A4M EXAM 2026 EXAM SCRIPT WITH FULL
ANSWERS
◉ What is the mechanism of action of migraine headache? Answer:
Extreme cerebral vasoconstriction followed by vaso-dilatation
◉ Which neuro-transmitter deficiencies have been implicated in the
development of migraine headaches? Answer: GABA and serotonin
◉ T or F: thymectomy is recommended for treatment of myasthenia
gravis Answer: False; current evidence does not support thymus
removal due to risks of surgery and lack of evidence; however, 70%
of patients with myasthenia gravis have thymus hypertrophy and
10-15% have thymomas. IVIG may be helpful for management of
myasthenia gravis.
◉ T or F: many of the pharmacologic treatment options for
demential increase homocysteine levels, which may directly
contribute to cognitive decline Answer: T
◉ T or F: consumption of milk > 16 oz / day over a 30 year time
period leads to a 230% increased risk of Alzheimer's disease
Answer: T
,◉ Which areas of the brain are affected in a SPECT scan of a patient
with Alzheimer's disease? Answer: Posterior cingulate gyrus;
parietal and temporal lobes
◉ What area of the brain is affected in a SPECT scan of a patient with
Lewy Body dementia? Answer: Occipital lobe
◉ T or F: IGG to periodontal bacteria is elevated in patients with
dementia Answer: True
◉ What abnormalities are found in the brain on autopsy of patients
with Alzheimer's disease? Answer: Beta-amyloid plaque and neuro-
fibrillary tangles. Neurofibrillary tangles are formed from mutations
on tau protein. Beta-amyloid plaques are formed from breakdown of
APP (amyloid precursor protein). Beta amyloid causes destruction in
brain parenchyma by combining with salt and water in the brain. It
also causes influx of calcium into neurons, leading to apoptosis.
◉ Type of dementia associated with protein deposits known as
alpha-synuclein; visual hallucinations; low dopamine levels Answer:
Lewy body dementia
◉ What is mechanism for brain injury from concussion? Answer: -
Excitotoxic reaction mediated by increased extracellular glutamate /
aspartate and increased intracellular calcium
,- Microglia (normally dormant) become activated and release ROS;
inflammatory prostaglandins; cytokines and chemokines
- High levels of extracellular glutamate reduce astrocytic glutathione
◉ Type of dementia most commonly caused by abnormalities on tau
protein. Characterized by uninhibited behavior, primary aphasia,
lack of insight Answer: Frontal Lobe Dementia
◉ What area of the adrenal gland are the sex hormones produced?
Answer: Zona reticularis
◉ Where is aldosterone produced in adrenal gland? Answer: Zona
granulosa (outer layer)
◉ T or F: both Curcumin and Resveratrol cross the BBB and are
helpful in treatment of both TBI and dementia Answer: True.
Resveratrol improves beta amyloid clearance from brain.
◉ How many genes do humans have? Answer: Humans have 23,000
genes - only 1.5% of which code for proteins
◉ Which estrogen metabolite is protective against breast and
ovarian cancer? Answer: 2 methoxy estrone
, ◉ T or F: High blood insulin levels inhibit the conversion of
saturated fatty acids to MUFA's, leading to elevated blood
triglycerides Answer: True
◉ What is the first sign of pancreatic insufficiency? Answer:
Deficiency in pancreatic lipase or elastase.
◉ How do nutrients such as carnosine and vitamin B1 help to
reduce HA1c? Answer: Interferes with glycosylation of proteins
◉ What is Type 2 hypothyroidism? Answer: Reduction in thyroid
hormone receptor sensitivity - associated with normal serum levels
of all thyroid hormones but sx of hypothyroidism. Receptor
sensitivity can be affected by iron levels and Vitamin D.
◉ Which nutrients impact T4 to T3 conversion? Answer: Selenium,
zinc
◉ T or F: serum calcium levels are an accurate predictor of bodily
calcium stores Answer: False. Serum calcium is tightly regulated by
PTH, calcitonin, Vitamin D. If serum calcium is low, bone will be
resorbed to replete levels.
◉ Which element is present in highest amount in the human body?
Answer: calcium (total body calcium = 1000 grams)
ANSWERS
◉ What is the mechanism of action of migraine headache? Answer:
Extreme cerebral vasoconstriction followed by vaso-dilatation
◉ Which neuro-transmitter deficiencies have been implicated in the
development of migraine headaches? Answer: GABA and serotonin
◉ T or F: thymectomy is recommended for treatment of myasthenia
gravis Answer: False; current evidence does not support thymus
removal due to risks of surgery and lack of evidence; however, 70%
of patients with myasthenia gravis have thymus hypertrophy and
10-15% have thymomas. IVIG may be helpful for management of
myasthenia gravis.
◉ T or F: many of the pharmacologic treatment options for
demential increase homocysteine levels, which may directly
contribute to cognitive decline Answer: T
◉ T or F: consumption of milk > 16 oz / day over a 30 year time
period leads to a 230% increased risk of Alzheimer's disease
Answer: T
,◉ Which areas of the brain are affected in a SPECT scan of a patient
with Alzheimer's disease? Answer: Posterior cingulate gyrus;
parietal and temporal lobes
◉ What area of the brain is affected in a SPECT scan of a patient with
Lewy Body dementia? Answer: Occipital lobe
◉ T or F: IGG to periodontal bacteria is elevated in patients with
dementia Answer: True
◉ What abnormalities are found in the brain on autopsy of patients
with Alzheimer's disease? Answer: Beta-amyloid plaque and neuro-
fibrillary tangles. Neurofibrillary tangles are formed from mutations
on tau protein. Beta-amyloid plaques are formed from breakdown of
APP (amyloid precursor protein). Beta amyloid causes destruction in
brain parenchyma by combining with salt and water in the brain. It
also causes influx of calcium into neurons, leading to apoptosis.
◉ Type of dementia associated with protein deposits known as
alpha-synuclein; visual hallucinations; low dopamine levels Answer:
Lewy body dementia
◉ What is mechanism for brain injury from concussion? Answer: -
Excitotoxic reaction mediated by increased extracellular glutamate /
aspartate and increased intracellular calcium
,- Microglia (normally dormant) become activated and release ROS;
inflammatory prostaglandins; cytokines and chemokines
- High levels of extracellular glutamate reduce astrocytic glutathione
◉ Type of dementia most commonly caused by abnormalities on tau
protein. Characterized by uninhibited behavior, primary aphasia,
lack of insight Answer: Frontal Lobe Dementia
◉ What area of the adrenal gland are the sex hormones produced?
Answer: Zona reticularis
◉ Where is aldosterone produced in adrenal gland? Answer: Zona
granulosa (outer layer)
◉ T or F: both Curcumin and Resveratrol cross the BBB and are
helpful in treatment of both TBI and dementia Answer: True.
Resveratrol improves beta amyloid clearance from brain.
◉ How many genes do humans have? Answer: Humans have 23,000
genes - only 1.5% of which code for proteins
◉ Which estrogen metabolite is protective against breast and
ovarian cancer? Answer: 2 methoxy estrone
, ◉ T or F: High blood insulin levels inhibit the conversion of
saturated fatty acids to MUFA's, leading to elevated blood
triglycerides Answer: True
◉ What is the first sign of pancreatic insufficiency? Answer:
Deficiency in pancreatic lipase or elastase.
◉ How do nutrients such as carnosine and vitamin B1 help to
reduce HA1c? Answer: Interferes with glycosylation of proteins
◉ What is Type 2 hypothyroidism? Answer: Reduction in thyroid
hormone receptor sensitivity - associated with normal serum levels
of all thyroid hormones but sx of hypothyroidism. Receptor
sensitivity can be affected by iron levels and Vitamin D.
◉ Which nutrients impact T4 to T3 conversion? Answer: Selenium,
zinc
◉ T or F: serum calcium levels are an accurate predictor of bodily
calcium stores Answer: False. Serum calcium is tightly regulated by
PTH, calcitonin, Vitamin D. If serum calcium is low, bone will be
resorbed to replete levels.
◉ Which element is present in highest amount in the human body?
Answer: calcium (total body calcium = 1000 grams)
