Common Syndromes and their Recognition Flashcards
What is the genetic basis of Down Syndrome?
Trisomy 21
Mostly nondisjunction (translocation and mosaicism)
Prevalence 1 per 660
List the clinical features of Down Syndrome
- Oblique (upslanted) palpebral fissures
- Single transverse palmar crease
- Hypotonia
- Round face and flat nasal bridge
- Epicanthic folds
- Brushfield spots in iris
- Small mouth and protruding tongue
- Small ears
- Flat occiput and third fontanelle
- Short neck
- ‘Sandal gap’ between first and second toe
Describe the prognosis in Down Syndrome
IQ 20-55
Gap to normal widens through childhood
Most survive to middle age then decline due to Alzheimers
What medical conditions are associated with Down Syndrome?
- 40% have congenital heart disease, esp VSD and AVSD
- Hypothyroidism
- Alzheimer’s
- Glue ear
- Atlantoaxial instability
- Delayed motor milestones
- Short stature
- Visual impairment from cataracts, squint, myopia
- Increased risk of leukaemia and solid tumours
- Obstructive sleep apnoea
- Epilepsy
What is the genetic basis of Patau Syndrome?
Trisomy 13
List the clinical features of Patau Syndrome
- Cleft palate
- Polydactyly
- Cardiac defects
- Eye defects (microphthalmia)
- Structural defect of brain and scalp defects
Describe the prognosis in Patau Syndrome
Almost all die by age 3
What medical conditions are associated with Patau Syndrome?
- Cardiac and renal problems
What is the genetic basis of Edwards Syndrome?
Trisomy 18
More common in females
List the clinical features of Edwards Syndrome
- Small chin
- Cardiac abnormalities
- Prominent occiput
- Flexed, overlapping fingers
- Rocker-bottom’ feet
Describe the prognosis of Edwards Syndrome
Half die by 2mths
Severe LD
What medical conditions are associated with Edwards Syndrome?
- Cardiac and renal problems
What is the genetic basis of Fragile X Syndrome?
X-linked
Trinucleotide repeat expansion
Anticipation
List the clinical features of Fragile X Syndrome
- Prominent ears
- High arched palate
- Macro-orchidism
- Macrocephaly
- Characteristic facies - long face, prominent mandible, broad forehead
Describe the prognosis in Fragile X Syndrome
Speech impairment Autism in up to 50% Impulsive Shy Severe LD
What medical conditions are associated with Fragile X Syndrome?
- Mitral valve prolapse
- Epilepsy
- Scoliosis
- Joint laxity
What is the genetic basis of Prader-Willi Syndrome?
Lack of paternal 15q
List the clinical features of Prader-Willi Syndrome
- Obesity
- Hypogonadism
- Hypotonia
- Violent temper
- Sleep apnoea
- Neonatal feeding difficulties
- Faltering growth in infancy
- Learning difficulties
Describe the prognosis of Prader-Willi Syndrome
Mild LD
Expressive language disorder
What medical conditions are associated with Prader-Willi Syndrome?
- Late onset diabetes
2. Psychiatric - e.g. OCD, anxiety
What is the genetic basis of Angelman Syndrome?
Lack of maternal 15q
List the clinical features of Angelman Syndrome
- Microcephaly
2. Ataxic, jerky movements
Describe the prognosis of Angelman Syndrome
Severe LD
What medical conditions are associated with Angelman Syndrome?
- Epilepsy
2. GI conditions
What is the genetic basis of Cri-du-Chat syndrome?
5p deletion
List the clinical features of Cri-du-Chat syndrome
- Round flat face
- Hypertelorism (abnormal large distance between two organs)
- Micrognathia
- Characteristic cry like mewling of a cat
Describe the prognosis of Cri-du-Chat syndrome
Severe LD
What medical conditions are associated with Cri-du-Chat syndrome?
None
What is the genetic basis of Klinefelter Syndrome?
47 XXY
List the clinical features of Klinefelter Syndrome
- Infertility
- Hypogonadism with small testes
- Pubertal development may appear normal
- Gynaecomastia in adolescence
- Tall stature
- Intelligence usually normal range
Describe the prognosis of Klinefelter Syndrome
May have LD
What medical conditions are associated with Klinefelter Syndrome?
None
What is the genetic basis of Turner Syndrome?
45 X
List the clinical features of Turner Syndrome
- Spoon shaped nails
- Short stature (cardinal feature)
- Neck webbing or thick neck
- Wide carrying angle
- Widely spaced nipples
- Delayed puberty
- Ovarian dysgenesis
What medical conditions are associated with Turner Syndrome?
- Congenital heart defects - aortic valve stenosis, coarctation of the aorta
- Infertility
- Hypothyroidism
- Renal anomalies
- Pigmented moles
- Recurrent otitis media
What is the genetic basis of Tuberous Sclerosis?
AD often spontaneous mutation of TSC1 or TSC2 genes
List the clinical features of Tuberous Sclerosis
- Multiple hamartomas
- Infantile spasms
- Aggression and self injury
Describe the prognosis of Tuberous Sclerosis
Hyperkinetic
Autistic traits
Severe LD in some cases
What medical conditions are associated with Tuberous Sclerosis?
- Infantile spasms
- Epilepsy
- Hamartomas
What is the genetic basis of Neurofibromatosis?
AD inheritance of mutation in NF1 or NF2 gene
List the clinical features of Neurofibromatosis
- Neurofibromata
- Café-au-lait spots
- Axillary freckling
- Optic glioma
- Lisch nodule seen on slit lamp examination
- Bony lesions from sphenoid dysplasia
- First degree relative with NF1
(NF2 - bilateral acoustic neuroma are predominant feature)
Describe the prognosis of Neurofibromatosis
10% severe LD
What are the medical conditions associated with Neurofibromatosis?
- Sarcomatous change of the benign tumours
What is the genetic basis of PKU?
AR
Phenylalanine hydroxylase deficiency
Describe the prognosis with PKU
Microcephalic mental impairment
Autism
Epilepsy
What is the genetic basis of Lesch-Nyan Syndrome?
X-linked recessive
Uric acid metabolism
List the clinical features of Lesch-Nyan Syndrome
- Hypotonia
- Dysphagia
- Growth retardation
Describe the prognosis of Lesch-Nyan Syndrome
Normal development in infancy
Moderate LD
Death in 20s from resp or renal failure
What medical conditions are associated with Lesch-Nyan Syndrome?
- Epilepsy
What is the genetic basis of Rett Syndrome?
X-linked dominant
List the clinical features of Rett Syndrome
- Fits
- Agitation
- Truncal ataxia
- Depression
Describe the prognosis of Rett Syndrome
Normal development for first year then lose speech, mobility, etc.
What is the genetic basis of DiGeorge Syndrome?
22q11 deletion (‘catch 22’)
List the clinical features of DiGeorge Syndrome
- Short philtrum
- Thin upper lip
- Prominent ears
- Hypocalcaemia
- T-cell deficiency
- Short stature
What medical conditions are associated with DiGeorge syndrome?
- Branchial arch and heart defects (aortic arch anomalies, TOF, common arterial trunk)
- Immunodeficiency
- Hypocalcaemia (hypoparathyroidism)
What is the genetic basis of Noonan Syndrome?
AD inheritance
List the clinical features of Noonan Syndrome
- Characteristic facies - hypertelorism, ptosis, ear abnormalities
- Occasional mild LD
- Short webbed neck
- Trident hair line
- Pectus excavatum
- Short stature
- Mild developmental delay
- Undescended testes
What medical conditions are associated with Noonan Syndrome?
- Congenital heart disease (pulmonary stenosis, ASD)
What is the genetic basis of Williams Syndrome?
7q11 microdeletion
List the clinical features of Williams Syndrome
- Short stature
- Characteristic facies:
- Periorbital fullness
- Full cheeks
- Anteverted nares
- Wide mouth with full lips
- Small widely spaced teeth - Mild to moderate LD
What are the medical conditions associated with Williams Syndrome?
- Transient neonatal hypercalcaemia
2. Congenital heart disease (supravalvular aortic stenosis)