Stress Health And Well Being Thriving in the 21st Century 1st Edition By Rick Harrington – Test Bank

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Sample Questions Posted Below

Chapter 5: The Impact of Stress on Health Conditions

MULTIPLE CHOICE

1.Some estimates suggest that primary care physicians can medically explain only ____% of the symptoms that patients report.

ANS: C PTS: 1 REF: Introduction

2.Some health conditions are considered ____ because they are health conditions with no detectable organic cause.

ANS: A PTS: 1 REF: Introduction

3.Stress may play ____ in the development of some health conditions, and in other conditions it appears to play ____ yet contributes to the exacerbation of symptoms.

ANS: D PTS: 1 REF: Introduction

4.According to the American Heart Association, ____% of cardiovascular disease deaths are from coronary heart disease, ____% from stroke, ____% from heart failure, ____% from high blood pressure, and other causes constitute the remainder.

ANS: D PTS: 1 REF: Cardiovascular Disease

5.Hispanic Americans are ____ likely to have coronary heart disease than non-Hispanic white Americans and are ____ likely to die from it.

ANS: B PTS: 1 REF: Cardiovascular Disease

6.A hardened and partially occluded artery is no longer able to expand to allow sufficient blood to flow to the heart muscle when blood pressure increases. ____ refers to this “hardening” of the arteries.  ____ is a form of ____.

ANS: D PTS: 1 REF: Cardiovascular Disease

7.Elevated levels of ____ are associated with a 3-fold risk of a recurrent myocardial infarction (MI) or death due to a coronary event.

ANS: D PTS: 1 REF: Cardiovascular Disease

8.____ grow and turn into very large fatty foam cells, which stimulate smooth muscle cells from the middle layer of the arterial wall to migrate to and congregate at the site, causing atherosclerotic plaque to form inside the vascular wall.

ANS: A PTS: 1 REF: Cardiovascular Disease

9.Stress is commonly believed to be associated with ____.

ANS: B PTS: 1 REF: Cardiovascular Disease

10.Chronic distress emotions as well as ____ are demonstrated risk factors for coronary heart disease.

ANS: B PTS: 1 REF: Cardiovascular Disease

11.The skeletal muscles are often measured in psychophysiological research with a(n) ____.

ANS: C PTS: 1 REF: Skeletal Muscle Conditions

12.Evidence suggests that tension-type headache onset, a skeletal muscle condition, is related to ____ stressors and migraine headache, a neurovascular condition, to ____ stressors.

ANS: C PTS: 1 REF: Skeletal Muscle Conditions

13.____ is characterized by a hypersensitivity of the skin to particular foods or environmental allergens that results in the skin becoming inflamed, feeling itchy, and perhaps scaling or flaking.

ANS:BPTS:1

REF: Atopic Disorders- Asthma, Allergic Rhinitis, and Atopic Dermatitis

14.At present, most coping strategies recommended for those with hay fever and skin allergies involve ____.

ANS:CPTS:1

REF: Atopic Disorders- Asthma, Allergic Rhinitis, and Atopic Dermatitis

15.According to the American Cancer Society, ____ cancer is more prevalent than any other type of cancer, accounting for almost 50% of the cancers diagnosed in the United States.

ANS: C PTS: 1 REF: Cancer

16.Irritable bowel syndrome (IBS) is a functional disorder, that is, a disorder ____.

ANS: D PTS: 1 REF: Gastrointestinal System Conditions

17.____ is also a serious inflammatory bowel disease that is characterized by GI symptoms and ulcers of the colon.

ANS: D PTS: 1 REF: Gastrointestinal System Conditions

18.____ is a chronic autoimmune disorder characterized by inflammation of and sometimes damage to the joints and surrounding tissues.

ANS: A PTS: 1 REF: Systemic Autoimmune Disorders

19.Which of the following is thought to be most linked to stress?

ANS: D PTS: 1 REF: The Strong Evidence; The Weak Evidence

20.Stress in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) stimulates ____.

ANS: D PTS: 1 REF: Systemic Autoimmune Disorders

SHORT ANSWER

1.Describe coronary heart disease and coronary atherosclerosis.

ANS:

Coronary heart disease (CHD), also called coronary artery disease (CAD), is the leading cause of death in the United States for both men and women eclipsing cancer. CHD is a progressive degenerative inflammatory disease that involves coronary atherosclerosis. The atherosclerosis process is believed to be the body’s way of responding to injury of the interior walls of the affected arteries. The inner lining of the vascular wall, the intima, is composed of endothelial cells. These cells form a type of “Teflon lining” that prevents other cells from sticking to them. However, with sufficient irritation or injury, these endothelial cells become compromised.

PTS: 1 REF: Cardiovascular Disease

2.What are some lifestyle changes that can help prevent coronary heart disease (CHD)?

ANS:

Prevention of CHD includes lifestyle changes such as not smoking, eating fruits and vegetables, exercising, lowering cholesterol, controlling obesity, preventing diabetes, managing stress, preventing high blood pressure, and using alcohol in moderation if at all.

PTS: 1 REF: Cardiovascular Disease

3.What is ischemia? In what context does it develop? What can it lead to?

ANS:

In the advanced stages of atherosclerosis, heart muscle deprived of oxygen develops ischemia (too little blood flow), which can in turn lead to angina or myocardial tissue death. A myocardial infarction (MI), known also as a heart attack, may be the ultimate result. There are typically three forms of clinical symptoms presentation. These include angina pectoris (chest pain), an acute coronary syndrome (ACS; otherwise known as myocardial infarction), or sudden cardiac death (cardiac arrest that occurs very shortly after symptom onset that results in death).

PTS: 1 REF: Cardiovascular Disease

4.What psychological stressors are related to coronary vascular disease?

ANS:

Among workers in general, the mix of job strain, low job control, and low social support is related to coronary vascular disease (CVD). In a review of research on work stress and cardiovascular disease, Landsbergis and his colleagues concluded that the psychological stress of having a low degree of control known as low decision latitude was the most consistent predictor of CVD. They cited as support for their conclusion studies such as Haynes and Feinleib’s Framingham Heart Study that found clerical workers to be twice as likely as white collar workers (e.g., managers) to have heart disease.

PTS: 1 REF: Cardiovascular Disease

5.Why is taking a daily baby aspirin recommended for heart health?

ANS:

Baby aspirin works as both an anti-inflammatory and anti-clotting agent (it blocks an enzyme that helps platelets aggregate). The downside to the use of daily aspirin is that it can increase the chance of bleeding in the gastrointestinal tract, so baby aspirin is the minimum effective low risk dose.

PTS: 1 REF: Cardiovascular Disease

6.What are endothelial cells?

ANS:

The inner lining of the vascular wall, the intima, is composed of endothelial cells. These cells form a type of “Teflon lining” that prevents other cells from sticking to them. However, with sufficient irritation or injury, these endothelial cells become compromised.

PTS: 1 REF: Cardiovascular Disease

7.How does irritation or injury of endothelial cells lead to lowered LDL levels?

ANS:

Irritation or injury stimulates the inflammatory response and calls the white blood cells to action, the leukocytes. Leukocytes called monocytes are attracted to vascular adhesion molecules on the endothelial cells and penetrate the vascular wall. Once inside, these monocytes transform into macrophages that eat modified LDL (low density lipoprotein), otherwise known as “bad cholesterol.”

PTS: 1 REF: Cardiovascular Disease

8.Why is it important to keep LDL levels within normal limits?

ANS:

It’s noteworthy that the more LDL particles circulating in the blood stream, the greater the likelihood some will penetrate the endothelial lining. That’s why it is important to keep LDL levels within normal limits. As Granato explains, these particles tend to congregate on the endothelium “like condensation on a shower door.”

PTS: 1 REF: Cardiovascular Disease

9.What are the three types of muscles in the human body?

ANS:

The human body has three types of muscles, the skeletal muscles, the heart or cardiac muscles, and the smooth muscles. The skeletal muscles, the muscles of the body attached to bone, are also known as the striated muscles because of their shape and color and as the voluntary muscles since we have control over their contractions except during reflex actions. These muscles contrast with the heart muscles, which are responsible for the heart’s contractions, and the smooth muscles such as those found in the gastrointestinal tract that are responsible for gastric motility and in the walls of the arteries.

PTS: 1 REF: Skeletal Muscle Conditions

10.What is a tension-type headache (TTH)?

ANS:

The most common type of headache is the tension-type headache (TTH). This type of headache, formerly known simply as tension headache, was renamed TTH in 1988 by the International Headache Society. TTH accounts for the vast majority of all headaches and is characterized by head pain that often has corollary pain in the neck, back, or other related muscle areas. It is different from migraine headaches.

PTS: 1 REF: Skeletal Muscle Conditions

11.Describe migraine headaches.

ANS:

Migraines are believed to be neurovascular in origin, and are experienced more frequently by women than men. They are typically felt more on one side of the head. These painful headaches (i.e., migraines) may be accompanied by feelings of nausea and auras such as unusual lights or odors. It is a common belief that headaches, especially tension-type headaches (TTHs), are stress related. But does the research support this belief? Research suggests that TTHs are related to proximal (i.e., near term) stressors and that development of migraine headache patterns are related to distal (i.e., distant term) stressors.

PTS: 1 REF: Skeletal Muscle Conditions

12.Briefly describe bruxism, temporo-mandibular pain and dysfunction syndrome (TMPDS).

ANS:

Bruxism is defined as an involuntary habit of excessive teeth clenching or grinding that can lead to abrasive wear on the teeth, headaches, and/or temporo-mandibular pain and dysfunction syndrome (TMPDS). Both TMPDS and bruxism seem to be stress related. TMPDS is characterized by myofascial pain, particularly in the temporo-mandibular joint (the joint used to open and close our jaw) and the muscles involved in mastication (i.e., chewing). The TM joint may emit clicking or popping sounds during movement, and there may also be deviations in jaw movement. Ruth Moulton was the first to propose that the habit of teeth grinding along with TM joint problems may be a misguided attempt to reduce inner tension that inadvertently creates a vicious cycle of muscle spasm followed by pain and then, once again, spasm.

PTS: 1 REF: Skeletal Muscle Conditions

13.Is there a link between psychosocial factors and atopic disorders?

ANS:

In a meta-analysis examining the relationship between atopic disorders and psychosocial factors, the investigators determined that the psychosocial factors of early stress exposure, psychological distress, and low social support were significantly related to the future onset of atopic disorders and their clinical course. They also found support for a bi-directional relationship in which the presence of an atopic disorder is significantly related to psychological distress and vice versa.

PTS: 1 REF: Atopic Disorders- Asthma, Allergic Rhinitis, and Atopic Dermatitis

14.What are atopic disorders?

ANS:

Atopic disorders like asthma are characterized by a biological hypersensitivity and inflammation.  These mucosal inflammatory disorders are believed to be due to a dysregulation of the immune system whereby it over-responds to certain exogenous antigens.  The atopic category includes asthma, allergic rhinitis (i.e., hay fever), atopic dermatitis (e.g., some forms of eczema), and conjunctivitis (e.g., allergy form of pink eye).

PTS: 1 REF: Atopic Disorders- Asthma, Allergic Rhinitis, and Atopic Dermatitis

15.What are some primary prevention strategies for allergy and allergic asthma?

ANS:

There are a number of primary prevention strategies for allergy and allergic asthma (one form of asthma). These include avoiding tobacco smoke, especially during pregnancy and early childhood and eliminating it from the work place; reducing indoor air pollution; minimizing exposure of at-risk young children to inhalant allergies like dust mites, cockroaches, and furry animals; preventing or eliminating exposure to highly irritating or sensitizing agents in occupational settings; minimizing exposure to damp housing conditions; and breastfeeding infants exclusively until the age of 4 to 6 months (breast milk may contain some protective factors).

PTS: 1 REF: Atopic Disorders- Asthma, Allergic Rhinitis, and Atopic Dermatitis

16.What is allergic rhinitis (AR) and what are some of its symptoms?

ANS:

Allergic rhinitis (AR) sufferers have allergic reactions to certain pollens, dust particles, or airborne chemicals. Symptoms include itchy, watery, or burning eyes; nasal congestion; loss of smell or runny nose; stuffy head; headaches over the paranasal area (alongside the nose); blunted taste; an itchy roof of the mouth; dry cough; sore throat; drainage down the back of the throat; itchy ears; or a full or plugged feeling in the ears.

PTS: 1 REF: Atopic Disorders- Asthma, Allergic Rhinitis, and Atopic Dermatitis

17.What is inflammatory bowel disease (IBD) and how does it differ from irritable bowel syndrome (IBS)?

ANS:

Searle and Bennett reviewed a decade of literature between 1990 and 2000 that included 14 papers on a related though more serious condition called inflammatory bowel disease (IBD). Whereas IBS is a functional disease that eludes detection with traditional testing, IBD always has visible inflammation of the intestinal lining that is seen through x-ray or colonoscopy. IBD is a broad term that incorporates both Crohn’s disease (CD) and ulcerative colitis (UC).

PTS:1REF:Gastrointestinal System Conditions

18.Does stress play a role in the development of lupus or its prognosis?

ANS:

As far back as the mid-1950s, Selwyn Brody concluded after studying 42 lupus patients that “stress plays a part in the precipitation, recurrence, and exacerbation of the disease.” However, more recently, after reviewing the SLE and stress studies done from 1990 to 2006, Bricou et al. surmised that “stress as a causal factor is not proved, but it seems to act as an exacerbating factor in disease activity and to have an impact on the quality of life.”

PTS: 1 REF: Systemic Autoimmune Disorders

19.What are some coping strategies that would be helpful in dealing with rheumatoid arthritis?

ANS:

As with the management of SLE, pharmacological approaches may include use of NSAIDs or corticosteroids. There is also a class of medications called disease-modifying anti-rheumatic drugs (DMARDS) that can be used to alter the course of the disease. Surgical approaches (e.g., joint surgery) may also be indicated. Behavioral approaches include stress management, cognitive behavioral therapy, and self-management approaches.

PTS: 1 REF: Systemic Autoimmune Disorders

20.Describe systemic autoimmune disorders.

ANS:

In systemic autoimmune disorders, the body’s immune system mistakenly attacks its own cells and tissues. The immune system is dysregulated in that it fails to recognize self from other. Immune dysregulation is an under- or over-reaction of the immune system to exogenous or endogenous threats. In autoimmune disorders, the immune dysregulation is an example of an over-reaction against mistaken endogenous threats. Over-reactions of the immune system are believed to play a role in transplant tissue rejection and in well known autoimmune diseases such as lupus erythematosus and rheumatoid arthritis.

PTS: 1 REF: Systemic Autoimmune Disorders

ESSAY

1.What is the relationship between essential hypertension and stress?

ANS:

Essential hypertension (HTN), known by most simply as high blood pressure, is a chronic condition with no known organic cause that is characterized by systolic blood pressure (SBP) (the top number when blood pressure is reported) of 140 mm Hg or higher or diastolic blood pressure (DBP) (the bottom number when blood pressure is reported) of 90 mm Hg or higher. This condition is related to increased risk of myocardial infarction (MI), congestive heart failure, stroke, and peripheral vascular disease since it can result in structural changes in the blood vessels and heart. 

Hypertensives are documented to have higher levels of circulating catecholamines suggesting overall higher sympathetic nervous system reactivity to stressors. In their meta-analytic review of behavioral stress and hypertension, Fredrikson and Matthews determined that individuals with HTN show “exaggerated blood pressure responses to all stressors” irrespective of their psychological elements. Thus, it appears that HTN individuals display hormonal changes and blood pressure changes indicative of exaggerated physiological reactions to stress.

PTS: 1 REF: Cardiovascular Disease

2.What are some of the physiological effects of anger, hostility and anxiety?

ANS:

Anger and hostility may play a role in acute myocardial infarctions (MI’s) or lethal arrhythmias. As Futterman explains, anger increases catecholamine levels, blood pressure, heart rate, the likelihood of vasospasms, as well as platelet aggregation thus making it more likely that there will be a disruption of vulnerable areas of plaque resulting in occlusive ischemia followed by an MI or sudden cardiac death (SCD). Futterman also points out that, “emotional or psychological stress, specifically anger or hostility, are significant and independent risk factors in ischemic heart disease and can precipitate an acute myocardial infarction (MI) or lethal arrhythmias.” A recent meta-analysis also concluded that “anger and hostility are associated with coronary heart disease (CHD) outcomes both in healthy and CHD populations.” Trait anger is associated with both an increased risk for hypertension and CHD in men although anxiety may be a better CHD predictor than hostility for women.

PTS: 1 REF: Cardiovascular Disease

3.Describe the nine recommendations for reducing the risk of myocardial infarction (MI).

ANS:

Do not smoke- No amount of smoking is safe. Eat fruits and vegetables- Eating a variety of fruits and vegetables lowers the risk of CHD by 30%. Exercise more- Physical exercise can strengthen the heart muscle, lower blood pressure, help with weight management, reduce the risk of diabetes, and preserve muscle mass. Lower cholesterol- The key to controlling cholesterol is to keep LDL levels low and HDL (high density lipoproteins- the “good cholesterol”) levels high. Control obesity- Obesity increases the risk of diabetes, hypertension, and high cholesterol. Prevent diabetes- Diabetes, a disorder of metabolism that results in high circulating levels of glucose in the bloodstream following digestion, dramatically increases the risk and severity of CHD. Manage stress- Given what you have previously read, it goes without saying that managing stress is an important strategy for reducing risk of CHD. Prevent high blood pressure- High blood pressure may damage the lining of the arterial wall initiating the CHD process. Alcohol- Moderate alcohol (1-2 drinks) intake actually decreases the chance of CHD.

PTS: 1 REF: Cardiovascular Disease

4.How do exercise and stress management strategies compare to medical care alone in their effectiveness at reducing emotional distress and cardiovascular risk markers?

ANS:

Blumenthal et al. demonstrated that exercise and stress management were more effective at reducing emotional distress and cardiovascular risk markers than medical care alone in their randomized controlled trial study. However, one review of 36 trials concluded that stress management alone showed no strong evidence for reducing cardiac mortality even though it was associated with a reduction of non-fatal MIs. The authors also expressed concern about the poor quality of many of the studies examined and saw a tendency toward publication bias of favorable studies. As a result, they expressed skepticism about the validity of some of the results that showed beneficial outcomes for stress management. Evidence for the use of exercise-based rehabilitation programs for CHD is more supportive and on average these programs result in a 31% reduction in cardiac-related mortality for those with CHD.

PTS: 1 REF: Cardiovascular Disease

5.Are stress management strategies likely to be effective in reducing cholesterol levels?

ANS:

A large multi-site intervention study of 869 CHD patients found that participation in a three-month stress management program that was part of a combined multicomponent lifestyle intervention program led to reductions of total cholesterol/high density lipoprotein in CHD men participants and lowered levels of triglycerides in CHD men and women participants. Therefore, at least in CHD men and to a certain extent CHD women, stress management appeared to reduce their lipid levels. It appears, however, that the jury is still out regarding the nature of the complicated relationship between stress and serum lipid levels.

PTS: 1 REF: Cardiovascular Disease

6.What is sudden cardiac death (SCD)? Who is at risk of SCD? What are some of the primary categories of stress-related SCD?

ANS:

Sudden cardiac death (SCD) is due to a cardiac event that leads to an abrupt loss of consciousness shortly after the onset of the event. SCD is more likely to occur in individuals with pre-existing coronary and vascular diseases, such as those with coronary artery disease (CAD), angina pectoris, and hypertension, but may also occur in individuals with no evidence of coronary disease. Engel was the first scientific investigator to search newspaper accounts of people who had died of sudden death and draw a common thread of stress. He found that the primary categories of stress-related SCD were “personal danger or threat of injury,” “the collapse or death of a close person,” and “acute grief.”

PTS: 1 REF: Cardiovascular Disease

7.What is the relationship between stress and blood pressure?

ANS:

Acute stress can cause spikes in blood pressure while chronic stress can prevent elevated blood pressure from recovering to its normal homeostatic levels; chronic stress may also drive inflammatory responses. In addition, blood pressure spikes may cause tiny tears in the inner arterial walls that need to be patched by cholesterol-laden plaques. An example of the connection between stress and blood pressure was demonstrated in a study that found blood pressure activity was higher the day before and during a student examination period suggesting that the stress of anticipating an exam and the stress of taking an exam elevated blood pressure. Similarly, higher blood pressure was found in male Hispanic immigrant farm workers in the United States when they experienced increased stress due to perceived discrimination.

PTS: 1 REF: Cardiovascular Disease

8.Are there any effective preventive therapies for tension-type headaches (TTH’s)? What about treatments?

ANS:

Fumal and Schoenen reviewed the research on TTH and concluded that preventive therapy is generally not effective. However, acute behavioral treatment for specific episodes of TTH can be effective. In fact, there is good empirical evidence for the effectiveness of electromyography (EMG) biofeedback combined with relaxation. Overall, the authors recommended the combination of drug therapies (e.g., Ibuprofen or aspirin) and non-pharmacological approaches (e.g., stress management relaxation or physical therapies) for the treatment of TTH.

PTS: 1 REF: Skeletal Muscle Conditions

9.What role does stress play in atopic dermatitis?

ANS:

In a normal immune system Th1 and Th2 immunity are in proper balance. However, in eczema, there is too much Th2 relative to Th1. Upon reviewing the allergy literature, Hashizume and Takigawa concluded that acute stressors that chronically and repeatedly raise the anxiety levels of patients with atopic dermatitis lead to a worsening of allergic symptoms by dysregulating the immune system through enhancing Th2 responses. This model of stress-induced dysregulation toward Th2 immunity can be applied to all the atopic disorders. In a review by Marshall and Agarwal, the authors suggested “that chronic stress does not simply suppress the immune system, but induces a shift in the type-1/type-2 cytokine balance toward a predominant type-2 cytokine response. Such a change would favor the inflammatory milieu characteristic of asthma and allergic diseases.”

PTS: 1 REF: Atopic Disorders- Asthma, Allergic Rhinitis, and Atopic Dermatitis

10.What, if any, is the relationship between stress and cancer?

ANS:

There is a widespread belief that stress can lead to susceptibility to cancer. However, at the present time, the evidence for this belief is mixed. In a meta-analysis of 29 studies, Petticrew, Fraser, and Regan concluded that whereas analysis of their larger study’s sample found that adverse life events were twice as likely to be reported by breast cancer patients than by controls, when poorer quality studies were eliminated from their analysis, there did not appear to be a causal relationship between these variables. Current research findings continue to confirm that at most there is only a “weak association between life stress and losses in adulthood and breast cancer risk.”

Researchers have also discovered a positive relationship between stressful events such as foot-shock and subsequent tumor growth in animals such as mice. However, as discussed by Levinson and Bemis, it is difficult to generalize from mice to humans regarding this issue for several reasons. These rodent strains have been specifically bred to develop cancers from viruses, a process that is uncommon in humans, occurring in only 2% to 3% of known human cancers. In addition, when these animals are exposed to carcinogens, it is typically at very high doses, which does not match the chronic low-dose exposure that humans with cancer may have had in the real life environment.

PTS: 1 REF: Cancer