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The Genetic Counseling Game

Linda Casebolt
1994 Woodrow Wilson Biology Institute


INTRODUCTION:

In my own experience, I have found that games are an excellent teaching tool. The students enjoy playing the games, so they tend to be highly motivated. In addition, since the students are the ones doing the work and finding out information, they learn better and retain the information better than they would in a strictly lecture-discussion format.

PREREQUISITE SKILLS:

Students should have some background in the more common genetic conditions. They should also have studied the various methods of prenatal diagnosis. Reference books and textbooks will be helpful to students as they play the game.

OBJECTIVES:

  1. Students will assume the role of genetic counselors, perform fictitious tests, and gather information about parents and fetuses in several case studies.
  2. Students will determine what, if anything, is the problem with an unborn fetus.
  3. Students will describe the genetic condition and formulate a prognosis.

ADVANCE PREPARATION:

  1. Duplicate the game board on a piece of poster board, or have it enlarged and copied. (I suggest one set of materials for each four students. It is also possible to split the class and have half the students play on one day while the other half of the class is working on another activity.)
  2. Duplicate one set of student instructions, one set of case studies, one clues book, and one copy of KEY TO KARYOTYPES for each group of students. Each student should have a copy of the diagnosis sheet.
  3. You will need one die for each game.
  4. Students will furnish their own game pieces. A pen cap, coin, ring, or eraser will all work well.
  5. Fast groups of students will probably have time to play the game twice in a one hour class period, other students may only play the game one time.

KEY:

To find out the correct answers to each case study, see the "Newborn Characteristics" number in the Clues Book for that particular case study.



KEY TO KARYOTYPES:

#1male, no chromosomal abnormalities
#2female, no chromosomal abnormalities
#3female, trisomy 21
#4male, trisomy 21
#5male, deletion on p arm of chromosome 5
#6female, monosomy X
#7female no chromosomal abnormalities
#8male, trisomy 21
#9male, no chromosomal abnormalities
#10female, trisomy 21


Revised by Linda Casebolt and Richard Benz from an original game by Joe Ruhl, Jefferson High School, Lafayette, IN


The Genetic Counseling Game

Couples seek genetic counseling for many reasons. In this game you will be given an opportunity to be a genetic counselor. You will be given a case study of a couple who have come to you for help. The other players of the game will be working on the same case study. It is your job as a genetic counselor to solve the case as rapidly and as accurately as possible. To do this you will travel around the board, performing tests as you go. The first person to make an accurate and well thought out diagnosis is the winner.

Directions:

  1. Roll the die to see who goes first. The player who rolls the highest number will not only go first, but will choose a case study at random from the case study pile. All players will work on the same case study.
  2. The first player rolls the die and moves from the start square in the direction of the arrow. (All players must start in this direction, but after the first move, players may move in any direction they wish.)
  3. After the first player has finished her/his turn, the player to his/her left will move, and so on.
  4. If a player lands on a square with an arrow, that player may move into the DIAGNOSTIC SQUARE beside the arrow. (Players do not need to land exactly on an arrow, and may elect not to enter a square if they so choose.)
  5. Once a player is in a DIAGNOSTIC square, he/she consults the back of the case study card to find the number in the CLUES BOOK which contains the results of the test.
  6. Players should record the results of the tests they perform on their DIAGNOSIS SHEET. They should not show this sheet to the other players, unless they wish to help them win the game. Once a player has consulted the CLUES BOOK, his/her turn ends and the next player rolls the die.
  7. When a player has collected enough clues that she/he feels ready to make an informed diagnosis, she/he must return to the start square and show the DIAGNOSIS SHEET to the instructor. If the player is correct she/he is declared the winner. If not, he/she may rejoin the game.
  8. Play continues until all players have made a correct diagnosis, or until time runs out.

Points to remember:

  1. You may only look at NEWBORN CHARACTERISTICS after you have run three other tests. This is an easy way to find out the correct diagnosis, but it is the farthest square from the start.
  2. Amniocentesis must not be done without the results of an ultrasound.
  3. You will score points on this activity according to your finish in the game, and according to the completeness of your DIAGNOSIS SHEET. It is more important to be accurate than to be first. No client ever thanked the genetic counselor for being very quick with the wrong diagnosis.


Game Board



The Genetic Counseling Game
Student Diagnosis Sheet

Name: Case Study Number:
Test(s) Performed Results
1
2
3
4
5
6
7
8
Diagnosis:
Characteristics Of Condition:
Prognosis:


Case Study 1:

Mr. and Mrs. Evans are an African-American couple from Indianapolis. A few of their relatives on both sides have had sickle-cell anemia.

Clues Book References:

  • Blood test on parents: 35
  • Chorionic villus biopsy: 12
  • Previous children: 20
  • Amniocentesis (biochemical): 69
  • Amniocentesis (karyotype): 87
  • Fetal blood analysis: 70
  • Ultrasound: 88
  • Newborn characteristics: 38

Case Study 2:

Mr. and Mrs. Jones are an African-American couple from Gary, Indiana. A few of their relatives on both sides have had sickle-cell anemia.

Clues Book References:

  • Blood Test on parents: 36
  • Chorionic villus biopsy:71
  • Previous children: 89
  • Amniocentesis (biochemical): 85
  • Amniocentesis (karyotype): 37
  • Fetal blood analysis: 86
  • Ultrasound: 39
  • Newborn characteristics: 11

Case Study 3:

Mr. and Mrs. Carver are a Caucasian couple. They have just moved here from a north Canadian province where they were both born and reared in the north woods.

Clues Book References:

  • Blood test on parents: 3
  • Chorionic villus biopsy: 40
  • Previous children: 22
  • Amniocentesis (biochemical): 21
  • Amniocentesis (karyotype): 90
  • Fetal blood analysis: 14
  • Ultrasound: 73
  • Newborn characteristics: 42

Case Study 4:

Mr. and Mrs. Franks are a Caucasian couple who live in southeastern Kentucky. They both grew up in the Appalachian Mountains.

Clues Book References:

  • Blood test on parents: 41
  • Chorionic villus biopsy: 13
  • Previous children: 72
  • Amniocentesis (biochemical): 91
  • Amniocentesis (karyotype): 92
  • Fetal blood analysis: 44
  • Ultrasound: 94
  • Newborn characteristics: 75

Case Study 5:

Mr. and Mrs. Epstein are a Jewish couple from Chicago.

Clues Book References:

  • Blood test on parents: 74
  • Chorionic villus biopsy: 43
  • Previous children: 93
  • Amniocentesis (biochemical): 45
  • Amniocentesis (karyotype): 95
  • Fetal blood analysis: 76
  • Ultrasound: 2
  • Newborn characteristics: 77

Case Study 6:

Mr. and Mrs. Jacobson are a Jewish couple from New York City.

Clues Book References:

  • Blood test on parents: 4
  • Chorionic villus biopsy: 1
  • Previous children: 15
  • Amniocentesis (biochemical): 10
  • Amniocentesis (karyotype): 78
  • Fetal blood analysis: 46
  • Ultrasound: 9
  • Newborn characteristics: 84

Case Study 7:

Mr. and Mrs. Brown are a Caucasian couple from Fort Wayne, Indiana.

Clues Book References:

  • Blood test on parents: 8
  • Chorionic villus biopsy: 47
  • Previous children: 79
  • Amniocentesis (biochemical): 96
  • Amniocentesis (karyotype): 23
  • Fetal blood analysis: 83
  • Ultrasound: 49
  • Newborn characteristics: 97

Case Study 8:

Mr. and Mrs. Jones are a Caucasian couple from Muncie, Indiana

Clues Book References:

  • Blood test on parents: 82
  • Chorionic villus biopsy: 5
  • Previous children: 48
  • Amniocentesis (biochemical): 6
  • Amniocentesis (karyotype): 98
  • Fetal blood analysis: 51
  • Ultrasound: 81
  • Newborn characteristics: 52

Case Study 9:

Mr. and Mrs. Appleton live in South Bend, Indiana.

Clues Book References:

  • Blood test on parents: 24
  • Chorionic villus biopsy: 50
  • Previous children: 68
  • Amniocentesis (biochemical): 67
  • Amniocentesis (karyotype): 25
  • Fetal blood analysis: 53
  • Ultrasound: 80
  • Newborn characteristics: 66

Case Study 10:

Dr. and Mrs. Jackson are from Philadelphia. Dr. Jackson (age 40) is a surgeon. Mrs. Jackson (age 36) is a corporate lawyer. They have been married 2 years.

Clues Book References:

  • Blood test on parents: 7
  • Chorionic villus biopsy: 54
  • Previous children: 26
  • Amniocentesis (biochemical): 99
  • Amniocentesis (karyotype): 29
  • Fetal blood analysis: 100
  • Ultrasound: 65
  • Newborn characteristics: 101

Case Study 11:

Dr. and Dr. Richards are both college professors. Dr. Richards (age 40, husband) teaches math and Dr. Richards (age 37, wife) teaches chemistry.

Clues Book References:

  • Blood test on parents: 102
  • Chorionic villus biopsy: 28
  • Previous children: 112
  • Amniocentesis (biochemical): 111
  • Amniocentesis (karyotype):57
  • Fetal blood analysis: 27
  • Ultrasound: 56
  • Newborn characteristics: 103

Case Study 12:

Mr. and Mrs. Hughes own and operate a farm in northern Indiana. They are both 35.

Clues Book References:

  • Blood test on parents: 58
  • Chorionic villus biopsy: 55
  • Previous children: 30
  • Amniocentesis (biochemical): 104
  • Amniocentesis (karyotype): 18
  • Fetal blood analysis: 59
  • Ultrasound: 105
  • Newborn characteristics: 31

Case Study 13:

Mr. and Mrs. Edwards own and operate a furniture store in a small Illinois town.

Clues Book References:

  • Blood test on parents: 17
  • Chorionic villus biopsy: 32
  • Previous children: 60
  • Amniocentesis (biochemical): 63
  • Amniocentesis (karyotype): 16
  • Fetal blood analysis: 106
  • Ultrasound: 62
  • Newborn characteristics: 108

Case Study 14:

Mr. and Mrs. Sullivan are both 24 years of age. Mrs. Sullivan teaches high school biology and Mr. Sullivan is an architect.

Clues Book References:

  • Blood test on parents: 33
  • Chorionic villus biopsy: 107
  • Previous children: 61
  • Amniocentesis (biochemical): 109
  • Amniocentesis (karyotype): 34
  • Fetal blood analysis: 64
  • Ultrasound: 19
  • Newborn characteristics: 110

Genetic Counseling Clues

  1. These people are both in their late 30's but they aren't worried about chromosomal abnormalities so they have elected not to have CHORIONIC VILLUS SAMPLING performed.
  2. The ULTRASOUND reveals a normal fetus.
  3. Blood tests performed on both parents show that these people are both heterozygous for PKU disease.
  4. Blood tests show that these people are both carriers of the Tay-Sachs gene.
  5. These people have opted not to have CHORIONIC VILLUS SAMPLING done, due to the fact that it is still experimental.
  6. These people have opted not to have a biochemical analysis done on the amniotic fluid.
  7. These people have decided to forego having their blood tested.
  8. Blood tests show that the husband is Rh+ and the wife is Rh-.
  9. ULTRASOUND reveals a normal fetus.
  10. A biochemical analysis of the fetal cells shows a lack of the enzyme hexosaminidase A.
  11. The newborn baby boy appears perfectly healthy.
  12. Cells obtained by CVS were karyotyped. See karyotype #1.
  13. These people have chosen not to have CVS done.
  14. An analysis of the fetal blood reveals no problems.
  15. These people have had 2 children so far. Both children have died tragically of Tay-Sachs disease.
  16. See karyotype #9 for the results of the test.
  17. The pregnant woman's blood reveals unusually high levels of alpha fetoprotein (AFP).
  18. Due to her age (35), this pregnant woman has decided to have a karyotype analysis done on the fetal cells. See karyotype #6.
  19. ULTRASOUND reveals a hole at the base of the fetus' spine.
  20. These people have 3 normal, healthy children.
  21. Certain enzyme levels can be detected and measured prenatally. An analysis of the amniotic fluid reveals no problems.
  22. These people have 5 children, all of whom were born in their cabin in northern Canada. Two of their children are mentally retarded.
  23. These people have decided against amniocentesis. They are both in their early twenties and are not too concerned about chromosome problems.
  24. Karyotypes were done on the white blood cells of both parents: the husband is 46, XY and the wife is 46, XX.
  25. Amniocentesis was performed. See karyotype #5.
  26. No fetal blood analysis was done.
  27. These people have decided not to have CVS done.
  28. Amniocentesis was performed. See karyotype #7.
  29. These people have 4 healthy sons. The wife has also had 3 miscarriages.
  30. A baby girl has been born with the following characteristics: webbed neck and swelling around the abdomen.
  31. CHORIONIC VILLUS SAMPLING was done. See karyotype #2.
  32. The pregnant woman's blood test reveals unusually high levels of alpha fetoprotein (AFP).
  33. Amniocentesis was done. See karyotype #9.
  34. Both parents have been shown to be carriers of the gene for sickle-cell anemia.
  35. Amniocentesis was done. See karyotype #1.
  36. The newborn baby boy appears to be normal.
  37. ULTRASOUND reveals a normal fetus.
  38. CHORIONIC VILLUS SAMPLING was done. See karyotype #9.
  39. Because of religious beliefs, these people have decided not to have their blood tested.
  40. The newborn baby girl appears to be very healthy, although her PKU test was positive.
  41. CHORIONIC VILLUS SAMPLING was done. See karyotype #1.
  42. These people have decided against having any fetal blood drawn for study.
  43. Biochemical analysis of the amniotic fluid reveals normal enzyme levels.
  44. Fetal blood analysis shows a lack of the enzyme hexosaminidase A.
  45. Because they are in their early 20's, these people have decided against CVS.
  46. These people have 5 children, 2 of them have cystic fibrosis.
  47. ULTRASOUND reveals a normal fetus.
  48. Due to the fact that CHORIONIC VILLUS SAMPLING has been shown to be associated with a slightly higher rate of spontaneous abortion, these people have decided not to go through with this procedure.
  49. These people have decided not to have the fetal blood analyzed.
  50. The new baby is apparently normal. In fact, after 18 months, no complications have appeared.
  51. These people have decided not be have the fetal blood analyzed.
  52. These people have decided not to have this procedure.
  53. These people have decided against CHORIONIC VILLUS SAMPLING.
  54. ULTRASOUND reveals a normal fetus.
  55. Amniocentesis was done. See karyotype #3.
  56. Blood tests show the husband is Rh+ and the wife is Rh-.
  57. No fetal blood analysis was done.
  58. These people have 2 normal daughters.
  59. These people have 1 normal son.
  60. ULTRASOUND reveals twins.
  61. A biochemical analysis of the amniotic fluid reveals exceptionally high levels of alpha alphafetoprotein (AFP).
  62. No fetal blood analysis was done.
  63. ULTRASOUND reveals a normal fetus.
  64. This newborn baby shows the following characteristics: a cry that sounds like a cat's meow, microcephaly, and low-set ears.
  65. These people have decided not to have a biochemical analysis done on the amniotic fluid.
  66. These people have 1 normal child and 1 child with Down's Syndrome. They are concerned about whether the next child will be affected.
  67. Biochemical analysis reveals normal enzyme levels.
  68. Analysis of the fetal blood shows that this fetus has sickle-cell anemia.
  69. CHORIONIC VILLUS SAMPLING was done. See karyotype #9.
  70. As far as we know, this woman has been pregnant 7 times. She has had 3 miscarriages. She has 4 surviving children, 1 of whom is mentally retarded.
  71. ULTRASOUND reveals a normal fetus.
  72. Blood tests reveal both parents to be carriers of the Tay-Sachs gene.
  73. The newborn baby boy is perfectly normal and healthy.
  74. Fetal blood analysis shows normal enzyme levels.
  75. The new baby is a normal, healthy boy.
  76. Amniocentesis was done. See karyotype #1.
  77. These people have no children yet.
  78. ULTRASOUND reveals a normal fetus.
  79. ULTRASOUND reveals a normal fetus.
  80. These parents have declined to have blood tests run.
  81. Fetal blood analysis shows normal enzyme levels.
  82. The new baby boy is apparently normal.
  83. Biochemical analysis of the amniotic fluid reveals normal levels of several important enzymes.
  84. Analysis of the fetal blood reveals a normal fetus.
  85. Amniocentesis was performed. See karyotype #1.
  86. ULTRASOUND reveals a normal fetus.
  87. These people have 3 normal, healthy daughters.
  88. Amniocentesis was done. See karyotype #2.
  89. Biochemical analysis of the amniotic fluid reveals normal enzyme levels.
  90. Amniocentesis was done. See karyotype #1.
  91. These people are just starting their family. They have no children yet.
  92. ULTRASOUND reveals a normal fetus.
  93. Amniocentesis was done. See karyotype #9.
  94. Biochemical analysis reveals normal enzyme levels.
  95. An apparently healthy baby boy is born, but after 6 months, the baby shows signs of malnutrition, breathing difficulty, and very salty perspiration.
  96. Amniocentesis was done. See karyotype #1.
  97. These people have decided not to have a biochemical study done on the amniotic fluid.
  98. No fetal blood analysis was done.
  99. The new baby girl is perfectly healthy.
  100. These people have decided not to go through with this test.
  101. The new baby has the following characteristics: epicanthal eye folds; large, protruding tongue; and lack of complete muscle tone.
  102. These people have elected not to have a biochemical test done on the amniotic fluid.
  103. ULTRASOUND reveals a normal fetus.
  104. No fetal blood test was done.
  105. These people have decided not to have CHORIONIC VILLUS SAMPLING done.
  106. Two normal, healthy babies have been born! One is a boy and the other a girl.
  107. A biochemical analysis of the amniotic fluid reveals unusually high levels of alpha fetoprotein (AFP).
  108. The newborn baby has been born with an opening at the base of the spine. Paralysis is expected for all the body parts below this opening.
  109. These people have decided not to have a biochemical analysis done on the amniotic fluid.
  110. These people have no children yet.


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