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# *Fresh* Erythropoietin, known also as EPO

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*Fresh* Erythropoietin, known also as EPO [#permalink]

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03 Aug 2014, 10:50
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Question 1
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Question Stats:

43% (03:18) correct 57% (02:26) wrong based on 138

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Question 2
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44% (00:50) correct 56% (00:41) wrong based on 135

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Question 3
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32% (00:25) correct 68% (00:43) wrong based on 133

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36% (01:36) correct 64% (01:30) wrong based on 132

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Erythropoietin, known also as EPO, is a glycoprotein hormone that controls the production of red blood cells in a process called erythropoiesis. When the kidneys detect a lack of oxygen flowing through the bloodstream, they secrete this glycoprotein, increasing the production of red blood cells, the body’s primary method of transporting oxygen to tissues and muscles. Typically a human’s hematocrit level, the percentage of red blood cells in the bloodstream, is between 40 and 45. For most adult males, a hematocrit level of less than 42 is said to be anemic, meaning that red blood cells are in dangerously low supply; this number is substantially less for women.

Synthetic EPO is used to boost low hematocrit levels in chemotherapy patients and those suffering from kidney disease, who are unable to maintain the necessary levels without frequent EPO injections. Perhaps more famously, it is also used illicitly by many endurance athletes seeking to gain a competitive advantage by artificially increasing their red blood cell count. Traditionally, athletes have trained at high altitude to achieve a similar natural effect, but today more and more have chosen to artificially boost red blood cell activity through the use of synthetic EPO.

For all its negative publicity, synthetic EPO remains a positive medical advancement to treat anemia and prevent hypoxia, the condition in which tissues are deprived of oxygen. Researchers continue to improve the effectiveness of synthetic EPO and even to develop a new glycoprotein—called novel erythropoiesis-stimulating protein (NESP) —which eliminates several drawbacks of EPO in its current form. NESP not only requires smaller doses, but also lasts longer, eliminating the need for frequent and often-painful IV administration, which can have complications. Still, unlike the natural stimulus that occurs with the release of EPO, any artificial stimulus of red blood cell production has potential risks, as it raises hemoglobin to the desired levels above 15 grams per deciliter far too quickly. The body cannot properly adjust to the quick change in blood viscosity and substantial cardiac risk results. Given that risk, synthetic EPO must be highly regulated by the FDA so that its use is limited to medical necessity, not athletic performance enhancement.

1. According to the passage, which one of the following is a challenge in using synthetic EPO to treat patients?

(A) It has to be administered more frequently and in larger doses than is ideal.
(B) It does not increase hematocrit levels as quickly as naturally occurring EPO does.
(C) It has more cardiovascular risk than other treatments.
(D) It is frequently stolen by those seeking performance enhancement.
(E) It can result in dangerously low hematocrit levels.

[Reveal] Spoiler:
A

2. Which of the following can be inferred about training at high altitude?

(A) It is not as effective as synthetic EPO at increasing red blood cells in an athlete.
(B) It does not allow athletes to reach levels of hemoglobin above 15 grams per deciliter.
(C) It increases hemoglobin levels in an athlete more slowly than synthetic EPO does.
(D) It poses no health risks to the athlete.
(E) It does not increase the viscosity of blood to a dangerous level.

[Reveal] Spoiler:
C

3. All of the following are potential risks of synthetic EPO except that it ______ .

(A) can raise hemoglobin levels too quickly.
(B) increases hemoglobin to levels above 15 grams per deciliter.
(C) abruptly increases blood viscosity.
(D) increases the likelihood of cardiac problems.
(E) needs to be administered frequently.

[Reveal] Spoiler:
B

4. Which of the following can properly be inferred from the passage?

(A) Training at high altitude is safer than using synthetic EPO.
(B) A higher percentage of athletes are using performance enhancing drugs than in the past.
(C) NESP is a more effective treatment for raising hematocrit levels than synthetic EPO.
(D) NESP carries fewer risks than synthetic EPO.
(E) Kidneys have some mechanism for monitoring oxygen levels.

[Reveal] Spoiler:
E

[Reveal] Spoiler: Question #1 OA
[Reveal] Spoiler: Question #2 OA
[Reveal] Spoiler: Question #3 OA
[Reveal] Spoiler: Question #4 OA

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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03 Aug 2014, 23:13
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A,D,E,A....Waiting for OA

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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03 Aug 2014, 23:17
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my take of the above RC is as follows :
1) A :It has to be administered more frequently and in larger doses than is ideal
2) C : It increases hemoglobin levels in an athlete more slowly than synthetic EPO does.
3) C abruptly increases blood viscosity.
4) E: Kidneys have some mechanism for monitoring oxygen levels.

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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04 Aug 2014, 01:14
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My take
1) A :It has to be administered more frequently and in larger doses than is ideal
2) B
3) C: abruptly increases blood viscosity.
4) A

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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04 Aug 2014, 02:54
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8 mins

1. A - It has to be administered more frequently and in larger doses than is ideal.
2. E - It does not increase the viscosity of blood to a dangerous level.
3. E - needs to be administered frequently.
4. E - Kidneys have some mechanism for monitoring oxygen levels.

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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04 Aug 2014, 03:15
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A, C , B and A.
1. (A) It has to be administered more frequently and in larger doses than is ideal. << In treating patients, it's an issue mentioned in last paragraph.
2. (C) It increases hemoglobin levels in an athlete more slowly than synthetic EPO does. << both provided similar effect(para 2), but artificial method quickly increases the level(para 3).
3. (B) increases hemoglobin to levels above 15 grams per deciliter. << above 15 too quickly is the cause not above 15.
4. (A) Training at high altitude is safer than using synthetic EPO. << both provides similar effect(para 2), but natural methods do not increases level above 15 as quickly. Thus training at high altitude is safer.
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*Fresh* Erythropoietin, known also as EPO [#permalink]

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04 Aug 2014, 08:36
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OAs posted. Thanks for participating. Here are the OEs

Q1

[Reveal] Spoiler:
1. As for all detail-oriented questions, you must go back and find the necessary information to answer the question. Synthetic EPO is introduced in the second paragraph, but most of the details about how it is used come in the third paragraph. In the second and third sentences of the third paragraph, you learn that NESP eliminates several drawbacks of EPO by requiring smaller doses and less-frequent injections. Therefore, it must be true that large doses and frequent administration are challenges in using EPO (synonymous with drawbacks), so answer choice A is correct. It is easy, however, to miss this information and fall for one of the other choices. For answer choice B, the passage suggests naturally occurring EPO raises levels more slowly, not more quickly, so answer choice B is incorrect. For answer choice C, the common incorrect choice, you know that synthetic EPO has cardiovascular risk, but you do not know how that risk compares to other treatments. The statement in answer choice C may or may not be true, because this inference is far outside the scope of the passage. For answer choice D, while you know that synthetic EPO is used by athletes seeking performance enhancement, you do not know how they obtain that EPO. (Do they steal it or just get it from doctors?) For answer choice E, it is suggested that synthetic EPO helps increase low hematocrit levels, so it would be illogical to conclude that it can result in dangerously low hematocrit levels.

Q2

[Reveal] Spoiler:
Because training was discussed in the second paragraph, your natural tendency is to look there, but the more important information lies in the third paragraph. This is another classic example of misdirection; they tempt you to look in one place but the answer really lies elsewhere. Consider this sentence from the third paragraph: “Still, unlike the natural stimulus that occurs with the release of EPO, any artificial stimulus of red blood cell production has potential risks, as it raises hemoglobin to the desired levels above 15 grams per deciliter far too quickly.” Since training at high altitude is well defined as a “natural” stimulation of red blood cell production in the second paragraph, you can be sure from the italicized sentence above that the stimulation occurs more slowly with natural EPO that it does with synthetic EPO. Again, this is easy to miss but well defined when you put it together (as with most difficult correct answers in Reading Comp). Answer choice C must be correct. Of course, the other answer choices will be tempting but not inferable. While you might guess answer choice A to be true, there is simply no evidence for it. While it is true that many athletes are choosing synthetic EPO over traditional training, this does not mean it is more effective. It just might be easier! No evidence is given that synthetic EPO works better than training at high altitude for increasing hemoglobin. For answer choice B, no evidence is given for what levels of hemoglobin can be reached with high altitude training. For answer choice D, while the health risks of synthetic EPO are well defined, there is no discussion about health risks of training at high altitude. While you might be able to infer training at high altitude is safer than synthetic EPO in terms of one component (it raises hemoglobin levels more slowly), high-altitude training could pose many other health risks (and probably does). Be very
suspicious of any answer choice that is so categorical; it is unlikely that you could ever prove such a statement. For answer choice E, you know that the rapid increase of viscosity caused by synthetic EPO is dangerous, but you do not know anything about the risk of high viscosity on its own and whether high training raises the blood viscosity to dangerous levels. NOTE: Most difficult incorrect answer choices in Reading Comp reference something discussed in the passage but go just beyond what is inferable.

Q3

[Reveal] Spoiler:
While not as difficult as the last two, this question still has its pitfalls. Most of the risks of synthetic EPO are in the third paragraph, but you may have to look in the second. Answer choice A is clearly defined as a risk of synthetic EPO, as you can see from this section: “any artificial stimulus of red blood cell production has potential risks, as it raises hemoglobin to the desired levels above 15 grams per deciliter far too quickly.” Answer choice B is the correct answer, as it is not a risk of synthetic EPO. As you can see from the italicized section above, levels above 15 are “desired,” so this is not a risk. Answer choice C addresses the same issue as answer choice A and is a well-defined risk. The cardiac risk in answer choice D is well defined in the third paragraph. However, the risk associated with answer choice E is harder to find; therefore answer choice E is the common incorrect answer choice on this problem. From the section in the second paragraph “who are unable to maintain the necessary levels without frequent EPO injections” and the section in the third paragraph that references the frequency of injections as a drawback of EPO, it is logical to infer the frequency required is a risk: If patients cannot get injections frequently their health will be compromised.

Q4

[Reveal] Spoiler:
In this problem, there are no hints given in the question stem about where to look. In questions like this, go to the answer choices and examine them individually, finding clues about where to look. Answer choice A is too broad and categorical. You know that one component of high altitude training is safer than the use of synthetic EPO; it raises hemoglobin levels more slowly. But it could be that, overall, high-altitude training is much more dangerous than the use of synthetic EPO. Answer choice B is incorrect for similar reasons. You know that there has been an increase in the use of synthetic EPO by athletes, but you know nothing about other performance-enhancing drugs. Answer choice B goes way beyond the scope of information provided in this passage and is thus incorrect. For answer choice C, you only learn in the passage that NESP eliminates several drawbacks of EPO. You do not know whether it is more effective at raising hematocrit levels. Likewise for answer choice D: You know that NESP corrects several drawbacks of EPO, but you know nothing about its overall risks. It may have many more risks than EPO, but they are simply not discussed in this passage. If you managed to avoid temptation in answer choices A through D, then answer choice E is relatively easy to prove with this sentence in the first paragraph: “When kidneys detect a lack of oxygen flowing through the bloodstream, they secrete this glycoprotein, increasing the production of red blood cells, the body’s primary method of transporting oxygen to tissues and muscles.”

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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09 Aug 2014, 07:50
My pick D, C, E, E

1. According to the passage, which one of the following is a challenge in using synthetic EPO to treat patients?

(A) It has to be administered more frequently and in larger doses than is ideal.
(B) It does not increase hematocrit levels as quickly as naturally occurring EPO does.
(C) It has more cardiovascular risk than other treatments.
(D) It is frequently stolen by those seeking performance enhancement.
(E) It can result in dangerously low hematocrit levels.

2. Which of the following can be inferred about training at high altitude?

(A) It is not as effective as synthetic EPO at increasing red blood cells in an athlete.
(B) It does not allow athletes to reach levels of hemoglobin above 15 grams per deciliter.
(C) It increases hemoglobin levels in an athlete more slowly than synthetic EPO does.
(D) It poses no health risks to the athlete.
(E) It does not increase the viscosity of blood to a dangerous level.

3. All of the following are potential risks of synthetic EPO except that it ______ .

(A) can raise hemoglobin levels too quickly.
(B) increases hemoglobin to levels above 15 grams per deciliter.
(C) abruptly increases blood viscosity.
(D) increases the likelihood of cardiac problems.
(E) needs to be administered frequently.

4. Which of the following can properly be inferred from the passage?

(A) Training at high altitude is safer than using synthetic EPO.
(B) A higher percentage of athletes are using performance enhancing drugs than in the past.
(C) NESP is a more effective treatment for raising hematocrit levels than synthetic EPO.
(D) NESP carries fewer risks than synthetic EPO.
(E) Kidneys have some mechanism for monitoring oxygen levels.
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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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26 Aug 2014, 07:52
souvik101990 wrote:
OAs posted. Thanks for participating. Here are the OEs

Q1

[Reveal] Spoiler:
1. As for all detail-oriented questions, you must go back and find the necessary information to answer the question. Synthetic EPO is introduced in the second paragraph, but most of the details about how it is used come in the third paragraph. In the second and third sentences of the third paragraph, you learn that NESP eliminates several drawbacks of EPO by requiring smaller doses and less-frequent injections. Therefore, it must be true that large doses and frequent administration are challenges in using EPO (synonymous with drawbacks), so answer choice A is correct. It is easy, however, to miss this information and fall for one of the other choices. For answer choice B, the passage suggests naturally occurring EPO raises levels more slowly, not more quickly, so answer choice B is incorrect. For answer choice C, the common incorrect choice, you know that synthetic EPO has cardiovascular risk, but you do not know how that risk compares to other treatments. The statement in answer choice C may or may not be true, because this inference is far outside the scope of the passage. For answer choice D, while you know that synthetic EPO is used by athletes seeking performance enhancement, you do not know how they obtain that EPO. (Do they steal it or just get it from doctors?) For answer choice E, it is suggested that synthetic EPO helps increase low hematocrit levels, so it would be illogical to conclude that it can result in dangerously low hematocrit levels.

Q2

[Reveal] Spoiler:
Because training was discussed in the second paragraph, your natural tendency is to look there, but the more important information lies in the third paragraph. This is another classic example of misdirection; they tempt you to look in one place but the answer really lies elsewhere. Consider this sentence from the third paragraph: “Still, unlike the natural stimulus that occurs with the release of EPO, any artificial stimulus of red blood cell production has potential risks, as it raises hemoglobin to the desired levels above 15 grams per deciliter far too quickly.” Since training at high altitude is well defined as a “natural” stimulation of red blood cell production in the second paragraph, you can be sure from the italicized sentence above that the stimulation occurs more slowly with natural EPO that it does with synthetic EPO. Again, this is easy to miss but well defined when you put it together (as with most difficult correct answers in Reading Comp). Answer choice C must be correct. Of course, the other answer choices will be tempting but not inferable. While you might guess answer choice A to be true, there is simply no evidence for it. While it is true that many athletes are choosing synthetic EPO over traditional training, this does not mean it is more effective. It just might be easier! No evidence is given that synthetic EPO works better than training at high altitude for increasing hemoglobin. For answer choice B, no evidence is given for what levels of hemoglobin can be reached with high altitude training. For answer choice D, while the health risks of synthetic EPO are well defined, there is no discussion about health risks of training at high altitude. While you might be able to infer training at high altitude is safer than synthetic EPO in terms of one component (it raises hemoglobin levels more slowly), high-altitude training could pose many other health risks (and probably does). Be very
suspicious of any answer choice that is so categorical; it is unlikely that you could ever prove such a statement. For answer choice E, you know that the rapid increase of viscosity caused by synthetic EPO is dangerous, but you do not know anything about the risk of high viscosity on its own and whether high training raises the blood viscosity to dangerous levels. NOTE: Most difficult incorrect answer choices in Reading Comp reference something discussed in the passage but go just beyond what is inferable.

Q3

[Reveal] Spoiler:
While not as difficult as the last two, this question still has its pitfalls. Most of the risks of synthetic EPO are in the third paragraph, but you may have to look in the second. Answer choice A is clearly defined as a risk of synthetic EPO, as you can see from this section: “any artificial stimulus of red blood cell production has potential risks, as it raises hemoglobin to the desired levels above 15 grams per deciliter far too quickly.” Answer choice B is the correct answer, as it is not a risk of synthetic EPO. As you can see from the italicized section above, levels above 15 are “desired,” so this is not a risk. Answer choice C addresses the same issue as answer choice A and is a well-defined risk. The cardiac risk in answer choice D is well defined in the third paragraph. However, the risk associated with answer choice E is harder to find; therefore answer choice E is the common incorrect answer choice on this problem. From the section in the second paragraph “who are unable to maintain the necessary levels without frequent EPO injections” and the section in the third paragraph that references the frequency of injections as a drawback of EPO, it is logical to infer the frequency required is a risk: If patients cannot get injections frequently their health will be compromised.

Q4

[Reveal] Spoiler:
In this problem, there are no hints given in the question stem about where to look. In questions like this, go to the answer choices and examine them individually, finding clues about where to look. Answer choice A is too broad and categorical. You know that one component of high altitude training is safer than the use of synthetic EPO; it raises hemoglobin levels more slowly. But it could be that, overall, high-altitude training is much more dangerous than the use of synthetic EPO. Answer choice B is incorrect for similar reasons. You know that there has been an increase in the use of synthetic EPO by athletes, but you know nothing about other performance-enhancing drugs. Answer choice B goes way beyond the scope of information provided in this passage and is thus incorrect. For answer choice C, you only learn in the passage that NESP eliminates several drawbacks of EPO. You do not know whether it is more effective at raising hematocrit levels. Likewise for answer choice D: You know that NESP corrects several drawbacks of EPO, but you know nothing about its overall risks. It may have many more risks than EPO, but they are simply not discussed in this passage. If you managed to avoid temptation in answer choices A through D, then answer choice E is relatively easy to prove with this sentence in the first paragraph: “When kidneys detect a lack of oxygen flowing through the bloodstream, they secrete this glycoprotein, increasing the production of red blood cells, the body’s primary method of transporting oxygen to tissues and muscles.”

I have a question regarding Q4.
In CR we are told that inference is only things that are not explicitly written.
In this question, it's explicitly written that kidneys can detect a lack of oxygen in the bloodstream...
So I chose A.
I would appreciate if someone can address my concern.

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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06 Apr 2015, 06:51
Took 3 correct in 11 min....
The passage is not difficult but the questions are tough...

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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06 Apr 2015, 06:51
Took 3 correct in 11 min....
The passage is not difficult but the questions are tough...

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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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19 Apr 2015, 22:47
3 mins 11 seconds is menacingly/incedibly fast. Probably you should compete with Usmain Bolt in 100 metres reading!!!
I got this all correct but i took close to 600 seconds.
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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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10 Apr 2016, 07:14
Quote:
3. All of the following are potential risks of synthetic EPO except that it ______ .

(A) can raise hemoglobin levels too quickly.
(B) increases hemoglobin to levels above 15 grams per deciliter.
(C) abruptly increases blood viscosity.
(D) increases the likelihood of cardiac problems.
(E) needs to be administered frequently.

I have a doubt regarding the option C, which explains that risk associated with Synthetic EPO is quick change in viscosity and substantial cardiac risk results. The change in viscosity gives us no information as to whether it results in increase or decrease in viscosity. How can we say C is a risk?
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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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01 Nov 2016, 02:45
souvik101990

3.
"The body cannot properly adjust to the quick change in blood viscosity". This change doesn't indicate any direction. So, how can we say it is increasing?

4.
"Researchers continue to improve the effectiveness of synthetic EPO and even to develop a new glycoprotein—called novel erythropoiesis-stimulating protein (NESP)" doesn't it mean that NESP is more effective than synthetic EPO?
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Re: *Fresh* Erythropoietin, known also as EPO [#permalink]

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19 Dec 2016, 01:12
Mahmud6 wrote:
souvik101990

3.
"The body cannot properly adjust to the quick change in blood viscosity". This change doesn't indicate any direction. So, how can we say it is increasing?

4.
"Researchers continue to improve the effectiveness of synthetic EPO and even to develop a new glycoprotein—called novel erythropoiesis-stimulating protein (NESP)" doesn't it mean that NESP is more effective than synthetic EPO?

3. It can be increasing or decreasing. But we can infer that when the RBCs increase there will be an increase in viscosity not decrease. Hence we can safely infer that the viscosity increases. Even then if you have a doubt option 2 for the 3rd question only says that the Rbc levels increase by a certain number which is no where stated as risk but how fast one's body reaches that level is . Hence the correct answer will be 2.

4. As you have quoted effectiveness of the EPO is increased but no where it is stated that NESP is more effective in raising RBC levels than EPO. The author only states the advantages which includes longer effect of the injected RBCs and less frequent admission of the NESP.
When we effective it means that the drug has to perform better in increasing the RBCs and this is nowhere implied or mentioned. Hence for these reasons option 3 cannot be inferred.

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Re: *Fresh* Erythropoietin, known also as EPO   [#permalink] 19 Dec 2016, 01:12
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