Free MCAT-style practice, 6C
MCAT Stress Practice Questions
Nine free MCAT-style practice questions on stress, covering cognitive appraisal, types of stressors, the HPA axis, general adaptation syndrome and coping, with full explanations.
Quick concept primer
Stress is the process of appraising and responding to a demand, called a stressor. In the transactional model of Lazarus and Folkman, primary appraisal asks whether an event is irrelevant, benign or stressful (a harm, a threat or a challenge), and secondary appraisal asks whether your resources are enough to cope with it. Stressors range from daily hassles and major life events to catastrophes, and they include pleasant events (eustress) as well as unpleasant ones (distress).
The body answers on two timescales. Within seconds, the sympathetic nervous system drives the adrenal medulla to release epinephrine and norepinephrine. The slower HPA axis runs from hypothalamic CRH to pituitary ACTH to cortisol from the adrenal cortex, and cortisol feeds back to inhibit both upstream glands. Selye's general adaptation syndrome describes three stages: alarm, resistance and exhaustion. Coping can be problem focused (change the stressor) or emotion focused (change your reaction to it).
Traps: cortisol comes from the adrenal cortex and epinephrine from the adrenal medulla. Secondary appraisal is about coping resources, not about a later second look at the event. Exhaustion means depleted resources, not a return to baseline. The 6C Emotion and Stress pack adds flashcards and more practice across the whole category, and you can try a free sampler first.
9 practice questions
Question 1
Two nursing students learn that their clinical placement is moving to a busy trauma unit. Dana thinks, "This could wreck my evaluation." Priya thinks, "This will be demanding, but it is a chance to build skills." Both see the move as personally relevant, and neither has yet considered what she could do to handle it. In the transactional model, the students differ in which step?
- Secondary appraisal, because they judge their coping resources differently
- Primary appraisal, because one labels the event a threat and the other a challenge
- Emotion-focused coping, because each is managing her feelings about the event
- The resistance stage, because each is adapting to a prolonged stressor
Show answer and explanation
Answer: B. Primary appraisal, because one labels the event a threat and the other a challenge
Primary appraisal classifies a relevant event as harm, threat or challenge, and that classification is the only thing that differs here. Secondary appraisal would involve weighing resources and options, which the stem says has not happened yet. Neither student has begun coping, and the resistance stage belongs to Selye's physiological model, not to appraisal.
Question 2
Before a graded presentation, four participants rate how demanding the task will be and how adequate their own resources are for handling it (1 = very low, 7 = very high).
| Participant | Perceived demand | Perceived resources |
|---|---|---|
| W | 6 | 6 |
| X | 2 | 2 |
| Y | 2 | 6 |
| Z | 6 | 2 |
According to the transactional model, which participant is expected to report the most stress?
- Participant W
- Participant X
- Participant Y
- Participant Z
Show answer and explanation
Answer: D. Participant Z
In the transactional model, stress arises when appraised demands exceed appraised resources. Only participant Z rates demand high (6) and resources low (2), a gap of 4 points. W faces the same demand but judges resources as equal to it, X sees little demand at all, and Y has resources that far exceed a small demand.
Question 3
A patient has taken a high daily dose of a synthetic glucocorticoid for six months. While the patient is on the drug, which pattern is expected for the patient's own hormones?
- Low CRH, low ACTH and low cortisol output from the adrenal cortex
- High CRH, high ACTH and low cortisol output from the adrenal cortex
- Low CRH, high ACTH and high cortisol output from the adrenal cortex
- High CRH, low ACTH and high cortisol output from the adrenal cortex
Show answer and explanation
Answer: A. Low CRH, low ACTH and low cortisol output from the adrenal cortex
Glucocorticoids exert negative feedback on both the hypothalamus and the anterior pituitary, so the drug suppresses CRH and ACTH. Without ACTH stimulation the adrenal cortex makes little cortisol of its own. Choice B describes primary adrenal failure, where low cortisol removes feedback, and choices C and D break the CRH to ACTH to cortisol sequence.
Question 4
For five months a graduate student has cared for a seriously ill parent while working full time. For most of that period she functioned well, staying alert with persistently elevated cortisol. In the last three weeks she has had repeated infections, cannot concentrate and feels drained. In the general adaptation syndrome, which transition has occurred?
- Alarm to resistance
- Exhaustion to resistance
- Resistance to exhaustion
- Alarm to recovery
Show answer and explanation
Answer: C. Resistance to exhaustion
Months of sustained coping with elevated cortisol describe the resistance stage, in which the body adapts to a continuing stressor. Illness, poor concentration and depletion mark exhaustion, when resources run out. The alarm stage is the brief initial reaction, which ended long ago, and Selye's three stages do not run backward or include a recovery stage.
Question 5
Prolonged elevation of cortisol is associated with each of the following EXCEPT:
- reduced activity of lymphocytes and slower wound healing.
- lower blood glucose caused by decreased gluconeogenesis.
- impaired memory linked to changes in the hippocampus.
- higher risk of hypertension and cardiovascular disease.
Show answer and explanation
Answer: B. lower blood glucose caused by decreased gluconeogenesis.
Cortisol raises blood glucose by stimulating gluconeogenesis in the liver and promoting breakdown of protein and fat, so choice B has the direction reversed. The other three are recognized consequences of chronic stress: cortisol suppresses immune function, long exposure is linked to hippocampal damage and memory problems, and chronic stress hormones contribute to high blood pressure.
Question 6
After failing a licensing exam, four people respond in different ways. Which response is the clearest example of problem-focused coping?
- Calling a friend to vent about how unfair the exam was
- Going for long runs each evening in order to feel calmer
- Deciding that the result does not say anything important
- Using the score report to build a study plan around the weakest sections
Show answer and explanation
Answer: D. Using the score report to build a study plan around the weakest sections
Problem-focused coping acts on the stressor itself, here by preparing differently so the next attempt goes better. Venting, exercising to calm down and reinterpreting the result all target the emotional reaction and leave the cause untouched, so they are emotion-focused strategies. Emotion-focused coping is not always worse, but it is a different category.
Question 7
Two groups hear identical bursts of loud noise while solving puzzles. One group has a button that would stop the noise, although no participant ever presses it. The other group has no button. Mean salivary cortisol is shown.
| Group | Before task (nmol/L) | After task (nmol/L) |
|---|---|---|
| No button | 10 | 18 |
| Button available | 10 | 12 |
What is the percent increase in cortisol for the no-button group, and what is the best interpretation of the comparison?
- 44 percent; the loudness of a stressor fixes the size of the stress response
- 80 percent; the button group responded less because it heard less noise
- 80 percent; perceived control reduces the stress response to an unchanged stressor
- 180 percent; perceived control reduces the stress response to an unchanged stressor
Show answer and explanation
Answer: C. 80 percent; perceived control reduces the stress response to an unchanged stressor
The rise is 18 minus 10, or 8, on a baseline of 10, which is 80 percent. The button group rose only 20 percent although the noise was identical, so the difference reflects perceived control, not exposure. Choice A divides by the final value, choice D reports the ratio of final to initial, and choice B contradicts the design.
Question 8
A cyclist sees a car swerve toward her. Within two seconds her heart is racing and her pupils have dilated. Which pathway most directly produces this immediate response?
- Sympathetic activation, including epinephrine release from the adrenal medulla
- CRH release, followed by ACTH release, followed by cortisol secretion
- Vagal release of acetylcholine onto the sinoatrial node
- Release of antidiuretic hormone from the posterior pituitary
Show answer and explanation
Answer: A. Sympathetic activation, including epinephrine release from the adrenal medulla
The fast arm of the stress response is neural: sympathetic neurons act on the heart and pupils directly and trigger the adrenal medulla to release epinephrine within seconds. The HPA cascade in choice B takes minutes to raise cortisol. Vagal acetylcholine slows the heart, and antidiuretic hormone conserves water and does not raise heart rate.
Question 9
A medical student is delighted to match at her first-choice residency. Over the following week, while planning a cross-country move, she sleeps poorly and her resting heart rate is elevated. This situation best illustrates which idea?
- Eustress: positive events also place adaptive demands on the body
- Distress: only events appraised as negative can trigger a stress response
- Learned helplessness: repeated uncontrollable events reduce the effort to cope
- Exhaustion: her physiological resources for adaptation have been used up
Show answer and explanation
Answer: A. Eustress: positive events also place adaptive demands on the body
Eustress is stress from a positive or desired event, and it still requires adjustment and produces physiological arousal. Choice B is false because welcome changes such as a new job or a move count as stressors. Nothing in the stem describes uncontrollable failure, and one week of arousal after good news is not the exhaustion stage.