Examkin

Question

Difficulty: MediumNeonatal Disorders

Match the following clinical presentations of neonatal respiratory distress with their primary underlying pathophysiologic mechanism.

  • A 39-week gestation infant born via scheduled cesarean delivery without prior labor. Presents with tachypnea and prominent perihilar streaking on chest radiograph.Delayed clearance of alveolar fluid
  • A 28-week gestation infant presenting with severe retractions and cyanosis. Chest radiograph demonstrates diffuse reticulogranular infiltrates with air bronchograms.Insufficient production of pulmonary surfactant
  • A 41-week gestation infant born through thick meconium. Exam shows a barrel-shaped chest and radiograph reveals patchy bilateral infiltrates with lung hyperinflation.Mechanical airway obstruction and chemical pneumonitis
  • A 38-week gestation infant with severe respiratory distress immediately after birth. Examination reveals a scaphoid abdomen and absent breath sounds over the left hemithorax.Incomplete fusion of the pleuroperitoneal folds

Answer

The clinical vignettes correctly match as follows: scheduled cesarean presentation is caused by delayed alveolar fluid clearance; prematurity with ground-glass radiograph is caused by insufficient surfactant; post-term presentation with meconium is caused by airway obstruction and chemical pneumonitis; and the presentation with a scaphoid abdomen is caused by incomplete fusion of the pleuroperitoneal folds.
Each clinical presentation is a classic archetype of neonatal respiratory distress that directly corresponds to a specific physiological or structural deficit. Transient tachypnea of the newborn is a fluid clearance issue, respiratory distress syndrome is a surfactant deficiency issue, meconium aspiration syndrome is an obstructive and inflammatory issue, and congenital diaphragmatic hernia is a structural embryologic issue.

Step-by-Step Solution

1
Analyze the gestational age and radiographic findings of the first infant.
Term infant born via cesarean delivery with perihilar streaking.
Identifies transient tachypnea of the newborn, which stems from delayed alveolar fluid clearance.
2
Evaluate the gestational age and distinct radiographic pattern of the second infant.
Premature infant with reticulogranular infiltrates (ground-glass).
Identifies respiratory distress syndrome caused by surfactant deficiency.
3
Assess the birth history and physical findings of the third infant.
Post-term infant with meconium exposure and a barrel-shaped chest.
Recognizes meconium aspiration syndrome causing mechanical obstruction, hyperinflation, and chemical pneumonitis.
4
Examine the physical exam findings of the fourth infant.
Scaphoid abdomen and asymmetric breath sounds in a term infant.
Identifies a congenital diaphragmatic hernia resulting from an embryologic defect in the pleuroperitoneal folds.

Key Concept

Pathophysiology of neonatal respiratory distress syndromes
Estimated Time:1m 30s
Rate this question

Topics

Neonatal Disorders

More questions from this topic