*Question*
And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension. Since this development is likely to cause confusion and concern for many, I'm writing this post to help you understand the debate and what this might mean for you and your family. By the way, if you've read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines. The core principles of better blood pressure management for older adults remain the same: * Take care in how you and your doctors measure blood pressure (more on that here), * Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014, * And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control. Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers "diminishing returns" as we treat BP to get lower and lower. Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150). From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120. However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.) According to the above context, choose the correct option to answer the following question. Question: After the release of the new AHA guidelines, what is going to happen to the author's patients? Options: A. Their blood pressure treatment protocol will stay the same. B. not enough information C. They will be enrolled in a study. D. They will call their doctor.
**Answer**
A

*Question*
My best story is about Santa Claus. A mall Santa had a heart attack at work and was rushed to the Emergency Room in full cardiac arrest. Let me explain that a person playing Santa is generally a certain age (white beard) and body type (round) that is predisposed to cardiac disease. We did everything we could but ultimately our efforts were futile. The mall Santa rode his sleigh into the great beyond. A mother, there to visit another patient, was insistent that her 78 year old son be allowed back to visit his grandmother. We had a strict 12 year old age limit visitation policy. I was called to speak with her. "Why do you have such a stupid Draconian policy?" She insisted. "The Emergency Room is no place for a child ma'am. Besides, the germs and infections he may be exposed to, there are things he may see or hear that a child would have a hard time processing," I explained. "Like what?" She argued. "Well, there are people in pain moaning," I answered. "And drunks cursing at the staff. It's a tough place." "He's fine," she insisted. "I think I know how to parent. I don't need you to worry about what my son is able to handle." I caved in and allowed her back. As we passed the room with the dead Santa, a tech exited and opened the curtain. Her child looked in and saw Santa's lifeless body, ET tube sticking out of his throat, boots still on but costume cut to shreds and strewn across the room. The child lost it! "Mom, Santa Claus is Dead!" He cried. "I'm not going to get anything for Christmas." "Why would someone open the curtain?" The mother demanded. "I warned you," I said. "That's why we have a 12 years and above visitation policy." She was not happy. Come to find out the child had his picture made with that very Santa a few days prior. Very ironic. According to the above context, choose the correct option to answer the following question. Question: Who did everything they could to save Santa? Options: A. Doctors in the ER B. The ER worker C. Nurses in the ER D. not enough information
**Answer**
B

*Question*
Weight gain is a complex issue. But there is little doubt that the current food environment in Western countries heavy in highly processed salty, sugary, and fatty food has a big role to play. Most of the salt eaten in our diet has been added to food in the manufacturing process. This is in contrast to the small amount of salt naturally present in most foods or what is added at the table or at home in cooking. Salt can be a desirable taste, increasing the palatability of foods in addition to helping preserve it; that's why it is commonly added in processed foods. Combining salt and fat together is thought to be a potent combination in helping to promote passive over-consumption foods. Just think of how moreish salty chips can be. Having a greater liking for salty and fatty foods is associated with eating more kilojoules overall, uncontrolled eating, and overweight in children. This link between overconsumption of food and its degree of saltiness is considered stronger than having a liking for sweet and fatty foods. Teasing out further how salt may influence the over-consumption of fatty foods, sensory researchers from Deakin University recruited 48 healthy adults to take part in a tasting panel. Over four lunchtime sessions (following on from a standardised breakfast that morning), each person ate a meal of macaroni and cheese where the fat and salt content had been manipulated. The four meal combinations were low-fat/low-salt, low-fat/high-salt, high-fat/low-salt and high-fat/high-salt. Participants were encouraged to eat as much as they wished until feeling full. Eating rate, meal agreeability, and subjective ratings of hunger and fullness were also taken. Salt promotes over-eating Eleven percent more kilojoules were consumed when the meals eaten were high in salt. And this was irrespective of if the fat content was high or low. The fat content of the meal didn't result in people eating more food by weight, but because of its greater energy density, that meant more kilojoules were eaten. According to the above context, choose the correct option to answer the following question. Question: Who was tested during a food preference study at Deakin University? Options: A. A group of 48 healthy adults. B. not enough information C. A group of prospective students touring the campus at lunch time. D. A sampling of people whose favorite meal was lunch.
**Answer**
A