$i=0;
$sql = "SELECT * FROM `table` WHERE ..  ORDER BY RAND() LIMIT 5";
$q = mysqli_qoery($db, $sql);
while($r = mysqli_fetch_assoc($q))
{
    $i++;
   if($i == 1) // ako towa e purwata nowina
   {
    echo "<div><img src='//placehold.it/200x200' /> <h3>zaglavie</h3></div>";
   }
   else // vsichki ostanali
   {
      echo "<div><span ><img src='//placehold.it/90x90'/></span><h3>Zaglawie na pod nowini ili kakwoto sa tam</h3></div>";
   }
}