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Lymphomas and rare cancers of the thyroid

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Lymphomas and rare cancers of the thyroid  [#permalink]

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New post Updated on: 13 Aug 2018, 02:27
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Lymphomas and rare cancers of the thyroid and salivary glands are some malignancies that can be notoriously tricky to correctly diagnose from radiological images and pathological slides of biopsies; test results can be inconclusive or may return false results. Such findings reinforce the need for second opinions, opinions that can lead to significant changes in a patient's diagnosis or in recommendations for treating the cancers.

According to Thomas Feeley, vice president of medical operations at MD Anderson, as many as 25% of patients who arrive at the center with diagnoses for certain cancers such as lymphoma may receive a different diagnosis. Overall, 3% of MD Anderson patients each year end up with a significant change in diagnosis, affecting the final treatment that they receive. Kim Henderson, a paralegal in Houston, went to MD Anderson to be treated for cervical cancer after being diagnosed elsewhere. Pathologists at MD Anderson performed another biopsy that revealed she had a noninvasive precursor to cervical cancer—and not the far more serious invasive type as previously believed. Although she still needed surgery, she could now skip the radiation and chemotherapy that had originally been part of the treatment plan. Such instances further prove the need to get second opinion about the initial cancer diagnosis and to carefully evaluate all the available treatments. One should fight the natural impulse to get started with the treatment right at the initial cancer diagnosis.

Second opinions are important for other diseases as well. National Jewish Health, a Denver medical center, found in a study that more than half of patients it diagnosed with Chronic Obstructive Pulmonary Disease (COPD) had previously been misdiagnosed with asthma, leading to inappropriate treatments. A form of dementia is often incorrectly diagnosed as Alzheimer's, and studies show that doctors may misdiagnose coronary artery disease as other conditions.

However, not everyone should get a second opinion for every possible disease because such practice could lead to a significant rise in health-care costs. In addition, by getting second opinions, one also runs a risk of getting overwhelmed by possible conflicting opinions, especially when one is in a terribly vulnerable position. A probable solution for the patients is to find the doctor that they trust and follow his or her recommendation. Second opinions are more appropriate for life threatening diseases for which the diagnosis may be suspect to begin with.

1. According to the passage, which factor has MOST likely led to the need of second opinions in medical discipline?

A. There is a dire need to keep the healthcare costs low.

B. Second opinions lead to significant changes in diagnosis of a disease and recommendation on the treatment of the same.

C. They help patients skip unnecessary steps in treatment for a particular disease.

D. Radiological images and pathological slides of biopsies often misrepresent the nature of the disease.

E. There are some cancers that are very difficult to be diagnosed correctly with the help of radiology and pathological tests.

Passage Analysis:

Para 1 - Introduces "Second Opinions" and why they are important

•Test results for certain types of cancer can be inconclusive.
•So second opinions are important - can lead to changes in diagnosis and recommendations for treatments.


Para 2 - Justifies the stand on "Second Opinions“

•Case study of MD Anderson wrt certain cancers such as lymphoma
•Case of paralegal - Kim presented - her cervical cancer was diagnosed incorrectly. Was less severe upon second diagnosis. So treatment was different.


Para 3 - "Second Opinions" are important for other diseases as well.

•Example 1 of NJH - COPD example
•Example 2 of dementia misdiagnosis
•Example 3 of Coronary artery disease


Para 4 - Author's recommendation about who should use second opinions

•People facing life threatening diseases should opt for second opinions
•Second opinions should not be taken for all diseases
•could be overwhelming for patients
•could result in rise in health-care costs

The verbiage According to the passage - implies that this is a detail question. The question asks us to find the factor that most likely led to the need of second opinion in medical discipline. The passage is about second opinions in medical discipline. The author introduces the need for getting second opinions in first paragraph. Here he presents the reason for the same. Because certain cancers are tricky to be diagnosed with the help of current diagnostic technology using radiological images and pathological slides of biopsies, there is a need for second opinions.


There is a dire need to keep the healthcare costs low.

Choice A is incorrect. It basically states the opposite. The passage clearly states in last paragraph that getting second opinions may increase the health care costs.

B
Second opinions lead to significant changes in diagnosis of a disease and recommendation on the treatment of the same.

Choice B is outside the context of the discussion about the NEED for second opinions. It actually provides the benefits of getting second opinion. So for this reason, this choice is not correct. Note one more aspect about this question. It states the benefits is too deterministic fashion. The passage states that second opinions help in different diagnosis in certain specific cases of cancers, etc. It does not go far enough to say that it always helps for all diseases. So you should always be wary of such choices that go too far to generalize the facts presented in the passage.

C
They help patients skip unnecessary steps in treatment for a particular disease.

Choice C is also out of context answer choice. It presents result of getting second opinion instead of the need for getting second opinion in the first place. Furthermore, it does not even state the result correct since it picks up the specific effect of second opinion in the example presented in the passage and provides it as a generalized fact.

D
Radiological images and pathological slides of biopsies often misrepresent the nature of the disease.

Choice D is an inconsistent incorrect answer choice. The author does not go far enough to say that these images and slides misrepresent the nature of disease. He simply states that for certain diseases it may be tricky to do the diagnoses.

There are some cancers that are very difficult to be diagnosed correctly with the help of radiology and pathological tests.

Choice E is the correct answer for this detail question. It is a another way of stating what we came up with in the pre-thinking analysis.


2.The author exemplifies the case of the paralegal in Houston to illustrate

A. the prowess of radiology in diagnosing the correct nature of cancer cases.

B. that medical facilities at MD Anderson are better and more reliable than the other hospitals.

C.the point that second set of medical examinations can reveal remarkable changes not only in the diagnosis of specific malignancies but also in the treatment advised earlier.

D. the differences between the noninvasive precursor to cervical cancer and the far more serious invasive type.

E. the ineffectiveness of undergoing the same examinations again as she needed the surgery still but could only avoid chemotherapy.

This question asks us to find the purpose of the entity. The entity is the case of paralegal that has been mentioned in the passage. This has been mentioned in second paragraph of the passage. The case of Kim henderson is as follows – she was diagnosed with cervical cancer and she went to MD Anderson medical center for treatment. There the pathologists did another biopsy and it was found that she had a less serious type of cancer than the one previously diagnosed and now she could skip the initial prescribed treatment. This case further exemplifies the need to get second diagnosis.

the prowess of radiology in diagnosing the correct nature of cancer cases.

Choice A is not correct. It is in fact opposite of what is stated in the passage. The case clearly indicates that the initial diagnosis was not correct.

B
that medical facilities at MD Anderson are better and more reliable than the other hospitals.

Choice B is outside the scope of the passage. The author does not make any claims about MDAnderson facility being superior to other facilities.

the point that second set of medical examinations can reveal remarkable changes not only in the diagnosis of specific malignancies but also in the treatment advised earlier.

Choice C correctly communicates the purpose of the case of paralegal. Note that this choice is not a direct reword of our prethought purpose. However, it captures the essence well. Clearly the author shows through this case that second set of medical examinations can reveal remarkable changes not only in the diagnosis of specific malignancies but also in the treatment advised earlier. And this further implies the need to get second opinion – which was our prethought purpose.

Choice C is the correct answer.

D
the differences between the noninvasive precursor to cervical cancer and the far more serious invasive type.

Choice D is out of scope since the author does not intend to emphasize on the difference between the two. He simply mentions this difference to show that the initial diagnosis was so far from being correct

E
the ineffectiveness of undergoing the same examinations again as she needed the surgery still but could only avoid chemotherapy.

Choice E is a very carefully crafted inconsistent choice. It states the facts from the passage – undergoing same examinations again – needed surgery, avoided chemotherapy. But it spins these facts in a totally different manner that is complete inconsistent and goes in opposite direction of the what the author intended. So always be wary of such choices that use seemingly familiar terms from the passage.


3. Which of the following can be inferred from the passage?

A.Radiological images and pathological tests do not provide conclusive proof to diagnose cancers and certain types of chronic obstructive pulmonary disease.

B.High probability of wrong diagnosis of certain kinds of cancers from radiological images and pathological slides shows the importance of second opinions.

C.Correct diagnosis and recommendation of apt treatment ease the mental trauma of the patients diagnosed with cancer or brain tumor.

D.Misdiagnoses can result if the instruments used for pathological and radiological procedures are faulty.

E.Radiology and pathological tests must be avoided as far as possible as they are not only inconclusive in the diagnosis of certain malignancies but also capable of showing false results.

Radiological images and pathological tests do not provide conclusive proof to diagnose cancers and certain types of chronic obstructive pulmonary disease.

Choice A cannot be inferred since the passage only talks about difficulty in diagnosing certain kinds of cancers and not all cancers in general. Furthermore, the passage states that diagnosis can be tricky for certain cancers. It does not state that these tests always fail to conclusively diagnose even the mentioned specific cancers. And lastly, the passage does not mention that radiological images and pathological tests are used to diagnose the chronic obstructive pulmonary disease. So this choice is a very carefully crafted incorrect choice. It uses familiar terms from the passage but presents them in a manner that its no longer consistent with the information presented in the passage.

High probability of wrong diagnosis of certain kinds of cancers from radiological images and pathological slides shows the importance of second opinions.

Choice B can be inferred from the passage. The first paragraph of the passage can be summarized to infer the statement in choice B. Note how the usage of “high probability of wrong diagnosis” is the optimum way of translating the fact that diagnosis can be tricky.

So choice B is the correct answer.

C
Correct diagnosis and recommendation of apt treatment ease the mental trauma of the patients diagnosed with cancer or brain tumor.

Choice C is outside the scope of the passage since the mental trauma is not discussed anywhere in the passage.

D
Misdiagnoses can result if the instruments used for pathological and radiological procedures are faulty.


Choice D is also outside the scope of the passage since there is no mention of faulty equipment.

E
Radiology and pathological tests must be avoided as far as possible as they are not only inconclusive in the diagnosis of certain malignancies but also capable of showing false results.


Choice E cannot be inferred from the passage. The passage only suggests getting second opinions in certain cases. In fact the second opinions are also done by using the same tests but at different medical facilities with different experts. So in no way does the passage intend to imply the statement in this choice.


4. National Jewish Health found that

A.It is as difficult to diagnose COPD using radiological images and pathological tests as it is to diagnose cancer.

B.In the later examination more than half of patients diagnosed with Asthma were previously misdiagnosed with COPD.

C.More than half of its patients diagnosed with COPD were earlier misdiagnosed with Asthma and hence were given incorrect treatments.

D.doctors cannot differentiate between coronary artery disease and other similar conditions.

E. Alzheimer's need multiple screenings before actually being diagnosed.

The question reads - National Jewish Health found that. So this is a detail question. We know that National Jewish Health has been mentioned in the third paragraph of the passage. This medical center found that more than half of the patients it diagnosed with COPD had previously been misdiagnosed with asthma. This led to inappropriate treatments. So with this information we should evaluate the answer choices.

A
It is as difficult to diagnose COPD using radiological images and pathological tests as it is to diagnose cancer.

Choice A is an inconsistent answer choice. The findings of National Jewish Health had nothing to do with the radiological and pathological tests.

B
In the later examination more than half of patients diagnosed with Asthma were previously misdiagnosed with COPD.

Choice B states exact opposite of the findings of the study.

More than half of its patients diagnosed with COPD were earlier misdiagnosed with Asthma and hence were given incorrect treatments.

Choice C correctly states the findings of the study done by National Jewish Health. More than half of its patients diagnosed with COPD were earlier misdiagnosed with Asthma and hence were given incorrect treatments.

So choice C is the correct answer.

D
doctors cannot differentiate between coronary artery disease and other similar conditions.

Choice D is out of context since the findings of NJH were limited to COPD only. The author presents some other study when he talks about coronary artery disease.

E
Alzheimer's need multiple screenings before actually being diagnosed.

Likewise choice E is also out of context since the NJH study did not pertain to Alzheimer’s.


5. Which of the following best describes the structure of the first two paragraphs of the passage?

A. The author advocates the need of second opinions for all diseases, validated by an expert in the medical field.

B. The author criticizes the shortcoming of radiological images and pathological slides of biopsies in diagnosing COPD correctly and presents proof with the example of MD Anderson.

C. By presenting the percentage of misdiagnosed cases in a particular medical facility, the author reinforces the need of second opinion in the medical sphere.

D. That second opinion in certain cases such as diagnosis of specific cancers can bring about compelling changes in prescribed course of treatment has been justified by the author with the help of statistics.

E. Patients diagnosed with cancer impulsively begin the treatment at the first available facility rather than going for a second opinion that might suggest something else.

The question asks us to find the structure of para 1 and 2. or in other words we have to find the purpose of these two paragraph and how they related to one another. Now in first paragraph the author introduces the concept fo second opinions. He presents the case of certain cancers for which the diagnosis can be tricky and he states that second opinions can lead to significant changes in the treatement options. Then in second paragraph he justifiues his point by using expert testimony and examples of data obtained at MD Anderson medical center.

The author advocates the need of second opinions for all diseases, validated by an expert in the medical field.

Choice A is not correct since the author clearly mentions in para 1 that diagnosis of certain cancers is difficult. He does not generalize this to cover all diseases.

B
The author criticizes the shortcoming of radiological images and pathological slides of biopsies in diagnosing COPD correctly and presents proof with the example of MD Anderson.

Choice B is not correct since the author’s tone is not crucial. He merely states a fact about the difficulty in diagnosis and suggests a solution. Furthermore he does not talk about COPD in para 1 and 2.

C
By presenting the percentage of misdiagnosed cases in a particular medical facility, the author reinforces the need of second opinion in the medical sphere.

Choice C is not correct since it’s too broad. The author is very specific about second opinions for certain diseases. He does not apply his suggestion to entire medical sphere.

That second opinion in certain cases such as diagnosis of specific cancers can bring about compelling changes in prescribed course of treatment has been justified by the author with the help of statistics.

Choice D is the correct answer. It correctly indicates the role played by the two paragraphs in question. The first para indicates that “second opinion in certain cases such as diagnosis of specific cancers can bring about compelling changes in prescribed course of treatment” and second para is used to justify this point with the help of statistics.

E
Patients diagnosed with cancer impulsively begin the treatment at the first available facility rather than going for a second opinion that might suggest something else.

Choice E is not correct. In second paragraph The author does caution the reader to not take impulsive actions when it relates to getting treatment for certain cancers. However, this statement does not capture the essence of para 1 and 2. so it is out of context incorrect choice.


6. What does the author recommend as the proper use of Second opinions?

A. Patients must guard themselves against multiple antagonistic medical suggestions that might leave them confused.

B. Patients should stay away from second opinions as they may overwhelm patients rather than helping them.

C. Patients should seek second opinions when the probability of cost savings exceed the cost of seeking the opinions.

D. Patients must seek second opinions in serious situations where the original diagnosis may not be as reliable.

E. Patients must pick a doctor with excellent reputation and go with his or her recommendation.


This question asks us to state the authors recommendation about the proper use of second opinions. This appears to be an inference quetsion. Note that in last paragraph the author states his opinion “however not everyone should get a second opinion for every possible disease because such practice could lead to significant rise in health care costs. Towards the end of this paragraph he then states his sugestsion. So based on these two statements, it appears that the author makes the recommendation that One should get second opinions for life threatening diseases for which diagnosis may be suspect to begin with.


Patients must guard themselves against multiple antagonistic medical suggestions that might leave them confused.

Choice A is not the correct answer since the author presents a milder version of this statement as a reason why patients should not seek second opinions for all diseases.

B
Patients should stay away from second opinions as they may overwhelm patients rather than helping them.

Choice B is similar to choice A.

C
Patients should seek second opinions when the probability of cost savings exceed the cost of seeking the opinions.

Choice C is not correct since the cost savings do not come into picture at all in this discussion

Patients must seek second opinions in serious situations where the original diagnosis may not be as reliable.

Choice D is the correct answer. This is a reword of the prethought recommendation. Note that suspect diagnosis as stated in the passage can be construed as the diagnosis that is not as reliable.

E
Patients must pick a doctor with excellent reputation and go with his or her recommendation.

Choice E twists the recommendation provided by the author. The author states that the patients should find the doctor they trust. This does not necessarily mean the doctor with excellent reputation. So this choice is inconsistent.


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Originally posted by Skywalker18 on 01 Jul 2018, 23:22.
Last edited by workout on 13 Aug 2018, 02:27, edited 4 times in total.
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Re: Lymphomas and rare cancers of the thyroid  [#permalink]

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New post 09 Jul 2018, 04:28
for the question 1:- why is option b wrong. The statement of option b is same as mentioned in passage.
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Re: Lymphomas and rare cancers of the thyroid  [#permalink]

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New post 24 Jul 2018, 09:49
surabhi26 wrote:
for the question 1:- why is option b wrong. The statement of option b is same as mentioned in passage.


Because B B. Second opinions lead to significant changes in diagnosis of a disease and recommendation on the treatment of the same.
is pretty general. It is also not the MOST LIKELY reason to get a second opinion. It's a likely reason that has some truth to it but not the most Likely. The most likely reason is mentioned in the opening paragraph.
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Re: Lymphomas and rare cancers of the thyroid  [#permalink]

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New post 24 Jul 2018, 11:52
Answer to question 3 is debatable.

The author no where mentions 'high probability', the author just says readio.. and biopsies.. may give false results.

All the options are bad.

Please correct me if I am wrong.
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Re: Lymphomas and rare cancers of the thyroid  [#permalink]

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New post 24 Jul 2018, 12:35
thinkTheta wrote:
Answer to question 3 is debatable.

The author no where mentions 'high probability', the author just says readio.. and biopsies.. may give false results.

All the options are bad.

Please correct me if I am wrong.


Yes. All options are not great, but the OA is the best of the worst.
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Re: Lymphomas and rare cancers of the thyroid  [#permalink]

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New post 25 Jul 2018, 10:16
surabhi26 wrote:
for the question 1:- why is option b wrong. The statement of option b is same as mentioned in passage.


The question asks what led to the need of second opinions
I also marked B, but then realised "Such findings reinforce the need for second opinions, opinions that can lead to significant changes in a patient's diagnosis or in recommendations for treating the cancers" in the first para
Though B is very close but E is right.

Hope this helps.
Re: Lymphomas and rare cancers of the thyroid &nbs [#permalink] 25 Jul 2018, 10:16
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