A4M ACTUAL EXAM PAPER 2026
QUESTIONS WITH ANSWERS GRADED
A+
◍ where is estrogen produced?.
Answer: ovaries
◍ Where is DHEA produced?.
Answer: adrenal gland
◍ 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 statementse. Only a and b are true
statements.
Answer: 1. d
◍ estrogen can also be made from?.
Answer: DHEA
◍ estrogen should always be prescribed which route?.
Answer: transdermallyNOT PO- inflammatory
◍ For questions 2-4, match the property of the therapeutic compound, with its
correct name: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 D3 c. Vitamin E
d. CoEnzyme Q10 e. EPA/DHA.
Answer: 2. a3. e4. b
◍ how should transdermal estrogen be applied?.
Answer: apply to thigh and rub in for 2 minutes. can transfer for up to 12
hours.
◍ 5. Identify the true statements concerning the role of the inflammation in
aging and disease: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 in pro-inflammatory mediators, including IL-1,
IL-6, IL-8, and TNF-alpha.d. Only a and b are true statements.e. Only a and
c are true statements..
Answer: 5. e (the 2 major classes of inflammatory messengers are
prostaglandins and leukotrienes)
◍ 6. Identify the true statements concerning lifestyle (non-pharmacological)
approaches in hypertensive patients:a. A large percentage of essential HTN
patients may be appropriate candidates, as long as blood pressure is
evaluated and clinical target organ damage, clinical CVD, DM, or
significant risk factors are not present at the time of diagnosis and do not
develop later.b. Optimum nutrition, antioxidants, vitamins, and minerals are
counter indicated in patients taking antihypertensive drugs.c.
Non-pharmacological approaches to HTN are not valuable in patients with
normal B
P. d. A, b, c are true statements.e. None of the above are true statements..
Answer: 6. ab. ...may provide excellent adjunctive treatment...c. ...should be
encouraged...
◍ 7. Identify the true statements concerning the role of increased oxidative
stress in HTN:a. Increases oxidative stress is due to increased generation of
ROS with a suppressed response to RO
, S. b. Arachidonic acid metabolites do not contribute to increased levels or
RO
S. c. A reduced antioxidant reserve results from lower intracellular,
extracellular, enzymatic, and non-enzymatic antioxidants.d. a, b, and c are
true statementse. None of the above are true statements..
Answer: 7. ca. ...an exacerbated...b. ...do contribute....
◍ 8. Identify the true statements concerning protein intake and effect on BP:a.
Studies have demonstrated a consistent association between high protein
intake and reduction in B
P. b. Studies have demonstrated that non-animal protein is more effective
than animal protein, in reducing B
P. c. Bovine casein-derived peptides and whey protein-derived peptides
exhibit angiotensin-converting enzyme inhibitor (ACEI) activity.d. Sardine
muscle protein contains valyl-tyrosine (VAL-TYR), found to significantly
lower BP in HTN subjects.e. All of the above..
Answer: 8. e
◍ 9. Identify the true statements concerning the mechanism of action of
omega-3 and PUFA on BP:a. Suppress nitric oxide (NO)b. Decreases
leukotrienesc. Reduces glycogen storaged. Suppresses glucose uptakee.
Increases plasma norepinephrine.
Answer: 9. ba. stimulates NOc. increases glycogen storaged. increases
glucose uptakee. reduces plasma norepi
◍ hormonal holiday.
Answer: after patient has been on hormones for 6 months, must take holiday
every month. 1. take hormones monday to saturday. none on sunday.2. take
hormones days 1-25 and 4 days off. 3. if patient wishes to cycle then take all
hormones including T every day except for progesterone days 14-25 (mock
cycling)
◍ estrogen and progesterone replacement therapy is contraindicated in which
patients?.
Answer: history of hormonally related cancer- breast, ovarian, uterine
, ◍ how to lower excess levels of estrogen?.
Answer: improve phase I and phase II detox in the liver, exercise, lower
dose of estrogen replacement, weight loss
◍ 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)..
Answer: 10. ea. consume 10b. Consume mod high protein 1.5-1.8
g.kg/dayc/d. 60 min daily with aerobic and resistance training
◍ estrone.
Answer: E1
◍ estradiol.
Answer: E2
◍ estriol.
Answer: E3
◍ For questions 11-13, match the description of the neurological/cognitive
diagnostic method with the name of the diagnostic: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.13. A measure of the body's
oxidative stress state, elevated levels have been demonstrated in
schizophrenia and mild cognitive impairment (MCI).a. Apo E4 proteinb.
CRPc. Vitamin D3d. Homocysteinee. Lipid peroxides (malondialdehyde).
Answer: 11. b12. d13. e
◍ 14. Identify the true statements concerning inflammation in cognitive and
neurodegenerative diseases:a. Interplay of immune response activation and
QUESTIONS WITH ANSWERS GRADED
A+
◍ where is estrogen produced?.
Answer: ovaries
◍ Where is DHEA produced?.
Answer: adrenal gland
◍ 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 statementse. Only a and b are true
statements.
Answer: 1. d
◍ estrogen can also be made from?.
Answer: DHEA
◍ estrogen should always be prescribed which route?.
Answer: transdermallyNOT PO- inflammatory
◍ For questions 2-4, match the property of the therapeutic compound, with its
correct name: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 D3 c. Vitamin E
d. CoEnzyme Q10 e. EPA/DHA.
Answer: 2. a3. e4. b
◍ how should transdermal estrogen be applied?.
Answer: apply to thigh and rub in for 2 minutes. can transfer for up to 12
hours.
◍ 5. Identify the true statements concerning the role of the inflammation in
aging and disease: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 in pro-inflammatory mediators, including IL-1,
IL-6, IL-8, and TNF-alpha.d. Only a and b are true statements.e. Only a and
c are true statements..
Answer: 5. e (the 2 major classes of inflammatory messengers are
prostaglandins and leukotrienes)
◍ 6. Identify the true statements concerning lifestyle (non-pharmacological)
approaches in hypertensive patients:a. A large percentage of essential HTN
patients may be appropriate candidates, as long as blood pressure is
evaluated and clinical target organ damage, clinical CVD, DM, or
significant risk factors are not present at the time of diagnosis and do not
develop later.b. Optimum nutrition, antioxidants, vitamins, and minerals are
counter indicated in patients taking antihypertensive drugs.c.
Non-pharmacological approaches to HTN are not valuable in patients with
normal B
P. d. A, b, c are true statements.e. None of the above are true statements..
Answer: 6. ab. ...may provide excellent adjunctive treatment...c. ...should be
encouraged...
◍ 7. Identify the true statements concerning the role of increased oxidative
stress in HTN:a. Increases oxidative stress is due to increased generation of
ROS with a suppressed response to RO
, S. b. Arachidonic acid metabolites do not contribute to increased levels or
RO
S. c. A reduced antioxidant reserve results from lower intracellular,
extracellular, enzymatic, and non-enzymatic antioxidants.d. a, b, and c are
true statementse. None of the above are true statements..
Answer: 7. ca. ...an exacerbated...b. ...do contribute....
◍ 8. Identify the true statements concerning protein intake and effect on BP:a.
Studies have demonstrated a consistent association between high protein
intake and reduction in B
P. b. Studies have demonstrated that non-animal protein is more effective
than animal protein, in reducing B
P. c. Bovine casein-derived peptides and whey protein-derived peptides
exhibit angiotensin-converting enzyme inhibitor (ACEI) activity.d. Sardine
muscle protein contains valyl-tyrosine (VAL-TYR), found to significantly
lower BP in HTN subjects.e. All of the above..
Answer: 8. e
◍ 9. Identify the true statements concerning the mechanism of action of
omega-3 and PUFA on BP:a. Suppress nitric oxide (NO)b. Decreases
leukotrienesc. Reduces glycogen storaged. Suppresses glucose uptakee.
Increases plasma norepinephrine.
Answer: 9. ba. stimulates NOc. increases glycogen storaged. increases
glucose uptakee. reduces plasma norepi
◍ hormonal holiday.
Answer: after patient has been on hormones for 6 months, must take holiday
every month. 1. take hormones monday to saturday. none on sunday.2. take
hormones days 1-25 and 4 days off. 3. if patient wishes to cycle then take all
hormones including T every day except for progesterone days 14-25 (mock
cycling)
◍ estrogen and progesterone replacement therapy is contraindicated in which
patients?.
Answer: history of hormonally related cancer- breast, ovarian, uterine
, ◍ how to lower excess levels of estrogen?.
Answer: improve phase I and phase II detox in the liver, exercise, lower
dose of estrogen replacement, weight loss
◍ 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)..
Answer: 10. ea. consume 10b. Consume mod high protein 1.5-1.8
g.kg/dayc/d. 60 min daily with aerobic and resistance training
◍ estrone.
Answer: E1
◍ estradiol.
Answer: E2
◍ estriol.
Answer: E3
◍ For questions 11-13, match the description of the neurological/cognitive
diagnostic method with the name of the diagnostic: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.13. A measure of the body's
oxidative stress state, elevated levels have been demonstrated in
schizophrenia and mild cognitive impairment (MCI).a. Apo E4 proteinb.
CRPc. Vitamin D3d. Homocysteinee. Lipid peroxides (malondialdehyde).
Answer: 11. b12. d13. e
◍ 14. Identify the true statements concerning inflammation in cognitive and
neurodegenerative diseases:a. Interplay of immune response activation and
