Genetics Flashcards

1
Q

What are monogenic (mendelian) disorders?

ii. what are its patterns of inheritance?

A

they are caused by defects in a single gene

mainly studied by looking at a single family

ii. Autosomal dominance, Autosomal recessive, X linked dominant, X linked recessive, Y linked and mitochondrial

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2
Q

What are polygenic disorders?

A

Disorders caused by defects in multiple genes

Usually a combination of genetic and environmental influences

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3
Q

What does a circle mean in a family tree?

A

female

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4
Q

what does a square mean in a family tree?

A

male

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5
Q

what does a black shape mean in a family tree?

A

the person is affected with the trait

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6
Q

what does a shape with a dot mean in a family tree?

A

the person is a carrier ( autosomal or X-linked inheritance) but are not affected

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7
Q

what does a double line mean in a family tree?

A

consanguinity - means they are related in some way and have reproduced with each other

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8
Q

where do men inherit there x chromosome from?

A

their mother

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9
Q

What type of genetic abnormalities (mutations) lead to monogenic disorders?

ii. which of these abnormalities cause loss of function in proteins?

A

Single nucleotide variants (SNVs) result in several type of protein coding change:

  1. Missense amino acids change - substitution of one amino acid for another
  2. Nonsense amino acid change - generation of a stop codon
  3. Splice site alteration- defect in splicing can cause aberrant protein or premature truncation

small insertions and deletions (indels):

  1. In-frame indels - results in gains or losses of amino acids, amino acid substitutions or generation of premature stop codons or defects in splicing
  2. Out- of frame indels - typically result in frameshift changes that frequently result in premature truncation of the encoded protein
    ii. Loss of function (LOF) mutations typically result from nonsense, frameshift or canonical splice site mutations
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10
Q

What Genetic tests can be used for monogenic disorders?

A

1.single gene testing (Sanger):

Suitable for diagnosis of disorders with low genetic heterogeneity e.g. MEN28 and RET mutations)

suitable for predictive testing in relatives at risk of specific mutation

  1. Disease targeting gene panels (NGS):

appropriate for disorders with high genetic heterogeneity

  1. Whole-exome sequencing/ whole genome sequencing (NGS):

suitable for disorders with unknown genetic aetiology e.g. severe undiagnosed phenotypes

4.Genetic tests for disorders due to chromosomal abnormalities or copy number variations (CNVs)

Karyotype: suitable when abnormal complement of chromosomes suspected e.g. turner/ Klinefelter syndrome

aCGH: suitable when copy number variants/ chromosomal abnormality suspected e.g. turner, Klinefelter syndrome, developmental delay

FISH - suitable when predetermined chromosomal abnormality suspected e.g. 22q deletion syndrome

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11
Q

What endocrine tumours are caused by Multiple endocrine type 1 (MEN1)

A
  1. Pancreatic NETs e.g. insulinoma, Gastrinoma
  2. Parathyroid adenomas- causes primary hyperparathyroidism in all patients (95%)
  3. Pituitary adenomas e.g. prolactinoma and somatotropinoma
  4. adrenocortical tumours e.g. conn’s adenoma
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12
Q

What non endocrine features are caused by MEN1 syndrome?

A

Lipomas

collagenomas

angiofibromas

Meningiomas

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13
Q

what type of autosomal disorder is MEN1 syndrome?

ii. which gene is affected?

A

Autosomal dominant

ii. MEN1 gene located in chromosome 11

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14
Q

what is the leading cause of death for people with MEN1 disorder?

A

50% of people carrying this inheritance disorder will die due to it

malignant pancreatic neuroendocrine tumour

thymic carcinoids

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15
Q

what are the indications for getting germline MEN1 genetic testing?

ii. who else should be tested
iii. when should testing occur?

A
  1. clinical : Two or more MEN1- associated tumours or a diagnosis of familial MEN 1
  2. Suspicious for MEN 1 i.e. multiple parathyroid adenomas <40 years old, recurrent hyperparathyroidism or gastrinoma
  3. atypical MEN1 - development of tow or non classical MEN1 associated tumours e.g. parathyroid and adrenal tumour
    ii. asymptomatic first- degree relative
    iii. As soon as possible
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16
Q

What pathways is the MEN1 gene involved ?

A
  1. DNA damage - double strand break repair
  2. involved in chromatin remodelling
  3. Regulation of key cell signalling e.g. mTOR pathway
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17
Q

What type of autosomal disorder is Multiple endocrine neoplasia type 2 (MEN2)?

ii. which gene is affected?

A

Autosomal dominant

ii. RET gene - found on 10th chromosome

18
Q

What are the two types of MEN2?

A

MEN2A- accounts for 90% of cases

MEN2B

19
Q

what are the endocrine tumours caused by MEN2A?

A

Medullary thyroid cancer (MTC)

Pheochromocytoma - occur in 50% of patients but dependent on genotype. May occur in children and are frequently bilateral

Parathyroid tumours - 30% of patients

20
Q

What are the the endocrine tumours caused by MEN2B?

A

Medullary thyroid cancer (MTC)

Pheochromocytoma - 50% of patients

Parathyroid tumours - occurs in 30% of patients

21
Q

What are the non endocrine features caused by MEN2A?

A

Cutaneous lichen amyloidosis

Hirschsprung disease

22
Q

what are the non endocrine features caused by MEN2B?

A

Mucosal neuromas

Marfanoid habitus

Ganglioneuromatosis

23
Q

what is the main cause of death in MEN2 patients?

A

MTC

24
Q

what does Medullary thyroid cancer derive from?

A

parafollicular C cells in thyroid

25
Q

what are the clinical features of MTC?

A

Nick mass

diarrhoea and flushing

Ectopic ACTH and cushing

26
Q

How do you diagnose MTC?

A

Imaging:

Neck Ultrasound

Fine needle aspiration (FNA)

measure basal serum calcitonin - can also be used a tumour marker for treatment

27
Q

How do you manage MTC?

A

Dependent on stage of disease

curative surgery for localised disease- thyroidectomy with variable extent lymph node dissection

management of advanced disease can use tyrosine kinase receptors

28
Q

how do you diagnose pheochromocytoma?

A

based on elevated urinary or plasma metanephrines

29
Q

How do you manage MEN2?

A

screening:

RET genetic testing

MTC

Phaeomchromocytoma

primary hyperparathyroidism

30
Q

What are the endocrine tumours caused Von hippel Lindau syndrome?

A

Pheochromocytoma

Pancreatic NET

31
Q

What are the non endocrine features of Von hippel Lindau syndrome?

A

Renal cell carcinoma - main common feature

Haemangioblastomas - (retinal and CNS) - main common feature

Renal cysts

Pancreatic cysts

32
Q

What type of autosomal disorder is Von hippel Lindau syndrome?

ii. What gene is affected?

A

Autosomal dominant

ii. VHL gene - gene is used to regulates the expression of hypoxia inducible factors in cells. if there is a mutation then there is a loss in reaction to hypoxia in cells

33
Q

How do you diagnose VHL?

A

screening:

Retinal angioma - ophthalmic examinations - anually and beginin in infancy

CNS haemangioblastoma - MRI scans of the head - every 12-36 months begin at adolescence

Renal cell carcinoma and pancreatic tumours -every 12 months begin at 16 years of age

Phaeochromocytoma - Blood pressure monitoring and 24 hr urine or fractionated plasma metanephrines- annually

Familes at high risk for phaeochromocytoma- more intesen surveillance e.g. adrenal imaging - annually, begin at 8 years of age

34
Q

what endocrine tumours are caused by Neurofibromatosis type 1?

A

Pheochromocytoma- rare

35
Q

what are the non endocrine features of Neurofibromatosis type 1?

A

Axillary freckling, neurofibromas, optic

gliomas, skeletal abnormalities (scoliosis), GISTs,cafe au lait patches and learning difficulties

36
Q

what are the endocrine tumours caused by Carney complex?

A

PPNAD, thyroid tumours,

pituitary adenoma

37
Q

what are are the non endocrine features of carney complex?

A

Lentigines, atrial myxomas, sertoli cell

tumours

38
Q

what gene is mutated to cause carney complex?

A

PRKAR1A

39
Q

what type of mutation to cause McCune albright syndrome?

A

Post-zygotic somatic GNAS
mutation (i.e. not germline)

Constitutive adenylyl
cyclase signaling

Overproduction of several
hormones

40
Q

what is moasicism?

A

GNAS mutation occurs in early embryonic stage rather than inheritance. This means a proportion of cells are effected and a proportion are not effected by this trait

41
Q

Give examples of Monogenic disorders which can cause endocrine related clinical features?

A
1. Multiple Endocrine Neoplasia
Type 1 (MEN1)
2. Multiple Endocrine Neoplasia
Type 2 (MEN2A)
3. Multiple Endocrine Neoplasia
Type 3 (MEN2B)
4. Multiple Endocrine Neoplasia
Type 4 (MEN4)
  1. Neurofibromatosis Type 1
  2. Von Hippel Lindau
  3. Carney Complex
  4. Familial Isolated pituitary
    Adenoma (FIPA)
  5. Familial phaeochromocytoma/paraganglioma syndromes

10.Hyperparathyroidism-Jaw Tumour
(HPT-JT) syndrome

  1. Tuberous Sclerosis