Genetics Flashcards
What type of defect is cleft palate?
Déformation
What type of defect is potters sequence?
Primary defect malformation (renal issues)
Then deformation from oligohydramnios
Definition of major anomaly? Examples?
• MAJOR ANOMALY: a congenital anomaly severe enough to need
surgical intervention, increased morbidity and/or mortality,
potentially has a long-term impact medically and/or psychologically.
• Examples: cleft lip and palate, spina bifida / myelomeningocele, omphalocele,
duodenal atresia, congenital heart disease
Définition of Minor Anomaly ?
Examples?
- MINOR ANOMALY: a congenital anomaly that requires no treatment at all or can be easily corrected, do not cause increased morbidity or mortality, often common in population.
- Examples: postaxial polydactyly, abnormal palmar creases, low-set ears, preauricular tag
What complications can patients with 22q11 Deletion Sequence have?
• CHD (64%),
conotruncal, e.g., VSD, TOF, IAA type B, truncus, aberrant subclavian
• Palatal abnormalities (67%): velopharyngeal insufficiency, submucosal cleft, cleft palate, dysphagia
Airway/related: vascular ring, laryngeal web, subglottic stenosis
Gl: anteriorly placed/imperforate anus, esophageal atresia, umbilical / inguinal hernia
• Immune deficiency (77%) e.g., frequent infections, thymic hypoplasia
Craniofacial: prominent nasal bridge, micrognathia, asymmetric crying facies
• Hearing loss (sensorineural / conductive)
Developmental delay / learning difficulties (70%-90%)
Psychiatric: autism spectrum (20% of children), schizophrenia (25% of adults), ADD, anxiety
Skeletal: scoliosis, rib / vertebral anomalies, clubfoot
Genitourinary: hydronephrosis, renal anomalies, cryptorchidism, hypospadias
• Laboratory: hypoCa, hypoparathyroidism (50%), GH deficiency, cytopenias (lymphopenia)
Features of T18
- Trisomy 18 aka Edward’s syndrome
- Majority (95%) of trisomy 18 conceptuses spontaneously aborted
- Incidence 1/7500 livebirths
Clinical features:
• Physical: prominent occiput, low set ears, micrognathia, small mouth, high arched palate, clenched fists (2nd and 5th fingers overlapping 3rd and 4th), rockerbottom feet, hypoplastic nails (especially 5th fingernail), short sternum, hypertonia
• Other / major anomalies: CHD (VSD, PDA, ASD, poly-valvular disease) in 80-100%,
central apnea - respiratory failure, horseshoe kidneys
- Postnatal survival poor: 50% die in 1st week, most do not live past 1st year
- Severe intellectual disability in survivors
Describe Potters sequence
• Potter sequence (deformation)
• External and internal abnormalities caused by
oligohydramnios
• Primary defect a malformation: posterior urethral valves, renal
agenesis, multicystic dysplastic kidneys
• Lack of fetal urine > oligohydramnios > fetus has a flat face due to compression of the face against the uterine wall, club foot due to no room for significant movement, and associated lung hypoplasia
• “Potter facies”: wrinkly skin, low-set ears, flat nose & chin, widely
spaced, epicanthal folds.
T21 is most at risk for
A. Intestinal atresia
B. Congenital hypothyroidism
C. Transient myeloproliferative disorder (TMD)
D. Hirschsprung’s disease
A. Intestinal atresia (Duodenal atresia)
Features of 22q11 deletion syndrome
• CHD (64%), especially conotruncal, e.g., VSD, TOF, IAA type B, truncus, aberrant subclavian
Palatal abnormalities (67%): velopharyngeal insufficiency, submucosal cleft, cleft palate, dysphagia
Airway/related: vascular ring, laryngeal web, subglottic stenosis
Gl: anteriorly placed/imperforate anus, esophageal atresia, umbilical / inguinal hernia
• Immune deficiency (77%) e.g., frequent infections, thymic hypoplasia
Craniofacial: prominent nasal bridge, micrognathia, asymmetric crying facies
Hearing loss (sensorineural / conductive)
Developmental delay / learning difficulties (70%-90%)
Psychiatric: autism spectrum (20% of children), schizophrenia (25% of adults), ADD, anxiety
• Skeletal: scoliosis, rib / vertebral anomalies, clubfoot
Genitourinary: hydronephrosis, renal anomalies, cryptorchidism, hypospadias
Laboratory: hypoCa, hypoparathyroidism (50%),
GH deficiency, cytopenias (lymphopenia)
Feature of Noonan
• Autosomal dominant
Multiple genes: most common PTPN11 in 50%, other genes include SOS1, RAF1, RIT1,
KRAS
- CHD: most common pulmonary valve stenosis (PS), hypertrophic cardiomyopathy
- Broad/ webbed neck
Characteristic faces
• Low-set posteriorly rotated ears, blue-green irises, widely-spaced downslanting eyes, ptosis.
Chest wall abnormalities: superior pectus carinatum, inferior pectus excavatum
Widely spaced nipples
• Short stature
• Cryptorchidism
Developmental delay (variable degree)
Coagulation defects, e.g., PT, PTT, platelet count may show abnormalities.
• Lymphatic dysplasias of the lungs, intestines, and/or lower extremities
How do you confirm T21
Routine Karyotype
Robertsoniam translocation - can increase risk for future pregnancies up to 15%
When to order microarray ?
It is the first-line test recommended by the American
College of Medical Genetics (ACMG) for multiple congenital anomalies that do not fit a specific pattern of diagnosis
How to test for CF?
Single gene sequencing: CFTR gene for cystic fibrosis.
**The majority of infants with meconium ileus end up having cystic fibrosis. 20% of
CF patients present in the neonatal period with meconium ileus.
How to test for BWS
• DNA Methylation studies
Beckwith-Wiedemann syndrome (BWS) is an overgrowth syndrome
that should be suspected if a neonate has one or more of the
following major/minor findings.
• Major findings: macrosomia, macroglossia, hemihyperplasia,
omphalocele, embryonal tumor (e.g., Wilms tumor, hepatoblastoma),
visceromegaly, anterior linear ear lobe creases and/or posterior
helical ear pits, large placenta
• Minor findings (relatively common in population): polyhydramnios,
prematurity, neonatal hypoglycemia, vascular lesions e.g. nevus
simplex (forehead, back of the neck)
Most common gene imprinting error during in vitro fertilization
Beckwidth wiedemann syndrome
What does dysostosis refer to?
Abnormalities in early patterning events during skeletal development
Occurs GA 3-6 weeks
Ie: spondylocostal dysostosis (AR, mutation in notch ligand DLL3)
What is the genetic defect associated with trnasient neonatal diabetes mellitus? Chromosome?
Genomic imprinting
Chromosome 6
Manifests with IUGR, FTT, hyperglycemia and dehydration 4-6 weeks
3 year old girl with developmental delay, hand foot sucking and cheerful disposition. Dx and chromosomal location?
Angelman syndrome
Deletion of maternal inherited gene UBE3A on Chromosome 15q11
What diagnostic test do you send to diagnose uniparental disomy?
Single nucleotide polymorphism microarray
Comparative genomic hybridization refers to which test?
Fancy way of saying Microarray
Can detect deletions or duplications
Takes longer than karyotype
Beckwidth wiedemann is associated with (gain or deletion)?
Gain of methylation of maternal chromosome or paternal duplication
Overgrowth, think double
Supravalvular subaortic stenosis is associate with which syndrome?
Williams
7q11 deletion
Can also have peripheral pulmonic stenosis, hypoplastic nails, prominent lips, hoarse voice, stellate iris pattern, mental deficiency
Cell free fetal DNA is usually _______ than are maternally derived cfDNA
Shorter
Most commin presenting clinical manifestation klinefelter syndrome?
Infertility from azoospermia
Iugr, microcephaly, short sternum, camptylodactlyly, clenched hand, multicystic dysplastic kidney. Dx?
Trisomy 18
Triangular face, IUGR, 5th finger clinodactyly, leg length asymmetric, cryptoorchidism. Dx?
Silver Russell Syndrome
Remember this is a genomic imprinting disorder
Large polycystic kidneys, post axial polydactyly, occipital encephalocele. Dx?
Meckel Gruber syndrome (AR)
Chromostome 17
How is mRNA formed?
From transcription of DNA
Primary mRNA is formed first, undergoes splicing (removal of introns) to form mature mRNA
Ribosomal RNA
RNA that is part of ribosome and helps bind mRNa and tRNA to ribosome
Transfer RNA
RNA that transports amino acids and assists in translation of mature mRNA
The anticodon portion of tRNA (contains specific AA at 3’ end) binds to complementary mRNA codon
Transcription
MRNA is synthesized from DNA template
DNA polymerase
Enzyme important in DNA replication by utilizing complementary DNA strands as a template to synthesize new strand
RNA polymerase
Enzyme that binds to promoter region and synthesizes mRNA from a DNA template
Reverse transcriptase
Enzyme that transcribes RNA into DNA (reverses transcription)
Intron
Dna sequence of a gene located between 2 exons that is transcribed into mRNA but spliced out during formation of mature mRNA
Exon
DNA sequence of gene located between 2 introns that is transcribed into mRNA and retained after primary mRNA is spliced