Genetic and Pediatric Diseases Flashcards

1
Q

What is the difference among genetic diseases, hereditary diseases, and congenital disorders?

A

Genetic diseases are due to permanent DNA changes - can be due to somatic DNA mutations.

Hereditary diseases are derived from germline DNA.

Congenital disorders might not be genetic.

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2
Q

Are all genetic disorders present in infancy and childhood?

Are all pediatric diseases of genetic origin?

A

Nope, nope.

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3
Q

Do autosomal dominant and recessive disorders manifest equally between both sexes?

A

yeah

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4
Q

What is the pattern of inheritance of Marfan’s syndrome? Can the mutation be sporadic? Does it exhibit variable expressivity?

A

Autosomal dominant.

1/3 of cases are from sporadic mutations.

Yeah variable expressivity; manifests through a variety of abnormalities (pleiotropy).

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5
Q

What is the subcellular etiology of Marfan’s syndrome? What organs can be affected?

A

Fibrillin-1 mutation: messed up fibrillin, which links elastin together in CT.

Affects the heart, aorta, skeleton, ligaments, eyes (ciliary zonules of the lens are suspended by fibrillin), and skin.

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6
Q

The fibrillin-1 gene is located on chromosome _____ and there are more than ______ different distinct mutations affecting the gene.

A

chromosome 15, more than 600 mutations that affect the gene

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7
Q

What are the clinical features of Marfan’s syndrome (7)?

A
  1. Tall, long legs.
  2. Long extremities and fingers (arachnodactyly - spider fingers).
  3. Long skull.
  4. Deformed chest.
  5. Weak tendons, ligaments, joints –> hyperflexible joints, dislocations.
  6. Hernias
  7. Kyphoscoliosis
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8
Q

Specifically how does Marfan’s syndrome affect the aorta and heart?

A

Tunica media of the aorta is weakened due to fragmented elastic fibers –> predisposition to dissecting aneurysm.

Heart valves are floppy, especially the mitral.

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9
Q

What is the leading cause of death in the case of Marfan’s syndrome?

A

cardiovascular disorders

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10
Q

Specifically how does Marfan’s syndrome affect the eyes (3)?

A
  1. Dislocation of the lens
  2. Severe myopia
  3. Retinal detachment
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11
Q

Consanguineous marriage increases the incidence of ________ ________ disorders.

A

autosomal recessive

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12
Q

Autosomal recessive disorders usually affect enzyme proteins, while autosomal dominant disorders often affect….(2).

A

Autosomal dominant disorders usually affect structural components such cytoskeletal proteins (collagen) and regulatory proteins in complex metabolic pathways.

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13
Q

What is the pattern of inheritance of cystic fibrosis?

A

Autosomal recessive

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14
Q

CF is a widespread disorder of ________ ________ affecting fluid secretion in exocrine glands and the epithelial lining of the _________, _________ and __________ tracts.

A

disorder of epithelial transport

affects respiratory, gastrointestinal, and reproductive tracts

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15
Q

Name the disease: abnormally thick mucus that obstructs the lumina of airways, pancreatic and biliary ducts, as well as the fetal intestine, and impairs airway mucociliary function.

A

Cystic fibrosis

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16
Q

What is the most common lethal autosomal recessive diseases in caucasians?

A

Cystic fibrosis

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17
Q

CF patients have chronic ________ disease, deficient ________ pancreatic function, and other complications of thickened _______ in the small intestine, liver, and reproductive tract

A

chronic pulmonary disease, deficient exocrine pancreatic function, complications of thickened mucus in the small intestine, liver, and reproductive tract

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18
Q

What is the most common genetic defect involved in CF? What does the gene product do in sweat glands and respiratory epithelium?

A

Mutation of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) on chromosome 7.

In sweat glands, the CFTR protein normally pulls Cl- out of sweat (and Na+ follows) - which is why the sweat is so salty.

In respiratory epithelium the CFTR protein normally pumps Cl- INTO mucus - sets up osmotic gradient for H2O to follow. This is why mucus is so thick.

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19
Q

More than 1,300 CFTR mutations have been identified and 1 in ___ Caucasians are carriers. Incidence is 1 in ______ in Caucasian newborns.

A

1 in 25 are carriers

1 in 3,200 incidence

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20
Q

What are the clinical features of CF (7)?

A
  1. Pulmonary infection
    - abscess
    - chronic bronchitis
    - bronchiectasis
    - honeycomb lung
    - mucus plugging
  2. Cor pulmonale
  3. Chronic pancreatitis
  4. Hypertonic sweat
  5. Obstructed vas defrens, sterility
  6. Meconium ileus (newborn)
  7. Secondary biliary cirrhosis
21
Q

What microscopic changes would one see in a histologic section of a pancreas from a CF patient (2)?

A
  1. Dilated ducts plugged with eosinophilic mucin.

2. Pressure atrophy of exocrine glands –> replacement by fibrous tissue.

22
Q

Does CF affect islet function?

A

Nope

23
Q

What is the pattern of inheritance of hemophilia?

A

X-linked recessive

24
Q

What is the clinical manifestation of hemophilia (1!)?

A

Bleeding!

-can be in joints

25
Q

How did Queen Victoria’s family develop hemophilia?

A

Spontaneous mutation

26
Q

Where do people get their mitochondrial DNA from?

A

Mom

27
Q

What is the pattern of inheritance of mitochondrial myopathy?

A

mitochondrial! through mom.

28
Q

Mutations of mitochondrial genes cause inadequate oxidative phosphorylation and affect organs with high _______ ________ (e.g. CNS, eyes, heart, muscles)

A

high energy consumption

29
Q

Define aneuploid.

A

Karyotypes that are not exact multiples of the haploid number

30
Q

What is the most common cause of congenital retardation?

A

Down syndrome

31
Q

What causes Down syndrome?

A

Trisomy 21 - nondisjunction during maternal meiosis I, translocation, or mosaicism

32
Q

What happens to the incidence of Down syndrome as mothers age?

A

It goes up

33
Q

What are the clinical features of Down syndrome (12)?

A
  1. Severely reduced IQ.
  2. Craniofacial features: characteristic facies, Brushfield spots in the iris, slanted eyes.
  3. Congenital heart defects.
  4. Shorter bones of the ribs, pelvis and extremities.
  5. Single palmar crease.
  6. Wide gap b/t 1st and 2nd toes.
  7. Males mostly sterile with arrested spermatogenesis.
  8. 10-20x increased risk for AML.
  9. Predisposition to bacterial infection.
  10. Predisposition to autoimmune diseases.
  11. Alzheimer’s dementia in almost 100% of older pts.
  12. Big, wrinkled, protruding tongue.
34
Q

___% of offspring of females with Down syndrome also have trisomy 21.

A

40%

35
Q

Name three chromosomal possibilities for Klinefelter syndrome.

A
  1. 47, XXY
  2. 48, XXXY
  3. 46, XY / 47 XXY (mosaic)
36
Q

Are Klinefelter patients phenotypically male?

A

Yeah

37
Q

Nondisjunction during ______ meiosis I is often responsible for Klinefelter syndrome.

A

paternal meiosis 1

38
Q

Describe the changes seen in the three testicular cell types in the case of Klinefelter syndrome.

A

Germ cells and Sertoli cells are absent. Leydig cells increase in number but don’t make much testosterone.

39
Q

What is the incidence of Klinefelter syndrome?

A

1 in 1,000 male newborns.

40
Q

What are the clinical features of Klinefelter syndrome (5)?

A
  1. Increased FSH, LH (cuz Leydig cells aren’t making testosterone).
  2. Tall, slim, femininized habitus (build) from increased estradiol.
  3. Gynecomastia
  4. Testicular atrophy
  5. BARR BODY
41
Q

What is 45, X?

A

Turner syndrome

42
Q

What are the clinical features of Turner syndrome (10)?

A
  1. Sexual infantilism
  2. Primary amenorrhea and sterility
  3. Small stature
  4. Short, webbed neck
  5. Low posterior hairline
  6. Wide carrying angle
  7. Broad chest, widely spaced nipples
  8. Hyper-convex fingernails
  9. CV abnormalities in 50% - coarctation of aorta in 15%
  10. Increased risk for autoimmune diseases and thyroid goiter.
43
Q

Is susceptibility to teratogens specific for each embryologic stage? Is the mechanism of teratogens specific for each teratogen?

A

Yeah, yeah

44
Q

Is teratogenicity dose-dependent? Can they produce death, growth retardation, malformation, or functional impairment?

A

Yeah, yeah

45
Q

At what gestational ages do most things develop?

A

From weeks 2-9ish. CNS first, then cardio, extremities, eyes, and external genitalia.

46
Q

True or false: fetal alcohol syndrome is seen in 1-3 per 1,000 births in the Europe and U.S. and can be as high as 20-150 per 1,000 in certain populations.

A

True

47
Q

What are the clinical features of fetal alcohol syndrome (8)?

A
  1. Prenatal growth retardation
  2. Microcephaly
  3. Epicanthal folds
  4. Short palpebral fissure
  5. Maxillary hypoplasia
  6. Thin upper lip
  7. Small jaw
  8. Poorly developed philtrum (the groove thing on the upper lip)
48
Q

Is fetal alcohol syndrome a common cause of acquired mental retardation?

A

Yeah