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Kaplan Qbank USMLE



Author11 Posts
  #1

A 17-year-old girl has hemophilia A. Her older brother also has hemophilia A, but neither of their parents is affected. Which of the following is the most likely explanation for the development of hemophilia in this girl?
0 A) Aneuploidy
0 6) Balanced autosomal translocation
0 C) Inheritance of defective factor Vlll alleles from both parents
0 D) Skewed X-chromosome inactivation
0 E) Unequal recombination

  #2

E unequal recombination. both X are from mother. no X from father.

if its skewed inactivation of normal X then it would be a random one and need not cause disaese.


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  #3

now i doubt why cant it be skewed x inactivation?

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  #4

D is more suitable

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  #5

yes robin. its D

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  #6

can you explain what skewed x inactivation mean?

  #7

in the female one of the X chromosomes either the maternal or the paternal is inactivated..randomly..and exist as barr bodies and in an X linked disease which generaly affects only male if the normal X chromosome gets inactivated even the female would then suffer from the disease..I think tht is what it means

  #8

yes doc you are right. here the X from the father is normal.(because son is affected which means X from mother is diseased and father shud have disease if X is diseased as he as only one X)

so in the daughter the X from father is inactivated.SKEWED here means that its a selective inactivation of father's X. even in stats we means it is inclined towards a particular direction it is not equally chanced. here its the same.




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  #9

6.
So in this case,-- Hemophilia A (X-linked recessive), the mother is a carrier with one X affected, but she is not diseased.

The father is normal.

If you do a punnet square you will see:
1. One daughter has One affected X, and should be a carrier.
2. Other daughter inherited both normal X's and is not diseased or a carrier.
3. One son has the disease because he inherited the abnormal X from the mom.
4. The other son is normal because he inherited the Normal x from mom and Y from dad....


So now what you are saying is that in order for 1 to be diseased instead of being a carrier, the normal X has to be inactivated? Isn't this random and either X chromosome can be inactivated in different cells (e.g. in some cells the normal one will be inactivated, while in other cells the abnormal one will be inactivated)???

So, how does the daughter have the disease?

Thanks. smiling face


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  #10

well inactivation of the x is random and thus, unfortunately the carrier has randomly got greater inaactivation of the normal x -chromosome causing the disease to be manifested despite the heterozygous status

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  #11

ya its d-







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