Stress is far more than just a feeling of being overwhelmed; it is a powerful physiological response with profound effects on the body. As a “transcending behavioral concept” explored in the PharmD curriculum, particularly in Patient Care 4, understanding stress is critical for a holistic approach to patient care. The intricate connection between stress and physical health is exemplified by the microbiota-gut-brain axis and its relevance to conditions like Irritable Bowel Syndrome (IBS). This quiz will test your knowledge on the physiology of the stress response, its impact on GI and other disorders, and the behavioral management strategies pharmacists can recommend to improve patient outcomes.
1. The “fight-or-flight” response to acute stress is primarily mediated by which branch of the nervous system?
- a. The parasympathetic nervous system
- b. The somatic nervous system
- c. The sympathetic nervous system
- d. The enteric nervous system
Answer: c. The sympathetic nervous system
2. Which hormone is commonly referred to as the primary “stress hormone” and is released from the adrenal cortex?
- a. Insulin
- b. Testosterone
- c. Cortisol
- d. Melatonin
Answer: c. Cortisol
3. The Hypothalamic-Pituitary-Adrenal (HPA) axis is the central pathway for the chronic stress response. What is the correct sequence of hormone release in this axis?
- a. Cortisol -> ACTH -> CRH
- b. ACTH -> CRH -> Cortisol
- c. CRH -> ACTH -> Cortisol
- d. Cortisol -> CRH -> ACTH
Answer: c. CRH -> ACTH -> Cortisol
4. The “microbiota-gut-brain axis” refers to the bidirectional communication between the central nervous system and:
- a. The cardiovascular system.
- b. The renal system.
- c. The enteric nervous system and gut microbes.
- d. The musculoskeletal system.
Answer: c. The enteric nervous system and gut microbes.
5. In patients with Irritable Bowel Syndrome (IBS), stress is known to exacerbate which of the following?
- a. Visceral hypersensitivity (increased gut-related pain perception).
- b. Gut motility (causing diarrhea or constipation).
- c. Intestinal permeability.
- d. All of the above.
Answer: d. All of the above.
6. The “Transcending Concept Behavioral: Stress” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. According to the curriculum’s suggested TED Talk, how can changing one’s perception of the stress response affect its physiological impact?
- a. It has no effect on the body.
- b. It makes the stress response worse.
- c. Viewing the physical signs of stress (e.g., fast heart rate) as helpful preparation for a challenge can lead to healthier cardiovascular profiles during stress.
- d. It eliminates the release of cortisol entirely.
Answer: c. Viewing the physical signs of stress (e.g., fast heart rate) as helpful preparation for a challenge can lead to healthier cardiovascular profiles during stress.
8. Chronic elevation of cortisol due to long-term stress can lead to:
- a. An enhanced immune response.
- b. Suppression of the immune system, making one more susceptible to infections.
- c. Lower blood sugar levels.
- d. Decreased blood pressure.
Answer: b. Suppression of the immune system, making one more susceptible to infections.
9. The gut-brain axis communication is primarily facilitated by:
- a. The skeletal system
- b. The integumentary system
- c. The vagus nerve
- d. The lymphatic system
Answer: c. The vagus nerve
10. Which of the following is a non-pharmacologic, behavioral strategy for managing stress?
- a. Taking a benzodiazepine.
- b. Drinking caffeine.
- c. Practicing mindfulness meditation and deep breathing exercises.
- d. Ignoring the source of stress.
Answer: c. Practicing mindfulness meditation and deep breathing exercises.
11. The link between stress and visceral pain is particularly relevant to which GI condition?
- a. GERD
- b. Peptic Ulcer Disease
- c. Celiac Disease
- d. Irritable Bowel Syndrome (IBS)
Answer: d. Irritable Bowel Syndrome (IBS)
12. The release of catecholamines like epinephrine and norepinephrine during an acute stress response causes:
- a. A decrease in heart rate and blood pressure.
- b. An increase in heart rate, blood pressure, and glucose availability.
- c. An increase in digestion.
- d. A feeling of calmness.
Answer: b. An increase in heart rate, blood pressure, and glucose availability.
13. A pharmacist counseling a patient with IBS who notes their symptoms are worse during exams should:
- a. Recommend an opioid for the pain.
- b. Acknowledge the link between stress and their symptoms and suggest stress management techniques.
- c. Tell the patient their symptoms are not real.
- d. Advise the patient to drop out of school.
Answer: b. Acknowledge the link between stress and their symptoms and suggest stress management techniques.
14. How can stress alter the gut microbiota?
- a. It can change the composition and diversity of gut bacteria.
- b. It sterilizes the gut, killing all bacteria.
- c. It only affects the fungi in the gut.
- d. Stress has no effect on gut microbiota.
Answer: a. It can change the composition and diversity of gut bacteria.
15. A key role of the pharmacist in managing stress-related conditions is:
- a. To prescribe anti-anxiety medications.
- b. To act as a licensed therapist.
- c. To identify medication-related problems and recognize when non-pharmacologic or behavioral interventions may be beneficial.
- d. To manage the patient’s finances to reduce stress.
Answer: c. To identify medication-related problems and recognize when non-pharmacologic or behavioral interventions may be beneficial.
16. Which of the following is a physical symptom often associated with chronic stress?
- a. Tension headaches
- b. Muscle aches
- c. Fatigue
- d. All of the above.
Answer: d. All of the above.
17. The “How stress affects your body” video is a suggested resource in the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
18. What is meant by “visceral hypersensitivity” in the context of IBS and stress?
- a. An increased sensitivity to skin touch.
- b. A heightened pain response to normal gut sensations like stretching.
- c. An allergy to certain foods.
- d. A decreased perception of pain.
Answer: b. A heightened pain response to normal gut sensations like stretching.
19. Which of the following is a healthy coping mechanism for stress?
- a. Regular physical activity.
- b. Binge-watching television for hours.
- c. Increased alcohol consumption.
- d. Avoiding social interaction.
Answer: a. Regular physical activity.
20. The concept of a holistic patient view, which includes psychological variables like stress, is mentioned in the HIPPE syllabus.
- a. True
- b. False
Answer: a. True
21. Chronic stress can negatively impact cardiovascular health by:
- a. Lowering cholesterol.
- b. Consistently elevating blood pressure and heart rate.
- c. Making blood vessels more elastic.
- d. Decreasing inflammation.
Answer: b. Consistently elevating blood pressure and heart rate.
22. How does the “tend-and-befriend” stress response, often associated with oxytocin, differ from “fight-or-flight”?
- a. It involves seeking social support and caring for others.
- b. It is a more aggressive response.
- c. It is only seen in males.
- d. It is mediated by cortisol.
Answer: a. It involves seeking social support and caring for others.
23. The enteric nervous system is often called the “second brain” because:
- a. It contains more neurons than the spinal cord and can function independently of the CNS.
- b. It is located in the skull.
- c. It is responsible for conscious thought.
- d. It controls vision and hearing.
Answer: a. It contains more neurons than the spinal cord and can function independently of the CNS.
24. The term “allostatic load” refers to:
- a. The immediate benefit of an acute stress response.
- b. The “wear and tear” on the body that accumulates from chronic stress.
- c. The total weight of a person’s life stressors.
- d. The maximum amount of stress a person can handle.
Answer: b. The “wear and tear” on the body that accumulates from chronic stress.
25. A patient with GERD reports their heartburn is significantly worse during periods of high work stress. This is likely because stress can:
- a. Decrease gastric acid production.
- b. Increase esophageal sensitivity to acid and alter motility.
- c. Cure the GERD.
- d. Strengthen the lower esophageal sphincter.
Answer: b. Increase esophageal sensitivity to acid and alter motility.
26. Which of the following is a key principle of Cognitive Behavioral Therapy (CBT) for managing stress?
- a. Focusing only on past events.
- b. Identifying and changing negative thought patterns and behaviors.
- c. Using medication as the only treatment.
- d. Avoiding all stressful situations.
Answer: b. Identifying and changing negative thought patterns and behaviors.
27. The adrenal medulla is responsible for releasing which stress hormones?
- a. Cortisol and aldosterone
- b. Epinephrine and norepinephrine
- c. T3 and T4
- d. Insulin and glucagon
Answer: b. Epinephrine and norepinephrine
28. Poor sleep is both a cause and a consequence of stress.
- a. True
- b. False
Answer: a. True
29. When counseling a patient on stress, a pharmacist can appropriately:
- a. Prescribe an antidepressant.
- b. Provide psychoanalysis.
- c. Recommend evidence-based non-pharmacologic techniques like exercise and refer to a mental health professional if needed.
- d. Diagnose the patient with an anxiety disorder.
Answer: c. Recommend evidence-based non-pharmacologic techniques like exercise and refer to a mental health professional if needed.
30. The microbiota-gut-brain axis is a concept specifically linked to IBS in the curriculum readings.
- a. True
- b. False
Answer: a. True
31. The parasympathetic nervous system is associated with what state?
- a. “Fight or flight”
- b. “Rest and digest”
- c. High alert
- d. Panic
Answer: b. “Rest and digest”
32. The perception that you have control over a stressor can:
- a. Make the stress response worse.
- b. Mitigate the negative health effects of the stress.
- c. Eliminate the stressor completely.
- d. Has no impact on the stress response.
Answer: b. Mitigate the negative health effects of the stress.
33. What effect does acute stress have on memory?
- a. It always impairs memory formation.
- b. It can enhance the formation of emotionally-charged memories.
- c. It has no effect on memory.
- d. It erases all short-term memories.
Answer: b. It can enhance the formation of emotionally-charged memories.
34. Chronic stress can contribute to which of the following conditions?
- a. Depression and anxiety
- b. Cardiovascular disease
- c. Obesity
- d. All of the above
Answer: d. All of the above
35. A pharmacist can help a patient manage stress by:
- a. Identifying if any of their medications can cause anxiety or insomnia.
- b. Counseling on proper sleep hygiene.
- c. Providing information on community mental health resources.
- d. All of the above.
Answer: d. All of the above.
36. The release of CRH from the hypothalamus is the first step in the HPA axis.
- a. True
- b. False
Answer: a. True
37. The communication between the gut microbiota and the brain can influence:
- a. Mood and behavior.
- b. Immune function.
- c. The stress response.
- d. All of the above.
Answer: d. All of the above.
38. Which of the following is a relaxation technique?
- a. Progressive muscle relaxation
- b. Checking social media
- c. Drinking an energy drink
- d. Arguing with a colleague
Answer: a. Progressive muscle relaxation
39. A “stress-related headache” is most commonly what type of headache?
- a. Migraine
- b. Cluster
- c. Tension-type
- d. Sinus
Answer: c. Tension-type
40. Recognizing that stress can impact a patient’s adherence to their medication regimen is an important consideration for a pharmacist.
- a. True
- b. False
Answer: a. True
41. The adrenal glands are located on top of which organs?
- a. The liver
- b. The lungs
- c. The kidneys
- d. The pancreas
Answer: c. The kidneys
42. Which of the following is NOT a good strategy for building resilience to stress?
- a. Maintaining strong social connections.
- b. Having a sense of purpose.
- c. Isolating oneself and avoiding challenges.
- d. Practicing self-compassion.
Answer: c. Isolating oneself and avoiding challenges.
43. The idea that one’s mindset about stress can change its effects is a central theme in one of the suggested TED talks for the curriculum.
- a. True
- b. False
Answer: a. True
44. How does stress contribute to changes in gut motility in IBS?
- a. It always causes constipation.
- b. It always causes diarrhea.
- c. It can alter nerve signals, leading to either increased or decreased transit time.
- d. It has no effect on motility.
Answer: c. It can alter nerve signals, leading to either increased or decreased transit time.
45. For a student pharmacist, an effective way to manage academic stress is to:
- a. Procrastinate on all assignments.
- b. Stop attending lectures.
- c. Utilize time management techniques and schedule regular breaks for relaxation.
- d. Rely solely on caffeine.
Answer: c. Utilize time management techniques and schedule regular breaks for relaxation.
46. The study of the interactions between psychological processes and the nervous and immune systems is called:
- a. Pharmacogenomics
- b. Pharmacokinetics
- c. Psychoneuroimmunology
- d. Pathophysiology
Answer: c. Psychoneuroimmunology
47. Which part of the brain is the primary activator of the stress response?
- a. The cerebellum
- b. The amygdala
- c. The prefrontal cortex
- d. The hippocampus
Answer: b. The amygdala
48. What is the role of cortisol in a negative feedback loop?
- a. High levels of cortisol signal the hypothalamus and pituitary to stop releasing CRH and ACTH.
- b. High levels of cortisol signal for more CRH and ACTH to be released.
- c. Cortisol has no role in feedback.
- d. Cortisol only provides positive feedback.
Answer: a. High levels of cortisol signal the hypothalamus and pituitary to stop releasing CRH and ACTH.
49. Considering a patient’s stress level is part of a comprehensive, holistic assessment.
- a. True
- b. False
Answer: a. True
50. The ultimate goal of stress management is to:
- a. Eliminate all stress from life.
- b. Develop healthy coping strategies to manage stress effectively and mitigate its negative impact on health.
- c. Ignore stress completely.
- d. Use medication to block the stress response entirely.
Answer: b. Develop healthy coping strategies to manage stress effectively and mitigate its negative impact on health.