Genetics Flashcards

1
Q

What do you need to do a DNA or chromosome test on a baby in utero?

A

Tissue with the same genetic make up

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2
Q

What are some examples of foetal testing?

A

Placenta- chorionic villus biopsy
Skin/Urine cells- amniocentesis
Blood- foetal blood sampling
Foetal DNA from maternal serum

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3
Q

When can CVS be carried out?

A

11.5 weeks

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4
Q

When can amniocentesis be carried out?

A

15 weeks +

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5
Q

What is the miscarriage risk of CVS?

A

1-2%

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6
Q

What is the miscarriage risk of amniocentesis?

A

0.5-1%

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7
Q

What is the miscarriage risk of foetal blood sampling?

A

1-2%

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8
Q

What is the miscarriage risk of foetal DNA from maternal blood?

A

None

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9
Q

When can foetal DNA from maternal blood be tested?

A

8 weeks +

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10
Q

When can foetal blood sampling be carried out?

A

18 weeks +

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11
Q

What viability of tissue is needed in CVS?

A

Good

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12
Q

What viability of tissue is needed in amniocentesis?

A

Poor

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13
Q

What viability of tissue is needed in foetal blood sampling?

A

Good

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14
Q

What viability of tissue is needed in foetal DNA from maternal blood testing?

A

Stable mother

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15
Q

What risks are there in CVS?

A

Miscarriage

Confined placental mosaicism

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16
Q

What limits are there in foetal DNA from maternal blood testing?

A

Limited analyses available

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17
Q

What whole genome analyses are available?

A

Standard karyotype- in metaphase
Array CGH (chromosomes)
Quantification of foetal DNA in maternal serum
Whole genome sequencing

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18
Q

What targeted analyses are available?

A

Point mutation testing
FISH
Quantitative Fluorescent PCR

19
Q

What are copy number variations?

A

Insertions or deletions of DNA segments

20
Q

How can you tell if a change is a copy number variation or mutation?

A

Mutation will be de-novo, polymorphism will be present in normal parent
Mutation will be bigger, affect known gene, and previously reported in same phenotype

21
Q

When is FISH used?

A

When missing chromosome is too small to see

22
Q

What is QF PCR used for?

A

Rapid counting of specific chromosomes- allows a dosage analysis of polymorphic repeat sequences at several loci on target chromosomes

23
Q

When is aCGH or chromosome analysis used?

A

High risk of chromosomal trisomy on screening
Fetal abnormality on scanning-small size, especially if symmetrical growth failure, increased nuchal thickness, structural malformation e.g. brain, heart
Parent has balanced chromosomal rearrangement

24
Q

When is serum screening carried out?

A

Week 16- look for biochemical markers of Down’s

25
Q

When is a detailed scan to look for other fetal abnormalities carried out?

A

20 weeks

26
Q

When may increased nuchal thickness be seen?

A

Dating USS at 12 weeks

27
Q

What can be assessed through free fetal DNA in maternal circulation?

A

Sex determination
Trisomy testing
Chromosome deletions
Single gene

28
Q

Why is free fetal DNA in maternal circulation a challenging test?

A

Only 10% of DNA comes from fetus

29
Q

If a pregnant women who has 1 son with DMD, what test should be carried out?

A

NIPT through free fetal DNA to look for Y chromosome, if found do CVS

30
Q

A pregnant women of 18 weeks has a detailed scan showing an AVSD, a common defect in Down’s, what testing should be done and why?

A

Amniocentesis/aCGH
18 weeks
Cardiac defect may have other causes
aCGH will detect small deletions such as 22q11

31
Q

From initial 18 week scan and detection of AVSD on USS, when should amnio and aCGH be performed and results confirmed by?

A

+1-2 days: amniocentesis

+6 days: aCGH confirms result

32
Q

What is a Robertsonian translocation?

A

Two acrocentric chromosomes stuck end to end (increased risk of trisomy)

33
Q

What is aneuploidy?

A

Too many or too few chromosomes

34
Q

What would aCGH look like in the parent with a balanced translocation ?

A

Normal- aCGH only detects imbalance

35
Q

What reproductive risks are there in reciprocal translocations?

A

For most translocations, ~50% will have either normal chromosomes or balanced translocation
Unbalanced:
Miscarriage (large segments)
Dysmorphic delayed child (small segments)

36
Q

A 10wks pregnant woman comes to see you, she has a balanced reciprocal translocation between Ch4 and Ch9, known to have a high risk of multiple malformations in a liveborn child, how do you manage?

A

CVB at 11.5 weeks
Direct Karyotype or Fish may be available at 11.5+3 days
At 13 weeks full karyotype complete

37
Q

What is aCGH used for?

A

Chromosome deletions/duplications (analysis for balanced rearrangements)

38
Q

What needs to be known to use FISH or DNA analysis?

A

Diagnosis

39
Q

When can specific anomalies be detected?

A

Cardiac 12-20wks
Microcephaly after 22wks
Short Limbs after 22wks
Brain malformations

40
Q

What is the best management to test for suspected DMD?

A

CVB

41
Q

How can free fetal DNA in maternal serum help in diagnosing DMD?

A

At 8 weeks sexing on DNA, if boy proceed to invasive testing, if girl no concerns

42
Q

What is Pre Implantation Genetic Diagnosis (PGD)?

A

Perform a genetic test on an embryo before re-implanting one with the ‘correct’ genotype

43
Q

What is the process involved in PGD?

A
Down regulation
Ovarian stimulation- FSH
USS-follicular assessment
Oocyte retrieval
Fertilisation by ICSI
Embryo biopsy day 3
44
Q

When may PGD be considered?

A
Parental chromosome abnormality 
Robertsonian translocation
Reciprocal translocation
X-linked disorders
Re-implantation of female embryos
Other single gene disorders
Increasing numbers of conditions
Spinal Muscular Atrophy
Cystic fibrosis
Huntingtons disease