Rosh Pediatrics Practice Exam

If a neonate lacks sufficient surfactant at 28 weeks gestation, which clinical manifestations might you observe?

1. Decreased breath sounds on one side

2. Evidence of meconium staining

3. Expiratory grunting, retractions, nasal flaring, and cyanosis

4. Sudden episodes of cyanosis with feeding

The correct answer is: Expiratory grunting, retractions, nasal flaring, and cyanosis

In the context of a neonate who lacks sufficient surfactant, particularly at 28 weeks gestation, the clinical manifestations commonly observed include expiratory grunting, retractions, nasal flaring, and cyanosis. This presentation is indicative of neonatal respiratory distress syndrome (NRDS), which is primarily caused by inadequate surfactant production. Surfactant plays a crucial role in reducing surface tension within the alveoli, preventing collapse during exhalation and facilitating effective gas exchange. In the absence of adequate surfactant, neonates experience increased work of breathing and impaired lung mechanics, leading to respiratory distress. Expiratory grunting is a form of respiratory effort where the neonate attempts to keep the alveoli open during exhalation, while retractions indicate the use of accessory muscles to breathe, signaling increased respiratory effort. Nasal flaring is a compensatory response to respiratory distress, as the neonate seeks to maximize airflow. Cyanosis reflects oxygen desaturation, which can occur due to inadequate oxygenation of the blood as a result of these respiratory difficulties. Together, these symptoms paint a clear picture of severe respiratory compromise in neonates experiencing surfactant deficiency. In contrast, the other options present unrelated or less characteristic signs