A patient awaiting selective surgery presents the following symptoms. Which of them indicate (s) a heightened activity of the sympathetic portion of his autonomic nervous system ?

Options

A. pale skin
B. sweaty plams
C. a yearning for water due to a dry mouth
D. all of the above

Explanation

To determine which symptoms indicate heightened activity of the sympathetic portion of the autonomic nervous system, we need to analyze each symptom presented in the question.

### Step-by-Step Solution:

1. **Understanding the Autonomic Nervous System**:
- The autonomic nervous system (ANS) is divided into two main parts: the sympathetic and parasympathetic nervous systems.
- The sympathetic nervous system is often referred to as the "fight or flight" system, which prepares the body for stressful situations.

2. **Analyzing the Symptoms**:
- **Symptom 1: Pale Skin**:
- Sympathetic activation can lead to vasoconstriction (narrowing of blood vessels) in the skin, resulting in pale skin.
- **Symptom 2: Sweaty Palms**:
- Increased sympathetic activity stimulates sweat glands, leading to sweating, especially in the palms.
- **Symptom 3: Burning for Water Due to Dry Mouth**:
- The sympathetic response inhibits salivation, causing dry mouth and a feeling of thirst.

3. **Conclusion**:
- All three symptoms (pale skin, sweaty palms, and dry mouth) are indicative of heightened sympathetic activity.
- Therefore, the correct answer is **Option 4: All of the above**.

### Final Answer:
All of the above symptoms indicate heightened activity of the sympathetic portion of the autonomic nervous system.

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