Stress

Question 1

What are the different definitions of stress?

Answer 1

• emphasising certain words in speech
• a force applied to a body causing deformation/strain
• emotional or mental pressure

Question 2

Examples of physical ‘stressors’

Answer 2

injury, surgery, infection, shock, pain, cold exposure, sustained exercise

Question 3

Examples of threats that are ‘stressors’

Answer 3

imprisonment, exams

Question 4

Which body systems interact during stress?

Answer 4

nervous, endocrine, immune

Question 5

What do the effects of stress depend on?

Answer 5

duration and severity of the stressor, effectiveness of any responses

Question 6

What are the 3 stages of the stress response?

Answer 6

alarm reaction, resistance phase, exhaustion phase

Question 7

What term describes the 3 stage process of the body responding to stress?

Answer 7

General Adaptation Syndrome

Question 8

What is the first stage of the General Adaptation Syndrome?

Answer 8

alarm reaction

Question 9

What response takes place in the alarm reaction?

Answer 9

fight, flight or fright response (has physiological effects)

Question 10

What is the second stage of the General Adaptation Syndrome?

Answer 10

resistance phase

Question 11

What happens during the resistance phase?

Answer 11

with persistent exposure to the stressor, the body adapts (counteracts physiological changes) so the stress response is diminished and the stress is no longer a ‘threat’

Question 12

What is the third stage of the General Adaptation Syndrome?

Answer 12

exhaustion phase

Question 13

What would cause the exhaustion phase to be reached?

Answer 13

severe, persistent stress which renders the body’s responses futile

Question 14

What are the effects of the exhaustion phase?

Answer 14

pathological effects

Question 15

Example of an advantage of stress

Answer 15

a little bit of stress can improve learning

Question 16

Why may stress benefit learning?

Answer 16

due to increased attention

Question 17

What is the neural component of the alarm reaction?

Answer 17

sympathetic NS

Question 18

Which glands are involved in the hormonal response of the alarm reaction?

Answer 18

adrenal glands

Question 19

Which structure is known as the sympathetic ganglion?

Answer 19

adrenal medulla (secretes adrenaline which enhances the sympathetic response)

Question 20

Which hormones are released during the alarm reaction?

Answer 20

adrenaline and corticosteroids

Question 21

Where is adrenaline released from?

Answer 21

adrenal medulla

Question 22

Where are corticosteroids released from?

Answer 22

adrenal cortex

Question 23

Where is the origin of the sympathetic NS found?

Answer 23

thoracolumbar region of the spinal cord T1-L2

Question 24

What are the effects of the sympathetic NS in the alarm reaction?

Answer 24

increase cardiac output, redistribute cardiac output, metabolic effects, stimulate adrenaline release

Question 25

How is cardiac output increased by the sympathetic NS?

Answer 25

Sympathetic NS increases heart rate and ventricular contractility which results in an increased CO

Question 26

In what way is cardiac output redistributed as a result of the sympathetic NS in the alarm reaction?

Answer 26

decreased blood flow to gut/kidney, increased blood flow to muscle

Question 27

What are the metabolic changes that are triggered by the sympathetic NS during the alarm reaction?

Answer 27

glycogen is broken down to release glucose (glycogenolysis), fat stores are mobilised (release of free fatty acids)

Question 28

What is the effect of adrenaline?

Answer 28

prolongs the action of the sympathetic nerves during the alarm reaction (increases CO, redistributes blood flow, metabolic effects)

Question 29

Where are the adrenal glands located?

Answer 29

superior to kidneys (suprarenal glands)

Question 30

Alternative name for adrenaline

Answer 30

epinephrine

Question 31

What types of steroid hormones are included within the term corticosteroids?

Answer 31

glucocorticoids and mineralocorticoids

Question 32

What are the effects of glucocorticoids?

Answer 32

metabolic, immunosuppressive, anti-inflammatory, vasoconstrictive effects

Question 33

What is the function of mineralocorticoids?

Answer 33

regulate water and electrolyte balance by affecting ion transport in renal tubules

Question 34

Example of glucocorticoids

Answer 34

steroids such as cortisol

Question 35

What is the main stress hormone?

Answer 35

cortisol

Question 36

What are the actions of cortisol?

Answer 36

metabolic effects, 'permissive effect' to adrenaline, anti-inflammatory, immunosuppression

Question 37

What are the metabolic effects of cortisol?

Answer 37

increases energy production from glucose, amino acids and fats. Increases protein breakdown

Question 38

What is meant by the 'permissive effect' cortisol has on adrenaline?

Answer 38

cortisol enhances the actions of adrenaline

Question 39

Which hormones have a 'permissive effect' on adrenaline?

Answer 39

cortisol and thyroid hormone

Question 40

What are the pharmacological uses of cortisol?

Answer 40

used as an anti-inflammatory and sometimes immunosuppressant (corticosteroid drug therapy)

Question 41

Why is there an increased incidence of illness during times of stress?

Answer 41

glucocorticoids (cortisol) are released during the alarm reaction and have an anti-inflammatory and immunosuppressive effect

Question 42

How do glucocorticoids have an anti-inflammatory and immunosuppressive effect?

Answer 42

inhibit the release of prostaglandins and leukotrienes (chemical mediators) and inhibit macrophages and helper T lymphocytes

Question 43

Example of a condition that may be treated using corticosteroid therapy

Answer 43

arthritis (anti-inflammatory drug)

Question 44

What is the effect of long-term corticosteroid therapy?

Answer 44

suppresses corticotrophin releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) which suppresses the natural stress response

Question 45

Which individuals are at risk during surgical procedures (e.g. dental extractions)?

Answer 45

patients on corticosteroid therapy

Question 46

What is the name of the pathway that controls cortisol release?

Answer 46

hypothalamic-pituitary-adrenal axis

Question 47

Describe the control of cortisol release by the hypothalamic-pituitary-adrenal axis

Answer 47

stressor causes the hypothalamus to release Corticotrophin Releasing Hormone (CRH) which triggers the anterior pituitary gland to release Adrenocorticotrophic Hormone. ACTH causes the adrenal cortex to release cortisol

Question 48

Explain the negative feedback involved in the hypothalamus-pituitary-adrenal axis

Answer 48

cortisol acts on the hypothalamus and the anterior pituitary to inhibit the release of Corticotrophin Releasing Hormone (CRH) and Adrenocorticotrophic Hormone (ACTH), respectively

Question 49

What is stress analgesia?

Answer 49

pain is diminished during physical stress (e.g. sport, battle)

Question 50

How does stress analgesia work?

Answer 50

endogenous opioid peptides, endorphins and enkephalins are released in the CNS which suppress nociception

Question 51

How is stress assessed in an individual?

Answer 51

by changes in blood pressure and heart rate

Question 52

How does stress vary with different treatments?

Answer 52

the amount of stress increases with the severity of the treatment

Question 53

What is the difference in the heart rate response between men and women during stress?

Answer 53

women have a higher HR response

Question 54

How does the stress response vary between children and adults?

Answer 54

children tend to have a greater stress response

Question 55

Which patients are likely to have a greater stress response?

Answer 55

anxious patients and even more so with dental phobics

Question 56

What factors may increase patient stress in dentistry?

Answer 56

pain, local anaesthesia, noise of dental instruments, PPE

Question 57

What is the stress-induced effect on systolic BP?

Answer 57

increases by + 5-20mmHg

Question 58

What is the stress-induced effect on diastolic BP?

Answer 58

increases by + 4-8mmHg

Question 59

What is the stress-induced effect on heart rate?

Answer 59

increases by up to +20bpm

Question 60

What is a normal heart rate?

Answer 60

approx 80bpm

Question 61

When are the effects of stress greater for dentists?

Answer 61

when standing, with complex procedures, with anxious patients

Question 62

What happens to an individual if the stressors persist?

Answer 62

either they cope and enter the adaptation phase or they don't and enter the exhaustion phase

Question 63

How does the adaptation/resistance phase usually occur?

Answer 63

if the individual's responses are effective in removing the stressor

Question 64

What happens if the acute stress response fails to diminish the stressor?

Answer 64

the individual enters the exhaustion phase and the effects of stress persist

Question 65

What are potential consequences of persistent stress?

Answer 65

adrenal failure, immunosuppression, peptic ulcers, CVS disease, (death in extreme cases)

Question 66

What type of individuals are more prone to high blood pressure and CVD?

Answer 66

type A (hard-working, competitive) individuals compared to type B (more relaxed, less impatient)