A neonate presents with cyclic respiratory distress: distress alternating with relief when the baby cries (opens the mouth). Distress worsens at rest and during feeding. The FIRST diagnostic step is:
- A Attempting to pass a size 5F or 6F soft suction catheter through each nostril to a depth of 3.5 cm ✓
- B CT scan of the nasopharynx under sedation
- C Rigid nasopharyngoscopy under general anaesthesia
- D MRI of the posterior nasal cavity
Explanation
The cyclic pattern (distress relieved by crying/mouth opening) in a neonate is pathognomonic of bilateral choanal atresia — neonates are obligate nasal breathers. The first and simplest diagnostic step is attempting to pass a size 5-6 French soft catheter through each nostril: inability to advance >3.5 cm confirms choanal obstruction. Confirmation and characterisation (bony ~90% vs membranous ~10%, and unilateral vs bilateral) is then done by CT scan. Immediate management is placement of a nasopharyngeal or oral airway to secure breathing while surgical correction (endoscopic transnasal approach) is planned.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.