1. The patient shown below is a premature newborn.

The most likely diagnosis

is:
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height="240">
a. Transient tachypnea of the newborn
b. Congenital lobar emphysema
c. Hyaline membrane disease
d. Cystic adenomatoid malformation
e. Meconium aspiration syndrome


Correct Answer: Hyaline membrane disease
Your Answer: Transient tachypnea of the newborn

Explanation
There is a diffuse and somewhat uniform, hazy, ground-glass appearance to the
lungs. The lungs are not overaerated. Hyaline membrane disease, which is also called
Respiratory Distress Syndrome of the Newborn (RDS), is caused by inadequate
surfactant production which leads to atelectasis, intrapulmonary shunting, reduced
lung compliance and hyaline membrane formation. Premature infants, infants of
diabetic mothers and infants delivered by Cesarean section are predisposed.




2. The patient is a 3 month old. What is the most likely diagnosis?
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height="240">
a. Transient tachypnea of the newborn
b. Congenital lobar emphysema
c. Hyaline membrane disease
d. Cystic adenomatoid malformation
e. Meconium aspiration syndrome


Correct Answer: Cystic adenomatoid malformation
Your Answer: Congenital lobar emphysema

Explanation
There is overaeration of the left lung with a shift of the heart and mediastinal
structures to the right. Of importance is the presence of the stomach bubble in its usual
position beneath the left hemidiaphragm. Cystic adenomatoid malformation is a
unilateral expansile mass of disorganized pulmonary tissue which typically
communicates with the bronchial tree and has a normal vascular supply. The opposite
lung can be hypoplastic. In certain types, it can be associated with other fetal
anomalies of the heart, kidneys or small bowel.




3. The patient is a post-mature newborn. What is the most likely diagnosis?
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height="240">
a. Transient tachypnea of the newborn
b. Congenital lobar emphysema
c. Hyaline membrane disease
d. Cystic adenomatoid malformation
e. Meconium aspiration syndrome


Correct Answer: Meconium aspiration syndrome
Your Answer: Hyaline membrane disease

Explanation
There are thick, rope-like densities throughout both lungs. The lungs are overaerated.
Meconium aspiration typically occurs in postmature infants who have some fetal
distress. Aspirated meconium can produce chemical pneumonitis and atelectasis from
bronchial obstruction. These infants are frequently meconium-stained. Despite a 25%
incidence of spontaneous pneumothorax, most clear with 48 hours.




4. The patient shown below most likely has:
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height="240">
a. Transient tachypnea of the newborn
b. Congenital lobar emphysema
c. Hyaline membrane disease
d. Cystic adenomatoid malformation
e. Meconium aspiration syndrome


Correct Answer: Congenital lobar emphysema
Your Answer: Cystic adenomatoid malformation

Explanation
There is overaeration of the left upper lobe and shift of the heart and mediastinal
structures toward the right. These are signs of an overexpanded lobe. Congenital lobar
emphysema may appear after birth as a mass-like density containing fluid which then
becomes more lucent as it fills with air over the first two weeks of life. It most often
involves the left upper lobe and may produce respiratory distress and cyanosis. The
treatment is surgical resection.




5. The patient is a premature infant with respiratory distress. A film done the
next day is normal. What is the most likely diagnosis?
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height="220">
a. Transient tachypnea of the newborn
b. Congenital lobar emphysema
c. Hyaline membrane disease
d. Cystic adenomatoid malformation
e. Meconium aspiration syndrome


Correct Answer: Transient tachypnea of the newborn
Your Answer: Meconium aspiration syndrome

Explanation
There is fluid in the minor fissure and there is a right pleural effusion present. These
are signs of excess fluid in the lungs. The history given is that this is a premature
infant whose chest x-ray clears rapidly. The findings are those of Transient Tachypnea
of the Newborn (TTN). TTN occurs in babies born by C-section and who are
premature. It is thought to be due in part to the lack of thoracic compression that
occurs with vaginal delivery. The respiratory rate is typically elevated. It clears
rapidly, usually within 1-4 days.