Neonatology: bilateral choanal atresia: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatology: bilateral choanal atresia

Sample item

A term newborn is cyanosed and in distress when quiet, with retractions, but becomes pink when crying. A feeding catheter cannot be passed through either nostril. What is the immediate measure to secure the airway?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Insert an oral airway

Neonates are obligate nasal breathers, so bilateral choanal atresia produces cyclical cyanosis relieved by crying. An oral airway or McGovern nipple keeps the mouth open and secures air entry until CT confirms the diagnosis and surgery is planned. The anomaly is part of CHARGE syndrome in a proportion of cases.

Option by option

  • A. Place a nasopharyngeal airway

    A nasopharyngeal airway cannot pass through an atretic choana.

  • B. Perform urgent tracheostomy

    Tracheostomy is rarely needed and is not the first measure when an oral airway works.

  • C. Insert an oral airway (correct)

    Correct. An oral airway bypasses the blocked nasal passages and is the first step.

  • D. Start high-flow oxygen by nasal prongs

    Nasal prongs deliver gas into a blocked passage and do not relieve the obstruction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, Insert an oral airway. Neonates are obligate nasal breathers, so bilateral choanal atresia produces cyclical cyanosis relieved by crying.

Why is "Place a nasopharyngeal airway" not the answer?

A nasopharyngeal airway cannot pass through an atretic choana.

Why is "Perform urgent tracheostomy" not the answer?

Tracheostomy is rarely needed and is not the first measure when an oral airway works.

Why is "Start high-flow oxygen by nasal prongs" not the answer?

Nasal prongs deliver gas into a blocked passage and do not relieve the obstruction.

What concept does this question test?

It tests Neonatology: bilateral choanal atresia in Pediatrics. An oral airway or McGovern nipple keeps the mouth open and secures air entry until CT confirms the diagnosis and surgery is planned. The anomaly is part of CHARGE syndrome in a proportion of cases.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatology: bilateral choanal atresia?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.