Respiratory Distress Syndrome — MCQs

10 questions

Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?

Hyaline membrane disease of the lungs is characterized by –

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:

Child with PDA will NOT have:

With reference to Respiratory Distress Syndrome (RDS), which of the following statements is false?

All of the following are true for retinopathy of prematurity except which of the following?

A 3-month-old child presents with indrawing of the chest and a respiratory rate of 52 breaths per minute. This condition can be classified as:

A neonate delivered at 36-week gestation develops respiratory distress soon after birth. CXR is as shown. Likely diagnosis?

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

Q10

Chronic lung disease in infancy is defined as

Respiratory Distress Syndrome Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?

A. Endotracheal tube intubation
B. Chest compression
C. Adrenaline
D. None of the above (Correct Answer)

Explanation: ***None of the above*** - All listed interventions—**endotracheal tube intubation**, **chest compressions**, and **adrenaline administration**—are standard components of neonatal resuscitation when the heart rate remains below 60 beats/min despite initial steps. - This question asks which is *NOT* included, implying that all options are, in fact, appropriate interventions in this critical scenario. *Endotracheal tube intubation* - This is a critical step in **securing the airway** and ensuring effective positive pressure ventilation when other methods fail or prolonged mechanical ventilation is anticipated. - It's indicated if the heart rate remains below 60 bpm despite adequate bag-mask ventilation and chest compressions. *Chest compression* - **Chest compressions** are initiated when the heart rate is less than 60 bpm *after* 30 seconds of effective positive pressure ventilation. - They are used in conjunction with positive pressure ventilation to improve cardiac output and myocardial perfusion. *Adrenaline* - **Adrenaline** is administered if the heart rate remains below 60 bpm *despite* adequate ventilation and chest compressions. - It acts as a potent **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility.

Question 2: Hyaline membrane disease of the lungs is characterized by –

A. FRC is reduced compared to closing volume (Correct Answer)
B. FRC is increased compared to closing volume
C. FRC is equal to closing volume
D. FRC is not related to closing volume

Explanation: ***FRC is reduced compared to closing volume*** - In **Hyaline Membrane Disease (HMD)**, severe **surfactant deficiency** leads to widespread **atelectasis** and a significant reduction in **functional residual capacity (FRC)**. - Due to the collapse of alveoli and small airways, the **closing volume (CV)**, which is the lung volume at which small airways begin to close, becomes relatively larger than the already reduced FRC. *FRC is increased compared to closing volume* - This statement is incorrect because HMD is characterized by diffuse **atelectasis**, which drastically reduces **FRC**. - An increased FRC relative to closing volume would imply better lung compliance and less small airway closure, contrary to the pathology of HMD. *FRC is equal to closing volume* - This scenario would represent a critical point where extensive airway closure occurs, but in HMD, the **FRC is significantly lower** than the critical closing volume due to severe **surfactant deficiency** and widespread collapse. - While there is considerable airway closure, the FRC is typically *below* the closing volume, leading to shunt and severe hypoxemia. *FRC is not related to closing volume* - This is incorrect because FRC and closing volume are intimately related in lung mechanics, especially in conditions like HMD. - **Closing volume** reflects the point at which airways begin to collapse, and in disease states like HMD, the interplay between a reduced FRC and an elevated closing volume explains the severe gas exchange abnormalities.

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: Child with PDA will NOT have:

A. Necrotizing enterocolitis
B. CO₂ washout
C. Bounding pulses
D. Pulmonary hemorrhage

Explanation: This question asks which finding is NOT associated with Patent Ductus Arteriosus (PDA). *Bounding pulses* - **Bounding pulses ARE characteristically present in PDA**, not absent - Result from wide pulse pressure due to diastolic run-off from aorta to pulmonary artery - This is a classic clinical sign of hemodynamically significant PDA ***Necrotizing enterocolitis - needs verification*** - PDA CAN be associated with NEC in premature infants - "Steal phenomenon" diverts blood from splanchnic circulation - However, NEC is multifactorial and not a direct consequence of PDA ***CO₂ washout - needs verification*** - Increased pulmonary blood flow from PDA can affect ventilation - May contribute to respiratory complications - The relationship is complex and context-dependent ***Pulmonary hemorrhage - needs verification*** - Large PDA with significant left-to-right shunt increases pulmonary blood flow - Can lead to pulmonary hemorrhage, especially in preterm infants - Increased pulmonary vascular pressure and volume cause capillary damage **Note:** This question has a structural issue - all listed options except bounding pulses (which IS present in PDA) CAN occur with PDA. The question requires review for medical accuracy and clarity.

Question 5: With reference to Respiratory Distress Syndrome (RDS), which of the following statements is false?

A. Leads to respiratory distress in premature infants
B. Is less common in babies born to diabetic mothers (Correct Answer)
C. Is treated by administering surfactant therapy
D. Usually occurs in infants born before 34 weeks of gestation

Explanation: ***Is less common in babies born to diabetic mothers*** - Babies born to **diabetic mothers** are at an **increased risk** of Respiratory Distress Syndrome (RDS) due to delayed lung maturation caused by **hyperinsulinemia.** - Insulin inhibits the production of **surfactant**, a substance critical for reducing surface tension in the alveoli and preventing lung collapse. - This statement is **FALSE** - RDS is actually **MORE common** in infants of diabetic mothers. *Leads to respiratory distress in premature infants* - RDS is primarily a disease of **prematurity**, resulting from a deficiency of **surfactant** in the immature lungs. - This deficiency leads to widespread **atelectasis** (lung collapse), which causes breathing difficulties immediately or shortly after birth. - This statement is **TRUE**. *Is treated by administering surfactant therapy* - **Surfactant therapy** is a cornerstone of RDS treatment, often delivered via an **endotracheal tube**. - It works by replacing the deficient natural surfactant, thereby improving **lung compliance** and reducing the work of breathing. - This statement is **TRUE**. *Usually occurs in infants born before 34 weeks of gestation* - RDS predominantly affects infants born **before 34 weeks of gestation**, as their lungs are typically not mature enough to produce sufficient surfactant. - The risk **decreases significantly** with increasing gestational age, with full-term infants rarely developing the condition. - This statement is **TRUE**.

Question 6: All of the following are true for retinopathy of prematurity except which of the following?

A. Due to hypoxia there occurs neovascularization followed by fibroproliferation
B. Occurs in premature infants due to abnormal retinal blood vessel development.
C. End result is bilateral blindness (Correct Answer)
D. Blindness can be prevented by early diagnosis and ablation of avascular peripheral retina with cryotherapy or photocoagulation

Explanation: ***End result is bilateral blindness*** - While retinopathy of prematurity (ROP) can lead to severe vision loss or blindness, it is not always a bilateral end result, especially with early diagnosis and treatment. The severity can vary between eyes, and some cases resolve spontaneously. - Modern screening and intervention strategies, such as laser photocoagulation or anti-VEGF injections, are often successful in preventing complete blindness in one or both eyes. *Due to hypoxia there occurs neovascularization followed by fibroproliferation* - This statement accurately describes the pathogenesis of ROP. The initial phase involves delayed normal retinal vascularization, followed by a proliferative phase characterized by **neovascularization** in response to hypoxia in the avascular retina. - These new, abnormal vessels are fragile and prone to bleeding, and their associated **fibrovascular proliferation** can lead to retinal detachment. *Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation* - This is a true statement. **Early diagnosis** through ophthalmologic screening of premature infants is crucial, and treatments like **laser photocoagulation** or **cryotherapy** are effective in ablating the avascular peripheral retina to halt the progression of abnormal vessel growth. - These interventions reduce the hypoxic drive that fuels neovascularization, thereby preventing severe retinal detachment and subsequent blindness. *Occurs in premature infants due to abnormal retinal blood vessel development.* - This statement is correct. ROP is a disease primarily affecting **premature infants** because their retinal blood vessels have not completed development by the time of birth. - Postnatal factors, including oxygen fluctuations and low birth weight, further disrupt this critical development, leading to **abnormal vascularization**.

Question 7: A 3-month-old child presents with indrawing of the chest and a respiratory rate of 52 breaths per minute. This condition can be classified as:

A. SIRS
B. Respiratory distress (Correct Answer)
C. Tachypnoea
D. ARDS

Explanation: ***Respiratory distress*** - **Indrawing of the chest** is a classic sign of increased work of breathing, indicating the child is struggling to oxygenate. - A respiratory rate of **52 breaths per minute in a 3-month-old** is significantly elevated and, combined with indrawing, points to respiratory distress. - According to **WHO IMCI guidelines**, chest indrawing in a child with fast breathing is classified as **pneumonia/respiratory distress** requiring immediate treatment. *SIRS* - **Systemic Inflammatory Response Syndrome (SIRS)** criteria are typically more comprehensive and include fever or hypothermia, tachycardia, tachypnea, and abnormal white blood cell count. - While tachypnea is present, the other defining features of SIRS are not fully met by the information provided, nor does indrawing directly classify as SIRS. *Tachypnoea* - **Tachypnoea** refers specifically to an elevated respiratory rate, which is present (52 breaths per minute). - However, the presence of **chest indrawing** indicates more than just rapid breathing; it signifies significant respiratory effort and compromise. - The classification must capture both the elevated rate and the increased work of breathing. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a severe form of lung injury characterized by widespread inflammation, hypoxemia, and bilateral infiltrates on chest imaging. - While respiratory distress is a feature of ARDS, the given information is insufficient to diagnose ARDS, which requires specific criteria relating to oxygenation and radiological findings.

Question 8: A neonate delivered at 36-week gestation develops respiratory distress soon after birth. CXR is as shown. Likely diagnosis?

A. Meconium Aspiration Syndrome
B. Respiratory Distress Syndrome (Correct Answer)
C. Transient Tachypnea of Newborn
D. Neonatal Pneumonia

Explanation: ***Respiratory Distress Syndrome*** - The chest X-ray shows classic features of RDS, including a diffuse **reticulogranular pattern** (ground-glass appearance) and prominent **air bronchograms**, indicative of widespread alveolar atelectasis. - This condition is primarily caused by **surfactant deficiency** in preterm infants (like this 36-week neonate), leading to increased surface tension, alveolar collapse, and respiratory distress shortly after birth. ***Transient Tachypnea of Newborn*** - This is caused by delayed clearance of **fetal lung fluid** and is more common in term infants delivered by Caesarean section. - The chest X-ray typically shows **perihilar streaking**, fluid in the interlobar fissures, and hyperinflation, which are not the primary findings in the provided image. ***Neonatal Pneumonia*** - While it can present with respiratory distress, neonatal pneumonia typically shows **asymmetrical patchy infiltrates**, consolidation, or pleural effusions on chest X-ray. - The diffuse, symmetrical ground-glass appearance seen here is less characteristic of an infectious process like pneumonia, which is often more localized. ***Meconium Aspiration Syndrome*** - This condition occurs in term or post-term infants following aspiration of **meconium-stained amniotic fluid**, which is not mentioned in the history. - The characteristic X-ray findings are coarse, patchy opacities, **hyperinflation**, and potential air-leak syndromes (e.g., pneumothorax), which differ from the image.

Question 9: 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 10: Chronic lung disease in infancy is defined as

A. Need for supplemental oxygen at 36 weeks postmenstrual age (Correct Answer)
B. Tachypnoea > 50 breaths/ min within 1 week of birth
C. Presence of bilateral infiltrates on chest Xray for 2 weeks
D. Reticulogranular pattern on chest Xray for 6 weeks

Explanation: ***Need for supplemental oxygen at 36 weeks after conception*** - **Chronic lung disease (CLD)**, also known as **bronchopulmonary dysplasia (BPD)**, is defined by the need for **supplemental oxygen** at 36 weeks postmenstrual age (corrected gestational age) or at 56 days postnatal age, whichever comes first, for infants born before 32 weeks gestation. - This definition reflects persistent respiratory morbidity requiring ongoing support, indicative of lung injury and abnormal development. *Tachypnoea > 50 breaths/ min within 1 week of birth* - **Tachypnoea** within the first week of birth can be a symptom of various neonatal respiratory conditions, such as **transient tachypnoea of the newborn (TTN)** or **respiratory distress syndrome (RDS)**, but it is not a defining feature of CLD. - CLD is characterized by a *prolonged* need for respiratory support, not just an acute symptom in the first week. *Presence of bilateral infiltrates on chest Xray for 2 weeks* - **Bilateral infiltrates** on a chest X-ray over two weeks could suggest conditions like **pneumonia** or **ARDS**, but it is not the diagnostic criterion for CLD. - The definition of CLD focuses on the physiological need for oxygen, rather than specific radiographic findings in isolation. *Reticulogranular pattern on chest Xray for 6 weeks* - A **reticulogranular pattern** on chest X-ray is characteristic of **respiratory distress syndrome (RDS)**, typically seen in premature infants due to surfactant deficiency. - While RDS can precede CLD, a **reticulogranular pattern** typically improves with treatment (surfactant therapy, ventilation) and does not persist for 6 weeks as a defining feature of chronic lung disease.

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