BCEM Flashcards
Orotic Aciduria
Inher, Mech, Pres (Epi + 4), Micro Finding, RX?
AR.
Defect in UMP Synthase ->
Inability to convert Orotic acid -> UMP
(De Novo Pyrimidine Syn pathway).
PRES: Children
- Failure to thrive
- Megaloblastic Anemia CAN’T be cured by Vit B9 or B12
- Glossitis
- Orotic acid in urine
FINDING:
- Hypersegmented Neutrophils
RX = UMP (allows bypassing of mutated enzyme)
a-amanitin Ingestion
(found in Amanita phalloides = “death cap” mushrooms)
Mech & Pres?
Inhibits RNA Polymerase II -> Severe hepatotoxicity
I-Cell (Inclusion Cell) Disease
Classification, Mech (3 steps), Pres (3), Labs?
Inherited. Lysosomal Storage Disorder.
MECH:
Defect in Phosphotransferase -> Failure of Golgi to phosphorylate MANNOSE residues on glycoproteins (ie↓mannose-6P) -> Proteins secreted extracellularly rather than delivered to lysosomes.
** Often fatal in childhood. **
PRES:
- Coarse facial features
- Clouded corneas
- Restricted joint movement
LABS:
- High lysosomal enzymes
Chediak-Higashi Sx
Genetics, Mech (2), Pres (3)?
Mutation in LYST gene (lysosomal trafficking regulator).
- ↓fusion of lysosomes & phagosomes
- ↓microtubule sorting of endosomal proteins
Kartagener’s Sx (1ry ciliary dyskinesia)
Mech, Pres (4), Comp?
Immotile cilia due to defective dynein arm.
PRES:
- Infertility (ie immotile sperm and dysfunctional fallopian tube cilia)
- Situs Inversus
- Bronchiectasis
- Chronic Sinusitis (particles and bacteria not pushed out)
COMP:
-↑risk of ectopic pregnancy
Osteogenesis Imperfecta (“Brittle Bone Disease”)
Def’n, Inher, Mech, Pres (4)?
Congenital defect of bone RESORPTION -> structurally WEAK bone.
AD.
Deficiency (↓production) of Type 1 Collagen.
Inability to form Procollagen (defective glycosylation of
pro-a-chain hydroxylysine).
PRES:
- “Blue sclera” (thin collagen on sclera => can see underlying
choroidal veins = blue.
THINK: You can see veins under thin skin.)
- Multiple bone fractures with minimal trauma (may occur during birth)
- Hearing loss (fracturing of middle ear bones = ossicles)
- Dental imperfections (lack of dentin)
** May be confused with child abuse **
Ehlers-Danlos Sx
Def’n, Mech (2 steps), Inher, Classification (3 types),
Pres (3), Comp / Assoc (3)?
Deficiency of Type III Collagen (faulty synthesis).
Mutation in Type V Collagen ->
Defective Tropocollagen CROSS-LINKING.
Autosomal.
CLASSIFICATION:
- Hypermobility type
- Classical type (mutation in Type V Collagen -> joint + skin pres)
- Vascular type (Type III Collagen def -> vascular + organ pres)
PRES:
- Hypermobile joints
- Elastic skin
- Easy bruising / tendency to bleed
COMP / ASSOC:
- Aortic + Berry Aneurysms
- Organ rupture
- Joint dislocation
Menkes Dz
Def’n, Mech (2 steps), Pres (3)?
Connective tis dz.
Impaired Cu abs + transport ->↓activity of Lysyl Oxidase.
PRES:
- “Brittle + kinky hair”
- Growth retardation
- Hypotonia
Alport Sx
Mech (2), Inher, Pres (3)?
- Defective Type IV Collagen due to mutation.
- Thin + split GLOMERULAR BM -> defective ability to filter blood.
XR (MC)
PRES:
- Deafness
- Cataracts / ocular disturbances
- Nephritic Sx
Marfan Sx
Mech, Pres (5), Comp (2)?
Fibrillin defect (Fibrillin-1 mutation).
PRES:
- “Tall with long extremities” + Arachnodactyly (abnormally long + slender fingers and toes)
- Hyperflexible / hypermobile joints
- Lens dislocation + subluxation (usually upward + temporally)
- Aortic incompetence (due to cystic medial necrosis of aorta)
- Floppy Mitral valve
COMP:
- Dissecting Aortic Aneurysm / Berry Aneurysm
- Mitral
Familial Hypercholesterolemia
Mech (2 steps), Pres (2)?
Absent / defective LDL receptor ->↑LDL.
PRES:
- Severe atherosclerosis early in life
- Achilles tendon xanthoma
Mitochondrial Myopathies
List (3), Micro Finding?
- Leber’s Hereditary Optic Neuropathy (acute loss of central vision)
- Myoclonic Epilepsy
- Mitochondrial Encephalopathy
FINDING:
- “Ragged red fibers”
Cystic Fibrosis
* MC lethal genetic dz in Caucasians*
Inher, Genetics, Mech (5 steps, 3 effects),
DX, Comp (8: 2 Resp, 4 GI, 1 Repro, 1 Vit), RX (2)?
AR.
Defect in CFTR, chr 7.
MECH:
Defective CFTR ->
Defective Cl channels in lungs, GI tract + sweat glands ->
↑intracel Cl ->
Compensatory↑Na + H20 reabs ->
ECF Na + H20 losses / RENAL K + H wasting.
(Analogous to taking Loop Diuretic)
- THICK MUCUS secreted into lungs + GI tract
- Hypokalemia
- Contraction Alkalosis
DX:
-↑Cl (> 60) in sweat
COMP:
- Recurrent pulm infections and chronic bronchitis / bronchiectasis
- Nasal polyps
- Meconium Ileus in newborns
- Malabsorption / Steatorrhea
- Cholesterol Stones
- Pancreatic insuf
- Infertility in Males (absent sperm)
- Vit A, D, E, K deficiencies
RX:
- N-acetylcysteine (to cleave disulfide bonds w/in mucus glycoproteins)
- DNAse / Dornase Alfa (to clear leukocytic debris)
McCune-Albright Sx
Mech, Pres (4)?
Mosaic G-protein signaling mutation.
PRES:
- Endocrine abnormalities
- Precocious Puberty
- Cafe-au-Lait spots
- Polyostotic fibrous dysplasia
Muscular Dystrophies
3 Types, Inher, General Pres (2)?
- Duchenne
- Becker
- Myotonic Type I
INHER: XR (Duchenne + Becker’s)
GENERAL PRES:
- Muscle wasting
- Myotonia
Duchenne Muscular Dystrophy
Genetics, Pres (Epi + 2), Lab Findings (2), DX (2), Comp?
FRAMESHIFT Deletion of Dystrophin gene.
PRES: Onset before 5 yrs
- Weakness in pelvic girdle muscles that progresses superiorly
- Pseudohypertrophy of calf muscles (due to fibrofatty replacement of muscle) -> Gower Maneuver
LABS:
- ↑Aldolase
- ↑CPK
DX:
- Western Blot
- Muscle biopsy
COMP:
- Dilated Cardiomyopathy
Becker Muscular Dystrophy
Genetics, Pres (Epi)?
POINT mutation in Dystrophin gene.
PRES: Onset in adolescence / early adulthood
* Less severe than Duchenne *
Myotonic Type I Dystrophy
Genetics, Pres (4)?
CTG trinucleotide repeat expansion in DMPK gene ->
Abnormal expression of Myotonin protein kinase.
PRES:
- Frontal balding
- Cataracts
- Arrhythmia
- Testicular atrophy
Fragile X Sx
Genetics, Pres (4)?
Trinucleotide repeat disorder (CGG) ->
Defect affecting expression and methylation of FMR1 gene.
PRES:
- Long face with large jaw + large everted ears
- Autism
- Mitral Prolapse
- Testes enlarged
Down Sx (Trisomy 21)
Genetics,
Pres (7: THINK: 4 above heart, heart, 2 below heart ),
1st Trimester U/S Findings (2), 2nd Trimester Quad Screen (4),
Comp (3)?
- Meiotic ND (95%. Assoc w advanced maternal age)
- Robertsonian Translocation (4%)
- Mosaicism (1%)
PRES:
- Intellectual disability
- Flat facies and “single palmar crease”
- “Gap between first two toes”
- Brushfield Spots in eyes
- Congenital HD (ASD or VSD)
- Duodenal Atresia
- Hirschsprung Dz
1st TRIMESTER U/S:
- ↑nuchal translucency + hypoplastic nasal bone
- PAPP-A↓
QUAD SCREEN:
- a-fetoprotein↓
- b-HCG↑
- Estriol↓
- Inhibin A ↑
COMP:
- ASD (due to defects in ostium primum) + VSD
- ALL + AML (AML usually before age 5)
- Alzheimer’s
Edwards Sx (Trisomy 18)
Pres (Epi + 6: 3 above heart, heart, 2 re extremities),
1st Trimester U/S Finding, 2nd Trimester Quad Screen (4)?
PRES: Infant. Death usually within 1 yr of birth.
- Microcephaly
- Severe intellectual disability
- Micrognathia (small jaw), low-set ears + prominent occiput
- Congenital HD
- Clenched hands
- “Rocker-bottom” feet
1st TRIMESTER U/S:
- PAPP-A ↓
QUAD SCREEN: Everything ↓
- a-fetoprotein↓
- b-HCG↓
- Estriol↓
- Inhibin A↓or normal
Patau Sx (Trisomy 13)
Pres (Epi + 6: 3 above heart, heart, 2 re extremities),
1st Trimester U/S Findings (2)?
PRES: Infant. Death usually within 1 yr of birth.
- Microcephaly / Holoprosencephaly
- Severe intellectual disability
- Microphthalmia + Cleft Lip / Palate
- Congenital HD
- Polydactyly
- “Rocker-bottom” feet
1st TRIMESTER U/S:
- ↑nuchal translucency
- PAPP-A↓