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System based disorders II

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Term
Definition
Cystic Fibrosis   respiratory, exocrine pancreas, intestesting, vas deferens, hepatobiliary and sweat glands  
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Cystic fibrosis   15-20% neonates meconium ileus >95% males infertile  
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Cystic fibrosis   dx: sweat Cl>60 mEq/L OR CFTR disease causing mutations  
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Cystic fibrosis   deltaF508 (0.7 of ~1500 alleles)  
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Cystic fibrosis   antibiotics, bronchodilators, mucolytic (pulmonzyme, mucomyst), chest PT; avoid smoking, resp viruses and dehydration  
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Cystic fibrosis   mutation specific therapy (G551D) using Ivacaftor/Kalydeco  
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Heritable Pulmonary Arterial Hypertension (HPAH)   dyspnea 60%, fatigue 19%, chest pain 7%, edema 3%; PA pressure <25 mmHg (rest)/ >30 (exercise) and other causes exclueded; increased PA pressure causes right heart failure and death within 3 yrs of dx  
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Heritable Pulmonary Arterial Hypertension (HPAH)   ~6% of cases familial: AD w/ 10% pen, variable age onset and ?anticipation; 2.4 females/males; BMPR2 and ACVRL1, BMPR1B, CAV1,, ENG and SMAD8 rare  
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Heritable Pulmonary Arterial Hypertenstion   treatment; sc/iv treprostinil,; po Bosentant, sildenafil; neb Iloprost and IV epoprostenol  
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Idiopathic Pulmonary Fibrosis (IPF)   Bibasilar reticular anomalies/nodules on high res CT, abnl lung func (VC), usually 50-70 yrs; +/- lung Ca; 30-50% 5 yr survival  
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Idiopathic Pulmonary Fibrosis (IPF)   TERT and TERC (short telomeres) or SFTPC in 8-15% multiplex or 3% simplex; all AD reduced penetrance;  
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Pulmonary Fibrosis   occurs in Hermansky Pudlak (AR), Dyskeratosis Congenita (AD, AR, XL)  
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Idiopathic Pulmonary Fibrosis   treatment: supp O2, lung transplant, no smoking  
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Adenosine Deaminase Def   SCID with FTT, opportunistic infections, marked lymphocytopenia, absent humoral and cellular, usually Dx <6/12  
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Adenosine Deaminase Def   <1% ADA activity (purine metabolism) or 2 known ADA causing muts (AR)  
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Adenosine Deaminase Def   antibiotic, antifungual, IV immunoglobulin (IVIg), Pneumocystis prophylaxis, bone marrow/stem cell transplant; PED ADA ERT  
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Common Variable Immune Def (CVID)   humoral immune def after 24/12 (often young adults), sinopulmonary (Strep, H flu, Kleb pn), meningitis after bacterial infections, chronic diarrhea, malabsorption, +/- lymphoid hyperplasia, autoimmune, lymphomas  
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Common Variable Immune Def (CVID)   IgG < 100 mg/dL to low, poor response to Pneumovax  
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Common Variable Immune Def (CVID)   loss RAC1, CD19, BAFFER protein; TNFRSF13B (TAC1)10-15%, ICOS (<1%), muts (AD, AR)  
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Common Variable Immune Def (CVID)   rx: immune globulin (IVIg), antibiotics, monitor lymphoma, thyroid function  
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AD Hyper IgE syndrome   boils, cysts forming pneumonia and very high IgE; characteristic face, Chiari malform, +/- eczema, candiasis, osteopenia, fractures, scoliosis, arterial tortuosity and aneurysms  
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AD Hyper IgE syndrome   IgE >2000 IU/mL (~15X) STAT3 gene (AD)  
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AD Hyper IgE syndrome   rx: antibiotics to prevent Staph absecess/pn  
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X linked hyper IgM syndrome   50% onset by 1 yr, >90% by 4yr; recurrent respiratory bacterial, recurrent diarrhea w/ FTT; neutro & thrombopenia, anemia; 10-15% CNS infections; liver, GI, pancreatic tumors; lymphoma (Hodgkins) and EBV  
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X linked hyper IgM syndrome   CD40LG (aka TNFSF5/CD154) muts in 95% of affected males (XL)  
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X linked hyper IgM syndrome   allogenic hematopoietic cell transplantation, recombinant granulocyte stim factor (G-CSF) for neutopenia, antibiotics  
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IPEX syndrome   Immune dysregulation, Polyendocrinopathy, Enteropathy; watery diarrhea, eczema, diabetes, autoimmune thyroid, anemia, low polys and plts, tubular neuropathy  
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IPEX syndrome   FOXP3 muts in ~25% affected males (XL)  
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IPEX syndrome   rx: immunosuppression, steriods, granulocyte stim factor, bone marrow transplant  
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XL SCID   severe combined cellular and humoral immunodef, present 1-3/12 w FTT, oral/diaper candidiasis, absent tonsils and lymph nodes, recurrent and presistent infections  
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XL SCID   NBS in 10 states, IL2RG muts found in >99% of affected males (XL)  
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XL SCID   rx: antibiotics (esp pneumocystis, IVIg, bone marrow transplant ASAP, gene therapy?  
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AR SCID   SCID presents in 1st yr, recurrent bacterial, viral, and opportunistic infections, diarrhea, oral moniliasis, FTT, Pneumocystis, usually die by 2 yrs unless stem cell transplant  
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AR SCID   due to abnl T cell receptor signaling; low CD3,4,8 T cells; ZAP70 muts (AR)  
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AR SCID   IVIg, antibacterial,-fungal, -protozoal, allogenic HSCT within 3/12; avoid live viral vaccines  
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GATA1 related XL cytopenia   thrombocytopenia +/- anemia w 1 or more of the following: plt dysfx, mild beta thal, neutropenia and congen erythropoietic porphyris in males  
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GATA1 related XL cytopenia   rx: plt or rbc transfusions, avoid ASA, NSAIDs  
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Hemophilia A   prolonged oozing after trauma, tooth extractions or surgery, age at dx relates to F8 activity, sever joint/deep muscle bleeds <2 yrs, 10% carriers bleed  
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Hemophilia A   Low F8 clotting activity with nl von Willebrand factor level; F8 muts in 98% of affected males (XL), IVS 22 inversion in 48% severe cases and dels/dups in 6%  
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Hemophilia A   hemophilia center, IV F8, DDAVP, avoid ASA, IM injections, impact sports and activities, and always rx before circumcision  
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Hemophilia B   prolonged oozing after trauma, tooth extractions or surgery, age at dx relates to F9 activity, severe joint/deep muscle bleeds <2yrs, 10% carriers bleed  
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Hemophilia B   low F9 clotting activity; F9 mut in 100% of affected males (XL), dels/dups 3%  
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Hemophilia B   rx; hemophilia center, IV F9, avoid ASA, IM injections, impact sports and activities; always rx before circumcision  
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Sickle Cell Disease   intermittent vaso-oclusive events and hemolytic anemia, dactylitis, splenic infarction and asplenia, cholelithiasis, PAH, leg ulcers  
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Sickle cell Disease   HBB muts B(s) Glu6Val, B(c), B(punjab), B(arab) - all AR; SS and SC <3.6% and Sb(thal) >3.6% Hb A2  
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Sickle Cell Disease   rx: hydration, transfusion, penicillin, hydroxyurea, rx PAH phosphodiesterase inhibs/nitric oxide  
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Alpha Thalessemia   significant Hb Bart hydrops fetalis (Hb Bard Syn) and HbH disease w 90% vs 5% Hb Bart  
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Alpha Thalessemia   Hb Bart syn, HbH, alpha thal trait, silent carrier and nl have deletion of 4,3,2,1,1 alpha globin genes; dels 90% and point 10% of mut, alpha thal moderates SS  
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Alpha Thalessemia   rx: Hb Bart syn fatal, HbH transfuse prn; avoid excess FE rx and sulphonamides in HbH  
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Hb Bart syndrome   4 null alpha genes  
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HbH   3 null alpha genes  
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alpha thal trait   2 null alpha genes (in cis or trans)  
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silent carrier   1 null alpha gene  
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Beta Thalessemia   reduced beta globin causes microcytic hypochromic anemia and dec HbA; Bthal major > severe anemia and hepatosplenomegaly <2 yrs, marrow expansion  
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Beta Thalessemia   RBC indices, dec Hb A2 and inc Hb F >12 months; nucleated RBCs  
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Beta Thalessemia   rx; regular transfusion, Fe chelation, bone marrow transplant, splenectomy?; monitor endo function; avoid EtOH & iron meds  
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Thiamine Responsive Megaloblastic Anemia   triad of megaloblastic anemia, SNHL and DM; +/- optic atrophy, CHD, arrythmias, strokes  
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Thiamine Responsive Megaloblastic Anemia   SLC19A2 muts in 100% (AR)  
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Thiamine Responsive Megaloblastic Anemia   rx: anemia corrected by high dose Thiamine (B1), RBC remain macrocytic and SNHL irreversible  
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XL Adrenal Hypoplasia Congenita (AHC)   acute adrenal insufficiency by 3 wks in ~60%; vomiting, hypoglycemia and salt wasting with hyper kalemia; +/- cryptochidism  
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XL Adrenal Hypoplasia Congenita (AHC)   NROB1 (DAX1) dels in 100% with glycerol kinase def +/- DMD; but point muts in nearly all isolated AHC  
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XL Adrenal Hypoplasia Congenita (AHC)   rx: IV glucose, NaCl; glucocorticoids, mineralocorticoids and NaCl  
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Antley Bixler (cyto p450 oxidooreductase def)   steroidogenic defect ranging from cortisol deficiency to Antly Bixler syndrome with ambiguous genitalia, craniosynostosis, choanal atresia,radiohumeral synostosis  
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Antley Bixler (cyto p450 oxidooreductase def)   sterol/steriod abnormalities, POR muts (AR)  
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Antley Bixler (cyto p450 oxidooreductase def)   rx: tracheostomy, cortisol, surgery for craniosynostosis and hypospadias  
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Congenital Adrenal Hyperplasia   >90% CYP21OHD, impaired cortisol synthesis by adrenal cortex, simple virilizing (25%) and salt wasting (low cortisol and inadequate aldosterone) (75%), NBS of neonates lowers risk for initial fatal salt wasting crisis  
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Congenital Adrenal Hyperplasia   CYP21A2 panel of 9 seq or del/dups detect 80-98% (AR)  
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Congenital Adrenal Hyperplasia   rx: glucocorticoid (increase w stress), salt wasting add mineralocorticoid and NaCl  
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Congenital Adrenal Hyperplasia   ACTH causes adrenal hyperplasia and overproduction og 17OHP and hormones  
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Familial Hyperinsulinism   Hypoglycemia (ranges from severe neonatal to mild childhood onset)  
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Familial Hyperinsulinism   ~45% ABCC8 and 5% KCNJ11 (AR), ~5% GLUD1 and 5% HNF4A (AD w anticipation)  
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Familial Hyperinsulinism   rx: IV glucose, diazoxide, etc, diet, pancreatic resection, avoid fasting  
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Isolated Gonadotropin Releasing Hormone (GnRH) Def   low LH and FSH w hypogonadism, +/- micropenis/cryptochidism, small testes, absent puberty, 60% anosmia (aka Kallmann), bimanual synkinesis  
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Isolated Gonadtropin Releasing Hormone (GnRH) def   FGFR1, PROKR2, PROK2, CHD7, FGF8 muts ~25% (AD), KAL1 ~10% (XL) muts/del  
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Isolated Gonadtropin Releasing Hormone (GnRH) deff   Testosterone, hCG in males and estrogen, progestins in females  
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PROP1 related combined pituitary hormone def   combined pituatary hormone def (CPHD) w GH, TSH, LH, FSH, and PrL +/- ACTH deficiencies, short stature, FTT in childhood  
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PROP1 related combined pituatary hormone def   PROP1 muts >98% (AR)  
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PROP1 related combined pituatary hormone def   rx: GH, L thyroxine, +/- testosterone or estrogens, +/- hyrocortisone  
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Achondoplasia and Hypochondroplasia   Rhizomelic short stature, macrocephaly/inc ICP; kyphosis, lordosis, narrowing interpedicular distance, trident hand, genu varum, cranio-cervial compression and spinal stenosis  
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Achondroplasia and Hypochondroplasia   dx: signs and x-rays; FGFR3: Achondroplasia 98% G>A transition due to CpG results in Gly380Arg; Hypochondroplasia Asn650Lys C>A and 21% C>G  
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Achondroplasia and Hypochondroplasia   rx: cns shunt for ICP, sleep and cc apnea; otitis; orthopedics for gibbus, genu varum and spinal stenosis  
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Osteogenesis Imperfecta   Fx fater min trauma, +/- dentinogenesis imperfect (gray/brown) and HL (adults  
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OI type 1   non-deforming with blue sclerae  
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OI type 2   perinatal lethal  
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OI type 3   progressively deforming  
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OI type 4   variable OI with nl sclerae  
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Osteogenesis imperfecta   dx: FHx (fx/signs), X rays (fx, wormian, codfish vertebrae and oseopenia); COL1A1/2 molecular test and/or biochemical analysis of type 1 collagen  
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COL1A1/2 ratio   2:1  
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Osteogenesis Imperfecta   Molecular testing COL1A/2 detects 90% of OI types 1-4 (AD, >95% seq changes and 2% del/dup); biochemical detects 90,98,84,84% of OI types 1-4  
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Ostoeogenesis imperfecta   rx: orthopedic and otolaryngology management, periodic dental and hearing eval; bisphosphonates, oral alendronate or risedronate and GH may reduce fx, increase bone density and improve growth  
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OI V-VII   Fx, no dentinogenesis (D) or hearing loss; abnl vertebrae and hyperplastic callous  
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OI V   IFITM5 (AD)  
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OI VI   SERPINF1 (AR)  
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OI VII   CRTAP (AR)  
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OI VIII   Fx, no dentinogenesis or HL; short limb dwarfism, gracile long bones  
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OI VIII   LEPRE1 (AR)  
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OI IX   Fx, white to gray sclerae, short limb dwarfism, bowed limbs  
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OI IX   PPIB (AR)  
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Type II Collagenopathies   Achondrogenesis 2; Kniest, SED, Stickler  
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Achondrogenesis Type 2 (Langer Saldino)   micromelic dwarfism, CP, short ribs and abnl vert; stillborn/neonatal death; COL2A1 (AD)  
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Kniest   short stature and trunk (platysopondyly); hearing loss; myopia and retinal detach (MRD and cataract; COL2A1 (AD)  
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Spondyloepiphyseal Dysplasia (SEDC)   flat face/CP, MRD, abnl vert, cervical myelopathy; COL2A1 (AD)  
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Stickler   flat face, MRD and cataract, HL, CP +/- Robin; COL2A1 (85%) and COL11A1 (10-15%)  
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Diastrophic dysplasia   short limbs, nl skull, hitchhikers thumbs, spine (scoliosis, lordosis, kyphosis), joint contractures and osteoarthritis, CP 1/3, cystic ears 2/3, club feet  
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Diastrophic dysplasia   clinical and radiologic confirmed by SLC26A2 >90% have seq variants  
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Diastrophic dysplasia   rx: PT, casting, ortho surgery with caution as deformities tend to recur, watch C spine for cord compression  
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Ehlers Danlos   5 types: 1.classic (i and ii) 2. hypermobility (III) 3.kyphoscoliotic (vi) 4. vascular(iv)  
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Classic EDS (i and ii)   skin hyperextensible, abnl wound healing and joint hypermobility  
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Hypermobility EDS (iii)   soft skin, dislocation, pain +/- aortic dilation  
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Kyphoscoliotic EDS (vi)   friable, hyperextensible skin; scars, bruising, hypotonia, progressive scoliosis and fragile sclerea  
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Vascular EDS (iv)   thin, translucent skin; bruising, vascular rupture (12% death secondary to arterial or uterine rupture in pregnancy); GI perforation  
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Classic EDS (i and ii)   ~50% have COL5A1/2 seq, del/dup (AD)  
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Hypermobility EDS (iii)   TNXB haploinsufficiency; very rare (AD)  
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Kyphoscoliotic EDS (vi)   increase deoxypyrimidine/pyrimidine ration in urine (HPLC) due to def lysyl hydroxylase (PLOD1) activity (fibroblast); PLOD1 seq?; del/dups ~18% (AR)  
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Vascular EDS (iv)   COL3A1 seq >95%, del/dup 2% (AD)  
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Classic EDS (i and ii)   rx: care with sutures, ascorbic acid? avoid ASA and contact sports  
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Hypermobility EDS (iii)   rx: watch aorta and avoid cs/joint hyperextension  
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Kyphoscoliotic EDS (vi)   rx: ortho, opthal, pregnancy risk and avoid cs  
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Vascular EDS (iv)   avoid contact sports and arteriography  
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Marfan syndrome   ocular (myopia, ectopia lentis); skeletal (dolichosternomelia, pectus, scoliosis); aoritc dilation/tear/rupture/MV prolapse  
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Marfan syndrome   dx: FHx, exam (esp ectopia lentis and aneurysm); FBN1 seq 70-93%, dels/dups? (AD), 25% de novo  
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Marfan syndrome   rx: lens surgery, beta blockers/losartan for aortic dilation, surgery 5 cm or if 1 cm/yr; yearly opthal & ECHO; avoid contact sports, isometric; CV stimulants and LASIK; inc CV risk with pregnancy  
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Loeys Dietz syndrome   vascular (CNS, thoracic and abdominal arterial aneurysms/dissections) and skeletal (pectus excav/carin, scoliosis, lax joints, arachnodactyly and clubfeet).  
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LDS type I   75% hypertelorism, bifid uvula/CP and craniosynostosis  
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LDS type II   25% velvety/translucent skin; atrophic scars  
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Loeys Dietz   TGFBR1/2 in 95% (AD), 3/4 de novo  
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Leoys Dietz   rx: aortic dissection at smaller diameters than MFS, beta blockers, C spine instability, avoid contact sports and CV stimulants  
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Multiple Epiphyseal Dysplasia   joint pain (hips and knees), malformations (hands, feet and knees) and scoliosis; 50% had clubfoot, clinodactyly or CP at birth; adult Ht 150-180 cm  
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Multiple Epiphyseal Dysplasia   dx: clin and x-ray; SLC26A2 seq variants in ~100% (AR)  
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Multiple Epiphyseal Dysplasia   rx: orthopedic, avoid sports involving joint overload and caution with NSAIDs  
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Pseudoxanthoma Elasticum   affects elastic tissue skin, eye, CV and GI systems; skin (papules); retina (streaks and hemorrhage); GI bleeds, angina/claudication  
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Pseudoxanthoma Elasticum   dx: skin and eye findings and skin biopsy; ABCC6 seq ~90% both alleles w dels in 5-30% (AR)  
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Pseudoxanthoma Elasticum   rx: intraocular injections for macular degeneration; avoid contact sports, ASA, NSAIDs, retinal exams in pregnancy  
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Branchiootorenal Spectrum Disorders   ear pits, tags, anomalies causing deafness >90%; branchial fistulae/cysts and renal hypoplasia, dysplasia or agenesis  
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Branchiootic Syn (BOS)   BOR w/out renal anomalies  
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Branchiootorenal disorders   EYA1, SIX5, SIX1 seq, dups/dels in 40% (AD) with 10% de novo  
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Branchiootorenal disorders   rx: excision fistulae/cysts, ear surgery, aids, cochlear implants  
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Lowe syndrome   eyes: cataracts, glaucoma and poor vision; CNS: hypotonia, absent DTRs and 75-90% mild to severe delay; Renal: Fanconi, RTA, renal  
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Lowe syndrome   OCRL seq variant in 95% affected males and carriers (XL); enzyme in fibroblasts  
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Lowe syndrome   rx: remove cataracts, GERD; oral Na/KHCO3, PO4 and calcitriol; avoid contact lens  
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Polycystic kidney disease (AD)   late onset, bilateral renal cysts; liver and pancreatic cysts; CNS/aortic aneurysms and MVP; renal pain, hypertension, renal failure by 60 yrs  
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Polycystic kidney disease (AD)   dx: renal imaging; 85% PKD1 and 15% PKD2 most seq but few del/dups (AD); contiguous PKD1 and TSC2 del > PKD in utero and Tuberous Sclerosis; rare early onset PKD with neg FHx due to hypo morph PKD1 in trans  
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Polycystic kidney disease (AD)   rx: hypertension, pain, cyst decompression, nephrolithiasis, clip small and aortic replacement for large aneurysms; avoid nephrotoxic, caffeine and smoking  
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Polycystic kidney disease (AR)   neonates with enlarged echogenic kidneys: ~45% hepatomegaly, dilated bile ducts and echogenicity; pulmonary hypoplasia w 30% dying by 1 yr of resp insuff and >50% have renal failure in first decade  
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Polycystic kidney disease (AR)   dx: clin findings in absence of renal cysts in parents; ~80% PKHD1 seq variants, dups/dels seen  
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Polycystic kidney disease (AR)   rx: resp failure, hypertension, avoid NSAIDS, aminoglycosides and caffeine  
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UMOD associated kidney disease   hyperuricemia and goat from dec renal excretion uric acid; increase creatinine 5-40 yrs and renal failure >40 yrs; isosthenuria may exacerbate bouts of dehydration  
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UMOD associated kidney disease   UMOD (aka uromodulin/Tamm Horsfall protein) seq variants in >95% (AD)  
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UMOD associated kidney disease   rx: allopurinol/probenecid for gout; nepherology management, peritoneal dialysis, renal transplant; avoid nephrotoxic meds, dehydration and meats  
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