to surfactant deficiency [2]. *Asthma* - Characterized by **bronchoconstriction**, **mucus plugging**, and **airway inflammation**, but not hyaline deposits in alveolar walls. - Pathologically, there is hyperplasia of goblet cells, hypertrophy of bronchial smooth muscle, and eosinophilic infiltration. *Chronic bronchitis* - Defined by **chronic productive cough** due to hypertrophy of mucous glands and increased mucus production in the bronchi, not alveolar hyaline deposits. - It primarily affects the **large airways** and is associated with chronic inflammation and airway obstruction. *Interstitial lung disease* - Involves inflammation and fibrosis of the **interstitium of the lung**, leading to impaired gas exchange. - While it causes architectural distortion, **hyaline deposits** in the alveolar walls are not a defining pathological feature. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 679-681. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, p. 466.

Question 5: What is the most appropriate treatment for a clinically significant pneumothorax in a newborn requiring intervention?

A. Needle decompression
B. Chest tube insertion (Correct Answer)
C. Oxygen therapy
D. Administration of surfactant

Explanation: ***Chest tube insertion*** - A **chest tube** is indicated for a clinically significant pneumothorax in a newborn to effectively **evacuate air** from the pleural space and allow lung re-expansion. - This procedure provides **continuous drainage** and prevents tension pneumothorax, ensuring adequate ventilation and oxygenation. *Oxygen therapy* - While supportive, **oxygen therapy alone** is insufficient for a clinically significant pneumothorax that requires intervention to remove trapped air. - It only addresses **hypoxemia** but does not resolve the underlying issue of air accumulation in the pleural space. *Administration of surfactant* - **Surfactant administration** is primarily used to treat or prevent **respiratory distress syndrome** in preterm infants by improving lung compliance. - It does not directly treat a pneumothorax, which is a mechanical problem of air leakage into the pleural space. *Needle decompression* - **Needle decompression** is an emergency temporizing measure for a **tension pneumothorax** in older children or adults. - In newborns, it is less common due to the small chest size and risk of injury to underlying structures; **chest tube insertion** is generally preferred for definitive management.

Question 6: Following tests are done for assessing fetal lung maturity. Which of the following test results does not indicate adequate fetal lung maturity?

A. Foam stability index greater than 47
B. Presence of phosphatidylglycerol
C. Lecithin/sphingomyelin ratio less than 2 (Correct Answer)
D. Optical density at 650 nm less than 0.15

Explanation: ***Lecithin/sphingomyelin ratio less than 2*** - A **lecithin/sphingomyelin (L/S) ratio** of **less than 2:1** indicates a higher risk of respiratory distress syndrome (RDS) due to insufficient **surfactant** production. - Surfactant is crucial for reducing surface tension in the alveoli, preventing their collapse at the end of expiration. - An L/S ratio **≥2:1** is considered indicative of fetal lung maturity. *Foam stability index greater than 47* - A **foam stability index (FSI) greater than or equal to 47** indicates the presence of sufficient **surfactant** to create stable foam, suggesting **fetal lung maturity**. - This test is based on the ability of surfactant to reduce surface tension in amniotic fluid when mixed with ethanol. *Presence of phosphatidylglycerol* - The **presence of phosphatidylglycerol (PG)** in the amniotic fluid is a strong indicator of **fetal lung maturity**. - PG is a mature **surfactant** component that appears later in gestation and signifies a very low risk of respiratory distress syndrome (RDS). *Optical density at 650 nm less than 0.15* - An **optical density (OD) at 650 nm of less than 0.15** in the amniotic fluid indicates **fetal lung maturity**. - This test measures the turbidity of amniotic fluid, with lower values indicating the presence of mature surfactant and clear fluid.

Question 7: Failure of rupture of buccopharyngeal membrane leads to?

A. Epistaxis
B. Rhinophyma
C. Crooked nose
D. Choanal atresia (Correct Answer)

Explanation: ***Choanal atresia*** - The **buccopharyngeal membrane** (also called the oronasal or choanal membrane) normally ruptures to establish communication between the nasal cavity and the pharynx. - Failure of this rupture results in a bony or membranous obstruction of the posterior nasal opening (choana). - This presents as **bilateral nasal obstruction in neonates**, which is life-threatening as neonates are obligate nasal breathers. *Epistaxis* - This refers to a **nosebleed**, which is typically caused by trauma, dryness, or underlying blood dyscrasias. - It is not related to the developmental failure of the buccopharyngeal membrane. *Rhinophyma* - This is a feature of advanced **rosacea**, characterized by an enlarged, red, and bulbous nose due to sebaceous gland hypertrophy. - It is a dermatological condition unrelated to embryonic development. *Crooked nose* - A crooked nose usually results from **trauma** or developmental abnormalities of the nasal cartilages and bones. - It is a structural deformity of the external nose and not the internal nasal passages.

Question 8: Uncommon finding in congestive cardiac failure in a newborn -

A. Pedal edema (Correct Answer)
B. Tachycardia
C. Tachypnoea
D. Hepatomegaly

Explanation: ***Pedal edema*** - While **edema** can occur in newborns with **congestive heart failure (CHF)**, it is less common to see isolated **pedal edema** compared to older children or adults. - In newborns, fluid retention often manifests as **generalized edema** or **periorbital edema** due to less developed lymphatic drainage and different fluid distribution. *Tachycardia* - **Tachycardia** (increased heart rate) is a **very common** and significant finding in newborns with **CHF** as the heart attempts to maintain cardiac output. - It is an early compensatory mechanism in response to decreased pump function. *Tachypnoea* - **Tachypnoea** (increased respiratory rate) is a **common symptom** of **CHF** in newborns due to pulmonary congestion and increased effort of breathing. - The lungs become stiff and less compliant, leading to faster, shallow breathing. *Hepatomegaly* - **Hepatomegaly** (enlarged liver) is a **frequent and diagnostically important sign** of **right-sided heart failure** in newborns due to venous congestion. - The liver acts as a reservoir, and its enlargement often indicates increased systemic venous pressure.

Question 9: In triage of school bus accident of children, which one will you attend first and give priority?

A. Severe head injury
B. Boy in shock
C. Flail chest child
D. Airway obstruction of child (Correct Answer)

Explanation: ***Airway obstruction of child*** - An **obstructed airway** is an immediate life threat, as it prevents ventilation and oxygenation, leading to rapid **hypoxia** and death. - Triage prioritizes interventions that address immediate threats to life, following the **ABCDE (Airway, Breathing, Circulation, Disability, Exposure)** approach, making airway management the first priority. *Severe head injury* - While a severe head injury is critical and can lead to significant morbidity and mortality, it is generally **not the absolute first priority** over an obstructed airway unless it is actively causing immediate airway compromise. - Management often involves maintaining cerebral perfusion and oxygenation, which is secondary to ensuring a patent airway. *Boy in shock* - **Shock** indicates circulatory compromise, which is the **'C' in ABCDE**, and is a critical condition requiring rapid intervention to restore perfusion. - However, establishing a patent **airway ('A')** and ensuring **adequate breathing ('B')** are prerequisites for effectively treating shock. *Flail chest child* - A flail chest involves paradoxical movement of a segment of the chest wall, impairing effective breathing and potentially causing **pulmonary contusion**. - This affects **breathing ('B')**, making it a high priority, but an active **airway obstruction ('A')** would still take precedence to allow any breathing to occur.

Question 10: A 20 year old boy is brought to the emergency following a RTA (Road Traffic Accident) with respiratory distress and hypotension. He has subcutaneous emphysema and no air entry on the right side. What is the next best step in the management?

A. Start IV fluids after insertion of a wide-bore IV line
B. Shift the patient to the ICU and perform intubation
C. Initiate positive pressure ventilation
D. Needle decompression in the 5th intercostal space in the mid-axillary line (Correct Answer)

Explanation: ***Needle decompression in the 5th intercostal space*** - The combination of **respiratory distress**, hypotension, **subcutaneous emphysema**, and absent breath sounds on one side indicates a **tension pneumothorax**, which requires immediate decompression. - Performed using a large-bore needle (14- or 16-gauge) in the **5th intercostal space** in the mid-axillary line to relieve trapped air and restore hemodynamic stability. *Start IV fluids after insertion of a wide-bore IV line* - While **IV fluids** are essential for managing **hypotension** in trauma patients, addressing the underlying cause of tension pneumothorax takes immediate priority as delaying decompression could be fatal. - Fluid resuscitation alone will not resolve the mechanical compression of the heart and lungs caused by the trapped air. *Shift the patient to the ICU and perform intubation* - **Intubation** might become necessary if respiratory distress persists after decompression or if the patient's airway is compromised, but it is not the initial step to address a tension pneumothorax. - Delaying decompression to transport the patient to the **ICU** could lead to further clinical deterioration and cardiac arrest. *Initiate positive pressure ventilation* - **Positive pressure ventilation** in a patient with a tension pneumothorax can worsen the condition by further increasing the amount of trapped air in the pleural space, leading to more severe hemodynamic compromise. - It should only be considered after decompression and stabilization, depending on the patient's respiratory status.

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