FUNCTIONAL MEDICINE FINAL EXAM
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) 2025/2026 |
ALREADY GRADED A+
What are the primary organic acid abnormalities that occur in carnitine deficiency? --
CORRECT-- -adipate
-suberate
-ethylmalonate
What patterns of abnormalities discriminate mitochondrial inefficiency from ammonia
challenge as a cause of citric acid elevation? --CORRECT-- -high citrate, aconitate,
isocitrate
+ orotate indicates ammonia challenges
-wihtout orotate= mitochondrial inefficiency
What patterns suggest a deficiency of CoQ10? --CORRECT-- -High succinate, fumarate,
malate, HMG
-OR low HMG
What do A-ketoisovalerate, A-ketoisocaproate,
A-keto-B-methylvalerate measure? --CORRECT-- -Markers for branched chain keto
acids
-elevations indicate B complex need and/or lipoic acid
What does B-hydroxyisovalerate indicate? --CORRECT-- BCKAs and (more
specifically) biotin need
Homocysteine is a marker for which 3 B vitamins? --CORRECT-- B6, B9, B12
What markers help narrow down B6 deficiency? --CORRECT-- Xanthurenate and/or
kynurenate
--both elevated = B6 def
-Xanthurenate > kynurenate
,What nutritional marker is FIGLU significant in identifying? --CORRECT-- -High= folate
need
-Low= histidine and/or amino acid nee
What nutritional marker is MMA significant in identifying? --CORRECT-- B12
, Which neurotransmitters are associated with VMA, HVA, 5HIAA? --CORRECT--
Dopamine, norepinephrine, epinephrine
What does high VMA indicate? --CORRECT-- -Chronic stress response
-Heightened sympathetic reactions to stress
-Increased rate of catecholamine synthesis
-Ephedra, caffeine
-Hypertension
-GI dysfunction, headaches, decreased immunity, anxiety, fatigue, sleep probs
What does low VMA indicate? --CORRECT-- -Low levels of epi or norep.
-Adrenal insufficiency
-Tyrosine insufficiency (cofactor for NT prod.)
-Depression, sleep probs, anxiety, fatigue
What does high HVA indicate? --CORRECT-- -Dopamine catabolism
-EAA def.
-Copper def. if VMA is low
-Inadequate vit. C
-Agitation, ADD/ADHD
-L-dopa med.
What does low HVA indicate? --CORRECT-- -Chronic stress
-Depression, sleep probs, anxiety, fatigue, ADD/ADHD
What does high 5HIAA indicate? --CORRECT-- -Excessive serotonin turnover in the gut
and brain
-Use of SSRIs
-Supp with 5HTP or tryptophan
-Increased releases of serotonin
-Depression, osteoporosis, IBS (motility issues)
What does low 5HIAA indicate? --CORRECT-- -Low serotonin production
-Tryptophan def.
-IBS, depression, fatigue, insomnia, ADD/ADHD
-Potentially low cofactors (B6, B2, Cu)
What OA elevation may justify specifically aggressive vitamin C supplementation? --
CORRECT-- Elevated p-hydroxyphenyllactic acid (marker for tumor growth) and the
concomitant elevated cell division rate stimulation that tends to produce systemic
oxidative stress.
How does glutathione biosynthesis (from HCYs) relate to the organic acid marker 8-
OHdG? --CORRECT-- -Failure of the reciprocal regulation between transmethylation
and transsulfuration of Hcys can impair up-regulation of hepatic glutathione synthesis as
the
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) 2025/2026 |
ALREADY GRADED A+
What are the primary organic acid abnormalities that occur in carnitine deficiency? --
CORRECT-- -adipate
-suberate
-ethylmalonate
What patterns of abnormalities discriminate mitochondrial inefficiency from ammonia
challenge as a cause of citric acid elevation? --CORRECT-- -high citrate, aconitate,
isocitrate
+ orotate indicates ammonia challenges
-wihtout orotate= mitochondrial inefficiency
What patterns suggest a deficiency of CoQ10? --CORRECT-- -High succinate, fumarate,
malate, HMG
-OR low HMG
What do A-ketoisovalerate, A-ketoisocaproate,
A-keto-B-methylvalerate measure? --CORRECT-- -Markers for branched chain keto
acids
-elevations indicate B complex need and/or lipoic acid
What does B-hydroxyisovalerate indicate? --CORRECT-- BCKAs and (more
specifically) biotin need
Homocysteine is a marker for which 3 B vitamins? --CORRECT-- B6, B9, B12
What markers help narrow down B6 deficiency? --CORRECT-- Xanthurenate and/or
kynurenate
--both elevated = B6 def
-Xanthurenate > kynurenate
,What nutritional marker is FIGLU significant in identifying? --CORRECT-- -High= folate
need
-Low= histidine and/or amino acid nee
What nutritional marker is MMA significant in identifying? --CORRECT-- B12
, Which neurotransmitters are associated with VMA, HVA, 5HIAA? --CORRECT--
Dopamine, norepinephrine, epinephrine
What does high VMA indicate? --CORRECT-- -Chronic stress response
-Heightened sympathetic reactions to stress
-Increased rate of catecholamine synthesis
-Ephedra, caffeine
-Hypertension
-GI dysfunction, headaches, decreased immunity, anxiety, fatigue, sleep probs
What does low VMA indicate? --CORRECT-- -Low levels of epi or norep.
-Adrenal insufficiency
-Tyrosine insufficiency (cofactor for NT prod.)
-Depression, sleep probs, anxiety, fatigue
What does high HVA indicate? --CORRECT-- -Dopamine catabolism
-EAA def.
-Copper def. if VMA is low
-Inadequate vit. C
-Agitation, ADD/ADHD
-L-dopa med.
What does low HVA indicate? --CORRECT-- -Chronic stress
-Depression, sleep probs, anxiety, fatigue, ADD/ADHD
What does high 5HIAA indicate? --CORRECT-- -Excessive serotonin turnover in the gut
and brain
-Use of SSRIs
-Supp with 5HTP or tryptophan
-Increased releases of serotonin
-Depression, osteoporosis, IBS (motility issues)
What does low 5HIAA indicate? --CORRECT-- -Low serotonin production
-Tryptophan def.
-IBS, depression, fatigue, insomnia, ADD/ADHD
-Potentially low cofactors (B6, B2, Cu)
What OA elevation may justify specifically aggressive vitamin C supplementation? --
CORRECT-- Elevated p-hydroxyphenyllactic acid (marker for tumor growth) and the
concomitant elevated cell division rate stimulation that tends to produce systemic
oxidative stress.
How does glutathione biosynthesis (from HCYs) relate to the organic acid marker 8-
OHdG? --CORRECT-- -Failure of the reciprocal regulation between transmethylation
and transsulfuration of Hcys can impair up-regulation of hepatic glutathione synthesis as
the
