Answer :USMLE step 2 Mcq 166:A newborn presents with an early onset of dyspnea with chest retractions




Correct Answer: C

The clinical case given above indicates the likely diagnosis of transient tachypnea of the newborn, (Choice C) which is otherwise called Respiratory distress syndrome type II. It is characterized by the early onset of dyspnea with chest retractions, expiratory grunting and cyanosis. Neonates usually recover within 3 days.

The syndrome is believed to be secondary to slow absorption of fetal lung fluid resulting in decreased pulmonary compliance and tidal volume. 

The distinctive feature of transient tachypnea of the newborn from hyaline membrane disease (Choice E) are the infant’s sudden recovery and the absence of a radiographic reticulogranular pattern. 

In meconium aspiration syndrome (Choice A) the chest X-ray is characterized by patchy infiltrate, coarse streaking of both lung fields and flattening of diaphragm. A normal chest X-ray in an infant with severe hypoxia and no cardiac malformation suggests the diagnosis of persistent fetal circulation. ( Choice D). 

Fetal aspiration syndrome(Choice B) is very common during prolonged labor and difficult deliveries and may initiate vigorous respiratory movements in-utero because of interference with oxygen supply


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