Unit3.docx

Which statement best describes the immediate reaction of the stress response during physical stress such as blood loss?  A) The hypothalamic pituitary axis is activated by adrenocorticotropin hormone (ACTH) from the posterior pituitary.  B) The stress is perceived by the prefrontal cortex, amygdal...

Which statement best describes the immediate reaction of the stress response during physical stress such as blood loss?  A) The hypothalamic pituitary axis is activated by adrenocorticotropin hormone (ACTH) from the posterior pituitary.  B) The stress is perceived by the prefrontal cortex, amygdala and hippocampus. ** C) The brainstem and hypothalamus process the stressor and corticotropin releasing hormone is secreted.**  D) The central and sympathetic nervous systems are simultaneously activated.   Activation of the sympathetic nervous system results in:  A) Constriction of pupils and reduced salivary flow.  B) Increase in heart rate and vasodilation.  **C) Gluconeogenesis and elevation in inflammatory biomarkers.**  D) Activation of platelets increased peristalsis.   During the relaxation response:  A) Heart rate variability and oxygen consumption decrease ** B) Slow alpha brain waves and heart rate variability increase**  C) Cortisol and oxytocin increase  D) Nitric oxide and minute ventilation increase.   Relaxation has been associated with: ** A) Increased telomere length**  B) Lower heart rate variability  C) Decreased natural killer cells  D) Increased expression of genes associated with inflammation   Which of the following is NOT associated with the relaxation response?  A) Greater heart rate variability ** B) Inhibition of salivation**  C) Increase in alpha brain waves  D) Reduced respiratory rate   Meditation has been shown to result in the following changes:  A) Reduction in heart rate variability and c-reactive protein.  B) Decrease in telomere length.  C) Decrease in LDL and HDL cholesterol ** D) Increased communication between the right and left hemispheres through the corpus collosum.**   Which one of the following statements about hypnosis is true:  A) It uses the repetition of a mantra to achieve a state of relaxation. ** B) Hypnosis is a state of trance, or inner absorption that can naturally occur many times during the day.**  C) With hypnotic suggestion, people can reveal embarrassing secrets.  D) During hypnosis, it is common to lose consciousness.     The person most likely to benefit from guided imagery is:  A) A 25-year-old woman going into labor.  B) A 35-year-old refugee who witnessed a murder.  C) A 42-year-old man with generalized anxiety disorder who states he has trouble sitting still.  D)** A 69-year-old mathematician who has mild cognitive decline.**     The most utilized application of clinical hypnosis is for:  A) Irritable bowel syndrome  B) Smoking cessation  C) Anxiety ** D) Pain**     Progressive Muscle Relaxation:  A) Requires that it be practiced while lying down.  B) **Has evidence for improvement of quality of life in patients with cancer.**  C) Was developed by Dr. Benson in the 1970s.  D) Was originally developed for the treatment of pain.     Brain structural and functional changes with yoga have been observed:  A) Only if yoga training started in early adulthood. ** B) After 4 weeks of yoga practice.**  C) Only in people with 8 years of consistent practice.  D) With a daily practice for 10 years.     Which one of the following statements about yoga is true?  A) Yoga is the first line of treatment for generalized anxiety disorder.  B) Yoga increases salivary cortisol and plasma renin activity.  C)** Yoga increases heart rate variability and enhances baroreflex sensitivity.**  D) There are 4 limbs of yoga.     The most efficacious biofeedback for Raynaud\'s symptoms is:  A) Neurofeedback  B)** Thermal**  C) Heart rate variability  D) Electromyogram   The most common stress-related symptoms in adolescents is: ** A) Irritability, anger or depression**  B) Headache or light-headedness  C) Abdominal pain or constipation  D) Chest pain or palpitations   Which of the following is true about biofeedback in the pediatric population?  A) Neurofeedback has not been studied in children with ADHD  B) The biofeedback modalities are different from the ones used for adults. ** C) It is useful for the treatment of pediatric migraine.**  D) It does not decrease pain episodes in functional abdominal disorders.   You are speaking to a child who is in the ER with nausea and vomiting. What is the best language?  A) You look really sick. Tell me how you feel.  B) Try to relax and you will feel better.  C) I gave your mother a pill she can give you to help you feel better. ** D) You look like you don\'t feel well.**   The global prevalence of anxiety in children is estimated to be:  A) 10% ** B) 25%**  C) 40%  D) 75%   Common signs of stress in toddlers include: ** A) Night terrors, exaggerated separation anxiety and decreased appetite**  B) Fatigue, lightheadedness and dizziness  C) Migraines, abdominal pain, social withdrawal  D) Nightmares and depression   Which is a true statement regarding biofeedback for children with ADHD:  A) Meta-analyses indicate that neurofeedback is effective in reducing inattention.  B) The benefits of biofeedback for ADHD are widely accepted and not controversial.  C) One of the advantages is that neurofeedback requires only 10 treatments and is affordable. ** D) Neurofeedback changes brain waves to a low beta/theta ratio**   When compared to standard medical therapy, hypnosis for functional abdominal pain in children:  A) Is inferior.  B) Is equivalent.  **C) Is statistically more successful.**  D) Has not been studied.   \[Something like, John is 48 and has RLS. He is most likely to have which lab abnormality?\] Low ferritin   Children who snore are more likely to exhibit symptoms of: ** A) ADHD**  B) Seizures  C) Diabetes  D) Narcolepsy   Mary is concerned her 4-year-old son, who has no known health problems, sleeps too long. She states that he \"loves\" to sleep -- often sleeping 12 to 13 hours. The best response is:  A) Wake up your son after 9 hours since normal sleep for a 4-year-old is 7-9 hours. ** B) It is wonderful that he loves sleep. Normal sleep for a 4-year-old is 11-13 hours.**  C) We should order some blood work to see if he has problems with his thyroid.  D) Make sure that he naps during the day so that he doesn\'t have to sleep that long at night.   John tells you that he has been given a prescription for a diagnosis of insomnia and sees you for a second opinion. He likes to stay up late, until 12 or 1 AM. He is able to sleep until his alarm wakes him up for work at 6 AM, but doesn\'t feel rested. During the weekends, he feels energetic since he is able to \"catch up\" on sleep, often not getting up until 9 AM. The correct diagnosis is not insomnia but: ** A) Delayed sleep wake pattern disorder**  B) Central sleep apnea  C) Advanced circadian rhythm disorder  D) Shift work disorder   Mary complains of fatigue and insomnia that started 3 months ago when she underwent surgery for breast cancer. She is currently getting adjuvant chemotherapy. She asks if yoga can help. The best response is:  A) Yoga has been studied in cancer survivors but shows no benefit for insomnia.  **B) YOCAS, a special yoga program that has been studied in cancer survivors, shows benefits for both insomnia and fatigue.**  C) YOCAS is a special yoga program for cancer survivors. It has shown benefits in insomnia but not fatigue.  D) Studies have show that yoga is inferior to CBT-I for cancer survivors.   Botanicals that treat insomnia include:  A) Ashwagandha, California poppy, Licorice  B) St. John\'s Wort, Kava, Passionflower ** C) Chamomile, Ashwagandha, Valerian**  D) Guarana, Valerian, Hops   Which of the following is a normal adult sleep pattern:  A) Sleep onset latency of \30 minutes, sleep duration 8 hours with 5 cycles of NREM-REM   Circadian rhythm is controlled by:  A) The length a person stays awake.  B) The hormones dopamine and glutamate  C) A build-up of adenosine  **D) A cellular process that is driven by light**   Normal sleep length for an adult is:  A) 8-10 hours  B) 6-10 hours ** C) 7-9 hours**  D) 9-11 hours   After prolonged use, discontinuation of this botanical may cause symptoms similar to benzodiazepine withdrawal: ** A) Valerian**  B) Ashwagandha  C) Melatonin  D) Kava   A first-line and gold-standard therapy for insomnia is:  A) Yoga ** B) CBT-I**  C) Acupuncture  D) MBTI   Women who work night shift have approximately a \_\_\_\_\_\_\_% increased in breast cancer incidence:  A) 10%  B) 20% ** C) 40%**  D) 75%   Based on Dr. Hans Selye\'s description of the body\'s response to chronic stress, the following is the initial phase of the general adaptation syndrome: A\) Resistance B\) Adaptation **C) Alarm** D\) Exhaustion     A healthy 33-year-old woman presents to your clinic with concerns about persistent anxiety due to high stress levels at work. She is unable to change jobs at this time, does not want to use medications, and has a hard time sitting still. Which of the following relaxation practices would you *avoid* recommending? A\) Tai chi **B) Autogenic training** C\) Yoga D\) Exercise     Which of the following would not typically be considered a key component of relaxation techniques? A\) Daily practice **B) Clearing the mind** C\) Intentionality D\) Passive concentration     You are introducing hypnosis to your patient for the first time. Which of the following statements is the most user-friendly description of a hypnotic trance? A\) A hypnotic trance only happens if you are gullible or weak-minded. B\) A trance is \"going under\" when in a state of hypnosis. C\) A trance is what you will experience when being hypnotized by a practitioner. **D) A trance is a heightened state of conscious awareness deliberately created to enhance mind-body communication. It is similar to a daydream experience, but it is a deliberate and purposeful daydream that you are creating by being absorbed within healing thoughts, ideas, or images.** E\) All of the above are correct.   Your patient has been exhaustively worked up for a functional GI disorder with no signs of organic pathology. You have used hypnosis to specifically address the patient\'s symptoms without success. What is the appropriate strategy for continued treatment with hypnosis? A\) Symptomatic strategy B\) Rational-emotive therapy **C) Psychodynamic strategy** D\) Ideomotor E\) Ideosensory     Your patient is postmenopausal with continued distress from hot flashes. She tells you that she has already seen a news article about the effectiveness of hypnosis for hot flashes. She says, \"I want you to hypnotize me so that I won?t have any more hot flashes.\" What is the next step you take in treating her with hypnosis for these symptoms? A\) Guide her through a trance induction method with imagery specifically found to be useful in lessening hot flashes. B\) Personally tailor hypnotic suggestions that would enhance the effectiveness of hypnosis for her. That is, create suggestions that would help her personally relate to the words and images you use during the trance work (hypnosis session). C\) Debriefing to discover what previous experiences she may have had in the past with mind-body methods such as hypnosis, guided imagery, etc. **D) Educate her with an orientation about hypnosis to first dispel the myths and misconceptions commonly held by the general public, and provide her with information about what hypnosis is, how it is used, and answer her questions before proceeding with an induction method or test of suggestibility.** E\) Utilization. Offer her hypnotic suggestions and imagery for cooling sensations.   According to the polyvagal theory, the more primitive, nonmyelinated \"collapse\" part of the vagal circuit: A\) Can override the more recently evolved, myelinated part of the vagus system B\) Is made of afferent fibers running from the heart to the medulla oblongata **C) Can be overridden by the more recently evolved vagal circuit, which promotes safety and thriving** D\) Enhances immune function while lowering blood pressure In comparing tachograms of different emotional states, the one that shows an appreciative pattern will be: A\) A smooth, regular, low-amplitude or shallow wave form **B) A smooth, regular, high-amplitude sine wave form** C\) A high-amplitude, erratic wave form D\) A flat line with little variability     When teaching a patient a healthy breathing practice, an ideal pattern would be: **A) To have them practice gradually slowing their breathing from their current norm down to four to six breaths/minute, with exhales being longer than inhales.** B\) To ask them to aim for between eight and ten breaths/minute, as anything slower will cause stress or anxiety. C\) To ask them to sit up as straight as possible and practice taking a deep long inhale and not focus too much on the exhale. The inhale appears to be most important for triggering the parasympathetic increase. D\) Practice the yoga energizing breath technique with 10 short, powerful in and out breaths through one nostril while occluding the other.     Guided imagery may be described as: A\) A mind-body modality that can clarify the relationship between the patient\'s thoughts, emotions, and physical status B\) A way to reduce anxiety when preparing for surgery and medical interventions C\) A distraction technique that can reduce anxiety and pain D\) A psychotherapeutic tool **E) All of the above**   Guided imagery is remarkably safe if the following precautions are taken, except with which of the following? A\) The patient\'s psychological and emotional history is explored B\) The physician has training and experience in using guided imagery **C) It is used to explore issues of childhood trauma and abuse** D\) Serial steps are taken to determine the patient\'s ability to use and tolerate the exploration   All of the following are true about eh inner advisor technique except\" D\) It is a spiritual being whose job it is to look after the patient Guided imagery can help with: A\) Reducing anxiety B\) Solving problems C\) Boosting immunity D\) Making good medical decisions E\) Resolving emotional conflicts F\) Reducing stress G\) Relieving pain H\) Preparing for and facilitating childbirth I\) Resolving grief issues J\) End-of-life care **K) All of the above**   True or False: It is important for someone to read a person\'s journaling to give feedback and help process the information. No one has to read what is written. The therapeutic process occurs as the material is expressed in the writing, giving the internalized emotions an avenue for release, and increasing the individual\'s sense of control and understanding.   Which of the following conditions does NOT have the best evidence for the therapeutic effects of journaling? A\) Asthma B\) Success in acquiring a job C\) Rheumatoid arthritis **D) Diabetes control** E\) Blood pressure reduction   All of these have research supporting a positive outcome with journaling. Although it would make intuitive sense that diabetes and blood sugar control would also benefit, there are no data to support this claim.   All of the following are important in prescribing journaling except: A\) Establishing a trusting therapeutic relationship **B) Encouraging writing about stressful events, even if the individual does not feel ready to explore them** C\) Offering emotional and behavioral health services along with journaling to help support the healing process D\) Avoiding creating guilt that their current symptoms are a result of a past event E\) Having them write freely without being concerned about punctuation or grammar Meditation can cure which of the following conditions? A\) Coronary artery disease B\) Schizophrenia C\) Cancer **D) None of the above**     Which of the following is the most appropriate recommendation for a beginner learning to meditate? A\) Sit in the lotus position B\) Hard work makes for faster progress **C) Sit comfortably and still with \"resting eyes\"** D\) Thought analysis and problem solving is part of the practice   Which of the following is NOT one of the three Ps of mindfulness in medicine? A\) Presence **B) Positive attitude** C\) Pause D\) Proceed   When responding to a patient opening up to expressing his or her grief and suffering, an optimal initial response by a clinician might include the following: a. Thoughtful silence, self-disclosure, and insights for relief from one\'s own experience b. Identification of community resources a. **\"Tell me about it\" or similar encouragement** a. Interview for depression and/or anxiety b. Interview for professional grief counselor referral     Improving health outcomes is closely related to healthy behaviors. Of the following options, which is the most powerful factor that will empower patient action toward these behaviors: a. Establishing a strong therapeutic relationship b. Having a person-in-authority tell the person what they should do c. Having a family member ask them to change a. **Using a connection to that which gives the individual\'s life meaning to see how a behavior may help this grow.** There are multiple mnemonics a clinician can use to remind about the key ingredients (FICA, SPIRIT, HOPE) of spiritual exploration. The following is true for these tools (choose one): a. SPIRIT is the most extensively studied and should be used in preference over the others. a. **They remind us to have the patient educate us about their spiritual beliefs, the community they have to help it grow, and how we can support their process.** a. Should not be used in palliative care. b. Due to the power of spirituality on health, it is vital that the clinician uses one of these tools to adequately evaluate spiritual aspects of an individual\'s life.   What is the primary objective of the noise reduction approach to managing insomnia? a. Increasing objective measures of sleepiness a. **Decreasing psychophysiological activation associated with hyperarousal** a. Maintaining a sleep efficiency of at least 90% b. Providing effective CAM alternatives to sedative-hypnotics   What kind of disrupted temperature rhythm is commonly associated with sleep onset insomnia? a. An advanced circadian temperature rhythm b. A nocturnally elevated core body temperature c. A 24-hour elevation of core body temperature a. **A delayed circadian temperature rhythm**   New research suggests that insomnia patients who do not have access to behavioral sleep medicine specialists might effectively be treated in primary care by? a. **A brief, single-session of sleep restriction therapy** a. A short course of zolpidem b. A brief, single-session of stimulus control therapy c. Mind noise reduction strategies Which formulation and administration of melatonin is indicated for sleep maintenance insomnia or early morning awakenings? a. Immediate release sublingual formulations administered at or near bedtime b. Sustained-release formulations administered at or near bedtime a. **Immediate release sublingual formulations administered at awakening** a. Sustained-release formulations administered at awakening