Ch 11 Stress and Disease

Which statement regarding corticotropin-releasing hormone (CRH) and its influence on the immune system is true? a. CRH is also released from peripheral inflammatory sites. b. CRH causes vasoconstriction. c. CRH causes decreased vascular permeability. d. Red blood cells are the peripheral targets.

A CRH is released from the hypothalamus and from peripheral inflammatory sites. Because this hormone is proinflammatory, it causes vasodilation and increased vascular permeability. The primary target of peripheral CRH is the mast cell.

A stress response results in the stimulation of which sympathetic nervous system receptors? a. α-Adrenergic receptors b. Anterior pituitary receptors c. Adrenocorticotropic hormone (ACTH) d. Growth hormone (GH)

A The alpha receptors of the sympathetic nervous system are stimulated during the stress response and promote the release of catecholamines. The anterior pituitary receptors when stimulated result in ACTH and growth hormone production.

Which are stages in the development of the general adaptation syndrome? (Select all that apply.) a. Alarm b. Exposure c. Resistance d. Exhaustion

A,C,D The three successive stages in the development of the general adaptation syndrome are alarm, resistance, and exhaustion.

Where does the perception of stress initiate? (Select all that apply.) a. Peripheral nervous system b. Exocrine system c. Parasympathetic nervous system d. Central nervous system

A,D The perception of stress is initiated in the central nervous and peripheral nervous systems.

22. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Select all that apply.) a. IL-1 b. IL-6 c. TNF-ß d. IFN e. IL-12

ANS: A,B Although a number of stress factors initiate the production of CRH, of the options available, only high levels of IL-1 and IL-6 initiate such a response.

19. The effect epinephrine has on the immune system during the stress response is to increase which cells? (Select all that apply.) a. NK cells b. Immunoglobulins c. Cytokines d. T cells e. Th cells

ANS: A,D The injection of epinephrine into healthy human beings is associated with a transient increase of the number of lymphocytes (e.g., T cells, natural killer (NK) cells) in the peripheral blood. This association is not true of the other options.

2. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? a. Adrenal cortex b. Hypothalamus c. Anterior pituitary d. Limbic system

ANS: B The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system (SNS). The other organs are not stimulated by the alarm phase of GAS.

20. The increased production of proinflammatory cytokines is associated with which considerations? (Select all that apply.) a. Chronic respiratory dysfunction b. Elevated anxiety levels c. Immune disorders d. Age and gender e. Dementia

ANS: B,C Increased levels of proinflammatory cytokines have been shown to have a possible link between stress and immune function. Chronic respiratory dysfunction, age, gender, and dementia are not directly linked to cytokine levels.

3. During an anticipatory response to stress, what is the reaction from the limbic system stimulated by? a. The retronucleus of the anterior pituitary b. The anterior nucleus of the hippocampus c. The paraventricular nucleus of the hypothalamus d. The prefrontal nucleus of the amygdala

ANS: C The paraventricular nucleus (PVN) of the hypothalamus must be stimulated to cause the limbic system to be stimulated. The other areas are not involved in the stimulation of the limbic system.

5. Perceived stress elicits an emotional, anticipatory response that begins where? a. Prefrontal cortex b. Anterior pituitary c. Limbic system d. Hypothalamus

ANS: C The perception of stress initiates a series of events in the central and peripheral nervous systems. In the brain, stress elicits an anticipatory response that activates the limbic system; the brain area is responsible for motivation, emotions, and cognition.

Which statement is true regarding stress and the immune system? a. Seasonal allergies are related to stress. b. Cardiovascular disease is one condition that is related to stress. c. The level of proinflammatory cytokines is decreased. d. Negative emotions cause few alterations in cytokine production.

B Cardiovascular disease, aging, cancer, osteoporosis, arthritis, type II diabetes mellitus, and chronic obstructive pulmonary disease (COPD) are associated with the prolonged presence of proinflammatory cytokines. These proinflammatory cytokines increase during stress. Negative emotions are directly associated with the increased level of these proinflammatory cytokines.

Which statement is true regarding how cortisol reacts when activated by ACTH? a. Cortisol is plasma bound to corticotropin. b. Gluconeogenesis is halted. c. Cortisol increases blood glucose. d. Cortisol decreases protein synthesis.

C Cortisol has many actions. It is bound to a protein called transcortin. It stimulates gluconeogenesis, increases glucose production, and increases protein synthesis.

Which statement is true regarding the effects of circulating epinephrine in the body? a. The heart rate will slow down. b. The heart's contractility will decrease. c. Blood vessels to skeletal muscle will constrict. d. Transient hyperglycemia will result.

D Epinephrine dilates blood vessels of the muscles and causes transient hyperglycemia. The epinephrine will increase heart rate and contractility. The venous return to the heart will increase, thus increasing cardiac output and blood pressure.

18. A reduction in an individual's number of natural killer (NK) cells appears to correlate with an increased risk for the development of what? a. Depression b. Type 1 diabetes c. Obsessive compulsive disorder (OCD) d. Gastroesophageal reflux disorder (GERD)

ANS: A A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity. Currently, no research supports correlations between the number of NK cells and type 1 diabetes, OCD, or GERD.

10. What effect of increased secretions of epinephrine, glucagon, and growth hormone would the healthcare professional assess for? a. Hyperglycemia b. Hypertension c. Bronchodilation d. Pupil dilation

ANS: A Cortisol enhances the elevation of blood glucose promoted by other hormones, such as epinephrine, glucagon, and growth hormone. Increases in glucagon and growth hormone do not lead to increases in blood pressure, bronchodilation, or pupil dilation although epinephrine does.

4. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a. Norepinephrine b. Epinephrine c. Cortisol d. Adrenocorticotropic hormone (ACTH)

ANS: A The release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. Epinephrine's effects are primarily on the cardiovascular system. Cortisol's chief effects involve metabolic processes. By inhibiting the use of metabolic substances while promoting their formation, cortisol mobilizes glucose, amino acids, lipids, and fatty acids and delivers them to the bloodstream. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids.

12. What effect do androgens have on lymphocytes? a. Suppression of B-cell responses and enhancement of T-cell responses b. Suppression of T-cell responses and enhancement of B-cell responses c. Suppression of B- and T-cell responses d. Enhancement of B- and T-cell responses

ANS: C Androgens suppress T- and B-cell responses. Androgens do not enhance either B- or T-cell responses.

21. Which statements are true regarding lymphocytes? (Select all that apply.) a. Lymphocytes are involved in the production of the human growth hormone. b. Elevated catecholamine levels influence lymphocytes. c. Lymphocytes are synthesized in the anterior pituitary gland. d. Lymphocytes have receptors for the hormone prolactin. e. Lymphocytes produce endorphins in large amounts.

ANS: A, B, D GH is synthesized from the anterior pituitary gland and is produced by lymphocytes and mononuclear phagocytic cells. Several classes of lymphocytes have receptors for prolactin, suggesting a direct effect of prolactin on immune function. Although the effects of acute elevation of catecholamines on the alteration of lymphocyte function are real, they are short-lived, lasting only approximately 2 hours. Lymphocytes are not synthesized in the anterior pituitary gland or produce endorphins in large amounts.

14. Which statement is true concerning the differences between stress-induced hormonal alterations of men and women? a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes. b. Androgens appear to induce a greater degree of immune cell apoptosis after injury, creating greater immunosuppression in injured men than in injured women. c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol, especially in athletes older than 45 years of age. d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men.

ANS: B Androgens appear to induce a greater degree of immune cell apoptosis after injury, a mechanism that may elicit a greater immunosuppression in injured men vs. injured women. Men produce more proinflammatory cytokines. Competitive stress increases testosterone and cortisol. Estrogen is not increased in women after stressful stimuli.

6. A student asks the healthcare professional how immunity is decreased by stress. The professional responds that during a stress response, the helper T (Th) 1 response is suppressed by which hormone? a. ACTH b. Cortisol c. Prolactin d. Growth hormone

ANS: B Cortisol acts to suppress the activity of Th1 cells, which leads to a decrease in innate immunity and the proinflammatory response. Cortisol also stimulates the activity of Th2 cells, which increases adaptive immunity and the antiinflammatory response. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids. Prolactin is secreted in response to a variety of stressful stimuli and acts as a second messenger for IL-2 and has a positive influence on B-cell activation and differentiation. Growth hormone affects protein, lipid, and carbohydrate metabolism; counters effects of insulin; and is involved in tissue repair.

8. A severely stressed patient has cold, clammy skin. The healthcare professional quizzes the student about this effect. The student correctly answers that this effect is directly from which action? a. Epinephrine dilating blood vessels leading to the vital organs b. Norepinephrine constricting blood vessels in the skin c. Dilating the airways to increased oxygenation of the tissues d. Dysfunctional temperature regulation from cortisol secretion

ANS: B In a stress response, the actions of norepinephrine and epinephrine are complementary. While epinephrine dilates blood vessels to the vital organs (among other things), norepinephrine constricts blood vessels in the viscera and skin, providing more blood supply for those vital organs. The clinical result is cold, clammy skin. Epinephrine can also dilate airways, but this does not produce the skin changes as described. Temperature dysregulation is not the cause of the cold, clammy skin.

1. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a. Flight or fight b. Alarm c. Adaptation d. Arousal

ANS: C Exhaustion occurs if stress continues and adaptation is not successful, ultimately causing impairment of the immune response, heart failure, and kidney failure, leading to death. The other stages occur before the adaptation stage.

16. What are the signs that a patient is in the adaptive stage of the general adaptation syndrome? a. He or she begins to experience elevated heart and respiratory rates. b. He or she finds it difficult to concentrate on a solution for the stress. c. The patient perceives his or her only options are to run away or fight back. d. The patient has exceeded his or her ability to cope with the current situation.

ANS: C Fight-or-flight behaviors are characteristic of the more advanced adaptive stage, whereas the remaining options are noted in the initial alarm stage and are mediated by the sympathetic nervous system.

15. A patient perceives living in a state of chronic stress. What will diagnostic blood work ordered by the healthcare professional likely demonstrate? a. Decreased Th lymphocytes b. Increased erythrocytes c. Decreased Tc cells d. Increased platelets

ANS: C Illustrating 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 of stress was associated with reduced T cytotoxic (Tc)-cell cytotoxicity, although not with levels of circulating Th or Tc lymphocytes. Research has not shown this relationship with changes in Th lymphocytes, erythrocytes, or platelets.

13. The action of which hormone helps explain increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory diseases in women as a result of stimulation of the CRH gene promoter and central norepinephrine system? a. Progesterone b. Cortisol c. Estrogen d. Prolactin

ANS: C Of the options provided, only estrogen directly stimulates the CRH gene promoter and the central noradrenergic (norepinephrine) system, which may help explain adult women's slight hypercortisolism, increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory disease, all of which follow estradiol fluctuations.

11. A severely stressed patient has hypoglycemia each time the patient's blood glucose is checked. The healthcare professional should order laboratory tests to measure which hormone in the patient's blood? a. Epinephrine b. Norepinephrine c. Cortisol d. Growth hormone

ANS: C One of the primary effects of cortisol is the stimulation of gluconeogenesis or the formation of glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver. Neither reaction is a result of the effects of any of the other hormones.

9. Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting which structure? a. Adrenal cortex b. Pancreas c. Liver d. Anterior pituitary

ANS: C One of the primary effects of cortisol is the stimulation of gluconeogenesis through stimulation of the liver. The adrenal cortex, pancreas, and anterior pituitary do not produce stimulation of gluconeogenesis when exposed to cortisol.

7. Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of what? a. Epinephrine and aldosterone b. Norepinephrine and cortisol c. Epinephrine and norepinephrine d. Acetylcholine and cortisol

ANS: C The sympathetic nervous system is aroused during the stress response and causes the medulla of the adrenal gland to release catecholamines (80% epinephrine and 20% norepinephrine) into the bloodstream. Sympathetic stimulation of the adrenal medulla does not cause the secretion of aldosterone, cortisol, or acetylcholine.

17. What is the most influential factor in whether a person will experience a stress reaction? a. General state of physical health b. Spiritual belief system c. Intellectual abilities d. Ability to cope

ANS: D A person does not have a stress reaction unless the stress exceeds his or her coping abilities. General health, spiritual belief systems, and intellectual abilities do not have the same degree of influence on stress reactions.

Which is a function of norepinephrine? a. Increases contraction of the heart b. Constricts smooth muscle in all blood vessels c. Secretes steroid hormones d. Stimulates adrenal medulla

B Norepinephrine is released from the adrenal medulla and regulates blood pressure by constricting smooth muscle in all blood vessels. Epinephrine increases myocardial contractility and heart rate. The steroid hormones are stimulated by the hypothalamus, which sets off a chain of events during which steroid hormones are secreted from the adrenal cortex. Cortisol is one of the primary steroid hormones.

What is the definition of the reactive response? a. Mounting a response in anticipation of a stressor b. Mounting a response in reaction to a psychologic stressor c. Mounting a response to a learned stressor d. Mounting a response to a physical stressor

B A reactive response is a psychologic response to a stressor. An anticipatory response is a psychologic response to an anticipated response. A conditioned response is an anticipated psychologic (learned) response to stimuli that have been associated with danger.

Which statement is true regarding the immune system in response to stress? a. T-helper 1 (Th1) cells increase. b. A shift in Th1 cells occurs. c. The immune system is not affected. d. Cortisol is released.

D Stress can activate an excessive immune response through cortisol. It can cause the suppression of Th1 cells and a shift in Th2 cells.