The “fight or flight” response is a fundamental survival mechanism, a cascade of physiological changes that prepare the body to confront or flee from a perceived threat. While essential for acute danger, the chronic activation of this stress response in modern life can have significant health consequences. For PharmD students, understanding this response is key to managing not only their own professional stress but also to counseling patients on the interplay between stress, chronic disease, and medication.
1. The “fight or flight” response is primarily initiated and controlled by which part of the nervous system?
- Somatic Nervous System
- Central Nervous System
- Parasympathetic Nervous System
- Sympathetic Nervous System
Answer: Sympathetic Nervous System
2. Which two hormones are the primary chemical messengers released during the initial phase of the fight or flight response?
- Insulin and Glucagon
- Serotonin and Dopamine
- Epinephrine and Norepinephrine
- Estrogen and Testosterone
Answer: Epinephrine and Norepinephrine
3. The adrenal glands are critical to the stress response. Which part of the adrenal gland releases epinephrine?
- Adrenal Cortex
- Adrenal Medulla
- Zona Glomerulosa
- Zona Reticularis
Answer: Adrenal Medulla
4. What is the primary role of cortisol in the stress response?
- To decrease blood sugar levels
- To increase blood pressure and blood sugar, and reduce inflammation
- To promote immediate muscle contraction
- To induce a state of relaxation
Answer: To increase blood pressure and blood sugar, and to reduce inflammation
5. The physiological cascade involving the hypothalamus, pituitary gland, and adrenal glands is known as the:
- Renin-Angiotensin-Aldosterone System (RAAS)
- HPA Axis (Hypothalamic-Pituitary-Adrenal)
- Central Nervous System Pathway
- Krebs Cycle
Answer: HPA Axis (Hypothalamic-Pituitary-Adrenal)
6. During the fight or flight response, what happens to the pupils of the eyes?
- They constrict to focus on small details
- They dilate to take in more light and information
- They do not change
- They begin to tear up
Answer: They dilate to take in more light and information
7. How does the fight or flight response affect the digestive system?
- It increases digestive activity to provide more energy
- It slows down or stops digestion to divert blood flow to muscles
- It has no effect on the digestive system
- It causes an immediate feeling of hunger
Answer: It slows down or stops digestion to divert blood flow to muscles
8. Which of the following is a direct effect of epinephrine on the cardiovascular system?
- Decreased heart rate
- Vasodilation of all blood vessels
- Increased heart rate and force of contraction
- Decreased blood pressure
Answer: Increased heart rate and force of contraction
9. The relaxation response, often called “rest and digest,” is mediated by which part of the nervous system?
- Sympathetic Nervous System
- Parasympathetic Nervous System
- The spinal cord only
- The cerebellum
Answer: Parasympathetic Nervous System
10. Chronic activation of the stress response and elevated cortisol levels are linked to which of the following health problems?
- Weight gain, particularly abdominal obesity
- Improved immune function
- Lowered blood pressure
- Increased bone density
Answer: Weight gain, particularly abdominal obesity
11. Which neurotransmitter is the primary chemical messenger for the parasympathetic nervous system?
- Norepinephrine
- Dopamine
- Serotonin
- Acetylcholine
Answer: Acetylcholine
12. From a pharmacist’s perspective, understanding a patient’s stress level is important because chronic stress can:
- Improve medication adherence
- Negatively impact medication adherence and worsen chronic conditions
- Have no effect on disease states
- Make all medications more effective
Answer: Negatively impact medication adherence and worsen chronic conditions
13. A patient complains of a racing heart, sweating, and trembling when thinking about an upcoming exam. This is a classic example of:
- The relaxation response
- The fight or flight response
- A healthy digestive process
- A normal sleep cycle
Answer: The fight or flight response
14. What happens to breathing during the fight or flight response?
- It becomes slower and deeper
- It stops completely
- It becomes faster and more shallow to increase oxygen intake
- It does not change
Answer: It becomes faster and more shallow to increase oxygen intake
15. The “tend-and-befriend” response to stress, often described in females, is theorized to be driven by which hormone?
- Cortisol
- Epinephrine
- Oxytocin
- Aldosterone
Answer: Oxytocin
16. Long-term, chronic stress can suppress the immune system, making a person more susceptible to:
- Autoimmune diseases
- Infections like the common cold
- Stronger bones
- Improved memory
Answer: Infections like the common cold
17. How does the liver respond to the hormonal signals of the fight or flight response?
- It begins to store glucose from the bloodstream
- It releases stored glucose (glycogenolysis) to provide immediate energy
- It starts producing more cholesterol
- It slows down all of its functions
Answer: It releases stored glucose (glycogenolysis) to provide immediate energy
18. Beta-blockers are a class of drugs that can blunt some effects of the stress response by:
- Increasing cortisol levels
- Blocking the effects of epinephrine and norepinephrine on beta-receptors
- Stimulating the sympathetic nervous system
- Increasing heart rate
Answer: Blocking the effects of epinephrine and norepinephrine on beta-receptors
19. A non-pharmacologic technique that can help activate the parasympathetic nervous system and promote relaxation is:
- Drinking a large caffeinated beverage
- Watching a fast-paced action movie
- Practicing deep, diaphragmatic breathing
- Ruminating on stressful thoughts
Answer: Practicing deep, diaphragmatic breathing
20. The amygdala in the brain plays a crucial role in the stress response by acting as:
- The center for logical thought and reasoning
- The brain’s “threat detector” or fear center
- The area responsible for motor control
- The primary storage site for long-term memories
Answer: The brain’s “threat detector” or fear center
21. In the HPA axis, what hormone does the pituitary gland release to stimulate the adrenal cortex?
- Corticotropin-releasing hormone (CRH)
- Adrenocorticotropic hormone (ACTH)
- Cortisol
- Aldosterone
Answer: Adrenocorticotropic hormone (ACTH)
22. “Allostatic load” is a term used to describe:
- The body’s ability to achieve stability through change (allostasis)
- The wear and tear on the body that results from chronic stress
- The maximum amount of stress a person can handle
- A type of physical exercise
Answer: The wear and tear on the body that results from chronic stress
23. Which of the following is a potential cardiovascular consequence of chronic stress?
- Hypotension
- Bradycardia
- Hypertension and increased risk of heart disease
- Decreased cholesterol levels
Answer: Hypertension and increased risk of heart disease
24. The evolutionary purpose of the fight or flight response was to deal with:
- Acute physical threats
- Chronic psychological stress like work deadlines
- Social media notifications
- Final exams
Answer: Acute physical threats
25. A pharmacist experiencing “burnout” is suffering from a state of emotional, physical, and mental exhaustion caused by:
- A single, isolated stressful event
- Excessive and prolonged stress
- A lack of clinical knowledge
- Poor inventory management
Answer: Excessive and prolonged stress
26. How does the fight or flight response affect blood flow?
- It increases blood flow to all organs equally
- It shunts blood away from the skin and digestive tract and towards the large muscles and brain
- It decreases blood flow to the brain
- It increases blood flow to the kidneys and liver
Answer: It shunts blood away from the skin and digestive tract and towards the large muscles and brain
27. The hippocampus, an area of the brain involved in memory, can be negatively affected by high levels of which chronic stress hormone?
- Epinephrine
- Oxytocin
- Cortisol
- Prolactin
Answer: Cortisol
28. A patient on a non-selective beta-blocker for anxiety might experience which intended effect?
- A reduction in the physical symptoms of anxiety like rapid heartbeat and trembling
- An increase in mental alertness
- A cure for the underlying cause of their anxiety
- An improvement in digestive function
Answer: A reduction in the physical symptoms of anxiety like rapid heartbeat and trembling
29. Which of these activities is LEAST likely to help manage chronic stress?
- Regular physical exercise
- Mindfulness meditation
- Checking work emails constantly throughout the evening and night
- Getting adequate sleep
Answer: Checking work emails constantly throughout the evening and night
30. The “adrenaline rush” is a common term for the effects of which hormone?
- Cortisol
- Epinephrine
- Aldosterone
- Insulin
Answer: Epinephrine
31. The release of CRH from the hypothalamus is the first step in which pathway?
- The sympathetic-adrenal-medullary (SAM) system
- The HPA axis
- The relaxation response
- The digestive cascade
Answer: The HPA axis
32. The immediate, rapid response to stress is primarily driven by the ________, while the slower, more sustained response is driven by the ________.
- HPA axis; SAM system
- Parasympathetic system; HPA axis
- SAM system; HPA axis
- Parasympathetic system; Sympathetic system
Answer: SAM system; HPA axis
33. Why might a patient with asthma experience a worsening of symptoms during a stressful period?
- The stress response causes bronchodilation
- The inflammatory effects of chronic stress can exacerbate airway inflammation
- Stress has no effect on asthma
- The relaxation response triggers bronchoconstriction
Answer: The inflammatory effects of chronic stress can exacerbate airway inflammation
34. The “freeze” response, in addition to fight or flight, is characterized by:
- A sudden burst of energy and activity
- A state of tonic immobility and hypervigilance
- A feeling of calm and relaxation
- An increase in heart rate and breathing
Answer: A state of tonic immobility and hypervigilance
35. A pharmacist counseling on sleep hygiene as a stress management tool would recommend:
- Using electronic devices in bed until sleepy
- Consuming a large meal right before bed
- Establishing a consistent sleep-wake schedule
- Drinking a caffeinated beverage in the evening
Answer: Establishing a consistent sleep-wake schedule
36. The body’s inability to turn off the stress response can lead to a state of:
- Chronic relaxation
- Chronic inflammation and disease
- Improved health and wellness
- A permanently strengthened immune system
Answer: Chronic inflammation and disease
37. Which of the following is a behavioral symptom of chronic stress?
- Increased heart rate
- Dilated pupils
- Increased irritability and social withdrawal
- Increased blood sugar
Answer: Increased irritability and social withdrawal
38. The primary goal of stress management techniques is to:
- Eliminate all sources of stress from one’s life
- Increase the activation of the parasympathetic nervous system
- Permanently increase cortisol levels
- Avoid all social interaction
Answer: Increase the activation of the parasympathetic nervous system
39. In the context of the fight or flight response, the body’s primary goal is:
- Long-term health
- Digestion and growth
- Short-term survival
- Reproduction
Answer: Short-term survival
40. A patient taking a benzodiazepine for anxiety should be counseled on its mechanism, which involves enhancing the effect of what neurotransmitter?
- Serotonin
- Dopamine
- GABA (gamma-aminobutyric acid)
- Norepinephrine
Answer: GABA (gamma-aminobutyric acid)
41. Which of the following is NOT a physiological effect of the fight or flight response?
- Increased blood flow to skeletal muscles
- Increased heart rate
- Increased salivation and digestive activity
- Increased glucose release from the liver
Answer: Increased salivation and digestive activity
42. The part of the brain responsible for executive functions like planning and decision-making, which can be impaired during high stress, is the:
- Amygdala
- Hippocampus
- Prefrontal Cortex
- Cerebellum
Answer: Prefrontal Cortex
43. A pharmacist recognizes that stress management is an important part of managing chronic diseases like:
- Type 2 Diabetes
- Hypertension
- Autoimmune disorders
- All of the above
Answer: All of the above
44. What is the role of the parasympathetic nervous system after a threat has passed?
- To maintain a state of high alert
- To return the body to a state of homeostasis or calm
- To release more cortisol
- To increase heart rate further
Answer: To return the body to a state of homeostasis or calm
45. Chronic stress can lead to “adrenal fatigue,” a controversial term used to describe:
- The overproduction of adrenal hormones
- A state of burnout where the adrenal glands are thought to be unable to keep up with stress demands
- The normal functioning of the adrenal glands
- A type of adrenal cancer
Answer: A state of burnout where the adrenal glands are thought to be unable to keep up with stress demands
46. Which of the following is a cognitive symptom of chronic stress?
- Muscle tension
- High blood pressure
- Difficulty concentrating and memory problems
- Increased appetite
Answer: Difficulty concentrating and memory problems
47. From a wellness management perspective, a key to mitigating the negative effects of the stress response is to:
- Increase one’s resilience and coping mechanisms
- Avoid all challenges and difficult situations
- Focus only on pharmacologic solutions
- Ignore the physical symptoms of stress
Answer: Increase one’s resilience and coping mechanisms
48. Why does your mouth feel dry when you are nervous or frightened?
- The parasympathetic nervous system increases salivation
- The sympathetic nervous system inhibits salivation
- You are likely dehydrated
- It is a sign of a healthy stress response
Answer: The sympathetic nervous system inhibits salivation
49. The fight or flight response is an example of a(n):
- Learned behavior
- Conscious choice
- Innate, automatic physiological response
- Pathological condition
Answer: Innate, automatic physiological response
50. For a PharmD student, understanding the stress response is crucial for:
- Their own self-care and professional well-being
- Counseling patients on the mind-body connection in disease
- Recognizing how stress can impact therapy
- All of the above
Answer: All of the above
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com