A4M Practice Exam 2025/2026 – Anti-Aging Medicine, Mitochondria, Hormones, Inflammation, Exams of Nutrition and Aging

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A4M PRACTICE EXAM STUDY

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1. Identify the true statement(s) concerning the role of mitochondria in longevity, aging, and disease. a. Decreased mitochondrial function results in increased oxidative damage, caused by free radical formation combined with a decrease in antioxidant enzyme system activity. b. Maternal transmission of mitochondrial genomes is a factor in differences in longevity between male and female organisms (Drosophila model) c. Alteration of the electron transport chain (ETC) promotes survival and enhances longevity (C. elegans model). d. a, b, c are true statements e. Only a and b are true statements CORRECT ANSWER 1. d **2. For questions 2-4, match the property of the therapeutic compound, with its correct name CORRECT ANSWER

2. Shown to reduce all-cause mortality, as well as mortality specifically due to cardiovascular disease and cancers, in men.
3. Shown to decrease the rate of telomere shortening.
4. Combined with calcium, shown to reduce mortality in the elderly.** a. Vitamin C b. Vitamin D c. Vitamin E d. CoEnzyme Q e. EPA/DHA CORRECT ANSWER 2. a 3. e 4. b 5. Identify the true statements concerning the role of the inflammation in aging and disease CORRECT ANSWER a. Inflammation is implicated as a key factor in arthritis, asthma, allergies, diabetes, and heart disease. b. The two major classes of inflammatory messengers are prostaglandins and interleukins. c. Activation of the protein complex nuclear factor kappa beta in response to oxidative stress triggers as increase

b. ...do contribute....

8. Identify the true statements concerning protein intake and effect on BP CORRECT ANSWER

f. Studies have demonstrated a consistent association between high protein intake and reduction in BP. g. Studies have demonstrated that non-animal protein is more effective than animal protein, in reducing BP. h. Bovine casein-derived peptides and whey protein-derived peptides exhibit angiotensin-converting enzyme inhibitor (ACEI) activity. i. Sardine muscle protein contains valyl-tyrosine (VAL-TYR), found to signifi- cantly lower BP in HTN subjects. j. All of the above. CORRECT ANSWER 8. e

9. Identify the true statements concerning the mechanism of action of omega-3 and PUFA on BP

CORRECT ANSWER k. Suppress nitric oxide (NO) l. Decreases leukotrienes m. Reduces glycogen storage n. Suppresses glucose uptake

o. Increases plasma norepinephrine CORRECT ANSWER 9. b

a. stimulates NO

c. increases glycogen storage

d. increases glucose uptake

e. reduces plasma norepi

5. 10. With regard to the management of dyslipidemia identify the clinical recommendations concerning a regimen of nutrition and exercise. a. Consume at least 6 servings of fruits and vegies, whole grains, mixed and insoluble fibers. b. Limit daily protein intake to no more than 1.5 g/kg. c. Engage in aerobic exercise 30 min, 3 times a week. d. Engage in resistance training exercise 20 min, 4 times a week. e. Achieve ideal weight, BMI, waist circumference, and body composition (Body fat). CORRECT ANSWER
6. e

a. consume 10

b. Consume mod high protein 1.5-1.8 g.kg/day

c/d. 60 min daily with aerobic and resistance training

6. For questions 11-13, match the description of the neurological/cognitive diagnostic method with the name of the diagnostic CORRECT ANSWER

11. Elevated levels indicate chronic inflammation; chronic elevation may be predicative of dementia and

stroke.

12. Abnormal elevations reflect inadequate production of glutathione and/or methionine, and elevated levels

have recently been associated with autism, seizures, and stroke.

Alzheimer's disease. c. Parkinson's Disease, Alzheimer's disease, and Multiple sclerosis share a similar profile of pre-inflammatory cytokines, reactive microglia, mitochon- drial dysfunction and glutamate mediated changes in membrane receptor functions. d. a, b, and c are true statements e. Only a and c are true statements. CORRECT ANSWER 14. d

8. 15. Identify the true statements concerning concussion and brain aging CORRECT ANSWER a. Concussions, but not lesser head impacts, accelerate the brain's natural aging process. b. Concussion disrupts the brain's capacity to process and transfer informa- tion, expediting further deterioration of information processing. c. Worse outcomes in traumatic brain injury (TBI) occur independent of age. d. a, b, and c are true statements. e. Only a and c are true statements. CORRECT ANSWER 15. b

a. concussions, and even lesser

c. increasing age is a predictor of worse outcomes

9. For question 16-18 match the description of the Functional Medicine (FM) test with correct name CORRECT ANSWER

16. Assesses the capacity of the compound to bind to proteins, especially metalothionine in the kidneys, as

well as brain tissue and bones.

17. This evaluation can be used to determine the patient's diseases for which she/he is at risk for, despite being

currently asymptomatic.

18. Measures individual components of these compounds, with ratios being clinically more important than

individual levels in determining membrane health and dietary adequacy.

a. Fatty acid analysis

b. Brain MRI

c. Genomic genetic testing

d. Heavy metal testing

e. CXR CORRECT ANSWER 16. d

17. c
18. a
19. 19. Identify the true statements concerning thyroid physiology CORRECT ANSWER a. Less that 20% of the thyroid hormone produced in the body is T4. b. T3 is the active hormone, whereas T4 is a prohormone. c. An excess of selenium and iodine can result in less available thyroid activity. d. a, b, and c are true statements.

e. Osteoporosis/osteopenia CORRECT ANSWER 22. d

14. 23. Identify the true statements concerning estrogen CORRECT ANSWER a. E1 (estrone) is the main estrogen the body makes postmenopausally. b. Most of E2 (estradiol) is made in a woman's ovaries prior to menopause. c. E3 (estriol) is the strongest estrogen and is a potent stimulator of the breast and uterine lining. d. a, b, and c are true statements. e. Only a and b are true statements. CORRECT ANSWER 23. e c. E2 is the strongest estrogen, E3 has much less stimulation effect on the breast and uterine lining than estrone or estradiol.

15. 24. NO

25. NO

26. NO CORRECT ANSWER 0

16. 27. Identify the true statements concerning the body's response to acute infections CORRECT ANSWER a. Acute phase proteins are produced as a response to infection, in the goal to limit immune damage and eliminate invading organisms. b. CRP is an acute phase protein. c. The pancreas produces most acute phase proteins. d. a, b, c are true statements. e. Only a and b are true statements. CORRECT ANSWER 27. e c. the liver produces
17. For 28-30, match the description of effect of the vitamin/mineral as pertains to immune function, with its correct name CORRECT ANSWER

28. Major role in thymulin activation, which regulates proliferation of thymus based immune cells.

29. Reduces dendrites antigen presentation, inhibits TH1 proliferation, and reduces TNF-alpha.

30 Increases Th1 responses, with elevations in lymphocyte proliferation in response to mitogens.

a. Vitamin A

b. Vitamin D

c. Vitamin E

d. Selenium

e. Zinc CORRECT ANSWER 28. e

29. b

a. Increased waist circumference CORRECT ANSWER 40 in for males, 35 in for females. b. Low HDL cholesterol CORRECT ANSWER <40 mg/dL for males, <50 mg/dL for females. c. Hypertension CORRECT ANSWER BP >135/85 mmHG. d. a, b, c are factors for diagnosis e. Only a and c are factors for diagnosis. CORRECT ANSWER 32. d

20. 33. Identify the true statements concerning the role of obesity in Insulin Resistance CORRECT ANSWER a. Patients who present with sudden weight gain may be in Phase 1 of adrenal fatigue. b. The location of excess fat - ie, subcutaneous abdominal, inter-abdominal, intramuscular, intra-hepatic, etc. - is a minor consideration. c. The patient with abd obesity, or excess visceral adipose tissue, is not only at high risk for insulin resistance, but for dyslipidemia manifesting as elevated triglycerides and decreased HDL-C. d. a, b, and c are true statements. e. Only a and c are true statements. CORRECT ANSWER 33. e b Complications frequently found in obese patients appear to be associated with the locations fo excess fat...than the excess weight itself.
21. 34. NO CORRECT ANSWER 0
22. 35. Identify the true statements concerning the role of exercise for aging patients CORRECT ANSWER a. Improves frailty, by reducing risks of falls and related hospitalizations. b. Sedentary elderly men are at a markedly increased risk of dying, as com- pared to those men who engage in regular physical activity. c. Aerobic, but not strength training, plays a vital role in maintaining brain and cognitive health throughout life. d. a, b, c are true statements. e. Only a and b are true statements. CORRECT ANSWER 35. e c. both aerobic and strength training play a vital role in maintaining brain and cognitive health throughout life.

23. 36. Identify the true statements concerning sarcopenia. a. Not only characterized by loss of muscle mass and muscle strength, but often accompanies by gains in total body fat and visceral fat content. b. Associated with aging-related hormone declines, with men typically expe- riencing greater muscle loss, as compared to women. c. Can result in weakening of musculoskeletal system, diminishing the pa- tient's abilities for mobility and stability. d. a, b, and c are true statements. e. Only a and b are true statements. CORRECT ANSWER 36. d

27. 40. Upregulating of vascular endothelial growth factor (VEGF) in cancers has the following effects CORRECT ANSWER a. promotes high levels of aromatase, which feeds cancer cells. b. Stimulates protein-tyrosine kinase activity of its receptor to promote a cascade resulting in increased gene expression. c. Promotes the formation of new blood vessels that are required for the growth and metastasis of cancers. d. a, b, and c are true statements e. Only a and b are true statements. CORRECT ANSWER 40. c

a. Aromatase which feeds cancers cells is not a mechanism of VEGF.

b. Upregulation of epidermal growth factor, stimulates....

28. For questions 41 through 43, match the description of the cytokine as pertains to cancers, with its correct name CORRECT ANSWER

41. Pluripotent cytokine that promotes angiogenesis, tumor growth, and metastasis in experimental

models.

42. An endogenous pyrogen that is able to induce apoptotic cell death and inflammation.

43. Elevated expression of this cytokine has been detected in multiple epithe- lial tumors, its signaling is

implicated in tumorigenesis.

a. IL-

b. IL-

c. IL-

d. IL-

e. TNF-alpha CORRECT ANSWER 41. a

42. e
43. b
44. For questions 44-46, match the description of the nutritional compound as pertains to cancer prevention, with its correct name CORRECT ANSWER

44. Shown to inhibit the conversion of certain regulators of angiogenesis.

45. The body uses this enzyme to manufacture sulforaphane and in- dole-3-carbinol.

46. Inhibits markers of nitrosation.

a. Vitamin C

b. Garlic

c. Lycopene

of 402,127 participants, with an average 12.8 years of follow-up, reporting that consuming five or more portions of fish per week associated with a 13% reduction in the risk of all types of stroke. CORRECT ANSWER True

33. 47 d. Eating a Mediterranean diet enriched with olive oil may offer protec- tion against age-related bone loss. A team from the Hospital Dr. Josep Trueta (Spain) report that long-term consumption of a Mediterranean diet combined with olive oil may offer protection against age-related bone loss, writing that "the intake of olive oil has been related to the prevention of osteoporosis in experimental and in vitro models ... [with this study demonstrating] that olive oil preserves bone, at least as inferred by circulating bone markers, in humans." CORRECT ANSWER True
34. For questions 48-50, match the description of the B vitamin with its correct name CORRECT ANSWER

48. Necessary to form hemoglobin in RBCs, participates in the synthesis of RNA and DNA.

49. Necessary for the manufacture of the neurotransmitter acetylcholine, as well as Coenzyme A and the acyl

carrier protein.

50. Vital for the formation of FAD (flavin adenine dinucleotide) and FMN (flavin mononucleotide), both of which

are essential for metabolizing carbohydrates, proteins, and fats.

a. B2 (riboflavin)

b. B3 (niacin)

c. B5 (pantothenic acid)

d. B6 (pyroxidine)

e. B12 (cobalamin) CORRECT ANSWER 48. d

49. c
50. a