A4M Certification Study Guide | Anti-Aging
& Functional Medicine Review | Board Exam
Preparation
Question 1
how to lower high estrogen levels in males?
Correct Answer
decrease T dose
zinc
chrysin
anastrozole and other aromatase inhibitors
maca
grape see extract
wild nettle root
decrease alcohol
lose weight
resveratrol
high dose vit C
niacin
Question 2
what controls awake and asleep BP?
Correct Answer
Awake BP controlled by SNS
Asleep BP controlled by RAAS and SNS
Page 1 of 109
,Question 3
macrophages convert between 2 major phenotypic expressions- M1 and M2
Correct Answer
M1 expression=proinflammatory state, secrete cytokines, chemokines
M2 expression- antiinflammatory stance designed for clean-up of apoptotic
neutrophiles and induce resolution of the inflammatory response through activation
of G protein coupled receptors
Question 4
secondary source of brain inflammation: MARCoNS
Correct Answer
multiple antibiotic resistant coagulase negative Staph
colonized in mucosal membrane surfaces with minimal diffculty dt the MSH
deficient state in CIRS patients
Question 5
severity of insulin resistance
Correct Answer
If FBS high-normal (over 85 mg/dL) the risk of the patient dying of cardiovascular
disease is increased by 40%. Also increased risk of vascular death. May account for a
6 to 10% decrease in the volume of the hippocampus and amygdala.
Insulin resistance is a risk factor for cognitive decline.
Question 6
nocturnal non dipping treatment
Correct Answer
coreg and bystolic are only BB that will convert but best tx: ACE ARB and CCB
Page 2 of 109
,Question 7
Ginkgo Biloba
Correct Answer
a blood thinner so do not use in patients taking a prescription blood thinner or
mattokinase or in patients that have diseases that thinning the blood may be a
problem
Question 8
matrix metalloprotenase (MMP-9)
Correct Answer
proteases help remodel brain by digesting collagen components and play a role in
movement of inflammatory cells into CNS by causing disruption in BBB, MS patients
have higher levels
Question 9
use as main diagnostic variables to assess for CIRS inflammation
Correct Answer
matrix metalloproteinase 9 (MMP-9), transforming growth factor beta, and C4a-
Question 10
DHEA is made by?
Correct Answer
adrenal glands and some made by brain and skin
DHEA makes estrogen and testosterone
Question 11
Vanadium
Correct Answer
essential trace mental. 10-50 mcg. Improves insulin sensitivity. Exacerbations of
bipolar disorder may be a side effect.
Page 3 of 109
, Question 12
Where is DHEA produced?
Correct Answer
adrenal gland
Question 13
testosterone dosing in males
Correct Answer
Compounded cream is preferred method
5-50 mg cream
May compound chrysin in the same syringe with testosterone. Chrysin is a natural
aromatase inhibitor to lower estrogen levels. Male skin has higher concentration of
aromatase enzyme on the surface. Chrysin has a natural yellow color, does not stain
skin. Dose of chrysin depends on the level of estrone or estradiol- usually 5-50 mg
cream. Cannot put chrysin in a gel base. May compound progesterone in the same
syringe as t and chrysin.
Question 14
PPI and CHD risk
Correct Answer
PPIs elevate ADMA
decrease NO
Inhibit DDAH ( dimethylarginine
dimethylaminohydrolase enzyme) that degrades
ADMA.
• Impairs acid production in endothelial cell lysosomes
that prevent waste removal and accelerate
endothelial cell aging
• Increases risk for CHD
• Also increase risk for CKD
Page 4 of 109
& Functional Medicine Review | Board Exam
Preparation
Question 1
how to lower high estrogen levels in males?
Correct Answer
decrease T dose
zinc
chrysin
anastrozole and other aromatase inhibitors
maca
grape see extract
wild nettle root
decrease alcohol
lose weight
resveratrol
high dose vit C
niacin
Question 2
what controls awake and asleep BP?
Correct Answer
Awake BP controlled by SNS
Asleep BP controlled by RAAS and SNS
Page 1 of 109
,Question 3
macrophages convert between 2 major phenotypic expressions- M1 and M2
Correct Answer
M1 expression=proinflammatory state, secrete cytokines, chemokines
M2 expression- antiinflammatory stance designed for clean-up of apoptotic
neutrophiles and induce resolution of the inflammatory response through activation
of G protein coupled receptors
Question 4
secondary source of brain inflammation: MARCoNS
Correct Answer
multiple antibiotic resistant coagulase negative Staph
colonized in mucosal membrane surfaces with minimal diffculty dt the MSH
deficient state in CIRS patients
Question 5
severity of insulin resistance
Correct Answer
If FBS high-normal (over 85 mg/dL) the risk of the patient dying of cardiovascular
disease is increased by 40%. Also increased risk of vascular death. May account for a
6 to 10% decrease in the volume of the hippocampus and amygdala.
Insulin resistance is a risk factor for cognitive decline.
Question 6
nocturnal non dipping treatment
Correct Answer
coreg and bystolic are only BB that will convert but best tx: ACE ARB and CCB
Page 2 of 109
,Question 7
Ginkgo Biloba
Correct Answer
a blood thinner so do not use in patients taking a prescription blood thinner or
mattokinase or in patients that have diseases that thinning the blood may be a
problem
Question 8
matrix metalloprotenase (MMP-9)
Correct Answer
proteases help remodel brain by digesting collagen components and play a role in
movement of inflammatory cells into CNS by causing disruption in BBB, MS patients
have higher levels
Question 9
use as main diagnostic variables to assess for CIRS inflammation
Correct Answer
matrix metalloproteinase 9 (MMP-9), transforming growth factor beta, and C4a-
Question 10
DHEA is made by?
Correct Answer
adrenal glands and some made by brain and skin
DHEA makes estrogen and testosterone
Question 11
Vanadium
Correct Answer
essential trace mental. 10-50 mcg. Improves insulin sensitivity. Exacerbations of
bipolar disorder may be a side effect.
Page 3 of 109
, Question 12
Where is DHEA produced?
Correct Answer
adrenal gland
Question 13
testosterone dosing in males
Correct Answer
Compounded cream is preferred method
5-50 mg cream
May compound chrysin in the same syringe with testosterone. Chrysin is a natural
aromatase inhibitor to lower estrogen levels. Male skin has higher concentration of
aromatase enzyme on the surface. Chrysin has a natural yellow color, does not stain
skin. Dose of chrysin depends on the level of estrone or estradiol- usually 5-50 mg
cream. Cannot put chrysin in a gel base. May compound progesterone in the same
syringe as t and chrysin.
Question 14
PPI and CHD risk
Correct Answer
PPIs elevate ADMA
decrease NO
Inhibit DDAH ( dimethylarginine
dimethylaminohydrolase enzyme) that degrades
ADMA.
• Impairs acid production in endothelial cell lysosomes
that prevent waste removal and accelerate
endothelial cell aging
• Increases risk for CHD
• Also increase risk for CKD
Page 4 of 109
