Pediatric Syndromes Flashcards
What are the hallmark features of Osteogenesis Imperfecta?
- Multiple Fractures with little/no trauma
- Dentogenesis imperfect
- Hearing Loss
- Skeletal deformities
- Short stature
How many types of OI are there? How many have an identified gene?
There are 7 types. A gene COL1A1 and COL1A2 have been implicated in the first 4 types
What features should you ask about on family history when evaluating for OI
- Fractures
- Blue sclerae
- Dental problems
- Hearing loss
- Short stature
- Age at walking
What are the key history questions to ask for OI?
- Fractures at birth?
- Number fractures, bones involved, cause
- Limb deformities
- Joint dislocation
- Hearing Loss
What are the features on xray for OI?
1, Wormian bones (esp skull) for type 1.
- Bone density normal or reduced
- Progressive boney deformities type III
- Occiptial overhand and platyblasia in type IV
What are some disorders on the differential for OI
- NAT
- Juvenile osteoporosis
- Premature osteopoposis
- Hypophosphatasia (low or absent alk phos)
- Skeletal dysplasias with wormian bones
- Arthrogryposis
How is OI inherited?
Autosomal dominant Type II (perinatal lethal) usually de novo mutation
What is the genetic defect in OI?
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
How is lethality defined in perinatally detected skeletal dysplasias?
- Molecular diagnosis of a known lethal disorder
- U/S measurements associated with lethality (GA age dependent)
- chest-to-abdomen ratio 50%
- abdomen-to-femur ratio
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
c-thought to be secondary to in utero vascular event
What percentage of 22q11.2 deletions are de novo vs inherited?
- de novo ~ 90-93%
2. familial ~7-10%
What gene is responsible for the phenotype of 22q11.2 deletion?
TBX1
Bile duct paucity on liver biopsy + any 3 of:
- cardiac defects
- choleastasis
- skeletal abnormalities (butterfly vertebrae)
- eye (posterior embryotoxin)
- characteristic facial features
-other features including developmental delay, growth failure
Alagille syndrome
What percentage of Alagille syndrome mutations in JAG1 or NOTCH2 are de novo?
50-70%
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
Brugada syndrome