This study examined whether cortisol changes caused by examination stress are more associated with acute psychological state or physical symptoms of stress. Participants’ salivary cortisol was assayed before and after taking a final examination, and a survey was administered to assess their psychological state for depression, tension, and fatigue, as well as the degree to which they experienced a variety of physical symptoms. Physical symptoms, tension, and depression were found to positively correlate with changes in cortisol across the examination period with depression showing the strongest correlation. No correlation was observed between fatigue and changes in cortisol during the examination period. Additionally, physical symptoms were found to positively correlate with average cortisol across the examination period while depression and fatigue were found to negatively correlate with average cortisol across the examination period. No correlation was observed between tension and average cortisol during the examination period. None of these findings were statistically significant, which suggests that no relationship exists between cortisol and acute psychological state or physical symptoms of stress; however, the study was limited by its small sample size and several potentially confounding variables, making it difficult to draw any firm conclusions.