Genetic Flashcards

1
Q

What are telomers

A

Region of repetitive nucleotide sequence at the end of each chromosome which protects the chromosome from deterioration and fusion

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2
Q

Which are purines and which are pyrimidines
-Adenine
-Thymine
-Cytosine
-Guanine

A

-Purine: Adenine, Guanine
-Pyrimidine: Thymine, Cytosine

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3
Q

What are the purpose of these enzymes
-DNA polymerase
-Helices
-Ligase

A

-DNA polymerase: creases DNA molecules by assembling nucleotides
-Helicase: disrupts the DNA double bond to allow replication
-Ligase: DNA repair enzyme

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4
Q

How do you calculate carrier incidence and carrier frequency

A

Carrier Incidence: carrier frequency x carrier frequency x4

Carrier frequency: square root (carrier incidence/4)

“Incidence = frequency squared x 4

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5
Q

What is the difference between allelic and locus heterogeneity

A

-Allelic: more than one mutation in a gene (e.g. CF)
-Locus: mutations of more than one gene (e.g. TS)

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6
Q

What is the difference in these mutations
-missense
-silent point mutation
-nonsense mutation
-splicing mutation

A

-missense: point mutation results in codon change that causes a amino acid change e.g. sickle cell disease (A instead of T)
-Nonsense mutation: point mutation that results in a stop codon
-Silent mutation: codon change but same amino acid is still encoded for. Natural genetic variability
-Splicing mutation: failure to remove introns from transcripts DNA so intron DNA is left in the RNA molecule causing abnormal protein

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7
Q

Describe the concept of Anticipation

A

More triplet repeats occur in successive generations = increased severity of disease

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8
Q

What is penetrance

A

The presence/absence of a disease or trait. Must have both the phenotype and genotype

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9
Q

What is the difference between expressivity and penetrance

A

Penetrance= genotype + phenotype. Presence of disease both on person and in genome

Expressivity= variation in the clinical features of a mutation e.g. NF1

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10
Q

In consanguinity what is the risk of having a major problem
-Background risk
-Incest
-1st degree cousins
-2nd degree cousins

A

-3%
-50%
-6% (double)
-4%

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11
Q

Describe splice site mutation

A

Splicing- removal of non-coding introns
Mutation is splicing allows this non-coding material to be translated into the RNA. Results in mutation in end protein

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12
Q

Describe anticipation

A

Seen in triple repeat disorders. More aggressive and earlier disease in subsequent generations

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13
Q

What type of disorder is Myotonic muscular dystrophy
What is the genetic defect
What are the symptoms

A

Triplet repeat disorder
-CTG expansion mutation
-SX: facial hypotonia with V shaped lip, muscle weakness, heart condition issues, IQ/Behavioural issues

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14
Q

What type of mutation causes Fredrick ataxia
What is the gene
What age of onset
What are the symptoms

A

Triplet repeat mutation
FXN gene- GAA triplet repeat mutation = results in loss of function mutation
FXN gene encodes a mitochondrial protein that is used to chaperone iron. Mutation - iron accumulation and oxidative damage

Age onset: teenage years
Sx
-Brain: ataxia, peripheral neuropathy, loss of proprioception and vibration, loss deep tendon reflexs
-Muscle: weakness, kyphosis, foot deformity
-Heart: HOCM
-Endo: diabetes mellitus

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15
Q

What condition does a mutation in FMR1 gene cause

A

Fragile X
“Fragile Mother Related 1”

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16
Q

What does a mutation in FXN cause

A

Fredrick Ataxia
“Fredirick ataXiaN gene”

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17
Q

What study to do you use to check for Beckwith-Weidmann

A

Methylation specific multiple ligand probe analysis

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18
Q

What conditions will a microarray detect vs not

A

Detect: micro deletion, micro duplication, aneuploidy, unbalanced translocation, uniparental disomy if SNP analysis used, long stretches of homogeneity (SNP)

Won’t detect: balanced translocation, methylation abnormalities, triple repeat, single nucleotide

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19
Q

What test would be used for NF1 or Marfans

A

Sanger sequencing- will detect a mutation on a nucleotide level

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20
Q

What test is used for analysis of myotonic muscular dystrophy

A

triple repeat analysis - PCR reaction that is then analysed with southern blot to see the length of triplet repeats

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21
Q

What is the difference between western and southern blot

A

Western blot- protein analysis
Southern blot- DNA analysis

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22
Q

Describe the phases of mitosis

A

-interphase: DNA replicates. Go from 46 –> 92 chromatids
-prophase: formation of microtubules. nuclear envelop dissolves. Microspindles attache to each chromosome
-metaphase: chromosomes lined up along the equator (metaphase plate)
-anaphase: chromosomes pulled to separate ends of the cell by the microtubles
-Telophase: nuclear envelope reforms around opposite cluster of DNA
-Cytokinesis: remained of cell and cytoplasm divides to make 2 daughter cells

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23
Q

What is the gamete result if you have non-dysjunction in meiosis I vs meiosis II

A

Meiosis I: all the cell lines affected. 2 cells have N+1, 2 cells have N-1
Meiosis II: happens after the first division, so of the 4 cells produced, 2 won’t be affected. Of the remaining 2, 1 will gain (N+1) and one will loose (N-1)- therefore 4 gametes: 2 normal, 1 N+1, 1N-1

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24
Q

What is a Robertsonian chromosome and which are they

A

Contain an non central centromere. The DNA in the short arm (p arm) is redundant

Chromsomes 13, 14, 15, 21 and 22

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25
Q

In a maternal carrier of a translocation between T14 and T21, what is the hypothetical risk of having an abnormal gamete vs the actual risk

A

In theory, you only have a 1/6 chance of normal, 1/6 chance balance translocation, 1/6 chance T21 and then a 1/6 chance of T14, 1/6 chance of -21, 1/6 chance of -14

In reality, zygotes except normal, balance and T21 are non-viable so you risk of recurrence is 1%

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26
Q

What abnormal results on Quad screening would you expect for the 3 trisomies (21, 18, 13) and Turners Syndrome

A

T21: “HIgh” High hCG and Inhibin A
T18 “HE is low”- hCG and estriol
T13: “AFPateau is low” - low AFP
Turner: HIgh- high hCG and Inhibin A

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27
Q

What is the most consistent features of Turners syndrome and what is it due to

A

Short stature
Loss of the SHOX gene on the short arm of the X chromosome

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28
Q

You see a baby with puffy hands and feet and consider the diagnosis of congenital lymphoedema.
What condition should you screen for

A

Turners syndrome

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29
Q

Name features of Turner syndrome

A

-short stature
-webbed neck, low posterior hairline
-shield shaped chest, widely spaced nipples
-wide carry angle with cubits valgus
-amenrrhoea, delayed puberty
-cardiac: bicuspid aortic valve, coarcation of aorta
-renal: horse-shoe kidney, HTN
-Autoimmune: coeliac, hashimotos, IBD

30
Q

In Turners syndrome, when on growth hormone, what blood test is used to titrate effect

A

IGF-1

31
Q

What is the condition called that is due to a deletion in 5p chromosome

A

Cri du chat- ‘cry of the cat’
-meow like cry at birth, slanted eyes, hypotonia, hypertelorism

32
Q

What causes the condition Wolf-Hirschhorn syndrome
-what gene
-what symptoms

A

Deletion of the WHSC1 gene due to a macro deletion of chromosome 4p

‘Greek warrior helmet face’ with prominent forehead, wide flat nasal bridge, hypertelorism, microcephaly. Also get seizures and ID.

33
Q

What mutation causes Achondroplasia

A

FGF3- fibroblast growth factor 3

34
Q

What mutation causes Allagile syndrome and what are the features

A

JAG1 or NOTCH2 mutation - deletion

Triangular face, pointed chin, deep set eyes
Cardiac: peripheral pulmonary stenosis
Skeleteal: butterfly vertebrae
Liver: paucity of bile ducts –> cholestatic jaundice

35
Q

What sx do you get in CHARGE syndrome and what is the mutation

A

Coloboma- Heart defect- Atresia (choanal), retardation of growth, genitourinary defect, ear abnormalities AND cranial nerve dysfunction, especially of the facial nerve

Mutation: CHD7 “C-Harge disease”

36
Q

You see a child with high arched eyebrows, long lashes, a monobrow, long philtrum and short upturned nose

What is the disease and mutation

A

Cornelia de Lange Syndrome

NIPBL gene mutation

37
Q

What condition is due to a mutation in COL5A1 and COL5A2

A

EHLOS DANLOS- think “COL= COLLAGEN”

38
Q

What are the features of Ehlos Danlos syndrome, what is the mutation and what is the scoring system

A

Mutation: COL5A1 or COLD5A2
SX: joint hypermobility, poor wound healing, hyper extensible skin, mitral valve prolapse, autonomic dysfunction, tendon rupture

Scoring system- Beighton score X/9. >4 indicates joint hyper mobility.
-thumb hyperextension =2
-5th finger 90 degree hyperextension =2
-hyper extension elbows =2
-hyper extension knees =2
-flexion of hips so palms are on the floor =1

39
Q

What mutation causes Familial adenomatous polyposis
What is the management

A

APC gene on chromosome 5
6-12 monthly colonoscopy until old enough for total colectomy

40
Q

What mutation causes familial hypercholestrolaemia
What are the symptoms
What is the management

A

LDLR mutation - LDL receptor mutation
SX: increased LDL, normal/low HDL, normal triglycerides
-Tendon xanthomata
-Corneal acrus
-Xanthelmas
-Premature CVD
-Plantar xanthoma

Management: Diet, statin
Regular CAD screening and echo
Ezetimbe if statin not effective

41
Q

What is second line management after a statin in familiar hypercholesterolaemia and what is the MOA

What mutation causes this condition

A

Ezetimibe
Reduces fat absorption

LDL-receptor mutation

42
Q

What mutation causes Gilberts syndrome
What are the symptoms
What is the management
What is the homozygous version of this condition called

A

Uronyltransferase enzyme mutation (UGT1A1) which conjugates bilirubin

Sx; severe neonatal jaundice
TX: Phototherapy and liver transplan

Criggler-Najjar syndrome

43
Q

What is the defect in Neurofibromatosis
What is the diagnostic criteria

A

NF1 gene mutaiton
SX: >2 of
- Cafe au last spots >6
-Neurofibromas >2 or 1+ plexiform neurofibroma
-Auxillary freckling
-Lisch nodes 2+
-Osseous lesions- scapula and scoliosis
-Optic glioma
-Family history of NF1 in 1st degree relative

44
Q

In an optic glioma affecting vision, what is the treatment

A

Carboplatin

45
Q

What is the diagnostic criteria for NF2

A

Bilateral vestibular Schwannoma

OR
Family history AND
-unilateral vestibular
-brain tumour e/g. glioma, Schwannoma, meningioma

46
Q

What mutation is present in Noonans syndrome
What are the symptoms

A

PTPN1 is gene in 50% of cases

Short stature
Webbed neck
Low posterior hairline
Slanted eyes
Cardiac: pulmonary valve stenosis
Widely spaced nipples
Coagulopathy

47
Q

What conditions are caused by these defects
-JAG1/NOTCH2
-COL5A1
-FRG3
-APC
-CHD7
-PTPN1
-FBN1
-LDLR
-COL1A1

A

-Allagiles
-Ehlos Danlos
-Achondroplasia
-Familal adenomatous polyposis
-CHARGe disease
-Noonans
-Marfans
-Familial hypercholesterolaemia
-Ostengenesis imperfect

48
Q

A child has a mutation at COL1A1- what condition does it cause

A

Collagen Type 1
Result in osteogenesis imperfecta

49
Q

What are the symptoms of type 1-4 osteogenesis imperfect

A

Type 1: ‘classical’ - blue sclera, variable fractures, normal stature, most get premature conductive hearing loss

Type 2: lethal

Type 3: severe OI- multiple neonatal and easy fractures, blues sclera, short stature, most don’t walk

Type 4: mild- normal sclera, variable fractures, normal adult height. Increased conductive hearing loss

50
Q

What are the side effects of bisphosphonates given for OI

A

-Flu like illness
-Hypocalcaemia
-Jaw necrosis

51
Q

What pathway is activated in Tuberous sclerosis
What is a medication that blocks this pathway

A

mTOR pathway
Sirolimus

52
Q

What are major and minor criteria for tuberous sclerosis

A

Major Criteria:
1) Skin:
a. Facial angiomas (Adenoma sebaceum) – butterfly/malar distribution or forehead plaques
b. Ungal/periungal fibroma
c. >3hypomalanotic macules
d. Shagreen patch
e. Multiple retinal nodular hamartomas

2) Brain
a. Cortical tubers
b. Subependymal nodule
c. Subependymal giant cell astrocytoma

3) Other:
a. Renal angiomyolipoma
b. Cardiac rhabdomyoma
c. Lymphangioleiomyomatosis (LAM)
i. dilated lymphatic and interstital proliferation. Resultant obstruction and cystic lung disease. Presents with pneumothorax and dyspnoea.

Minor Criteria:
1) Cutaneous: confetti skin lesions, dental enamel pits, oral fibromas
2) Brain: cerebral white matter migration lines
3) Other: non renal hamartomas, bony cysts, multiple renal cysts, hamartomatous rectal polpys

53
Q

What is the mutation in Fanconi anaemia
What are the symptoms

A

FANCA or FANCC gene mutation
Defect in DNA repair

“FANCCONI”
-Frizzled blood: loss of haemopoietic stem cell -> pancytopenia
-Abnormal bones: absent radii, absent thumbs
-Not tall: short stature
-Crypoorchidism, hypogonadism, micropenis
-Cardiac: VSD, PDA
-Other: renal and gut e.g. aplasia, horseshoe kidney, malrotation, duodenal atresia
-N –> V = vertebral abnormalities
-Increased risk: increased risk of AML and myelodysplastic

54
Q

What is galactosemia
What is it due to
Mode of inheritance
Symptoms

A

Disorder of galactose metabolism
Due to enzyme mutation in Galactose kinase, Galactose-1-phosphate uridyl transferase OR UDP-Galactose-4 epimerise (GAL)

Mode: AR
Symptoms: Hepatmoegally, E-Coli SEPSIS, poor feeding, hypotonia
Eventual neurodevelopment impairment, cataracts, growth delay, ovarian failure

55
Q

What accumulates in homocysteinuria
What is it a defect of
What is the treatment

A

Homocysteine and methionine

Defect in cystathionine-B-synthetase due to CBS gene defect

Sx;
-marfanoid appearance
-downward displacement of ectopic lentis
-seizures, intellectual disability
-stroke/PE/clots as homocysteine inflamed endothelium

Treatment
-B6 vitamin- acts as a co-factor
Betanine- reduces homocystein back to methionine which is less harmful

56
Q

An accumulation of methionine is associated with what disorder

A

Homocysteinuria

57
Q

What co-factor + enzyme is involved converted homocysteine –> cysteine

A

cystathionine-B-synthetase
Vitamin B6 (pyroxidine)

58
Q

What type of mutation is sickle cell disease
How is it inherited
What are the symptoms
What do you seen in RBC that are important

What is the treatment

A

-point mutation of arginine –> thymine
-AR

SX: vaso-occlusion
-Brain: stroke, moyamoya (build collaterals around areas of vaso-occlusion which are fragile and burst easily)
-limbs: dactylics
-Spleen: vasoocclusion –> pain and infarction
-Infection secondary to lack of spleen. Increased risk of encapsulated bacterial infections + osteomyelitis will salmonella
-Lungs: acute chest syndrome
-Kidneys: proteinuria/ haematuria/ infarction
-Aplastic crisis

Red cell film: Howell-Jolly bodies

Treatment
-Hydroxurea- increases production of HbF
-Blood transfusion
-Folate
-May need iron chelation
-Stem cell transplant

59
Q

What is used in sickle cell disease to increased HbF production and reduce HbS production

A

Hydroxurea

60
Q

What causes sickle cell disease

A

Point mutation in gene causes a defect in the B-globin chain so that it shifts the Hb oxygenation curve right and when deoxygenated crystallises

61
Q

For the below B-thalassamia combinations list the outcome
-B0/B0
-B0/B+
-BO/B
-B+/B+
-B+/B

A

B-thallasaemia major
B-thalassaemia major
-B-thalassaemia minor/trait
-B-thalassaemia intermedia
-B-thalassaemia trait

62
Q

What symptoms occur in B-thalassaemia major
What do you seen on blood film

A

Anaemia
Alternate areas of haemaotopoiesis –> hepatosplenomegaly, frontal bossing, jaw enlargement
Iron overload- body absorbs iron as anaemia –> haemochromatosis like syndrome

Blood film:
-microcytic aneamia
-tear drops
-a-globin precipitates

63
Q

What are HbH cells and what disease are they associated with

A

HbH- tetrad of B-globin cells “Bart haemoglobin”
Associated with a-thalassaemia as not enough alpha chains produced so the B-chains precipitate

64
Q

What is associated with
-ATP7A
-ATP7B

A

-ATP7A: Menkes kinky hair
-ATP7B: Wilsons disease

both are disorders of copper transport

65
Q

In Wilsons disease
-what are the symptoms
-what would you see on serum copper and ceruloplasmin

A

Copper accumulation
-Liver: fibrosis
-Kidney: CKD
-Eyes: kayser–fischer rings
-Brain: mostly accumulates in basal ganglia –> Parkinson like symptoms

Increased serum copper
Low ceruloplasmin -ATP7B defect means copper isn’t excreted in bile or incorporated onto ceruloplasmin for transport in the blood, so it is rapidly broken down

66
Q

In Wilsons disease
-what is the gene and defect
-what is the treatment

A

-ATP7B defect
-Inability to excrete copper into bile or incorporate it into ceruloplasmin so it accumulates

Treatment
-Low copper diet
-Penicilliamine which is copper chelating
-Liver transplant

67
Q

SERPINA1 gene is mutated in what disease

A

A-1-antitrypsin

68
Q

What is the role of a-1-anti trypsin
Where is it produced
What defect causing a-1-anti-trypsin deficiency

What phenotype do you get with these genotypes
-M/M
-M/S
-M/Z
-S/S
-S/Z
-Z/Z
-Null: Null

A

protease inhibitor which protects the lung epithelium against neutrophil elastase and bacterial elastase

Produced in the liver. In mutation either not produced (null) , OR misfolded and accumulates in liver (Z) or reduced production (S)

MM: normal
M/S: carrier
M/Z: carrier
S/S: mild disease
S/Z: severe disease
Z/Z: severe disease with misfolding so accumulates in the liver
Nul; nil : severe lung disease, nil liver accumulation

69
Q

A child has a genetic condition that results in severe sunburn with minimal exposure. What is the disease and how is it inherited

A

Xeroderma Pigmentosa
AR

70
Q

What condition gives you Heinz bodies in RBC

A

G-6-P-D deficiency

71
Q

which medications do you avoid in g-6-pd
-pain
-antibiotics
-cardiovascular
-food

A

-aspirn
-cotrimoxazole, nitrofurantoin, chloramphenicol
-sulfonamides
-procainamide
-methyldopa
-fava beans