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Written exam > Genetics > Flashcards

Genetics Flashcards

1
Q

Overview of achondroplasia

A

Present from birth, short limbs, mid facial hypoplasia, prominent forehead
Developmental delay
Stenosis of spinal canal

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2
Q

Genetic cause of achondroplasia

A

Mutations at FGFR3 codon 380 (inhibits linear bone growth - fibroblast growth factor receptor 3)
Autosomal dominant but most cases are sporadic

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3
Q

Overview of Hunter syndrome

A

Mucopolysaccharidosis II (deficiency of iduronate-2-sulfatase)
Exclusively males, reported in females due to lionisation
Wide clinical manifestations due to marked molecular heterogeneity - coarse facial features, short stature, joint stiffness, ID, dysostosis multiplex, extensive dermal melanocytosis

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4
Q

Genetic cause of Hunter syndrome

A

X linked, Xq28
IDS gene, 80% point mutations major deletions and rearrangements in the remainder

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5
Q

Overview of Marfan syndrome

A

1/5000
Tall with long arm span, arachynodactyly, scoliosis
AV valve prolapse/regurg, arrhythmias, aortic dissection
Lens dislocation (60-70%)
Pneumothorax, pectus excavatum/restrictive lung disease

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6
Q

Genetic cause of Marfan syndrome

A

Autosomal dominant, mutations in gene encoding ECM protein fibrillar-1 (on 15q21)
30% are sporadic, new mutations associated with advanced paternal age

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7
Q

Triad of osteogenesis imperfecta

A

Fragile bones, blue sclerae, early deafness

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8
Q

Genetic cause of osteogenesis imperfecta

A

Structural or quantitative defects in type 1 collagen (primary component of the extracellular matrix of bone and skin), leads to osteoporosis
Classic OI is autosomal dominant

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9
Q

Overview of Stickler disease

A

Midface hypoplasia, P-R sequence
Severe myopia, glaucoma, cataracts, retinal detachment
Hearing loss
Hypermobile joints leading to early arthritis

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10
Q

Genetic cause of Stickler disease

A

Autosomal dominant - gene mutation causing defect in collagens type II, IX or XI

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11
Q

Which is the only urea cycle defect which is NOT autosomal recessive?

A

Ornithine transcarbamyase (OTC) deficiency
- X linked disorder, all males are affected, 10% of female carriers are affected

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12
Q

Why will the mother of a child with congenital myotonic dystrophy display a milder form of the condition?

A

Congenital myotonic dystrophy is a triplet repeat expansion disorder, i.e. expansion of the triplet repeat on transmission from mother to child

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13
Q

Missense mutation

A

Altered codon produces amino acid substitution

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14
Q

Nonsense mutation

A

Altered codon becomes a stop codon and produces a truncated protein (mRNA terminates at that point)

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15
Q

Splice site mutation

A

Insertion or deletion of nucleotides in the specific region at which splicing of an intron would usually take place, therefore one or more introns remain in mature mRNA and may result in aberrant proteins being produced

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16
Q

Child with seizures, developmental regression, post mortem shows bilateral symmetrical necrotising lesions in the brain

A

= Leigh syndrome (also known as subacute necrotising encephalomyelopathy)
- DD, seizures, ataxia, weakness, dystonia
- lactic acidosis
- bilateral symmetrical necrotising lesions in basal ganglia, thalamus, brainstem and spinal cord

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17
Q

Child with developmental regression, diagnosed with AR lysosomal storage disease

A

= metachromic leukodystrophy
Caused by arylsulfatase A gene mutation
- can be infantile, juvenile or late onset

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18
Q

Child with loss of language, stereotypical hand movements and MCEP2 mutation

A

= Rett syndrome
- affects girls, usually normal development initially but then loss of language
- microcephaly and stereotypical hand movements noted

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19
Q

What mutation is associated with AD hereditary pancreatitis?

A

PRSS1

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20
Q

What are the features of Triple A syndrome/Allgrove syndrome?

A

Achalasia, alacrima (usually first sign), adrenal insufficiency
AR inheritance, mutation in AAAR gene
Often have seizures and autonomic dysfunction
Symptomatic management

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21
Q

Clinical features of Tay-Sachs disease?

A

Usually around 6 months of age
Hyperekplexia (enhanced startle response) to sound, macrocephaly, hypertonia, and hyperreflexia with gradual loss of skills and seizures by the age of 2
Early death by the age of 5
>90% can have bilateral macular cherry-red spots

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22
Q

Genetics of Tay-Sachs disease?

A

AR condition caused by disruption of enzyme beta-hexosaminidase A
GM2 ganglioside build up to toxic levels in neurons leading to progressive neurodegenerative symptoms

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23
Q

Cause of metachromatic leukodystrophy

A

Results from white matter accumulation of sphingolipid that leads to demyelination and neurodegeneration

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24
Q

Clinical features of metachromatic leukodystrophy?

A

Infantile form most common
Presents with developmental delay, seizures, ataxia, and mixed upper and lower motor neuron signs due to peripheral neuropathy resulting in reduced/absent deep tendon reflexes

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25
Q

MRI findings in metachromatic leukodystrophy?

A

Frontal and periventricular confluent white matter T2 hyperintensity
(changes are seen later in disease)

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26
Q

Genetics of Fabry disease

A

X linked recessive condition due to deficiency in alpha-galactosidase A

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27
Q

Clinical features of Fabry disease?

A

Disease onset by 10 years
Initial manifestations include neuropathic pain, hyophydrosis, reduced exercise tolerance and fever of unknown cause
Angiokeratomas often develop in the second decade of life
By third decade, ischaemic cardiovascular and renal complications can be seen

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28
Q

What sequence is associated with velocardiofacial syndrome?

A

15-20% have Pierre-Robin sequence

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29
Q

Overview of velocardiofacial syndrome

A

22q11.2 micro deletion
Abnormal branchial arch development
Structural and functional palatal abnormalities, conotruncal cardiac defects, typical facies, hyper nasal speech, hypotonia, defective thymic development

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30
Q

Facial features of velocardiofacial syndrome in infancy

A

Round face with prominent parietal bones and bulbous nasal tip

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31
Q

Facial features of velocardiofacial syndrome in childhood

A

Long face, narrow palpebral fissures, puffy upper eyelids, squared nasal root, narrow alar base with thin alae nasi

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32
Q

What proportion of genetic material is shared between family members?

A

First degree relatives = 50%
Second degree relatives = 25%
Third degree relatives = 12.5%

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33
Q

What is the most specific test for identifying Fanconi’s anaemia?

A

Chromosomal breakage (DEB)

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34
Q

Clinical features of Fanconi’s anaemia?

A

Lethargy, fatigue, bruising or bleeding
Short stature, upper limb malformations (usually thumb/radius)
Aplastic anaemia
May have other skeletal anomalies (including microcephaly, hypertelorism) or congenital heart disease

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35
Q

Clinical features of Williams syndrome?

A

Short stature, developmental delay
Supravalvular aortic stenosis
Hypermobile joints
Hypercalcaemia
Elfin facies, long philtrum and wide mouth, flat nasal bridge, periorybital fullness

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36
Q

Crescendo-decrescendo systolic murmur, joint laxity, short stature, hypercalcaemia, wide mouth and elfin facies?

A

Williams syndrome

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37
Q

Scoliosis, elevated scapula, limited neck movement?

A

Klippel-Feil syndrome
- congenital fusion of the neck leads to limited neck ROM, 50% have scoliosis
- elevated scapula (has not descended congenitally to correct position) = Sprengel deformity

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38
Q

Classic triad of Klippel-Feil syndrome?

A

Short neck, low hairline and limited range of movement of the neck
- typical features only seen in <50%

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39
Q

Scoliosis and hypo plastic clavicles?

A

Cleidocranial dysplasia
- delayed closure of cranial sutures, have dental abnormalities and hypo plastic clavicles

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40
Q

Scoliosis, cardiac murmur, Beighton score is 8

A

Marfan syndrome
- Beighton score assess hypermobility (maximum score is 9, score of >4 suggests hypermobility)

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41
Q

What is complementary DNA (cDNA)?

A

= the template for a messenger RNA molecule
(Learnmed suggest mRNA could be a template for cDNA)
cDNA is synthesised from mRNA with reverse transcriptase, it has no introns

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42
Q

Which gene is most commonly associated with Noonan syndrome?

A

PTPN11 (accounts for 50% of cases)
- there are at least 14 known genes associated with Noonan syndrome

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43
Q

What is Haddad syndrome?

A

Combination of congenital central hypoventilation syndrome and Hirschsprung disease

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44
Q

Safety advice surrounding children with CCHS?

A

Children with CCHS have a suboptimal response to hypoxia and hypercarbia and will not have the same urge to resurface when holding their breath underwater, need close supervision when swimming

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45
Q

What is the mechanism associated with risk of spinal cord injury in patients with Down syndrome?

A

Children with Down syndrome are at risk of atlanto-axial subluxation, should have XR before participating in high risk/contact sports

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46
Q

Overview of trisomy 13 (Patau syndrome)

A

Scalp defect, holoprosencephaly, cleft lip/palate, heart abnormalities
Often present with multiple malformations in the neonatal period but with NORMAL GROWTH
Median survival 10 days, 80% mortality by 3 months, not necessarily ‘lethal’

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47
Q

Genetics and testing for trisomy 13?

A

Nondisjunction event (AMA), rarely translocation
Karyotype, microarray or FISH

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48
Q

Clinical features of trisomy 18 (Edwards syndrome)?

A

Wizened features (small palpebral fissures and microstomia)
Overlapping fingers
Rockerbottom feet
IUGR
Prominent occiput
Multiple malformations

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49
Q

Overview of trisomy 18?

A

Usually diagnosed prenatally with IUGR/abnormal maternal serum screening (low estriol, PAPP-A and bHCG)
Birth with IUGR, dysmorphic features and malformations
Median survival 14 days, death in first year common

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50
Q

Genetics and testing for trisomy 18?

A

Nondisjunction event most commonly (AMA)
Karyotype, microarray, FISH

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51
Q

Clinical features of trisomy 12 (Down syndrome)?

A

Hypotonia
Grimace when crying
Facial/physical features (dysmorphic)
Low IQ/developmental delay
Cardiac and GI features

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52
Q

Genetics and testing for trisomy 21?

A

Nondisjunction event 95% (AMA)
3-4% due to translocation, 1-2% mosaic (i.e. not seen in all cells)
Often diagnosed antenatally: increased nuchal fold/absent nasal bone on morph scan
Karyotype, microarray (will not show translocation), FISH

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53
Q

Facial features of trisomy 21?

A

Upslanting palpebral fissures
Epicanthal folds
Small low set ears
Flat nasal bridge
Small, brachycephalic head
Small open mouth, macroglossia

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54
Q

Cardiac features of trisomy 21?

A

TOF, AVSD, PDA

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55
Q

GIT features of trisomy 21?

A

Duodenal atresia 12%, TOF, Hirschprung <1%

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56
Q

Hypotonia, dysmorphic facial features, upslanting palpebral fissures, epicentral folds, short neck with excess skin at the back of the neck, TOF/AVSD, low IQ?

A

Trisomy 21

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57
Q

Trisomy 21 is associated with increased risk of which malignancy?

A

Leukaemia (particularly AML)

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58
Q

Short stature, coarctation of the aorta, primary ovarian failure?

A

Turner syndrome (45 XO)

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59
Q

Overview of clinical features of Turner syndrome

A

Short stature, aortic coarctation, primary ovarian failure
Shield chest, wide nipples, webbed neck
Horseshoe kidney, streaked ovaries (dysgenesis)
Congenital lymphoedema

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60
Q

Complications of Turner syndrome?

A

Increased risk of autoimmune disease (especially hypothyroidism and coeliac disease)
1/3 enter puberty spontaneously (the remainder need oestrogen treatment)

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61
Q

Genetics and testing for Turner syndrome?

A

45XO, 1/5000 (most spontaneously abort)
Karyotype, microarray, FISH

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62
Q

Wizened features, overlapping fingers, rockerbottom feet?

A

Trisomy 18 (Edwards)

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63
Q

Scalp defect, holoprosencephaly, cleft lip/palate, normal growth?

A

Trisomy 13 (Patau)

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64
Q

Eunochoid body habitus, underdeveloped secondary sex characteristics, learning issues, behavioural phenotypes?

A

Klinefelter’s

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65
Q

Clinical features of Klinefelter’s syndrome

A

Eunochoid body habitus (narrow shoulders, minimal body hair, gynaecomastia, wide hips)
Hypogonadism/lack of testosterone (primary gonadal failure)

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66
Q

Genetics and testing for Klinefelter’s syndrome

A

47XXY (sometimes have more X chromosomes)
Nondisjunction during meiotic division
Karyotype, microarray

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67
Q

Complications of Klinefelter’s syndrome

A

Low sperm count/infertility
Increased incidence of breast cancer
May need testosterone for pubertal induction

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68
Q

Overview of velocardiofacial syndrome

A

Result from failure of development of 3rd and 4th branchial arches
Wide phenotypic variation
Also known as di George syndrome
Dysmorphism (micrognathia, low set/square ears, asymmetric crying face)
30% have ID, 75% have learning issues

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69
Q

Clinical features of velocardiofacial syndrome

A

CATCH22
Cardiac - conotruncal and aortic arch defects
Abnormal facies - low set/square ears, hypertelorism, high nasal bone, micrognathia, short palpebral fissures
Thymic hypoplasia - variable T cell function, SCID in 1%
Cleft palate - full or submucosal
Hypocalcaemia - abnormal parathyroids
22q11.2 microdeletion - but in 5% have 10p13 microdeletion

+ have developmental delay, speech and language issues, cognitive impairment

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70
Q

Genetics and testing for velocardiofacial syndrome

A

22q11.2 microdeletion, can also be 10p13 microdeletion in rare cases
Microarray primarily, could also use FISH, need to check parents

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71
Q

Complications of velocardiofacial syndrome

A

Autism 20%
Psychiatric illnesses in 60%
Variable immune function (particularly T cell deficiencies), assess prior to live vaccines

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72
Q

Facial features of Williams syndrome?

A

Infants: “full” facies - periorbital fullness, short anteverted nose, long philtrum
Children: coarse facial features develop as children get older

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73
Q

Elfin facies, supravalvular aortic stenosis, cocktail personality, hypercalcaemia?

A

Williams syndrome

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74
Q

Clinical presentation of Williams?

A

Typically irritable infant
Child with short stature and developmental delay
Specific behaviours: over friendly, social disinhibition (leads to safety issues), attention problems
Mild ID commonly

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75
Q

Genetics and testing for Williams syndrome?

A

Microdeletion on 7q
Microarray, FISH

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76
Q

Complications of Williams syndrome

A

Hypothyroidism, hypercalcaemia (abdominal pain)
Increased risk hypertension
Supravalvular aortic stenosis
Joint laxity in infancy, arthritis in later life

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77
Q

Role of methylation testing?

A

Identifies if genes have been switched on or off, very helpful in imprinting disorders

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78
Q

Role of microarray in imprinting disorder?

A

Identifies if allele is missing/deleted in the active chromosome

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79
Q

Role of SNP array in imprinting disorder?

A

Identifies unipaternal disomy (both alleles inherited from the same parent)
Detects some, but not all UPD cases (may need UPD studies)

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80
Q

Neonatal hypotonia, hyperplasia after infancy, obesity, mild ID?

A

Prader-Willi syndrome

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81
Q

Clinical features of Prader-Willi syndrome?

A

Hypotonia (ranges from poor feeding up to respiratory issues neonatally)
Hyperphagia after infancy
ID
Obesity
Undescended testes
Hypopigmentation
Small hands and feet, subtle dysmorphism

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82
Q

Genetic features of Prader-Willi and testing?

A

Imprinting defect at 15q
Loss of paternally active genes (paternal deletion in 2/3 or maternal UPD in 1/3)
Diagnostic test is methylation testing 15q
Microarray abnormal in all deletion cases, and some UPD

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83
Q

Microcephaly, ID with absent speech, hand flapping, bouts of spontaneous laughter?

A

Angelman syndrome

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84
Q

Clinical features of Angelman syndrome

A

Microcephaly
Severe ID with absent speech
Hand flapping
Ataxia
Spontaneous laughter
Loves water, poor sleep
Can have seizures

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85
Q

Genetics of Angelman syndrome and testing?

A

Imprinting defect 15q
Loss of maternally active genes (maternal deletion or paternal UPD)
Diagnostic test methylation testing 15q11.2-q13 (absent in 70%)
UBE3A single gene sequencing (10%)

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86
Q

Maternal and paternal influence of IGF2?

A

Paternal copy: growth promoting
Maternal copy: growth restricting

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87
Q

Macrosomia, macroglossia, hemihypertrophy, omphalocele?

A

Overgrowth = Beckwith-Wiedemann syndrome

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88
Q

Key features of Beckwith-Wiedemann syndrome?

A

Overgrowth: macrosomia, macroglossia, hemihypertrophy, visceromegaly
Anterior abdominal wall defects: omphalocele, umbilical hernia
Ears: anterior lobe creases, posterior helix pits
Hypoglycaemia in neonatal period

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89
Q

Genetic features of Beckwith-Wiedemann syndrome?

A

Imprinting disorder at 11p15 (varying causes)
- loss of methylation of maternal gene in 50%, paternal UPD in up to 20%, CDKN1C mutations in 5-10%
85% sporadic, 15% inherited
BWS associated with IVF conception (loss of IC2 methylation)
Lose maternal function -> paternal over expression of 11p15 (IGF2)
Diagnostic test = methylation testing 11p (SNP is abnormal in rare cases and some paternal UPD)
Opposite of Russell-Silver syndrome

90
Q

Complications of Beckwith-Wiedemann syndrome?

A

Predisposed to embryonal malignancies
Wilms, rhabdomyosarcoma, neuroblastoma, hepatoblastoma -> abdominal USS every 3 months until 8 years

91
Q

Short stature, macrocephaly, asymmetry, triangular face?

A

Russell-Silver syndrome

92
Q

Clinical features of Russell-Silver syndrome

A

IUGR and short stature
Macrocephaly
Asymmetry
Triangular face (relative sparing of HC)
Clinodactyly
Cafe au lait spots
IQ usually normal, some speech delay
Hypoglycaemia risk in infancy

93
Q

Genetics of Russell-Silver syndrome and testing?

A

11p methylation defect in 50-60%, maternal UPD7 in <10%, remainder unknown
Methylation defect turns off IGF2 gene
Loss of paternal 11p (opposite of BWS)
First test is 11p methylation testing, if normal then UPD7 studies (from parents), or sometimes can detect UPD7 on SNP

94
Q

Summary of Beckwith-Wiedemann syndrome

A

Loss of maternal 11p15 gene
IGF-2 gene overactive (paternally expressed fetal growth factor)
Overgrowth disorder
Macrosomia, hypoglycaemia
Hemihypertrophy, macroglossia, visceromegaly
Beckworth = Big babies

95
Q

Summary of Russell-Silver syndrome

A

Loss of paternal 11p15 gene
IGF-2 gene turned off
Short stature
IUGR
Asymmetry, triangular face, preserved HC
Silver = Small

96
Q

Hirsutism, ulnar ray defects, severe GORD, synophrys, arched eyebrows, long eyelashes

A

Cornelia de Lange syndrome

97
Q

Key features of Cornelia de Lange syndrome?

A

IUGR
Hirsutism
Ulnar ray defects
Severe GORD (feeding issues +++)
Often severe ID with autistic traits
Face - short nose, long philtrum, synophrys (unibrow), arched eyebrows, long eyelashes

98
Q

Genetics of Cornelia de Lange syndrome and testing?

A

Single gene disorder: mutation in NIPBL most common (2/3)
Other genes include RAD21, SMC3, SMC1A (XL), HDAC8 (XL)
Clinical exome or panel including NIPBL, SMC1A, SMC3, HDAC8, RAD21

99
Q

Short stature, webbed neck, pulmonary stenosis, posteriorly rotated ears?

A

Noonan syndrome

100
Q

Features of Noonan syndrome

A

Short stature, webbed neck, pulmonary stenosis, developmental delay
Downslanting palpebral fissures, hypertelorism, low set rotated ears, chest wall deformity, cryptorchidism

101
Q

Genetics and testing for Noonan syndrome

A

Autosomal dominant
Single gene disorder: RASMAPK pathway, multiple genes, PTPN11 most commonly
Noonan gene panel or clinical exome

102
Q

Complications of Noonan syndrome

A

Small risk of bleeding disorders (need coags)
Small risk leukaemia (no screening recommended)

103
Q

Overgrowth, high anterior/temporal hairline, tall stature, macrocephaly, long face/pointed chin, mild ID?

A

Sotos syndrome

104
Q

Key features of Sotos syndrome

A

Overgrowth, advanced bone age
High anterior/temporal hairline
Long face, pointed chin, high bossed forehead
Tall stature, large head
Mild ID

105
Q

Genetics and testing for Sotos syndrome?

A

NSD1 mutations (>95% de novo)
10% deletions, 90% point mutations
Test with microarray (deletions in 10%) or clinical exome with overgrowth panel applied

106
Q

Tall stature, long arm span, joint laxity, lens dislocation, aortic root dilatation?

A

Marfan syndrome

107
Q

Key features of Marfan syndrome?

A

‘Tall and stretchy’
Tall with long arm span
Joint laxity
Ectopia lentis (upwards lens dislocation)
Aortic root dilatation
Chest wall deformity
Normal IQ

108
Q

Genetics and testing for Marfan syndrome?

A

Autosomal dominant, 1/4000
Single gene disorder: FBN1 mutations
Test: single gene FBN1 sequencing or aortopathy panel

109
Q

Complications and treatment for Marfan syndrome

A

Screen first degree relatives
ARBs/beta blockers to reduce dissection risk
Pneumothorax risk

110
Q

Tall stature, intellectual disability, ectopia lentis (downwards)?

A

Homocystinuria

111
Q

Key features of homocystinuria

A

‘Tall and stiff’
Tall stature with long limbs
ID
Ectopia lentis (downwards) +/- severe myopia

112
Q

Genetics and testing for homocystinuria?

A

AR metabolic condition, CBS gene
Diagnostic test: plasma total homocysteine (most detected on NBST)

113
Q

Treatment for homocystinuria?

A

Can’t process certain AAs: accumulate homocysteine therefore need protein restricted, methionine restricted diet with folate/B12 supplementation

114
Q

Complications of homocystinuria?

A

Thromboembolism
Seizures

115
Q

Intrahepatic biliary dysgenesis, butterfly vertebrae, pulmonary stenosis, posterior embryotoxon?

A

Alagille syndrome

116
Q

Key features of Alagille syndrome?

A

Intrahepatic biliary dysgenesis
Butterfly vertebrae
Pulmonary stenosis
Posterior embryotoxon
Triangular face, deep set eyes, prominent jaw, forehead prominence
Present as neonates with cholestatic jaundice with bile duct paucity

117
Q

Genetics and testing for Alagille syndrome

A

Single gene disorder: JAG1 deletion (10%) or point mutation, 30-50% are de novo (NOTCH2 1-2%)
Microarray (10%), exome with JAG1 and NOTCH2 analysis

118
Q

Complications of Alagille syndrome

A

Mortality 10% - liver and cardiac issues
?Renal issues

119
Q

Fractures in utero/minimal trauma, blue sclerae, hearing loss?

A

Osteogenesis imperfecta

120
Q

Key features of osteogenesis imperfecta?

A

Brittle bone disease
Fractures with minimal/no trauma
Prenatally can be noted to have short long bones
Hearing loss, blue sclerae, osteoporosis, wormian bones
Dental anomalies
Broad phenotypic severity

121
Q

Genetics and testing for osteogenesis imperfecta?

A

Single gene disorders of gene encoding collagen proteins: COL1A1 (most common) or COL1A2, mostly AD
If de novo, gonadal mosaicism risk is 3-5%
Testing: exome with OI gene panel analysis or OI gene panel

122
Q

Short stature, disproportionate short limbs, macrocephaly, trident hand?

A

Achondroplasia

123
Q

Key features of achondroplasia

A

Short stature
Disproportionate short limbs
Hypotonia and gross motor delay but normal IQ
Normal growth until 3rd trimester
Macrocephaly, flat nasal bridge, trident hand, normal trunk with rhizomelic limb shortening

124
Q

Genetics and testing for achondroplasia?

A

AD inheritance
Single gene disorder: FGFR3 mutation (causes inappropriate activation of MAPK pathway)
Diagnostic test is skeletal survey
Genetic testing: single gene sequencing FGFR3 mutation

125
Q

Complications of achondroplasia

A

Stenotic spinal canal (hydrocephalus, foramen magnum compression, lumbar canal stenosis)
OSA
Middle ear disease

126
Q

Management of achondroplasia

A

Monitor for complications
C natriuretic peptide (encoded by NPPC) and its receptor (NPR2) are potent stimulators of endochondrial ossification
Vosoritide is a recombinant form of CNP that blocks the activation of the MAPK pathway

127
Q

Large ears, large testes, long face, developmental delay, behavioural issues?

A

Fragile X syndrome

128
Q

Key features of fragile X syndrome?

A

ID, dev delay, autistic traits
Large ears, large testes, long face, joint laxity
Behaviour (ADHD, autistic traits, impulsive, shy, anxious)
Most common form of inherited ID (1-2% of children with ID have fragile X)

129
Q

Genetics and testing for Fragile X?

A

Triplet repeat disorder, X linked
Females with full mutations can have full picture/milder phenotype
Fragile X testing: sizing of triplet repeat, PCR/Southern blot

130
Q

Complications of Fragile X?

A

MVP
Aortic root dilatation
Autism diagnosis in 25%
Seizures in 20%

131
Q

Short palpebral fissures, flat philtrum, thin upper lip, developmental delay, IUGR, microcephaly?

A

Fetal alcohol syndrome
- not genetic but is a syndrome
- variation in phenotypes
- main implications are cognitive/behavioural
- complications include seizures

132
Q

Syndromes to consider in short stature?

A

Turners - nondysmorphic, webbed neck, shield chest
Noonan - dysmorphic, PS, CMP
Russell-Silver - macrocephaly, facial, asymmetry, CAL
Fanconi anaemia - microcephaly, BMF, thumb/radius anomalies
Williams - elfin face, SVAS, cocktail personality
Achondroplasia/skeletal dysplasias

133
Q

Short stature - proportionate?

A

Noonan
Turner
Williams
22q11 deletion, other CNVs
Fanconi anaemia

134
Q

Short stature - disproportionate?

A

Skeletal dysplasia (e.g. achondroplasia)
Russell-Silver syndrome

135
Q

Genetics of Fanconi anaemia

A

AR condition but mutations in DNA repair genes
Test: chromosome breakage studies, exome with Fanconi genes analysed

136
Q

Clinical features of Fanconi anaemia

A

Short stature and microcephaly
Developmental delay
Abnormal thumb/radius
Renal anomalies, GI atresias
Hyper/hypopigmentation, freckles, CAL patches
Pancytopenia/bone marrow failure

137
Q

Short stature, developmental delay, abnormal thumb/radius, pancytopenia?

A

Fanconi anaemia

138
Q

Syndromes associated with tall stature?

A

Marfan - joint laxity, superior lens dislocation, normal IQ
Homocystinuria - joint contractures, inferior lens dislocation, low IQ, risk of stroke
Klinefelters - nondysmorphic, eunuchoid habitus, mild learning difficulties, pubertal delay, infertility
Sotos - macrocephaly, not Marfanoid habitus, dysmorphic, advanced bone age
BWS - coarse facial features, abdominal wall defects, hypoglycaemia, asymmetry

139
Q

Syndromes associated with obesity?

A

Prader-Willi - hypotonia (feeding issues in neonatal period), hyperplasia and obesity, undescended testes, developmental delay
Bardet-Biedel - polydactyly, renal anomalies

140
Q

Syndromes associated with hypotonia in infancy?

A

PWS - undescended testes, micrognathia
Myotonic dystrophy - present with hypotonia, examine mother, percussion myotonia
SMA - alert and interactive with profound hypotonia and weakness
Peroxisomal disorders (Zellweger) - tall forehead, abnormal brain MRI, screen for these with VLCFAs
CDG - congenital disorders of glycosylation, screen for these with transferrin isoforms

141
Q

Key features of SMA

A

Muscle atrophy leading to weakness, normal intellect
Floppy baby, frog leg posture, expressive facies, tongue fasciculations
Muscles of respiration and swallowing involved over time

142
Q

Genetics of SMA?

A

AR, mutation in SMN1 gene
Doesn’t produce enough SMN protein therefore motor neurons die
SMN2 gene (next door) can produce some SMN protein, seen in milder forms
Test: SMN gene testing for common deletion, parents should be tested for carrier status

143
Q

Types of SMA?

A

Type 1: infantile onset, never sit, respiratory failure, life span <2 years
Type 2: 6-18 months onset, never walk, scoliosis, lifespan early adulthood
Type 3: 18 month to 12 years, walk in childhood, lose ability to walk as adult
Type 4: adult onset, mild weakness in adulthood, swallow/breathing normal

144
Q

SMA treatment

A

Nusinersen - disease modifying therapy
Targets SMN2 gene to upregulate the effects
Delays disease progression, improved acquisition of motor milestones

145
Q

Severe hypotonia, tall forehead, abnormal brain MRI, abnormal VLCFAs?

A

Zellweger syndrome

146
Q

Syndromes associated with pubertal delay?

A

Turner (45XO) - streak ovaries, short nondysmorphic female, webbed neck, shield chest with wide nipples, normal IQ
Klinefelter (47XXY) - hypogonadism, tall nondysmorphic male, eunochoid habitus, small testes, low IQ, impulsive behaviour

Any syndrome with short stature often causes pubertal delay (but other causes usually present earlier with other issues)

147
Q

Coarse facies, organomegaly, thick nose/ears?

A

Mucopolysaccharidosis

148
Q

Syndromes associated with aortic stenosis?

A

Williams (supravalvular)
Storage disorders (MPS)

149
Q

Syndromes associated with pulmonary stenosis

A

Noonan (valvular)
?Williams
Alagille (supravalvular pulmonary artery stenosis)
Turner
Down syndrome

150
Q

Syndrome associated with conotruncal anomalies?

A

22q11.2 deletion (truncus arteriosus)

151
Q

Syndromes associated with atrial/ventricular septal defects?

A

T21
22q11
FAS
Cornelia de Lange, Kabuki, Noonan

152
Q

Syndromes associated with coarctation?

A

Turner
Kabuki (short stature, cleft, CHD, dysmorphism, interrupted eyebrows, single gene disorder)

153
Q

Syndromes associated with aortic dilatation?

A

Marfan (also MVP, MR, AR)
Ehlers Danlos - connective tissue
Loeys Dietz (Marfan like syndrome with bifid uvula, tall stature, scaphocephaly, aortic dilatation)

154
Q

Syndromes associated with radial ray defects?

A

Fanconi anaemia
TAR - thrombocytopenia, absent radius (normal thumb)
VACTERL
Blackfan Diamond (thumb abnormal)
Goldenhar (OAVS)

155
Q

Syndromes associated with deafness - external ear normal?

A

Waardenburg - iris heterochromia, white forelock
Jervell-Lange-Nielson - long QT
Usher - retinitis pigmentosa
Pendred - hypothyroidism
Alport - collagen disorder affecting kidneys
NF2 - later onset deafness, CAL patches, cataracts
T21

156
Q

Syndromes associated with deafness - external ear abnormal?

A

Goldenhar - microtia (small ear), epibulbar dermoid, vertebral abnormalities
Treacher-Collins - bilateral microtia, hypoplastic zygoma

157
Q

Features of Waardenburg syndrome

A

Pigmentation disorder
Sensorineural hearing loss
White forelock
Heterochromia irides

158
Q

Genetics of Waardenburg syndrome

A

AD, usually single gene disorder caused by mutations in PAX3, MITF, SOX10 and others
Testing: single gene sequencing/panel

159
Q

Features of Goldenhar syndrome

A

Also known as oculi-auriculo-vertebral syndrome
Maldevelopment of the 1st and 2nd branchial arch
Hemifacial microsomia
Conductive deafness
Vertebral defects
Sporadic (cause unknown), clinical diagnosis

160
Q

Features of Treacher Collins syndrome

A

Single gene disorder caused by mutations in TCOF1
Mandibulofacial dysostosis
Sloping eyes, lower eyelid coloboma (keyhole defect)
Microtia
Malar hypoplasia (small midface)
Clinical diagnosis, but can do single gene testing for TCOF1
Conductive hearing loss, normal IQ

161
Q

Non-syndromic causes of deafness?

A

GJB2 gene - most common, AR, 1 in 30 carrier frequency
CMV - PCR, look for microcephaly/retinal issues
LQT - JLN, deafness, long QT
consider testing parents hearing

162
Q

Syndromes associated with cleft lip/palate

A

22q11.2 (cleft palate only, not lip)
Stickler syndrome
Pierre Robin sequence
T13
Kabuki syndrome

163
Q

Syndromes associated with coloboma

A

Coloboma = keyhole defect of iris, eyelid or retina
Cat eye syndrome - caused by inverted duplication of part of chromosome 22
CHARGE
Treacher Collins

164
Q

Syndromes associated with ocular lens dislocation

A

Marfan - up
Homocystinuria - down

165
Q

Syndromes associated with cataracts

A

T21
Smith Lemli Opitz - disorder of cholesterol metabolism, diagnosed on exome

166
Q

Syndromes associated with RBC abnormalities

A

Fanconi (pancytopenia around 5yo)
Diamond Blackfan anaemia (BMF, triphalyngeal thumbs)

167
Q

Syndromes associated with WBC abnormalities

A

22q11 - thymic aplasia -> SCID in some
CHARGE (leukopenia)

168
Q

Syndromes associated with platelet abnormalities

A

TAR (thrombocytopenia, absent radius with normal thumb)
Wiskott Aldrich (immune deficiency, eczema, thrombocytopenia)

169
Q

Syndromes associated with leukaemias

A

T21 - AML, ALL, transient myeloproliferative disease
Ataxia telangiectasia - leukaemia and lymphoma
Fanconi, Noonan - weak association with leukaemia

170
Q

Syndromes associated with bowel malignancy

A

Familial adenomatous polyposos - colorectal polyps
Peutz-Jegher - small bowel hamartomatous polyps, lip/buccal pigmentation (STK11 single gene mutations)

171
Q

Syndrome associated with wilms/hepatoblastoma/rhabdomyosarcoma?

A

Beckwith-Wiedemann syndrome

172
Q

Malignancy associated with neurofibromatosis?

A

NF1 - optic glioma (unilateral)
NF2 - vestibular schwannomas (bilateral)

173
Q

Syndromes associated with cafe au lait spots?

A

NF1 - short with big head, neurofibromas, Lisch nodules, axillary/inguinal freckling, learning issues, optic gliomas
Fanconi anaemia - short with small head, only a few CALs
McCune-Albright - polyostotic fibrous dysplasia, coast of Maine CAL, precocious puberty

174
Q

Features of Pierre Robin sequence

A

Micrognathia, cleft palate, airway obstruction
= SEQUENCE not a syndrome

175
Q

Overview of Stickler syndrome

A

Commonest syndrome associated with Pierre Robin sequence
Orofacial features: cleft palate/submucous cleft/bifid uvula
Ocular: myopia, vitreous changes, retinal detachment
Auditory: high frequency hearing loss
MSK: femoral head failure, scoliosis, osteoarthritis

176
Q

Features of VACTERL?

A

Vertebral
Anal
Cardiac
Tracheo-
Esophageal
Renal
Limb

177
Q

Features of CHARGE?

A

Coloboma
Heart defects
Atresia of choanae
Retardation (growth and mental)
Genital anomalies
Ear anomalies
Also: TOF, renal, skeletal

178
Q

Cause of CHARGE?

A

Mutations in CHD7 gene, perform single gene sequencing (often diagnosed on exome)

179
Q

Abnormal architecture of the vitreous gel?

A

Stickler syndrome
- often also have cleft palate or PR sequence, joint hyper mobility is common, can have Marfanoid habitus

180
Q

Congenital ichthyosiform erthroderma and cataracts?

A

Conradi disease
- ichthyosiform erthroderma resolves with time
- limb defects and cataracts also associated

181
Q

Brachycephaly, frontal bossing micrognathia, facial skin atrophy, cataracts?

A

Hallerman-Streiff syndrome
- beaked shaped nose
- ocular and dental abnormalities are common
- associated with skin trophy of the face and telangiectasia
- genetic cause unknown

182
Q

A defect in the gene coding for dysferlin is associated with which disease?

A

Limb-girdle muscular dystrophy

183
Q

Mutation causing Marfan’s syndrome?

A

Mutation in FBN1 - codes for fibrillin

184
Q

Consequences of FLNB mutations?

A

FLNB - codes for filming B
Larsen syndrome
Spondylocarpotarsal syndrome
Boomerang dysplasia

185
Q

Examples of disorders associated with anticipation?

A

Myotonic dystrophy
Huntington’s disease

186
Q

Triplet repeat disorders most commonly affect?

A

The nervous system

187
Q

Triplet repeats and anticipation?

A

Triplet repeat disorders tend to have a more severe phenotype with each generation (increasing severity referred to as anticipation)
- larger repeats with each generation, and larger means more severe and more unstable

188
Q

Fragile X syndrome is what kind of disorder?

A

Triple repeat disorder

189
Q

How is severity of a triplet repeat disorder determined?

A

Number of repeats

190
Q

Best test for detecting triple repeat disorder?

A

PCR or Southern blot

191
Q

Different coloured eyes, white hair?

A

Waardenburg syndrome
- sensorineural hearing loss
- pigmentation abnormalities affecting hair/eyes

192
Q

Which is the most common cardiac condition associated with neurofibromatosis?

A

Pulmonary stenosis

193
Q

Overview of Smith-Lemli-Opitz syndrome?

A

AR disorder
Caused by abnormal cholesterol metabolism
Cardiac and craniofacial abnormalities, photosensitivity, syndactyly, polydactyly, abnormal dermatoglyphics, microcephaly, FTT, developmental delay, hypotonia

194
Q

Definition of telomeres?

A

Specialised structures which “cap” the ends of chromosomes
A region of repetitive nucleotide sequences which protect the end of the chromosome from deterioration or fusion with neighbouring chromosomes

195
Q

Carrier risk of SMA?

A

1 in 40

196
Q

Older child with fatigue, weakness, muscle cramps, low K/Mg on bloods, low urinary calcium, symptoms improve with magnesium supplementation, microarray shows an NCCT (SLA12A3) gene mutation?

A

Gitelman’s syndrome (causes decreased sodium and chloride transport in the DCT)

197
Q

Electrolyte abnormalities in Bartter’s syndrome?

A

Hypokalaemia
Hypomagnesaemia
High urinary calcium
(present in infancy)

198
Q

High urinary calcium with mutation of CLCN5 or OCRL1?

A

Dent’s disease

199
Q

Proteinuria, renal tubular acidosis, congenital cataracts and developmental delay?

A

Lowe’s syndrome (= oculocerebrorenal syndrome)

200
Q

Short stature, microcephaly, micrognathia, under-developed/absent patella and small ears?

A

Meier-Gorlin syndrome

201
Q

Malar hypoplasia, micrognathia, cleft lip and cleft palate and downward slanting eyes?

A

Miller syndrome

202
Q

Why is Pierre Robin sequence referred to as a sequence?

A

Described as a sequence, because mandibular hypoplasia initiates a sequence of events antenatally that causes the other signs and symptoms

203
Q

Ear malformations (decreased folds, narrow ear canals, pre and post auricular ear tags), micrognathia, malfunction of the TMJ?

A

Auriculo-condylar syndrome
- can also have facial asymmetry, prominent cheeks, microstomia and cleft palate

204
Q

If a child with Pierre-Robin sequence is found to have ocular abnormalities, what should be suspected?

A

Stickler or Marshall syndrome
- ocular abnormalities are not a feature of Pierre-Robin sequence

205
Q

Possible syndromes associated with retinitis pigmentosa?

A

Usher syndrome (most common): congenital/early onset hearing problems, then develop RP
Bardet-Biedel syndrome (next most common): associated with polydactyly, obesity, renal anomalies and intellectual disability

206
Q

Lissencephaly, growth restriction and dysmorphic features?

A

Miller-Dieker syndrome
LIS1 point mutations or deletions (17p13.3)

207
Q

15q11-13 deletion?

A

If paternal deletion = Prader-Willi
If maternal deletion = Angelman

208
Q

13q4 deletion?

A

Retinoblastoma syndrome (following deletion of RB1 gene)

209
Q

16p13.3 deletion?

A

Rubenstein-Taybi syndrome

210
Q

17p11.2 deletion?

A

Smith-Magenis syndrome

211
Q

7q11.23 deletion?

A

Williams syndrome (deletion of elastin gene)

212
Q

22q11.2 deletion?

A

diGeorge syndrome/velocardiofacial syndrome (CATCH22)

213
Q

Features of Stickler syndrome?

A

AD, gene mutation causing defect in collagen
Midface hypoplasia, PR sequence
Severe myopia, glaucoma, cataracts, retinal detachment
Hearing loss, hypermobile joints

214
Q

Inheritence of haemophilia A and B?

A

X linked

215
Q

Types of Duane syndrome with regards to extraocular movements?

A

Type 1: difficulty abducting the eye (one D)
Type 2: difficulty adducting the eye (two Ds)
Type 3: difficulty with both abduction and adduction
80% of cases are type 1

216
Q

Causes and associations of Duane syndrome?

A

Caused by congenital strabismus, and abnormal development of CN VI, and anomalous innervation of the lateral rectus muscle
Left eye affected in 60% of cases
Associated with Klippel-Feil anomaly and hemifacial microsomia, bony abnormalities and deafness
Most cases are sporadic but can have AD inheritance

217
Q

Diagnostic criteria for NF1?

A

> 6 cafe au lait macules
2 neurofibromas or one plexiform neurofibroma
Freckling in axillary or inguinal regions
Optic glioma
Two or more Lisch nodules
Osseous lesions
First degree relative who is affected

218
Q

Overview of Goltz syndrome?

A

Also known as focal dermal hypoplasia
X linked disorder, affects girls (boys die)
Skin and skeletal abnormalities
Ocular abnormalities (coloboma, cataracts, microphthalmia, anophthalmia)

219
Q

Child with chronic sinusitis and bronchiectasis has genetic mutation affecting inner dynein arms?

A

Primary ciliary dyskinesia
Various genetic mutations can affect outer or inner dynein arms

220
Q

What is the most common abnormality leading to Prader-Willi syndrome?

A

Deletion of paternal allele 65-75%
Maternal UPD 20-30%
Imprinting defect 5%
Gene mutation 0.1%
Balanced translocation 0.1%

221
Q

Antibodies to test for neonatal lupus erythematosus?

A

Anti-Ro antibodies (category of anti-ENA antibodies)
Transplacental passage of maternal antibodies result in neonatal lupus, can manifest as congenital heart block
Risk increases with subsequent pregnancies

222
Q

What disorder is caused by a 22q11 microduplication?

A

Cat eye
NOT diGeorge - 22q11 microDELETION

Written exam (21 decks)

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