Pediatric Syndromes Flashcards

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1
Q

What are the hallmark features of Osteogenesis Imperfecta?

A
  1. Multiple Fractures with little/no trauma
  2. Dentogenesis imperfect
  3. Hearing Loss
  4. Skeletal deformities
  5. Short stature
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2
Q

How many types of OI are there? How many have an identified gene?

A

There are 7 types. A gene COL1A1 and COL1A2 have been implicated in the first 4 types

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3
Q

What features should you ask about on family history when evaluating for OI

A
  1. Fractures
  2. Blue sclerae
  3. Dental problems
  4. Hearing loss
  5. Short stature
  6. Age at walking
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4
Q

What are the key history questions to ask for OI?

A
  1. Fractures at birth?
  2. Number fractures, bones involved, cause
  3. Limb deformities
  4. Joint dislocation
  5. Hearing Loss
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5
Q

What are the features on xray for OI?

A

1, Wormian bones (esp skull) for type 1.

  1. Bone density normal or reduced
  2. Progressive boney deformities type III
  3. Occiptial overhand and platyblasia in type IV
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6
Q

What are some disorders on the differential for OI

A
  1. NAT
  2. Juvenile osteoporosis
  3. Premature osteopoposis
  4. Hypophosphatasia (low or absent alk phos)
  5. Skeletal dysplasias with wormian bones
  6. Arthrogryposis
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7
Q

How is OI inherited?

A
Autosomal dominant
Type II (perinatal lethal) usually de novo mutation
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8
Q

What is the genetic defect in OI?

A

OI I-IV due to mutations in either alpha1 or alpha2 chains of collagen 1
Mutations in COL1A1 or COL1A2 lead to either a premature stop codon -> 50% reduction in type 1 collagen
or glycine substitution -> disturb helical structure and stability of the collagen

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9
Q

How is lethality defined in perinatally detected skeletal dysplasias?

A
  1. Molecular diagnosis of a known lethal disorder
  2. U/S measurements associated with lethality (GA age dependent)
    - chest-to-abdomen ratio 50%
    - abdomen-to-femur ratio
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10
Q

Which of the following malformation syndromes is not associated with maternal diabetes?

A. Caudal dysgenesis
B. Femoral hypoplasia-unusual face syndrome
C. Amyoplasia congenita
D. Oculoauriculovertebral spectrum
E. Holoprosencephaly
A

c-thought to be secondary to in utero vascular event

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11
Q

What percentage of 22q11.2 deletions are de novo vs inherited?

A
  1. de novo ~ 90-93%

2. familial ~7-10%

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12
Q

What gene is responsible for the phenotype of 22q11.2 deletion?

A

TBX1

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13
Q

Bile duct paucity on liver biopsy + any 3 of:

  1. cardiac defects
  2. choleastasis
  3. skeletal abnormalities (butterfly vertebrae)
  4. eye (posterior embryotoxin)
  5. characteristic facial features

-other features including developmental delay, growth failure

A

Alagille syndrome

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14
Q

What percentage of Alagille syndrome mutations in JAG1 or NOTCH2 are de novo?

A

50-70%

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15
Q
Manifests primarily in adulthood
Syncope or nocturnal agonal respiration
ST segment abnormalities
High risk ventricular arrhythmias
Sudden death or SIDS
Family history of sudden death
A

Brugada syndrome

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16
Q

Name the disorder.

Slowly progressive weakness and atrophy of distal muscles in the feet and/or hands
Onset in the 1st-3rd decades
Hearing loss
Pes cavus  deformity
Hip dysplasia
A

Charcot-Marie Tooth (hereditary motor and sensory neuropathy)

  • many subtypes classified by inheritance and primary abnormality (abnormal myelin, axonopathy, or both)
  • usually AD or AR but CMTX is X-linked
17
Q

Name the disorder.

Progressive symmetric muscle weakness, proximal>distal
Calf hypertrophy
Onset before 5 years
Cardiomyopathy

A

Duchenne and Becker Muscular Dystrophy

X-linked recessive, mutations in DMD -> decreased or absent dystrophin production or abnormal dystrophin produced

CK 10x normal in DMD, CK 5x normal in BMD

18
Q

Name the disorder and mechanism

Progressive limb and gait ataxia, absent DTRs in LE
Onset before 25 yrs
glucose intolerance/diabetes
Hypertrophic Cardiomyopathy
Scoliosis, optic nerve atrophy
A

Fredereich’s ataxia

Autosomal recessive, triplet repeat disorder (GAA expansion in intron 1) -> loss of transcription of FRDA gene and decreased frataxin

66-1700 repeats disease causing.

19
Q

Name the disorder and gene.

Recurrent focal pressure palsies
Mild polyneuropathy
Absent ankle reflexes, reduced DTRs, 
Pes cavus foot deformity
Adult onset
A

Hereditary neuropathy with liability to pressure palsies

PMP22 (deletion in 80%, mutation in 20%)

Autosomal dominant

20
Q

Name the disorder and gene.

Multi-systemic disorder of:

  • skeletal and smooth muscle (myotonia, distal muscle weakness and atrophy)
  • Eye (early cataracts)
  • Heart (arrhythmias)
  • Impaired glucose tolerance

Anticipation with successive generations

A

Myotonic dystrophy

Autosomal dominant triplet repeat disease (CTG repeat expansion in 3’ UTR) in DMPK

Thought to cause disease through RNA gain of function mechanism: the transcribed CUG repeats interfere with alternative splicing of multiple genes including a chloride channel

disease with >50 repeats

21
Q

Name the disorder and pattern of inheritance.

Newborn male infant with macrosomia (BW > 5 kg), coarse facies, post-axial polydactyly.

A

=Simpson-Golabi-Behmel syndrome

  • X-linked recessive disorder due to mutations in GPC3
  • prenatal onset of overgrowth
  • macrocephaly often present at birth
  • cardiac conduction defects are common
22
Q

Name the disorder and pattern of inheritance.

relative macrocephaly, broad forehead, delayed closure of cranial sutures/fontalelle, clavicle defects, dental anomalies.

A

=cleidocranial dysplasia

-autosomal dominant disorder due to defects in RUNX2

  • wormian bones and delayed mineralization of pubic bone can be seen
  • short stature
  • narrow pelvis may necessitate c=section for pregnant women
23
Q

Name the disorder and gene.

Onset in infancy with muscle weakness, tongue fasciculations, absent DTRs.

A

Spinal muscular atrophy

95-98% have deletions of exon 7 of SMN1, 2-5% have a SNV

of copies of SMN 2 modifies the severity of the disease (more copies of SMN2, more mild phenotype and later onset of disease)

24
Q

Which molecular type of Tuberous Sclerosis is more likely to be associated with renal cyts: TSC1 or TSC2

A

=TSC2

-occurs if contiguous gene deletion with PKD1

25
Q

What is meant by SMA due to a gene conversion event

A

SMN1 and SMN2 genes differ in a key amino acid at the beginning of exon 7.

In SMN1 it is a T (or SMN1=SMNT), in SMN2 it is a C (or SMN2=SMNC). The presence of SMNC causes exclusion of exon 7 of SMN during RNA splicing and leads to an unstable mRNA that creates a non-functional protein.

While most SMA is due to a SMN1 deletion, a SNV at that key residue in exon 7 will convert SMN1 to the SMN2 form and result in a deficiency of SMN1 functional protein

26
Q

Most cases of SMA or caused by a SMN1 deletion or a point mutation?

A

=deletion of SMN1

27
Q

Which of the following genes causes X-linked hypohidrotic ectodermal dysplasia?

a. EDA
b. WNT10A
c. GJB6
d. MSX1

A

=EDA

AD form caused by mutations in EDAR

28
Q

What is the inheritance pattern, gene, and what is the most common molecular defect for incontinentia pigmenti?

A

X-linked dominant (lethal in males)
due to mutations in the IKBKG genes
2/3 due to multi-exon deletion (exons 4-10)

29
Q

State where the defect occurs in the epidermis and/or dermis with each of the following types of epidermolysis bullosa:

a. EB simplex
b. junctional EB
c. dystrophic EB

A

EB simplex- splitting in or above the basal layer
Junctional EB-defect within the basement membrane
Dystrophic EB-scarring below the basement membrane