-
Question 1
Correct
-
A 16-month-old child has been referred to the haematology team due to painful bone swellings in the hands and feet, along with a positive family history of sickle cell disease. What is the mode of inheritance for this condition?
Your Answer: Autosomal recessive
Explanation:Sickle cell anaemia is a genetic disorder that follows an autosomal recessive pattern of inheritance. This means that an individual must inherit two copies of the mutated gene, one from each parent who are carriers of the condition. Huntington’s Disease is an example of an autosomal dominant condition, while Fragile X syndrome is an example of an X-linked dominant condition. Haemophilia is an example of an X-linked recessive condition, and alpha-1 antitrypsin deficiency is an example of a co-dominant condition.
Sickle-cell anaemia is a genetic disorder that occurs when abnormal haemoglobin, known as HbS, is produced due to an autosomal recessive condition. This condition is more common in individuals of African descent, as the heterozygous condition provides some protection against malaria. About 10% of UK Afro-Caribbean’s are carriers of HbS, and they only experience symptoms if they are severely hypoxic. Homozygotes tend to develop symptoms between 4-6 months when the abnormal HbSS molecules replace fetal haemoglobin.
The pathophysiology of sickle-cell anaemia involves the substitution of the polar amino acid glutamate with the non-polar valine in each of the two beta chains (codon 6) of haemoglobin. This substitution decreases the water solubility of deoxy-Hb, causing HbS molecules to polymerise and sickle RBCs in the deoxygenated state. HbAS patients sickle at p02 2.5 – 4 kPa, while HbSS patients sickle at p02 5 – 6 kPa. Sickle cells are fragile and haemolyse, blocking small blood vessels and causing infarction.
The definitive diagnosis of sickle-cell anaemia is through haemoglobin electrophoresis.
-
This question is part of the following fields:
- Genetics
-
-
Question 2
Correct
-
A 6-year-old girl is referred to the Paediatric Clinic for failure to thrive. She has failed to maintain her weight and suffers from diarrhoea and frequent respiratory tract infections. A sweat test is performed and the chloride content of the sweat is 72 mmol/l.
Which of the following modes of inheritance fits best with this condition?Your Answer: Autosomal recessive
Explanation:Genetic Inheritance Patterns and Examples of Associated Conditions
Autosomal Recessive:
Autosomal recessive inheritance occurs when an individual inherits two copies of a mutated gene, one from each parent. The affected individual must inherit two copies of the mutated gene to develop the condition. Cystic fibrosis is an example of an autosomal recessive condition.Autosomal Dominant:
Autosomal dominant inheritance occurs when an individual inherits one copy of a mutated gene from one parent. The affected individual only needs to inherit one copy of the mutated gene to develop the condition. Marfan syndrome and familial hypercholesterolaemia are examples of autosomal dominant conditions.Chromosomal Non-Disjunction:
Chromosomal non-disjunction occurs when homologous chromosomes fail to separate during meiosis or when chromatids fail to separate during mitosis. This results in daughter cells having either two chromosomes/chromatids or none. Down syndrome is an example of a condition resulting from chromosomal non-disjunction.Chromosomal Translocation:
Chromosomal translocation occurs when two non-homologous chromosomes exchange parts, causing fusion chromosomes. Chronic myelogenous leukaemia is an example of a condition resulting from chromosomal translocation.Sex-Linked:
Sex-linked inheritance occurs when a mutated gene is located on the X or Y chromosome. As a result, the condition is more common in one sex than the other. Duchenne muscular dystrophy, red-green colour blindness, and haemophilia are examples of sex-linked conditions.Conclusion:
Understanding genetic inheritance patterns is important in diagnosing and managing genetic conditions. Genetic counselling can also be helpful in providing information about the risk of passing on a genetic condition to offspring. -
This question is part of the following fields:
- Genetics
-
-
Question 3
Correct
-
A 32-year-old primigravid woman at twelve weeks gestation visits her obstetrician for a routine booking appointment. She has sickle cell anaemia. She has sickle cell anaemia. Her partner’s sickle cell status is Hb AS. Her haemoglobin is 92 g/l (normal range: 115–155 g/l).
What is the likelihood of her baby having sickle cell disease?Your Answer: 1 in 2
Explanation:Probability of Inheriting Sickle Cell Disease
Sickle cell anaemia is an autosomal recessive condition that affects the haemoglobin in red blood cells. If one parent has sickle cell anaemia (HbSS) and the other is a carrier (HbAS), the baby has a 1 in 2 chance of inheriting the condition. The baby will inherit the HbS allele from the mother and either the HbA or HbS allele from the father, resulting in possible genotypes of HbAS, HbSS, HbAS, or HbSS. This gives the baby a 1 in 2 chance of having sickle cell disease and a 1 in 2 chance of being a carrier.
If both parents are carriers (HbAS), the baby has a 1 in 4 chance of inheriting sickle cell disease. If one parent has the condition and the other is a carrier, there is a 1 in 2 chance the child will inherit the condition. In the case of a heterozygous father and a mother with sickle cell disease, there is a 1 in 3 chance of the baby having the condition. Finally, if both parents are carriers and the baby inherits one HbS allele from each parent, there is a 1 in 8 chance of the baby having sickle cell disease and a 3 in 8 chance of being a carrier. Understanding the probabilities of inheriting sickle cell disease can help individuals make informed decisions about family planning and genetic testing.
-
This question is part of the following fields:
- Genetics
-
-
Question 4
Correct
-
A 35-year-old pregnant woman and her husband are informed at the 20-week antenatal scan of the presence of echogenic bowel in the male fetus. They had been trying to conceive unsuccessfully for three years until investigations revealed oligospermia and this pregnancy was a result of intrauterine insemination. Both parents are aged 35 years old. The father has had several episodes of upper respiratory tract infections that have required antibiotics and he has been admitted to hospital in the past with acute gastritis. The mother is fit and well without any significant past medical history.
Which of the following would be the most appropriate next investigation?
Your Answer: Testing for the CFTR gene mutation in both parents
Explanation:Cystic fibrosis (CF) is a genetic condition that requires two copies of a faulty CFTR gene, one from each parent. If symptoms are present, it is important to confirm the diagnosis in the father and determine if the mother is a carrier of the faulty gene before pursuing further testing. While a sweat test can diagnose CF in the father, it cannot determine carrier status in the mother. Invasive procedures such as amniocentesis and chorionic villous sampling should only be performed if there is strong suspicion of a chromosomal or genetic abnormality, and less invasive genetic testing of both parents should be considered first. Karyotyping is not a useful diagnostic tool for CF, as it only detects chromosomal abnormalities and not genetic ones.
-
This question is part of the following fields:
- Genetics
-
-
Question 5
Correct
-
A 3-year-old girl is referred to the paediatric clinic for failure to thrive. She has failed to maintain her weight and suffers from frequent vomiting and respiratory tract infections. A sweat test is performed and the chloride content of the sweat is 72 mmol/l (normal level <60 mmol/l).
Which of the following modes of inheritance fits best with this condition?Your Answer: Autosomal recessive
Explanation:Understanding Cystic Fibrosis: Inheritance and Characteristics
Cystic fibrosis is a genetic disorder that affects the chloride transport and secretion viscosity in the body due to a mutation in the CFTR gene. This disorder follows an autosomal recessive pattern of inheritance, meaning that an individual must inherit two copies of the mutated gene (one from each parent) to develop the disease. The most common mutation involved is the Δ508 mutation.
Cystic fibrosis is prevalent in northern European populations, with a frequency of approximately 1 in 3200. Males with the disease are often infertile due to congenital absence of the vas deferens.
It is important to note that cystic fibrosis is not an autosomal dominant or sex-linked disorder. Chromosomal non-disjunction and translocation can cause other genetic conditions, but they are not associated with cystic fibrosis. Understanding the inheritance and characteristics of cystic fibrosis can aid in diagnosis and management of the disease.
-
This question is part of the following fields:
- Genetics
-
-
Question 6
Incorrect
-
A patient in her 40s comes in with concerns about her family history of cancer. Which type of cancer is the least likely to be passed down through genetics?
Your Answer: Endometrial cancer
Correct Answer: Gastric cancer
Explanation:Familial adenomatous polyposis is responsible for the majority of cases of colon cancer, while HNPCC is responsible for a smaller percentage. Women with HNPCC have a significantly higher risk of developing endometrial cancer, approximately 5 times higher than the general population.
Cancer is a prevalent disease in the UK, with breast cancer being the most common type. Lung, colorectal, prostate, and bladder cancers also rank high on the list of common cancers. Non-Hodgkin’s lymphoma, melanoma, stomach, oesophagus, and pancreas cancers complete the top ten. However, when it comes to cancer-related deaths, lung cancer takes the lead, followed by colorectal, breast, prostate, and pancreatic cancers. Oesophagus, stomach, bladder, non-Hodgkin’s lymphoma, and ovarian cancers also contribute to cancer-related deaths in the UK. It is important to note that non-melanoma skin cancer is not included in these statistics.
-
This question is part of the following fields:
- Genetics
-
-
Question 7
Correct
-
A 25-year-old woman is seeking your assistance in getting a referral to a clinical geneticist. She has a family history of Huntington's disease, with her grandfather having died from the condition and her father recently diagnosed. She wants to learn more about the disease and its genetic inheritance. Which of the following statements is accurate?
Your Answer: Huntington's disease is caused by a defect on chromosome 4
Explanation:The cause of Huntington’s disease is a flaw in the huntingtin gene located on chromosome 4, resulting in a degenerative and irreversible neurological disorder. It is inherited in an autosomal dominant pattern and affects both genders equally.
Understanding Huntington’s Disease
Huntington’s disease is a progressive and incurable neurodegenerative condition that is inherited through an autosomal dominant pattern. It is caused by a trinucleotide repeat disorder, specifically an expansion of CAG. This results in the degeneration of cholinergic and GABAergic neurons in the striatum of the basal ganglia due to a defect in the huntingtin gene on chromosome 4.
One notable feature of Huntington’s disease is the phenomenon of anticipation, where the disease presents at an earlier age in successive generations. Symptoms typically develop after the age of 35 and include chorea, dystonia, saccadic eye movements, personality changes such as irritability, apathy, and depression, as well as intellectual impairment.
It is important to note that there is currently no cure for Huntington’s disease, and treatment is focused on managing symptoms and improving quality of life. Early diagnosis and genetic counseling can be helpful for individuals and families affected by this condition.
-
This question is part of the following fields:
- Genetics
-
-
Question 8
Correct
-
A 33-year-old man presents to the Emergency Department with acute chest pain described as tearing in nature. Upon clinical examination, a diastolic murmur consistent with aortic regurgitation is detected. Further investigation with chest computerised tomography (CT) confirms the presence of an ascending aortic dissection. The patient has a medical history of spontaneous pneumothorax and upward lens dislocation, but no significant family history. What is the probable underlying diagnosis?
Your Answer: Marfan syndrome
Explanation:Common Genetic and Neurological Syndromes: Symptoms and Characteristics
Marfan Syndrome, Ehlers-Danlos Syndrome, Homocystinuria, Korsakoff Syndrome, and Loffler Syndrome are all genetic and neurological syndromes that affect individuals in different ways.
Marfan Syndrome is caused by a mutation in the fibrillin gene, resulting in weakened elastic fibers and aortic dissection. Ehlers-Danlos Syndrome is characterized by fragile blood vessels, hyperelastic skin, and aneurysm formation. Homocystinuria is an autosomal recessive condition that causes downward lens dislocation, thrombotic episodes, osteoporosis, and intellectual disability. Korsakoff Syndrome occurs after Wernicke’s encephalopathy and results in the inability to acquire new memories. Finally, Loffler Syndrome is a transient respiratory condition caused by the allergic infiltration of the lungs by eosinophils.
Understanding the symptoms and characteristics of these syndromes is crucial for proper diagnosis and treatment.
-
This question is part of the following fields:
- Genetics
-
-
Question 9
Correct
-
A 30-year-old woman visits her doctor with worries about a genetic disorder. Her granddaughter, who is three years old, has been diagnosed with sickle cell anemia. She reports that no one else in the family has the condition.
What is the likelihood of her being a carrier of the sickle cell allele?Your Answer: 1 in 2
Explanation:Understanding the Probability of Cystic Fibrosis Inheritance
Cystic fibrosis is a genetic condition that is inherited in an autosomal recessive pattern. This means that for a child to be affected, they must inherit two mutated alleles – one from each parent. If one grandparent is a carrier, there is a 1 in 2 chance that they passed the gene on to their offspring, who is the parent of the affected child.
When both parents are carriers, there is a 1 in 4 chance that their child will be affected by cystic fibrosis. However, the chance of inheriting the condition is always 1 in 2 for boys and girls.
Diagnosis of cystic fibrosis often occurs before the age of two, with up to 75% of patients being diagnosed at this age. It is important to note that carriers of cystic fibrosis are relatively common, with an estimated 1 in 25 people in the UK being carriers.
Understanding the probability of cystic fibrosis inheritance is crucial for families with a history of the condition, as it can help them make informed decisions about family planning and genetic testing.
-
This question is part of the following fields:
- Genetics
-
-
Question 10
Correct
-
A 45-year old woman became pregnant unexpectedly. She had given birth to five healthy children in her 20s and 30s with her now 47-year-old husband. Chorionic villus biopsy and karyotype analysis revealed that she was carrying a fetus with trisomy 21 (Down syndrome).
What is the most likely cause of the condition?Your Answer: The mother’s age
Explanation:Down syndrome is a genetic condition that is caused by three mechanisms. The most common cause is Trisomy 21, which occurs when there is a non-separation of the homologous chromosomes during meiosis. This risk increases with advancing maternal age, with a likelihood of 1 in 1500 at age 20 and 1 in 50 at age 45 or older. Translocation, where part of chromosome 21 attaches to another chromosome, accounts for about 4% of cases. Mosaicism, where only some cells carry the extra copy of chromosome 21, is the rarest type. Paternal age is not a significant factor, but if either parent is a translocation carrier, there is a 1 in 2 chance of passing it on to their offspring. A spontaneous mutation in the fetus is not a cause of Down syndrome.
-
This question is part of the following fields:
- Genetics
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)