Gastrostomy tubes are commonly used to provide nutrition and hydration

2. According to the passage, the high mortality rate following gastrostomy found in research cited in paragraph two is not necessarily a direct result of the placement of a gastrostomy tube because

(A) tube insertion itself is only rarely associated with fatal complications
(B) 30-day and 1-year mortality was 24% and 63% respectively in 1991 among Medicare beneficiaries
(C) only cases in which the percutaneous endoscopic gastrostomy tube was incorrectly place were examined
(D) all the patients in the studies mentioned suffered from life threatening diseases
(E) most of the patients in the studies mentioned suffered from life threatening diseases

Last sentence of the second paragraph mentions the number of diseases that could be the cause of the mortality rate and GT tube insertions is rarely associated with any kind of complicates.

Choice A - is just mentions that GT tube insertions is rarely associated with any kind of complicates but it is not the cause of the deaths.

Between choice D and E, Choice D says All Patients whereas choice E says Most patients and is mentioned in the passage.
So, the correct answer is E

This question is from my GMAT Practice questions archives. Let me know if you have any specific concern regarding this question.

Cheers

Passage summary:
Para 1:
Gastrostomy tubes (GT) used for oral intake. Nos increased in US between 1988-1995.

Para 2:
High mortality rate. Possibly due to comorbidities.

Para 3:
Q - "Do physicians discuss benefits?" (also, this is the authors point of writing the passage).
Study - Doubts regarding informed consent process.

Para 4:
Literature - Suggests patients/surrogates might decline GT if fully informed. Examples given.


QUESTIONS:

1. The passage is primarily concerned with

(A) the morbidity and mortality rates associated with the use of gastrostomy tubes.
Easy to miss the fact that this answer choice only deals with the rates of morbidity and mortality. Discussed only in para 2 and no more. The concern is not the rate of morbidity and mortality. Rather, it is the fact that physicians are not discussing these rates with the patients/surrogates. Cannot be considered as the PRIMARY CONCERN of the passage. INCORRECT.

(B) the proliferation of the use of gastronomy tubes in patients aged 85 years or older.
Mentioned only once in the passage. Definitely not the PRIMARY CONCERN of the passage. INCORRECT.

(C) whether physicians adequately discuss the benefits and burdens of tube feeding with patients or surrogate decision-makers before gastrostomy tubes are inserted.
Given in para 3; Up until now, the author has been citing data from studies. This is the first time the author gives his opinion and spaces it using a colon. CORRECT.

(D) the growing number of patients undergoing placement of a gastrostomy tube.
Mentioned in the passage only to aid the authors case, but not the PRIMARY CONCERN of the passage. INCORRECT.

(E) the complications that often follow the insertion of a percutaneous endoscopic gastrostomy tube.
The complications are not the PRIMARY CONCERN. Rather, the lack of discussing them with the patients/surrogates is. INCORRECT.

PS. I had selected answer choice (A).


2. According to the passage, the high mortality rate following gastrostomy found in research cited in paragraph two is not necessarily a direct result of the placement of a gastrostomy tube because

Tricky question. The correct answer choice can be one that explicitly says that GTs did not result in a high mortality rate, or, it could be one that says that the high mortality rate was due to some other reason. Both sound legit. Both are mentioned in the passage.

(A) tube insertion itself is only rarely associated with fatal complications.
Sounds like a possible option. Will hold on to it.

(B) 30-day and 1-year mortality was 24% and 63% respectively in 1991 among Medicare beneficiaries.
Does not support why high mortality rate is not necessarily a direct result of the placement of a GT. INCORRECT.

(C) only cases in which the percutaneous endoscopic gastrostomy tube was incorrectly place were examined.
Does not support why high mortality rate is not necessarily a direct result of the placement of a GT. INCORRECT.

(D) all the patients in the studies mentioned suffered from life threatening diseases.
Para 2 says "most patients", not "all patients". INCORRECT.

(E) most of the patients in the studies mentioned suffered from life threatening diseases.
Possible correct answer.

Compare (A) and (E). To show that high mortality rate is not necessarily a direct result of the placement of a GT, it would be a stronger position to state that some other reason was causing the mortality as compared to simply state that the GT insertion itself only rarely caused fatal complications. If placement of a GT rarely causes mortality, and the patient has no comorbidity, and if the patient still dies, it would mean that the patient was one of the few that probably died due to the placement of a GT, right! Hence (E) is a better choice than (A).

PS. I selected answer choice (A). It's easier to comprehend the reasoning when the paragraph has been re-read.


3. It can be inferred from the passage that

(A) there are alternatives to the use of gastrostomy tubes to provide nutrition but not hydration for patients unwilling or unable to maintain an adequate oral intake.
Not mentioned in passage. INCORRECT.

(B) there are alternatives to the use of gastrostomy tubes to provide hydration but not nutrition for patients unwilling or unable to maintain an adequate oral intake.
Not mentioned in passage. INCORRECT.

(C) there are alternatives to the use of gastrostomy tubes to provide nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake.
Not directly mentioned. However, may be inferred. Not a big leap from what the author implies. Hold on to this answer choice.

(D) the alternatives to gastrostomy tubes do not provide adequate nutrition and hydration.
Not mentioned in passage. INCORRECT.

(E) the alternatives to gastrostomy tubes provide more adequate nutrition and hydration than the gastrostomy tubes.
Not mentioned in passage. INCORRECT.

Using method of elimination, CORRECT answer choice is (C).


4. The author uses the word “only” [Highlighted] most likely in order to

The author uses "only" here to show that less than majority (33%) would opt for GTs when the study represents a well informed group (mentally competent nursing home residents). This is also in acceptance with the main idea of the passage that the author is concerned with and the fact that, if given a choice, patients/surrogates would most probably not choose a GT when fully informed about its pros/cons.

(A) highlight the oddity of the decision of the patients.
The author is not referring to the oddity (33%). Rather, the author believes this figure is probably well represented since fully informed patients might decline GT. INCORRECT.

(B) emphasize the relatively low percentage of patients that would opt for a gastrostomy tube if given the choice.
Bingo. The author does "emphasize the relatively low percentage" choosing GT if given a choice by using the word "only". CORRECT.

(C) point out the limited value of inserting a gastrostomy tube.
The author is not concerned about the "limited value" of a GT in this sentence. INCORRECT.

(D) distinguish the primary factor in the decision making process of brain damaged patients.
The author is not concerned about the "primary factor in the decision making process of brain damaged patients" of a GT in this sentence. The author is also not distinguishing this factor. INCORRECT.

(E) single out a unique merit of gastrostomy tubes for brain damaged patients.
The author does not use "only" as merit here. INCORRECT.


CHEERS!

Paraphrasing:
Para 1: Gastrostomy tubes usage and increasing requirements in 1990, and 1991
Para 2: short term mortality rate statistics of gastrostomy tube insertion in 1990 and 1992, associated with fatal complications related to dementia, nerve system, cancer or internal organ failure.
Para 3: Doubt raise on Physician in usage of gastrostomy tube with concern with and approval from patients
Para 4: Small body of literature and survey suggests less than 33% favoured feeding by gastrostomy

1. The passage is primarily concerned with
(A) the morbidity and mortality rates associated with the use of gastrostomy tubes
Wrong: passage does not discuss about rate associated with medical condition, and death rate due to usage of gastrostomy tubes,
it gives statistics of gastrostomy usage in in 1990, and 1992, and survey conducted in favor for gastrostomy usage.

(B) the proliferation of the use of gastronomy tubes in patients aged 85 years or older
Wrong: this is used only to show statistically increasing utilization of gastronomy tube

(C) whether physicians adequately discuss the benefits and burdens of tube feeding with patients or surrogate decision-makers before gastrostomy tubes are inserted
Correct:
Para 1: gives introduction to gastrostomy tube and it increasing utilization
Para 2: usage of gastrostomy tube in critical medical condition
Para3: Raise doubt on physician and doctors, as mentioned in passage,
“The growing use of tube feeding in a population with limited life expectancy inevitably raises the following question: Do physicians discuss the benefits and burdens of tube feeding adequately with patients or surrogate decision-makers before gastrostomy tubes are inserted?”
Para 4: survey conducted in which less patients favoured of gastrostomy tube

(D) the growing number of patients undergoing placement of a gastrostomy tube
Wrong: this is used only to show statistically increasing utilization of gastronomy tube

(E) the complications that often follow the insertion of a percutaneous endoscopic gastrostomy tube
Wrong: Out of scope, complication details not mentioned in passage

2. According to the passage,
the high mortality rate following gastrostomy found in research
cited in paragraph two is not necessarily a direct result of the placement
of a gastrostomy tube because

(A) tube insertion itself is only rarely associated with fatal complications
Wrong: Rarely associated with fatal complication!
This sentence is to support statistics mentioned in passage,
“In a cohort of more than 7000 American veterans
who underwent placement of percutaneous endoscopic gastrostomy tubes between 1990 and 1992,
median survival was 7.5 months and 1-year mortality was 59%.
Among Medicare beneficiaries receiving gastrostomy tubes in 1991,
30-day and 1-year mortality was 24% and 63%, respectively.”

(B) 30-day and 1-year mortality was 24% and 63% respectively in 1991 among Medicare beneficiaries
Wrong: This is only statistics, not a reason of justification for high mortality rate.

(C) only cases in which the percutaneous endoscopic gastrostomy tube was incorrectly place were examined
Wrong: “only cases - incorrectly place was examined” this detail is not mentioned in the passage

(D) all the patients in the studies mentioned suffered from life threatening diseases
Wrong: as mentioned in passage,
“Most patients receiving gastrostomy tubes have advanced dementia, other types of severe neurological impairment, cancer, or advanced failure of other internal organs.”

(E) most of the patients in the studies mentioned suffered from life threatening diseases
Correct: as mentioned in the passage, “Most patients receiving gastrostomy tubes have advanced dementia, other types of severe neurological impairment, cancer, or advanced failure of other internal organs.”

3. It can be inferred from the passage that
Explanation: for inference, supporting sentence in passage
Passage 1st line: “Gastrostomy tubes are commonly used to provide nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake”

1. A small body of literature suggests that fully informed patients or their surrogates might in fact
Decline permanent tube feeding at a higher-than-expected rate: It means, alternative is available

2. O' Brien and colleagues asked 379 mentally competent nursing home residents
if they would want a gastrostomy tube
if they became unable to eat because of permanent brain damage;
only 33% expressed a preference for tube feedings in this circumstance It means other 66% needs alternative method

3. In an interview study of 121 competent patients with amyotrophic lateral sclerosis, only 28% favoured feeding by gastrostomy: it means remaining 72% favoured other feeding methods

(A) there are alternatives to the use of gastrostomy tubes to provide
nutrition but not hydration for patients unwilling or unable to maintain an adequate oral intake.
Wrong: as per passage 1st line – Easy elimination

(B) there are alternatives to the use of gastrostomy tubes to provide
hydration but not nutrition for patients unwilling or unable to maintain an adequate oral intake.
Wrong: as per passage 1st line – Easy elimination

(C) there are alternatives to the use of gastrostomy tubes to provide
nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake.
Correct: as per 1st line of passage and supporting 3 lines from the passage

(D) the alternatives to gastrostomy tubes do not provide
adequate nutrition and hydration
Wrong: Out of scope, alternatives of gastrostomy tube providing adequate is not mentioned in the passage, only can be inferred based on supporting 3 sentences from passage, alternatives are available

(E) the alternatives to gastrostomy tubes provide
more adequate nutrition and hydration than the gastrostomy tubes
Wrong: Out of scope, alternatives of gastrostomy tube providing adequate is not mentioned in the passage, only can be inferred based on supporting 3 sentences from passage, alternatives are available


4. The author uses the word “only” most likely in order to
Sentence: O' Brien and colleagues asked 379 mentally competent nursing home residents
if they would want a gastrostomy tube
if they became unable to eat because of permanent brain damage;
only 33% expressed a preference for tube feedings in this circumstance

(A) highlight the oddity of the decision of the patients
Wrong: Author does not differentiate category of patients based on oddity decision,
in fact, “only” highlights specific group preference of tube and other not.

(B) emphasize the relatively low percentage of patients
that would opt for a gastrostomy tube if given the choice
- Correct, as per the sentence mentioned above

(C) point out the limited value of inserting a gastrostomy tube
Wrong: It’s about preference on acceptance to use gastrostomy tube, not about the quantity of value utilization.

(D) distinguish the primary factor in the decision-making process of brain damaged patients
Wrong: Irrelevant, as it turns away from intended meaning from preference of utilization to ability of decision making

(E) single out a unique merit of gastrostomy tubes for brain damaged patients
Wrong: Out of scope, highlights about Unique merit about specific group of brain damaged patients

I still don't think (3) is a good question. I'm a doctor in the hospital and patients actually refuse to be on G-tube and rather die. So there actually may not be other good alternative options (it's just that G-tube itself is so **** that they just don't want it. Kinda like if you go into cardiac arrest, people choose not to go with chest compression and rather die)

I picked D because that is what is more medically accurate... Without paraneteral feeding will lead to poorer outcome with higher mortality than G-tube... This question only looked at it from one side and not the other.

Sajjad1994 If the source of this RC is GMAT Practice questions archives, does that mean that these are OG questions? If these are OG questions, when I go to practice with OG questions from the guides, will I have seen some passages/questions before if I do your RC Butler challenge often?

No this is not official question and it will not appear in any OG.

Hello Sajjad,

Can I get the OE for Q3?

Alternatively, you can read one here:

https://gmatclub.com/forum/gastrostomy- ... l#p2945138