ORIGINAL – IHP Examination – MCQ and Case Study Questions _ removed

Choose the correct definition of functional medicine:

Which physiological system links with the immune system, inflammation and microbiota in the functional medicine matrix?

In the context of functional medicine, which of the following defines genetic or acquired factors that predispose individuals to an illness or pattern?

Which of the following is NOT associated with functional medicine?

Which of the following correctly describes the functional medicine operating system acronym GO TO IT?

Which of the following hormones stimulates the production of hydrochloric acid by parietal cells and pepsinogen by chief cells?

Choose the enzyme responsible for the breakdown of sugars:

Which two endogenous antibacterial proteins are markers for IBD and not IBS?

Which of the following enzymes is an indicator of overall enzyme production?

Choose the correct order to implement the 6R approach to repair the gastrointestinal tract?

An elevated cortisol/DHEA ratio can lead to:

Choose the following 24hr urinary excretion cortisol test result that is normal when screening for Cushing’s Syndrome:

Which of the following from the Adrenal Stress Index Panel evaluates the toll of stress on immunity?

Choose the nutritional supplement that helps reset circadian rhythm for improved sleep and for normalising cortisol peak:

Identify the vitamin required for the formation of BH4, which is necessary for the synthesis of serotonin, dopamine, norepinephrine and epinephrine:

Which gland controls the amount of calcium in the body?

Which of the following is the most potent form of oestrogen?

Identify the effect of progesterone:

Which of the following drugs inhibits TSH secretion?

Which two metals are required for the proper binding of S-adenosyl-L-methionine (SAMe)?

Identify the adrenergic receptor responsible for vasoconstriction:

Which of the following muscarinic receptors is located in the substantia nigra?

Identify the marker associated with inflammation in coronary artery walls:

Which of the following contains quercetin and anthocyanins, which may reduce inflammation and protect against heart disease and cancer?

Which compound used in Diabetes treatment may have interactions with antibiotics, diltiazem, digoxin, verapamil and nelfinavir?

Which of the following increases intracellular glutathione production?

Identify the food that supports lung detoxification:

Which of the following supports colon detoxification?

Choose the option associated with elevated alpha-fetoprotein levels:

Which ratio is a dynamic indicator of oxidative stress within an organism?

Which of the following is classified as an endocannabinoid?

Which disease is associated with damage of dopamine producing cells in the substantia nigra of the brainstem?

Which of the following is an integrative neurological investigation?

Identify the urinary biomarker for neuropsychiatric disorders:

Which substance is associated with olfactory and neural growth stimulation?

Identify the substrate that interferes with ATP synthase / Complex-V in the electron transport chain:

Which of the following environmental toxins blocks ubiquinone from binding to Complex I of the electron transport chain?

Which of the following pharmaceuticals inhibits Complex I of the electron transport chain?

Which food is rich in magnesium and helps regulate and optimise communication in the brain-adrenal axis?

Identify the nutrient that provides basic mitochondrial support:

Which of the following cells is a precursor of plasma cells?

Which of the following components of the complement pathway is involved in initiating inflammation and leukocyte recruitment?

Which of the following botanicals contains polyphenols and may be utilised to suppress IgE antibody formation, inhibit mast cell degranulation, and inhibit histamine release?

When conducting SIBO testing, which one of these gases is measured in a breath sample?

Which food would you recommend to increase dietary selenium for post vaccine support?

Which of the following botanicals, containing a component P57, would you recommend to suppress appetite?

Which of the following adipokines promotes angiogenesis locally in adipose tissue, and has metabolic actions in the muscle?

Identify the molecule that binds melanocortin-4 receptors in the hypothalamic paraventricular nucleus causing decreased food intake:

Which of the following is an anti-hypertensive drug that may lead to weight gain ?

Identify the protein synthesised in the brain that stimulates feeding behaviour:

Which of the following supplements would you prescribe to a patient for fibromyalgia pain management?

Identify the botanical that may be used to treat plantar heel pain:

Which of the following would you prescribe to a patient to induce vascular dilation via NO (nitric oxide)?

Which of the following markers is associated with leaky gut?

Which of the following diseases is associated with neuropathic pain?

Which epigenetic modification is linked to the tumour invasion and metastasis pathway?

What type of cancer is a patient likely to have if they have a mutation in the KRAS gene?

Which of the following relates to epigenetic control?

Statins cause nutrient depletion by lowering levels of:

Which cannabinoid compound has been shown to decrease proliferation in the human breast cancer cell line, MCF-7?

Sandra works a full day job as an office secretary at a marketing firm. She has two children below the age of four. She has been a single mother for the past three years. Sandra complains that her days are stressful at work, and her children give her a hard time when she gets home at night.

She misses time to herself, socialising with friends, and engaging in her favourite hobbies which often help her relax. Most nights, the kids wake her up, making it difficult for her to sleep well. She does not find time to exercise, but tries to maintain a healthy diet by being conscious of her food choices.

Her main complaint is a constant state of irritability, aching muscles, and trouble with her digestive system. She suffers from constant headaches and fatigue daily. She often forgets important things, experiences brain fog and an inability to concentrate.

List three possible mediators/perpetuators experienced by Sandra that we can add to the functional medicine timeline. (3 marks)

Sandra works a full day job as an office secretary at a marketing firm. She has two children below the age of four. She has been a single mother for the past three years. Sandra complains that her days are stressful at work, and her children give her a hard time when she gets home at night.

She misses time to herself, socialising with friends, and engaging in her favourite hobbies which often help her relax. Most nights, the kids wake her up, making it difficult for her to sleep well. She does not find time to exercise, but tries to maintain a healthy diet by being conscious of her food choices.

Her main complaint is a constant state of irritability, aching muscles, and trouble with her digestive system. She suffers from constant headaches and fatigue daily. She often forgets important things, experiences brain fog and an inability to concentrate.

List a physiological imbalance present in Sandra, along with an integrative test that may be useful in determining the imbalance. (2 marks)

Steve is a 28 year old who recently got a job as a car salesman at a well known dealership in the city. Ever since a young age, he has been obese and this led to his trouble with social situations. He still lives with his parents, and does not have a partner. He smokes daily, and has been doing so for the past 6 years. He is often an emotional eater, but tries to get physical activity once a week by walking around the block.

As a child he experienced asthma, which progressed into adulthood. In addition, he has diabetes. His main concern is his consistent weight gain which he cannot seem to control with physical activity. Because of his consistent weight gain, he has fallen into a depressive state and does not have motivation to exercise. At work, he sometimes faces anxiety when meeting different people everyday. He also experiences abdominal pain, pain in his knee joints and ankles. He never feels fully satiated with his meals and tends to overeat.

List two modifiable lifestyle factors that Steve could change in order to improve his situation. (2 marks)

Steve is a 28 year old who recently got a job as a car salesman at a well known dealership in the city. Ever since a young age, he has been obese and this led to his trouble with social situations. He still lives with his parents, and does not have a partner. He smokes daily, and has been doing so for the past 6 years. He is often an emotional eater, but tries to get physical activity once a week by walking around the block.

As a child he experienced asthma, which progressed into adulthood. In addition, he has diabetes. His main concern is his consistent weight gain which he cannot seem to control with physical activity. Because of his consistent weight gain, he has fallen into a depressive state and does not have motivation to exercise. At work, he sometimes faces anxiety when meeting different people everyday. He also experiences abdominal pain, pain in his knee joints and ankles. He never feels fully satiated with his meals and tends to overeat.

Name three anti-inflammatory foods that can be included in an anti-inflammatory diet to help Steven: (3 marks)

Joyce is a 35 year old female who has recently experienced a significant decrease in her ability to perform mentally, even after having concentration issues since childhood. Her parents divorced when she was 6 years old, leading her to become emotionally attached to her mother. At the age of 15 years, her mother passed away from kidney failure and her anxiety worsened. She manifested OCD behaviours and restricted her eating. She developed anorexia and was admitted into a rehabilitation centre. Throughout this process, she placed blame on herself and often felt ashamed.

After living with extended family, where she did not feel a sense of comfort, she moved cities and went to university to study business administration. She became dependent on alcohol to relieve her feelings of stress and anxiety. She met her life partner in the last year of university and got married a year later. After working for two years and being married for three, stress still caused her to drink continuously. With her partner working long distances at times, she feels alone and experiences insomnia. She relapsed into her eating disorder and still experiences poor concentration, frequent mood swings, brain fog and anxiety.

List at least 4 triggering events in Joyce’s life that provokes her symptoms and signs of illness: (2 marks)

Joyce is a 35 year old female who has recently experienced a significant decrease in her ability to perform mentally, even after having concentration issues since childhood. Her parents divorced when she was 6 years old, leading her to become emotionally attached to her mother. At the age of 15 years, her mother passed away from kidney failure and her anxiety worsened. She manifested OCD behaviours and restricted her eating. She developed anorexia and was admitted into a rehabilitation centre. Throughout this process, she placed blame on herself and often felt ashamed.

After living with extended family, where she did not feel a sense of comfort, she moved cities and went to university to study business administration. She became dependent on alcohol to relieve her feelings of stress and anxiety. She met her life partner in the last year of university and got married a year later. After working for two years and being married for three, stress still caused her to drink continuously. With her partner working long distances at times, she feels alone and experiences insomnia. She relapsed into her eating disorder and still experiences poor concentration, frequent mood swings, brain fog and anxiety.

Name and provide support for a stress management technique that may be helpful for Joyce’s anxiety: (1 mark)

Joyce is a 35 year old female who has recently experienced a significant decrease in her ability to perform mentally, even after having concentration issues since childhood. Her parents divorced when she was 6 years old, leading her to become emotionally attached to her mother. At the age of 15 years, her mother passed away from kidney failure and her anxiety worsened. She manifested OCD behaviours and restricted her eating. She developed anorexia and was admitted into a rehabilitation centre. Throughout this process, she placed blame on herself and often felt ashamed.

After living with extended family, where she did not feel a sense of comfort, she moved cities and went to university to study business administration. She became dependent on alcohol to relieve her feelings of stress and anxiety. She met her life partner in the last year of university and got married a year later. After working for two years and being married for three, stress still caused her to drink continuously. With her partner working long distances at times, she feels alone and experiences insomnia. She relapsed into her eating disorder and still experiences poor concentration, frequent mood swings, brain fog and anxiety.

Why would a low protein diet be beneficial for Joyce? (2 marks)

Harry is a 40 year old male who works as a busy warehouse manager. At the age of 11, he experienced a severe GI infection, and was hospitalised for a week. When he was 18 years of age, his mother passed away from a stroke. He has a three year history of hypertension, which does not stabilise with medication. There is a family history of his paternal grandmother experiencing hypertension. He is a smoker of 20 years and does not have a regular exercise routine.

After visiting a cardiologist, no hyperlipidaemia was detected. ACE inhibitors as well as calcium channel blockers were prescribed. On average, his BP was 136/88. He has no surgical history and takes omega-3 supplements regularly. However, after ingesting the supplements he feels nauseous and often feels bloated after meals. He regularly experiences indigestion, night sweats and leg cramps when resting. He has been married for 15 years and has three young children below the age of 12. He is happy in his marriage and family life, although he does experience the usual stress of everyday life. He has a reduced appetite, but occasionally craves sugary and salty foods.

What integrative lab test could you carry out to identify if Harry has a taurine deficiency? (1 mark)

Harry is a 40 year old male who works as a busy warehouse manager. At the age of 11, he experienced a severe GI infection, and was hospitalised for a week. When he was 18 years of age, his mother passed away from a stroke. He has a three year history of hypertension, which does not stabilise with medication. There is a family history of his paternal grandmother experiencing hypertension. He is a smoker of 20 years and does not have a regular exercise routine.

After visiting a cardiologist, no hyperlipidaemia was detected. ACE inhibitors as well as calcium channel blockers were prescribed. On average, his BP was 136/88. He has no surgical history and takes omega-3 supplements regularly. However, after ingesting the supplements he feels nauseous and often feels bloated after meals. He regularly experiences indigestion, night sweats and leg cramps when resting. He has been married for 15 years and has three young children below the age of 12. He is happy in his marriage and family life, although he does experience the usual stress of everyday life. He has a reduced appetite, but occasionally craves sugary and salty foods.

What triggering event could have influenced the symptoms presently experienced by Harry? (1 mark)

Harry is a 40 year old male who works as a busy warehouse manager. At the age of 11, he experienced a severe GI infection, and was hospitalised for a week. When he was 18 years of age, his mother passed away from a stroke. He has a three year history of hypertension, which does not stabilise with medication. There is a family history of his paternal grandmother experiencing hypertension. He is a smoker of 20 years and does not have a regular exercise routine.

After visiting a cardiologist, no hyperlipidaemia was detected. ACE inhibitors as well as calcium channel blockers were prescribed. On average, his BP was 136/88. He has no surgical history and takes omega-3 supplements regularly. However, after ingesting the supplements he feels nauseous and often feels bloated after meals. He regularly experiences indigestion, night sweats and leg cramps when resting. He has been married for 15 years and has three young children below the age of 12. He is happy in his marriage and family life, although he does experience the usual stress of everyday life. He has a reduced appetite, but occasionally craves sugary and salty foods.

List and describe the possible treatment steps for Harry in the CORRECT ORDER: (3 marks)

Lucy is a 27 year old bank teller who has experienced diarrhoea constantly for 6 days. This is accompanied by abdominal cramps, increased flatulence and eructation. She also experiences heartburn and mild urticaria. These issues leave Lucy feeling depressed and she often experiences severe fatigue.

At the age of 3 months, Lucy contracted a severe pneumonia infection requiring IV antibiotics. When she was 3 years old, her tonsils were removed. These early factors contributed to Lucy developing anxiety and fear in medical settings. In childhood, Lucy always suffered with stomach discomfort and often missed out on school. After seeing a doctor, Lucy was treated for irritable bowel syndrome. Even after medication, Lucy still had problems with diarrhoea whenever she experienced stress.

In adolescence, Lucy started college and was involved in a few relationships. At the age of 21, her boyfriend died suddenly in a motor car crash which took a major toll on Lucy. She became depressed and her anxiety levels increased. Her digestive issues got worse at this stage in her life, and she became even more depressed. Her meals usually consisted of take-aways and fatty foods. Lucy also became dependent on alcohol to manage her anxiety.

Currently, Lucy is still single and works a full time job. She does not usually socialise with friends and stays home because of her constant digestive issues. In her free time, she usually spends time reading. She would like to branch out into other activities to make her feel better, but the constant diarrhoea, abdominal cramps and increased flatulence decrease her confidence levels to go out. She has trouble sleeping at night, as well as waking up in the morning.

Fill in Lucy’s Functional Medicine Matrix – Retelling the patient’s story:

Lucy is a 27 year old bank teller who has experienced diarrhoea constantly for 6 days. This is accompanied by abdominal cramps, increased flatulence and eructation. She also experiences heartburn and mild urticaria. These issues leave Lucy feeling depressed and she often experiences severe fatigue.

At the age of 3 months, Lucy contracted a severe pneumonia infection requiring IV antibiotics. When she was 3 years old, her tonsils were removed. These early factors contributed to Lucy developing anxiety and fear in medical settings. In childhood, Lucy always suffered with stomach discomfort and often missed out on school. After seeing a doctor, Lucy was treated for irritable bowel syndrome. Even after medication, Lucy still had problems with diarrhoea whenever she experienced stress.

In adolescence, Lucy started college and was involved in a few relationships. At the age of 21, her boyfriend died suddenly in a motor car crash which took a major toll on Lucy. She became depressed and her anxiety levels increased. Her digestive issues got worse at this stage in her life, and she became even more depressed. Her meals usually consisted of take-aways and fatty foods. Lucy also became dependent on alcohol to manage her anxiety.

Currently, Lucy is still single and works a full time job. She does not usually socialise with friends and stays home because of her constant digestive issues. In her free time, she usually spends time reading. She would like to branch out into other activities to make her feel better, but the constant diarrhoea, abdominal cramps and increased flatulence decrease her confidence levels to go out. She has trouble sleeping at night, as well as waking up in the morning.

Fill in Lucy’s Functional Medicine Matrix – Modifiable personal lifestyle factors:

Lucy is a 27 year old bank teller who has experienced diarrhoea constantly for 6 days. This is accompanied by abdominal cramps, increased flatulence and eructation. She also experiences heartburn and mild urticaria. These issues leave Lucy feeling depressed and she often experiences severe fatigue.

At the age of 3 months, Lucy contracted a severe pneumonia infection requiring IV antibiotics. When she was 3 years old, her tonsils were removed. These early factors contributed to Lucy developing anxiety and fear in medical settings. In childhood, Lucy always suffered with stomach discomfort and often missed out on school. After seeing a doctor, Lucy was treated for irritable bowel syndrome. Even after medication, Lucy still had problems with diarrhoea whenever she experienced stress.

In adolescence, Lucy started college and was involved in a few relationships. At the age of 21, her boyfriend died suddenly in a motor car crash which took a major toll on Lucy. She became depressed and her anxiety levels increased. Her digestive issues got worse at this stage in her life, and she became even more depressed. Her meals usually consisted of take-aways and fatty foods. Lucy also became dependent on alcohol to manage her anxiety.

Currently, Lucy is still single and works a full time job. She does not usually socialise with friends and stays home because of her constant digestive issues. In her free time, she usually spends time reading. She would like to branch out into other activities to make her feel better, but the constant diarrhoea, abdominal cramps and increased flatulence decrease her confidence levels to go out. She has trouble sleeping at night, as well as waking up in the morning.

Fill in Lucy’s Functional Medicine Matrix – Physiology and function – Organising the patient’s clinical imbalances: