• Areeba Husain Rizvi
  • Maha Awaiz
  • Zohra Ghanghro
  • Mehjabeen Ahmed Jafferi
  • Sina Aziz


Background: Pre-examination Stress is a common condition faced by students prior to exams and isquite predominant among medical students. Many studies have been conducted to assess the impact ofstress on students prior to examinations. This study however aims to determine the behavioural andphysiological changes occurring in the second year medical students during the pre-examination period.Methods: Questionnaires were distributed among students to review the changes that occurred in medicalstudents related to their behaviour, physical activities and functions just before exams. Duration of studywas two months from October-November, 2009. The questionnaire was divided into two parts. The firstpart contained demographic information about the patient, the second part contained opinions of studentsexperiencing pre-examination stress. SPSS was used for data management and approval from the EthicalReview Board of Dow University of Health Sciences was obtained before starting the research. Results:The data for this study was collected from 226 students of 2nd year MBBS, Dow Medical College,Karachi on specially designed questionnaires. Among the 226 students 22.1% were male while 77.9%were female with mean age 20±1 years. Changes observed in pre-examination period included anorexia,nausea, fatigue (54.87%), changed concentration span (80.09%), increased irritability (68.14%), moodswings (50.88%), disturbed menstrual cycle (15.91%), disturbed sleep cycle (80.97%), increased intake ofcaffeine/energy drinks (38.94%), disturbed metabolism (46.02%), aggravated skin problems such as acne(12.83%). Among the 226 students 42.04% did regular exercise and 76.12% prayed regularly. Both ofthese factors helped them in coping with stress. Conclusion: Majority included in our researchexperienced stress prior to exams but the signs and symptoms varied greatly. Irritability, increased intakeof caffeine/energy drinks, and disturbed sleep cycle seemed to dominate physiological and behaviouralchanges in the pre-examination period.Keywords: Behavioural changes, Physiological changes, Pre examination period, Medical students


Qureshi F, Alam J, Khan MA, Sheraz G. Effects of

examination stress on blood cell parameters of students in a

Pakistan medical college. J Ayub Med Coll Abbottabad


Dorshkind K, Horseman NS. Anterior pituitary hormones,

stress, and immune system homeostasis. Bioessays


Gurrero JM, Reiter RJ. A Brief Survey of Pineal GlandImmune System Interrelationships. Endocr Res


Marshall GD Jr, Aqarwall SK. Stress, immune regulation,

and immunity: applications for asthma. Allergy Asthma Proc


Loucks AB, Redman LM. The effect of stress on menstrual

function. Trends Endocrinol Metab 2004;15(10):466–71

Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y.

Prevalence of depression, anxiety and their associated factors

among medical students in Karachi, Pakistan. J Pak Med

Assoc 2006;56:583–6.

Farag NH, Vincent AS, McKey BS, Al'Absi M, Whitsett TL,

Lovallo WR. Sex differences in the hemodynamic responses

to mental stress: Effect of caffeine consumption.

Psychophysiology 2006;43:337–43.

Papadelis C, Kourtidou-Papadeli C, Vlachogiannis E,

Skepastianos P, Bamidis P, Maglaveras N, et al. Effects of

mental workload and caffeine on catecholamines and blood

pressure compared to performance variations. Brain Cogn


J Ayub Med Coll Abbottabad 2010;22(2) 155

Sansgiry SS, Sail K. Effect of students' perception of course

load on test anxiety. Am J Pharm Educ 2006;70:26.

Amanullah F, Aziz S. Factors causing exam anxiety in

medical students. J Pak Med Assoc 2008;58:167–70.

Lovallo WR, Farag NH, Vincent AS, Thomas TL, Wilson

MF. Cortisol responses to mental stress, exercise, and meals

following caffeine intake in men and women. Pharmacol

Biochem Behav 2006;83:441–7.

Ahs F., Furmark T., Michelgard A., Langstrom B, Appel L,

Wolf OT, et al. Hypothalamic blood flow correlates

positively with stress-induced cortisol levels in subjects with

social anxiety disorder. Psychosom Med 2006;68:859–62.

Liu J, Garza JC, Truong HV, Henschel J, Zhang W, Lu XY.

The melanocortinergic pathway is rapidly recruited by

emotional stress and contributes to stress-induced anorexia

and anxiety-like behavior. Endocrinology 2007;148:5531–40.

Wang L, Wang X, Wang W, Chen C, Ronnennberg AG,

Guang W, et al. Stress and dysmenorrhea: a population based

prospective study. Occup Environ Med 2004;61:1021–6.

Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou

E, Rose M, et al. Role of stress in functional gastrointestinal

disorders. Evidence for stress-induced alterations in

gastrointestinal motility and sensitivity. Dig Dis


Bhatia V, Tandon RK. Stress and the gastrointestinal tract. J

Gastroenterol Hepatol 2005;20:332–9.

Naliboff BD, Maye MR, Fass R, Fitzgerald LZ, Chang L,

Bolus R, et al. The effect of life stress on symptoms of

heartburn. Psychosom Med 2004;66:426–34.

Patz MD, Day HE, Burow A, Campeau S. Modulation of the

hypothalamo-pituitary-adrenocortical axis by caffeine.

Psychoneuroendocrinology 2006;31:493–500.

Kadison R. Getting an edge—use of stimulants and anti

depressants in College. N Engl Med J 2005;353:1089–91.

Fenster L, Waller K, Chen J, Hubbard AE, Windham GC,

Elkin E, et al. Psychological stress in the workplace and

menstrual function. Am J Epidemiol 1999;149(2):127–34.

(Erratum in Am J Epidemol 1999;149(7):686.)

Travis F, Haaga DA., Hagelin J, Tanner M, Nidich S,

Gaylord-King C, et al. Effects of Transcendental Meditation

practice on brain functioning and stress reactivity in college

students. Int J Psychophysiol 2009;71(2):170–6.