Metabolics/Genetics Flashcards
Classic presentation for galactosemia
- Jaundice, hepatomegaly
- FTT, poor feeding, emesis
- Sepsis (E. coli)
- Cataracts
Inheritance pattern for Marfan Syndrome
Autosomal dominant
Features of Noonan Syndrome
- Dysmorphic features = low posterior hairline, wide philtrum, hypertelorism, down slanting palpebral fissures, short nose with bulbous tip, cubitus valgus, nuchal skin fold, wide bi-temporal distance
- Cardiac = R sided lesions (PV stenosis, double outlet RV, HCM), lymphedema
- CNS = seizures, chiari I malformation, mild ID, eye issues
- Other = endo (short stature, hypothyroidism), MSK (scoliosis, club foot, pectus abnormality), GU (renal anomalies), heme (thrombocytopenia), onc (JMML)
Williams Syndrome - cardiac manifestations
Supravalvular AS + PS
Pulmonary valve stenosis
Hypertension
Sturge-Weber Syndrome - derm manifestations
Port wine stain V1/V2
What genetic syndrome do you think for hemihypertrophy?
BW
What neoplasm to look for for BW?
Hepatoblastoma
Wilm’s tumor
What oncology screening for BW?
Abdo US q3m
AFP q3m
Until age 8
Electrolyte disturbance in CAH?
Hypoglycaemia
Hyponatremia
Hyperkalemia
What neuro complication in achondroplasia?
Risk of foremen magnum narrowing/stenosis that can lead to hydrocephalus and OSA
SMA - genetic inheritance
Autosomal recessive
5 BM failure congenital syndromes
Fanconi anemia Schwachmann Diamond Dyskeratosis congenita Pearson syndromes Congenital amegakaryocytic thrombocytopenia
What BM failure syndrome is associated with VACTERL?
Fanconi anemia
What BM syndrome is associated with hair/skin findings?
Dyskeratosis congenita
Non-ketotic hypoglycaemia (x3 causes)
GDM/SGA/prep
Insulin mediated = hyperinsulinemia
Lipid disorders = beta oxidation, carnitine
VLCAD complications (x2)
Rhabo
Cardiomyopathy
Hemophilia A inheritance pattern
X-linked recessive
Most common chromosomal abnormality involved spontaneous first trimester miscarriages?
Trisomy 16
Turner Syndrome - karyotype
45 XO
Turner Syndrome - clinical presentation
- Dysmorphic ftrs: Low posterior hairline, cubitus valgus, nuchal skin fold, abnormal ears, shield chest with wide-spaced nipples, short 4th metacarpal, hyperconvex nails
- CVS: BAV, coarct, AS, HTN, lymphedema
- CNS: IQ normal, SNHL + CHL hearing loss, strabismus
- Endo: met syndrome, hypothyroid, short stature
- MSK/derm: pigment nevi, scoliosis, DDH, cystic hygroma
- Onc: neuroblastoma, gonadoblastoma
- Gyne: Ovarian failure
- GU: renal anomalies (horseshoe kidney, solitary kidney)
Friedrich Ataxia - inheritance pattern, pathophys of chromosomal abnormality, and x3 classical clinical features
- Auto recessive
- Chromo 9q13 = frataxin protein –> deficiency leads to accumulation of iron in mitochrondria = oxidative stress
- Features: ataxic gait, extensor plantar responses, loss of DTRs
Most likely finding on blood gas for urea cycle defect
Respiratory alkalosis
x3 top findings on labs for urea cycle defect
- resp alkalosis
- hyperammonemia
- little/no urea
Inheritance pattern for OTC deficiency
X-linked recessive
What IEM presents with more significant ketosis?
Organic acidemias
Important severe, complications from organic acidemias?
Strokes, myocarditis, pancreatitis
IEM cause for subdural hematoma and on ddx for maltreatment
Glutaric acidemia
IEM diagnosis on ddx for Marfan Syndrome
Homocysteinuria
x2 dx to think of for neonates with ketonuria
Organic acidemias and maple syrup urine disease
IEM presenting with liver failure, conjugated hyperbili, and RTA (type II)
Tyrosinemia
IEM with neutropenia
GSD 1
IEM to think of for rhabdo out of in keeping of mechanism
GSD-5 = McArdle
When can you get a false positive galactosemia screen?
G6PD
Medical based reason for soy based formula (x1)
Galactosemia
FAOD labs (x2)
- Hepatitis
- Non-ketotic hypoglycemia
Peroxismal disorder presenting in neonates
Zellweger
What is the dx that has developmental regression (starting within school aged), new spasticity, and adrenal failure?
Adrenoleukodystrophy
MELAS - what does that stand for?
Mitochondrial encephalomyopathy lactic acidosis, stroke like episodes
Sturge Weber - inheritance
Sporadic
Sturge Weber - derm and classic CNS sign
- Angioma involving leptomeninges - vascular lesion, tram track sign
- V1 and V2 port wine stain
Lesch Nyhan Syndrome - inheritance
X linked recessive
IEM with gout, kidney stones, dev delay, self injurious behav
Lesch Nyhan Syndrome
What x2 genotypes has the worst disease for alpha 1 antitrypsin?
SZ and ZZ
Incontinentia pigmenti - inheritance, derm manifestation, dental
- X linked dominant (males die in utero)
- Stages: 1 vesicles (linear/whorls), 2 ketatotic plaques, 3 hypopigmentation, 4 hyperpigmentation
- Peg teeth
What tumor is classic for Denys-Drash?
Wilm’s tumor
Triad of Denys Drasch
Nephropathy, ambiguous genitalia, Wilm’s tumor
IEM presenting with learning disabilities and behaviour problems that is often dx with ADHD
X linked leukodystrophy
Sacral agenesis - associated with?
IDM
Trinucleotide repeat disorders (4)
Fragile X, myotonic dystrophy, spinocerebellar ataxia, Huntington’s disease
PHACE Syndrome/association
- Posterior fossa abnormalities - dandy walker malformation
- hemangioma
- arterial/aortic abnormality
- cardiac
- eye abnormality
- sternal abnormalities
Supravalvular aortic stenosis
William Syndrome
CATCH-22
For DiGeorge Syndrome:
- Cardiac
- AbN facies
- Thymic hypoplasia
- Cleft lip+palate
- HypoCa
Inheritance pattern for DiGeorge
Autosomal dominant
What is the most common genetic condition associated with cutis aplasia?
T13
What is a clue on ECG for T21 that suggests AVSD?
Left axis deviation
What cardiac lesions are Turner syndrome patients at risk for?
Coarctation, BAV, long QTc
X2 heart lesions in Williams Syndrome
Supravalvular aortic stenosis
Pulmonary artery stenosis
Electrolyte abnormality in Williams Syndrome
HyperCa
What eye finding in Williams Syndrome?
Starburst eye pattern
What syndrome has aniridia?
WAGR
X3 syndromes with Persistent peripheral pulmonary stenosis
Alagille syndrome, noonan, William
When should PPS murmur go away?
3-6 months
What does Rhizomelic mean?
Proximal aspect of extremity is shorter - example femur
Why should we do a CT or MRI around 12 months of age for achondroplasia?
Narrowing of the foremen magnum
Differences in homocysteinuria compared to Marfan syndrome?
Higher risk of clotting and decreased cognition
Main cardiac abnormality for Noonan Syndrome
Pulmonary stenosis
What type of leukaemia for neurofibromatosis type 1?
Juvenile myelomonocytic leukaemia
Optho finding in Sturge Weber
Glaucoma
What MRI finding for children with Sturge Weber?
Ipsilateral leptomeningeal angioma
What neuro manifestation do you worry about for tuberous sclerosis?
Infantile spasms
What first line med for infantile spasm in tuberous sclerosis?
Vigabatrin
Cardiac rhabdomyosarcoma - what syndrome?
Tuberous sclerosis
Ectodermal dysplasia - dental finding
Conal dentition
Rett Syndrome - 3 clinical features
Writhing hands, dev regression, seizures
Inheritance for Rett Syndrome
MECP2 - X linked dominant
What syndrome is good at puzzles?
Prader Willi