PART A

Adolescent Alcohol Consumption

TEXT A

Although important to public policy, there has been no rigorous evidence syntheses of the long-term
consequences of late adolescent drinking.

Methods and Findings

This systematic review summarizes evidence from general population cohort studies of drinking between
15-19 years old and any subsequent outcomes aged 20 or greater, with at least 3 years of follow-up
study.

The principal findings are: There is consistent evidence that higher alcohol consumption in late
adolescence continues into adulthood and is also associated with alcohol problems including
dependence. Although a number of studies suggest links to adult physical and mental health and social
consequences, existing evidence is of insufficient quality to warrant causal inferences at this stage.

Conclusions

There is an urgent need for high-quality long-term prospective cohort studies in order to better
understand the public health burden that is consequent on late adolescent drinking, both in relation to
adult drinking and more broadly. Reducing alcohol drinking during late adolescence is likely to be
important for preventing long term adverse consequences as well as protecting against more immediate
harms.

TEXT B

Drinking and Driving

Getting behind the wheel of a vehicle after consuming alcohol is a serious crime. Drinking and driving is
sometimes called driving under the influence (DUI) or driving while intoxicated (DWI) and involves
operating a vehicle with a blood alcohol content (BAC) level of at least 0.08 percent. However, even a
small amount of alcohol can lead to harmful situations. Some drivers may not even show warning signs
of being under the influence, but that does not mean ft is any less dangerous. It is important to
remember that any form of drinking and driving is illegal and can come with strict punishment.

Alcoholism is a condition that can be treated with the help of a specialized treatment center. If you or
someone you love is struggling with a drinking problem, it is time to seek help and get your life back on
track. Alcohol consumption can put anyone at risk of causing an accident or other serious injury.
However, some populations are more likely to get behind the wheel of a car after drinking.

Drivers who are between the ages of 16 and 20 years old are 10 times more likely to be involved in a
fatal crash than drivers over the age of 21. While the number of underage drinking and driving cases has
significantly decreased, many communities are pushing out new initiatives to keep adolescents safe. In
2011 alone, close to one million high school teens admitted to drinking and driving.

The second highest alcohol-related crash risk includes individuals between the ages of 21 to 24. In 2012,
21- to 24-year-olds had the highest percentage of drivers In fatal crashes with a BAC level of 0.08 percent
or higher - 32 percent. Many of these cases involved binge drinking, a form of consuming too much
alcohol in a short period of time. This often affects college students and young professionals who attend
parties and other social events that have easy access to alcohol.

Suicide

Alcohol use interacts with conditions such as depression and stress to contribute to suicide, the third
leading cause of death among people between the ages of 14 and 25. In one study, 33 percent of eighth
grade females who drank heavily reported attempting suicide, compared with 11 percent who did not
drink.

Binge Drinking

The largest group at risk for drinking and driving are those who binge drink or are struggling with an
alcohol use disorder (AUD). This means they consume a large amount of alcohol in a short period of
time, putting them at risk for harmful side effects. It takes roughly half an hour to two hours for alcohol
to be absorbed into your bloodstream. During this time, your breathing may slow down and your
cognitive skills may be delayed. Because of this, it is always dangerous to drink and drive. Though most
college drinkers would deny it, young people do die solely from drinking. In 1995, 318 people aged 15 to
24 died as a result of alcohol poisoning alone, many of them after a night binge at college.

TEXT C

Table: Alcohol-Related Problems Reported by Year 12 High School Students Who Had Consumed
Alcoholic Beverages on at Least 10 Occasions In Their Lifetime

Alcohol-Related Problem Reported 12th Graders (%)

Caused you to behave in ways you later regretted 52
Interfered with your ability to think clearly 32
Caused you to drive unsafely 19
Caused you to be less stable emotionally 11
Got you in trouble with the police 9
Caused your physical health to be bad 6

TEXT D
Background

Alcohol ls responsible for approximately 4% of the global burden of disease. This burden is higher in high
Income countries and among men, accounting for 11% of all male deaths In the World Health
Organization (WHO) European region in 2004. There Is global concern about the binge drinking trend
among young people. Up to now prominent policy responses in the UK and elsewhere have been
attempts to manage antisocial behavior related to Intoxication In public spaces. Much less attention has
been given to risks to adult health and wellbeing.

There have been many cohort studies of the longer-term harms associated with adolescent drinking.
Some studies suggest that individuals "mature out" of late adolescent drinking patterns, whilst others
identify enduring effects on drinking and broader health and social functioning In adulthood. In the only
available meta-analysis of life-course variability, Johnstone and colleagues evaluated stability in drinking
frequency and found settled patterns after the age of 30 following earlier marked discontinuity. There
has, however, been no systematic review addressing the consequences of late adolescent drinking in
adulthood.

QUESTIONS 1- 7

In which text can you find information about

1. The degree of safety risk is independent on whether a drunken driver shows signs or not

2. Developed countries are affected by alcohol related problems more than others

3. A long follow-up investigation in teenage drinkers to find future complications

4. How drinking and driving are occasionally referred to as?

5. About two fifth of high school students stated that they involved in dangerous driving due to alcohol
consumption

6. Lack of solid proof for longstanding ramifications of late youth alcohol intake

7. Reference to legal actions against people who drink and drive

QUESTIONS 8-15

8. How many fatal road accidents involved drivers aged 21 to 24 under influence in 2012?

9. What needs to be reduced by mature adults to inhibit long-term and short-term problems?

10. What was the only reason behind the death of over three hundred young people in 1995?

11. What received poor attention in spite of its obvious consequences around the world?

12. How much time is required approximately for full absorption of alcohol in blood?
13. What was primarily assessed by Johnstone and his co-workers in a study?

14. Where an alcoholic patient can get treatment for a variety of alcohol-related issues?

15. What is the minimum blood alcoholic content level that makes driving an offense?

QUESTIONS 16-20

16. Approximatelyhigh-school students in 2011 acknowledged that they drove motor vehicles after
consuming alcohol.

17._______________________________ among youngsters has been becoming a worldwide issue.

18. Suicidal thoughts due to heavy alcohol intake among ________________________are 3 times higher
than their non-drinking peers.

19.______________________________________of grade 12 children reported cognitive problems after

drinking alcohol several times in their life.

20. To have deep understanding on civic health burden that leads to late teenage alcohol intake,
_________________________ studies are need of the hour.

READING SUB-TEST: PART C

Text 1: Brain Imaging Technologies

Brain imaging has greatly advanced In the last 20 years, due to a better understanding of the
electromagnetic spectrum and radiofrequency waves, in relation to protons In molecules within the cells
or the brain. New technologies allow non-invasive spatial mapping,(morphology),and observations of
processes within the brain during set tasks. Sequencing scanned sections of the brain, activity between
neurons in different parts of the brain can be observed and monitored. More recent technologies using a
higher frequency resolution can Identify the distribution of individual metabolites (large complex
molecules), pharmaceutical drugs. There are a number of scanning techniques, their purpose and
limitations are described below.

A computerised tomography (CT) scans use X-rays to show the structure of the brain, with details such as
blood perfusion, (plates a and b); the resultant images are two dimensional and of comparatively low
resolution, however, the quality has been much improved since 1998.With improved technology, the
single section has now become as multisectlon and the speed has increased eight times, giving well-
defined 3-D pictures. A CT scan may reveal underdeveloped parts of the brain or sites of injury from
impact, tumours, lesions or infection. Before a CT scan, the patient may drink but is asked not to eat for
four hours beforehand, and not to take strenuous exercise. A CT brain scan, the preferable scanning
method by doctors, will take about 30 minutes and the patient must lie still for the duration.

An MRI scanner uses a strong magnetic field and radio waves to create pictures of the tissues and other
structures Inside the brain, on a computer. The magnetic field aligns the protons (positively charged
particles) In hydrogen atoms, like tiny magnets. Bursts of radio waves are then sent to knock the protons
out of position, and as they realign, (relaxation time), they emit radio signals which are detected by a
receiving device the scanner. The signals emitted from different tissues vary, and can, therefore, be
distinguished in the computer picture. An MRI scanner can create clear detailed pictures of the structure
of the brain and detect any abnormalities or tumours. Sometimes a dye, or such as gadolinium may be
introduced via a vein in the arm, to improve contrast in the image. Images can be enhanced by
differences in the strength of the nuclear magnetic resonance signal recovered from different locations
in the brain.

Functional magnetic resonance Imaging (fMRI) can show which part of the brain is active, or functioning,
in response to the patient performing a given task, by recording the movement of blood flow. All atoms
and molecules have magnetic resonance, emitting tiny radio wave signals with movement, because they
contain protons. Different molecules have different magnetic resonance and two components of blood
are tracked to observe brain activity. Hemoglobin In the blood carries oxygen; oxyhemoglobin, around
the brain and when it is used up, it becomes deoxyhemoglobin. Where the oxygen is being 'used up'
shows the site of activity in the brain. The picture is made by monitoring the ratio of the tiny wave
frequencies between these two states whilst the patient carries out a task, e.g., tapping a finger, which
highlights the area of the brain functioning to carry out this task.

Positron emission tomography (PET) scanning produces a three-dimensional Image or functional

processes in the brain, (not just the structure). PET is a nuclear medicine imaging technique, which
requires the patient to receive a small injection of radioactive material (a sugar tracer; fluoride,
oxyglucose), Into the blood stream. The radioactive material causes the production of gamma-rays, these
are a form of electromagnetic radiation like X-rays, but of higher energy. The radioactive material is
transported around the body and into the brain. A ring of detectors outside the head Is used to detect
pairs of gamma rays emitted Indirectly by the positron-emitting radionuclide (tracer), In each part of the
brain under examination.

The single photon emission computed tomography records the signals from gamma rays, (singly, rather
than when the emissions are opposite at 18011), using two or more synchronized gamma cameras, and
the multiple 2-0 Images are computed, tomographically reconstructed, to 3-0. A section may be
examined from several angles but is slightly less clear than a PET Image. A SPECT scanner is less
expensive than a PET scanner and uses longer-lived, more easily obtained radioisotopes.

7. According to paragraph 1, technology;

A. Has made it easier to detect what is going on in a person’s brain.
B. Helps define how neurons act and multiply.
C. Makes the mapping of the brain a very simple task.
D. Can help identify how big complex parts are distributed.

8. According to paragraph 2, what is true about CT?

A. It works on the principles of X-rays.
B. It provides two-dimensional images.
C. It can help identify which parts of the brain are developed and which are not.
D. It will always just take half an hour

9. The word itty-bitty in paragraph 3 may means;

A. Effective
B. Gigantic
c. Small
D. Strong

10.According to paragraph 3, what is not true about an MRI?

A. During the scan, the tissues produce different signals and thus easily get identified.
B. Dye may be used to improve the quality of the image produced by the scan.
c. Protons emit radio signals.
D. The receiving device collects the emitted protons.

11. According to paragraph 4, an fMRI scan.

A. Produces more efficient images of the brain than an MRI.
B. Can detect which parts of the brain are active during movement.
C. Obtains the picture by closely analyzing the frequencies of the emitted waves.
D. Not given.

12. According to paragraph 5, a PET is;

A. An advanced technique like an MRI.
B. A nonmagnetic technique for the detection of brain functioning.
C. A technique in which a patient Is given a radioactive material injection.
D. Much more powerful than other techniques.

13. According to paragraph 6, what is true about a SPECT?

A. It produces quality images like an MRI.
B. It is similar to a PET in imaging.
c. It relies on gamma rays for detection.
D. Not given.

14. According to the Information provided, which technique Is considered the best of all by doctors?
A.MRI
B. fMRI
C. PET
D. SPECT

TEXT 2: A SAFER WAY TO DETECT HEART DISEASE

Researchers have used a specialized type of MRI to detect 88% of cases of coronary artery disease in a
group of patients with chest pain. The results suggest that the Imaging technique can detect heart
disease as accurately as conventional methods, but with much less risk. Coronary artery disease is the
most common form of heart disease and the leading cause of death In the United States. It occurs when
fat and calcium accumulate in the arteries that supply blood to the heart. Over time, less blood reaches
the heart and heart muscle dies. If the plaque blocks the arteries completely, a heart attack occurs.
Currently, the best way to detect the disease is through coronary angiography. physician threads a tube
into the heart, releases a dye, and uses X-ray Images to look for decreased blood flow. But there's a small
risk in this procedure that the tube will pierce an artery, resulting in bleeding, or else scrape plaque from
artery walls, which, once the chunks of plaque are in the bloodstream, can lead to a heart attack or
stroke. Other, noninvasive tests such as cardiac ultrasounds are less risky, but not as accurate. Ultrasound
Images can be poor in patients with other conditions such as obesity, requiring doctors to resort to
invasive tests.

While an MRI allows doctors to image the body using magnets and radio waves, until recently it could
not produce clear images of dynamically voyaging objects, such as a beating heart. In the past two years,
though, stronger magnets, more powerful computers, and new software have Improved MRI scanning.
''Recent developments allow us to acquire Images of the heart in motion," says Ricardo Cury, director of
clinical cardiac MRI at Massachusetts General Hospital in Boston and leader of the study. Doctors can
now watch the heart beating in real-time and the images are now sharp. "It's like opening up the heart
and looking at it directly," says Renato Santos, a cardiologist at Wake Forest University Baptist Medical
Center. "Until recently, MRI was a research tool," says Santos. "Now it's really a clinical tool...ready for
prime time."

Cury combined two cardiac MRI tests to improve the technique's ability to diagnose coronary artery
disease. In his study, published in the July Issue of Radiology, researchers at MGH, Harvard Medical
School, and Beneficencia Portuguesa Hospital in Sao Paulo, Brazil, examined 46 patients. They began
with an MRI stress test, injecting a harmless dye and medicine that stresses the heart. As the heart
pumped, they used MRI to look for decreased blood flow or evidence that the heart was working
abnormally. Next, they examined MRI Images of the heart for damaged areas or evidence of prior heart
attacks. If patients were abnormal in one or both tests, the doctors deduced blocked arteries.

Cury's results reinforce those of an earlier, unrelated study in which researchers at Duke University used
the same techniques to successfully diagnose coronary artery disease in 100 patients. The results are
good news for patients. The MRI exam is short and painless. By using it to triage people with chest pain
but actually without any disease, physicians might save such patients from unnecessary invasive
procedures. In cases where the heart disease is evident, MRI can help doctors decide what to do next,
for instance, whether surgery to clear or bypass a blocked artery ls necessary. After surgery, doctors can
use MRI to monitor arteries for future blockages non-invasively. Cury says that 12 percent of cases
misdiagnosed in his study are less than other noninvasive tests, and in certain cases artifacts of the
study's design. He adds that MRl's accuracy will increase as doctors learn to make better diagnoses from
MRI images. "Obviously 100% ls Ideal," says Santos. "I think MRI is going to get us closer to that than our
traditional methods."

15. Paragraph 1 talks more about;

A. breakthrough in Imaging.
8. How heart diseases can be detected.
C. How new techniques are more efficient than traditional techniques.
D. How a heart attack occurs.
16. According to paragraph 1, a simple cause of a heart attack is;
A. Heart doesn’t receive enough blood.
B. Fat gets deposited in arteries.
C. Arteries carry less blood to the heart.
D. All of these

17. What risk Is mentioned In paragraph 2?

A. The tube may puncture the artery.
8. The tube can cut off plaque.
c. The artery walls may release more plaque into the bloodstream.
D. All of these

18. Paragraph 2 talks more specifically about;

A. Techniques that are risky.
B. Why conventional techniques should not be used.
C. How expensive techniques are.
D. How risky CA can be.

19. According to paragraph 3, what Is true about MRI scanning?

A. MRI scans in previous years were less effective.
8. It was not possible to capture motion-based images.
c. MRI scans of the new generation are more effective with power imaging qualities.
D. use of powerful computers and software have made MRI scanning more effective.

20. According to paragraph 3, what is possible with MRI now?

A. It is easy to see the heart, live in action
B. It Is easy to track heart beating
C. It is easy to get more quality-based images
D. All of these

21. According to paragraph 4, which one of the following statements is true?

A. Cury led a team of doctors and researchers at MGH.
B. Cury detected blocked arteries.
C. The team of doctors compared 46 case studies.
D. Researchers began with the stress testing.

22. In paragraph 5, the word triage may mean;

A. To help
B. To examine
C. To show
D. To provide comfort