Chapter 11: Stress and Disease MULTIPLE MULTIPLE CHOICE
1. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is
not successful? successful? a. Flight or fight b. Alarm
c. Adaptation d. Arousal
ANS:
Exhaustion occurs if stress continues and adaptation is not successful! ultimately causing impairment of the immune response! heart failure! and "idne y failure! leading to death. #he other stages occur before the adaptation stage. $#S: 1
%EF: $age &&'
(. )hich organ is stimulated during the alarm phase of the general adaptation syndrome *+AS,? a. Adrenal cortex c. Anterior pituitary b. -ypothalamus d. imbic system ANS: /
#he alarm phase of the +AS begins when a stressor triggers the actions of the h ypothalamus and the sympathetic ner0ous system *SNS, *see Figure 111,. #he other organs are not stimulated by the alarm phase of +AS. $#S: 1
%EF: $age &&'
&. 2uring an anticipatory response to stress! the reaction from the limbic system is stimulated by
the: a. %etronucleus of the anterior pituitary b. Anterior nucleus of the hippocampus c. $ara0entricular nucleus of the hypothalamus d. $refrontal nucleus of the amygdala ANS:
#he para0entricular nucleus *$3N, of the hypothalamus h ypothalamus must be stimulated to cause the limbic system to be stimulated. #he other options are not in0ol0ed in the stimulation of the limbic system. $#S: 1
%EF: $age &41
4. )hich hormone prompts increased anxiety! 0igilance! and arousal during a stress response? a. Norepinephrine b. Epinephrine c. ortisol d. Adrenocorticotropic hormone *A#-, ANS: A
5nly the release of norepinephrine promotes arousal! increased 0igilance! increased anxiety! and other protecti0e emotional responses.
$#S: 1
%EF: $age &4&
6. $ercei0ed stress elicits an emotional! anticipatory response that begins where? a. $refrontal cortex c. imbic system b. Anterior pituitary d. -ypothalamus ANS:
$ercei0ed stressors elicit an anticipatory response that begins in the limbic system of the brain! the only option responsible for emotions and cognition. $#S: 1
%EF: $age &4&
7. 2uring a stress response! the helper # *#h, 1 response is suppress by which hormone? a. A#c. $rolactin b. ortisol d. +rowth hormone ANS: /
Stress can acti0ate an excessi0e immune response and ! through cortisol and catecholamines! suppress the #h1 response! causing a #h( shift. #his response is not acti0e by any of the other options. $#S: 1
%EF: $age &4'
8. )hat is the effect that lowserum albumin has on the central stress response? a. 9mpaired circulation of epinephrine and norepinephrine b. 9mpaired wound healing c. essened circulation of cortisol d. 2iminished oncotic pressure ANS: A
owserum albumin impairs circulation of both epinephrine and no repinephrine since both bind to plasma protein albumin. #he other options do not accurately describe the effect of lowserum albumin. $#S: 1
%EF: $age &46
. Stressage syndrome directly results in depressed function of which system? a. %espiratory c. 2igesti0e b. Endocrine d. 9mmune ANS: 2
5f the a0ailable options! immunodepression is the only ch aracteristic change obser0ed in stressage syndrome. $#S: 1
%EF: $age &6
'. Stressinduced sympathetic stimulation of the adrenal medulla causes the secretion of: a. Epinephrine and aldosterone c. Epinephrine and norepinephrine b. Norepinephrine and cortisol d. Acetylcholine and cortisol ANS:
#he sympathetic ner0ous system is aroused during the stress response and ca uses the medulla of the adrenal gland to release catecholamines *;< epinephrine and (;< norepinephrine, into the bloodstream. #he stressinduced efforts on the adrenal medulla do not include any of the other options. $#S: 1
%EF: $ages &44&46
1;. Stressinduced norepinephrine results in: a. $upil constriction b. $eripheral 0asoconstriction
c. 9ncreased sweat gland secretions d. 2ecreased blood pressure
ANS: /
2uring stress! norepinephrine raises blood pressure by constricting peripheral 0essels= it dilates the pupils of the eye! causes piloerection! and increases sweat gland action in the armpits and palms. $#S: 1
%EF: $age &46
11. %eleased stressinduced cortisol results in the stimulation of gluconeogenesis by affecting
which structure? a. Adrenal cortex b. $ancreas
c. i0er d. Anterior pituitary
ANS: A
5ne of the primary effects of cortisol is the stimulation of gluconeogenesis through stimulation of the adrenal cortex. #he other options do not produce a stimulation of gluconeogenesis when exposed to cortisol. $#S: 1
%EF: $age &47
1(. )hat is the effect of increased secretions of epinephrine! glucagon! and growth hormone? a. -yperglycemia c. /ronchodilation b. -ypertension d. $upil dilation ANS: A
ortisol enhances the ele0ation of blood glucose promoted by other hormones! such as epinephrine! glucagon! and growth hormone. #his effect is not true of the other options. $#S: 1
%EF: $age &47
1&. )hich hormone increases the formation of glucose from a mino acids and free fatty acids? a. Epinephrine c. ortisol b. Norepinephrine d. +rowth hormone ANS:
5ne of the primary effects of cortisol is the stimulation of gluconeogenesis or the formation of glucose from noncarbohydrate sources! such as a mino or free fatty acids in the li0er. Neither reaction is a result of the effects of any of the other options. $#S: 1
%EF: $age &47
14. )hat effect do androgens ha0e on lymphocytes?
a. b. c. d.
Suppression of /cell responses and enhancement of #cell responses Suppression of #cell #cell responses and enhancement enh ancement of /cell responses Suppression of / and #cell #cell responses Enhancement of / and #cell responses
ANS:
Androgens suppress # and /cell responses. #he other options do not n ot occur in response to androgens. $#S: 1
%EF: $age &6&
16. )hich gland regulates the immune response and mediates the apparent effects of circadian
rhythms on immunity? a. Anterior pituitary b. Adrenal
c. /asal ganglia d. $ineal
ANS: 2
5f the options a0ailable! only the pineal gland regulates the immune response and mediates the apparent effects of circadian rhythm on immunity. $#S: 1
%EF: $age &64
17. )hich cyto"ines initiate the production of corticotropinreleasing hormone *%-,? a. 9>1 and 97 c. 9FN and 91( b. 9( and #NFα d. #NF and 94 ANS: A
Although a number of stress factors initiate the production of %-! of the options a0ailable! only high le0els of 91 and 97 initiate such a response. $#S: 1
%EF: $ages &4&4'
18. #he release of which cyto"ines is triggered b y bacterial or 0iral infections! cancer! and tissue
in@ury that! in turn! initiate a stress response? a. 91 and 9( b. 91(! #NFα! and colonystimulating factor c. 9FN! #NF! and 97 d. 94 and 9(4 ANS:
5f the options offered! only the release of immune inflammatory mediators 97! #NF! and 9FN is triggered by bacterial or 0iral infections! cancer! and tissue in@ury that! in turn! initiates a stress response through the hypothalamicpituitaryadrenal *-$A, *-$A, pathway. $#S: 1
%EF: $age &4'
1. #he action of which hormone helps explain increases in affecti0e anxiety and eating disorders!
mood cycles! and 0ulnerability to autoimmune and inflammatory diseases in women as a result of stimulation of the %- gene promoter and central norepinephrine system? a. $rogesterone c. Estrogen b. ortisol d. $rolactin
ANS:
5f the options pro0ided! only estrogen directly stimulates the %- gene promoter and the central noradrenergic *norepinephrine, system! which may help explain adult womens slight hypercortisolism! increases in affecti0e anxiety and eating disorders! mood cycles! and 0ulnerability to autoimmune and inflammatory disease! all of which follow estradiol fluctuations. $#S: 1
%EF: $age &6;
1'. )hat effect does estrogen ha0e on lymphocytes? lymphoc ytes? a. 2epression of /cell functions and enhancement of #cell functions b. 2epression of #cell #cell functions and enhancement of /cell functions c. 2epression of / and #cell #cell functions d. Enhancement of / and #cell #cell functions ANS: /
Estrogens generally are associated with only a depression of #cell>dependent #cell>dependent immune functions and an enhancement of /cell functions. $#S: 1
%EF: $age &6&
true concerning the differences between stressinduced hormonal (;. )hich statement is true concerning alterations of men and women? a. After in@ury! women produce more proinflammatory cyto"ines than men! a profile that is associated with poor outcomes. b. Androgens appear to induce a greater degree of immune cell apoptosis apo ptosis after in@ury! creating greater immunosuppression in in@ured men than in in@ured women. c. $sychologic stress associated with some types of competition decreases both testosterone and cortisol! especially in athletes older than 46 years o f age. d. After stressful stimuli! estrogen is increased in wo men! but testosterone is decreased in men. ANS: /
Androgens appear to induce a greater degree of immune cell apoptosis apo ptosis after in@ury! a mechanism that may elicit a greater immunosuppression in in@ured men 0ersus in@ured women. #he other options are not true statements concerning the differences between how the genders are affected by stressinduced hormones. $#S: 1
%EF: $age &6&
ch ronic stress state (1. 2iagnostic blood wor" on indi0iduals who pe rcei0e themsel0es to be in a chronic will li"ely demonstrate: a. 2ecreased #h lymphocytes b. 9ncreased erythrocytes
c. 2ecreased #c cells d. 9ncreased platelets
ANS:
9llustrating the influence of chronic stress appraisal on the physiologic processes! a meta analysis of the relationships between stressors and immunity found that a higher perception higher perception of stress was associated with reduced # cytotoxic c ytotoxic *#c,cell *#c,cell cytotoxicity! although not with le0els of circulating #h or #c lymphocytes. %esearch has substantiates the other options. $#S: 1
%EF: $age &66
ge neral adaptation syndrome? ((. )hat are the signs that a patient is in the adapti0e stage of the general a. -e or she begins to experience ele0ated heart and respiratory rates. b. -e or she finds it difficult to concentrate on a solution for the stress. c. #he patient percei0es his or her only o nly options are to run away or fight bac". d. #he patient has exceeded his or her ability to cope with the current situation. ANS:
Fightorflight beha0iors are characteristic of the more ad0anced adapti0e stage! whereas the remaining options are noted in the initial alarm stage. $#S: 1
%EF: $age &&'
(&. #he most influential factor in whether a person will experience a stress reaction is his or her: a. +eneral state of physical health c. 9ntellectual abilities b. Spiritual belief system d. Ability to cope ANS: 2
A person does not ha0e a stress reaction unless the stress exceeds his or her cop ing abilities. #he other options do not ha0e h a0e the same degree of influence! as does a persons ability to cope. $#S: 1
%EF: $age &&'
(4. A reduction is an indi0iduals number of natural "iller *NB, cells appears to correlate with an
increased ris" for the de0elopment of: a. 2epression b. #ype #ype 1 diabetes c. 5bsessi0e compulsi0e disorder *52, d. +astroesophageal reflux disorder *+E%2, ANS: A
A metaanalysis metaanalysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural "iller cell acti0ity. urrently! urrently! no research supports the other options. $#S: 1
%EF: $age &66
(6. A nurse is pro0iding care to a terminally ill adult who has been with his life partner for o0er
67 years. %esearch supports the nurses assessment of the life partner for signs of: a. Suicidal ideations c. Se0ere stress reaction b. ardiac dysrhythmia d. Anorexia induced weight loss ANS:
#he results of a -ar0ard study showed e0iden ce that a spouses illness or death can increase a partners mortality by causing se0ere stress and remo0ing a primary source of emotional! psychologic! practical! and financial support. Although Although the other options may exist! research does not currently support them as ha0ing the stated correlation. $#S: 1 MULTIPLE RESPONSE
%EF: $age &68 C )hatDs New box
(7. #he effect epinephrine has on the immune system during the stress response is to increase
which cells? (Select cells? (Select all that apply.) a. NB cells b. 9mmunoglobulins c. yto"ines d. # cells e. #h cells ANS: A! 2
#he in@ection of epinephrine into healthy human beings is associated with a transient increase of the number of lymphocytes *e.g.! # cells! natural "iller *NB, cells, in the peripheral blood. #his association is not true of the other options. $#S: 1
%EF: $age &47
(8. )hich immune cells are suppressed by the corticotropinreleasing co rticotropinreleasing hormone *%-,? (Select
all that apply.) a pply.) a. onocytemacrophage cells b. yto"ines c. #c cells d. #h cells e. / cells ANS: A! 2
2irect suppressi0e effects of %- ha0e been reported on two immune cell types possessing %- receptorsthe monocyte and macrophage and 24 *# helper, lymphocytes. %- does not suppress the remaining options. $#S: 1
%EF: $ages &6&&64
(. #he increased production of proinflammatory cyto"ines is associated with which
considerations? (Select all that apply.) a. hronic respiratory dysfunction b. Ele0ated anxiety le0els c. 9mmune disorders d. Age and gender e. 2ementia ANS: /!
9ncreased le0els of proinflammatory cyto"ines has been shown to ha0e a possible lin" between stress and immune function. #he other options are not as directly lin"ed to cyto"ine le0els. $#S: 1
%EF: $age &6&
('. )hich statements are true regarding true regarding lymphocytes? (Select all that apply.) a. ymphocytes are in0ol0ed in the production of the human growth hormone. b. Ele0ated catecholamine le0els influence lymphocytes. c. ymphocytes ymphocytes are synthesiGed in the anterior pituitary gland. d. ymphocytes ha0e receptors for the hormone prolactin. e. ymphocytes ymphocytes produce endorphins in large amounts.
ANS: A! /! /! 2
+- is synthesiGed from the anterior pituitary gland and is produced by lymphocytes and mononuclear phagocytic cells. Se0eral classes of lymphoc ytes ha0e receptors for prolactin! suggesting a direct effect of prolactin on immune function. Although the effects of acute ele0ation of catecholamines on the alteration of lymphocyte function are real! they are short li0ed! lasting only approximately ( hours. #he other statements regarding lymphocytes are not true. $#S: 1
%EF: $age &6; C $age &6(
MATCHING
Match the hormone with its effects during a stress stress response. response. Hormones may be used more than once. HHHHHH A. Epinephrine HHHHHH /. Norepinephrine HHHHHH . ortisol &;. onstricts peripheral 0essels to increase blood pressure. &1. 9ncreases cardiac output by increasing heart rate and an d myocardial contractility. &(. 9ncreases gastric secretions. &;. ANS: / $#S: 1 %EF: $age &46 S: Norepinephrine regulates blood blood pressure by constricting constricting smooth smooth muscle in all blood 0essels. 0essels. &1. ANS: A $#S: 1 %EF: $age &46 S: Epinephrine enhances myocardial contractility *inotropic *inotropic effect,! effect,! increases the heart rate *chronotropic effect,! and increases 0enous return to the heart! all of which increase cardiac output and blood pressure. &(. ANS: $#S: 1 %EF: $age &48 S: ortisol promotes gastric secretion secretion in the gastrointestinal gastrointestinal tract.
