Exam 3 Flashcards
1
Q
What is the basic structure of an amino acid?
A
2
Q
What are the essential amino acids?
A
PVT TIM HALL
Phenylalanine
Tryptophan
Histidine
Valine
Isoleucine
(Arginine)
Threonine
Methionine
Leucine
Lysine
3
Q
The other 11 are non-essential amino acids, what does that mean?
A
They can be synthesized by the body and we don’t have to provide it ourselves.
4
Q
What is a complete protein?
A
Complete proteins contain all 9 essential amino acids in the required ratios.
5
Q
What is an incomplete protein?
A
An incomplete protein is missing one or more essential amino acids.
6
Q
Where do you find both complete and incomplete proteins in the diet?
A
Sources of complete proteins are from animal sources (meat, dairy, eggs).
Plant based proteins are typically incomplete proteins. Multiple sources of plant proteins should be combined to make a complete protein.
7
Q
Protein recommendations for vegetarians and vegans
A
It’s recommended that they consume ~10% more protein than estimated requirements to ensure adequate essential amino acid intake and to account for the lower digestibility of plant proteins.
8
Q
What are good protein sources for vegetarians and vegans?
A
- Black beans, chickpeas and other legumes
- Nuts and seeds
- Milk and dairy (for vegetarians)
- Quinoa
- Tempeh and Tofu
9
Q
What is Nitrogen balance?
A
Nitrogen balance is a method to measure whole body protein balance.
Protein balance = synthesis – degradation
Nitrogen balance = nitrogen intake (protein) – nitrogen excretion (urea in urine)
10
Q
What do the different protein balances mean?
A
When individuals are in protein balance (or nitrogen balance), there is no overall net gain or loss of protein.
Positive balance indicates protein accumulation, usually as a result of building muscle mass.
Negative balance indicates protein loss, which typically only occurs under sustained protein deficient diets and severe illness.
11
Q
What is nitrogen balance during exercise like?
A
when beginning an exercise program, individuals will go into negative protein balance for the first 1-2 weeks. After this time period, nitrogen balance can be maintained without increasing protein intake.
Increases over the RDA will allow athletes to maintain positive nitrogen balance and build muscle mass.
12
Q
Protein AMDR
A
The AMDR for protein is 10-35% of total caloric intake.
13
Q
Protein RDA for sedentary adults
A
The RDA for protein for healthy, sedentary adults is 0.8 g/kg.
14
Q
Protein recommendation for endurance athletes?
A
The recommendation for endurance athletes is 1.2-2.0 g/kg.
15
Q
Protein recommendation for strength athletes?
A
The recommendation for strength athletes is 1.6-2.0 g/kg.
16
Q
Do wesern diets supply enough protein?
A
Typically, western diets supply an abundance of high quality protein and deficiency is relatively uncommon. The general population has an intake substantially higher than the RDA.
17
Q
Protein intake and aging
A
Aging adults also benefit from a higher protein intake than the RDA. High levels of protein stimulate muscle protein synthesis and help combat the muscle mass loss associated with aging.
18
Q
Protein intake during weight loss correlation?
A
There is good evidence that a higher protein intake (on the order of a strength athlete’s recommendation) during weight loss will aid in retaining lean body mass.
19
Q
How is protein digested? (Step by step)
A
Mechanical digestion begins in the mouth with chewing.
Chemical digestion begins in the stomach. HCl denatures proteins- breaking down the 3D structure. Pepsin breaks down proteins into smaller fragments (peptides).
In the small intestine, pancreatic enzymes called peptidases break down peptides to small strings of 1-3 amino acids.
Amino acids are absorbed into the intestinal cell and then the blood through transporters.
Amino acids are absorbed by cells and used for synthesizing new proteins, oxidation for energy or use in other metabolic intermediates. Some amino acids can be modified to form other (non-essential) amino acids when needed.
Amino acid transport into muscle cells is greatly enhanced by insulin.
20
Q
What are some of the functions of protein other than maintaining and building muscle mass?
A
Enzymes used during chemical reactions
Component of the immune system
Involved in fluid, electrolyte, and acid/base balance
Many hormones are either proteins or transported through protein carriers
Provide structure (bones, teeth, etc.) and required for maintenance of tissues and organs.
Can be oxidized for energy
21
Q
How are we able to measure protein metabolism?
A
This is done by infusing a known amount of amino acids with stable isotope tracers into the subject. The stable isotopes allow researchers to track protein synthesis, degradation, and oxidation.
22
Q
Which amino acids can be used as stable isotope tracers? Why?
A
Only essential amino acids (EAA) can be used as stable isotope tracers because non-essential amino acids can be synthesized. This would result in an unknown portion of amino acids coming from the stable isotope and some coming from synthesis. By using only essential amino acids, the researcher knows the level of amino acid pools (only what was given to the subject).
Since branched chain amino acids are preferentially oxidized, the amino acid with the stable isotope tracer should be an essential amino acid and a branched chain amino acid.
23
Q
What does the rate of appearance and disappearance correlate to?
A
In the blood, the rate of disappearance of the tracer indicates protein synthesis while the rate of appearance indicates degradation.
24
Q
What aspect of protein metabolism can we measure through CO2 production?
A
Oxidation of proteins can also be measured through CO2 production.
25
Protein intake before exercise
The high CHO snack/meal consumed before exercise can contain some protein. However, there is no pre-exercise protein recommendations.
There is no good evidence of a change in muscle protein synthesis when protein is consumed prior to exercise.
There is no good evidence to support acute protein intake enhancing performance.
26
Protein intake during exercise?
It is not typically recommended to take protein during exercise.
One exception is during long (2 hours or more) intermittent resistant exercise, protein ingestion will facilitate muscle protein synthesis.
A second exception is for ultra-endurance events. Protein intake in this case may enhance recovery.
27
When is it most critical to consume protein? Why?
Post-Exercise. This is the most critical time for protein intake. Even if the athlete is not focusing on increasing muscle mass, post exercise protein intake is still important. A protein + CHO drink or meal is most effective for maximal glycogen replenishing and muscle protein synthesis (MPS)
28
How much protein should be consumed post-exercise and within what time frame?
Until recently, it has been recommended to consume 0.25-0.3g/kg of high quality protein within 2 hours of exercise to maximize MPS (for most people, this translates to 15-25 g). However, recent studies have shown that the effect of exercise on MPS lasts about 24 hours, so it is probably not necessary to eat within 2 hours of exercise.
29
What type of protein is recommended post-exercise?
High quality protein with high leucine levels is recommended. Leucine is important because it is a potent stimulator of MPS.
## Footnote
Quickly digesting protein is also ideal- whey protein digests quickly and drinks are better than solid food.
Chocolate milk is a good recovery drink because it is high in CHO, digests quickly, and has high leucine content.
Other protein powders/supplements meeting these requirements are also good recovery drinks, although they can quickly become very pricey.
30
When is muscle protein synthesis increased optimally?
MPS is increased optimally when 0.25-0.3 g/kg of high quality are consumed during frequent meals/snacks that total the RDA. This recommendation translates to 15-25 g per meal for most individuals.
31
What stimulates Muscle Protein Synthesis? (MPS)
muscle contraction, resistance exercise, insulin, testosterone, growth hormone, essential amino acids (especially leucine), and adequate caloric intake.
32
What stimulates muscle protein breakdown? (MBS)
intense or prolonged exercise, when beginning an exercise program (first 4-10 days), glucagon, cortisol, and inflammation factors.
33
Difference in MPS & MBS in sedentary vs active situation?
In a sedentary situation, the MPS roughly equals MPB.
Under resistance exercise conditions, MPS increases and there is net protein gain. MPS will remain elevated for 24 hours post exercise.
34
Arginine and citrulline as ergogenic aids
Claims to be a vasodilator and enhance blood flow to muscles. This is only effective in cardiac patients. Healthy individuals do not benefit from supplementation.
35
Arginine, lysine and ornithine as ergogenic aids
Claims to increase growth hormone and is not found to be effective.
36
Branched chain amino acids as ergogenic aids
Claims to spare glycogen and decrease muscle degradation, especially during endurance activities. There is some evidence of enhanced alertness and decreased perceived exertion during prolonged exercise. These data are very mixed and not yet conclusive. Branched chain amino acids are not necessary as long as the athlete has sufficient carbohydrate available.
37
Carnitine as an ergogenic aid
May be effective in increasing fat oxidation
38
β-alanine as an ergogenic aid
May enhance training capacity, specifically in short duration high intensity exercises. Increases intracellular acid-base buffering capacity
39
What are the risks associated with low protein intake?
individuals who restrict caloric intake are at risk of inadequate protein intake. Very low protein diets can result in muscle wasting and weakness.
40
What are the risks associated with high protein intake?
high protein intake is not generally harmful in healthy individuals. Protein eaten in excess of protein synthesis needs will be oxidized for energy.
41
What takes place during the oxidation of amino acids?
Amino acids are oxidized through a variety of pathways. Eventually, they will all be converted to acetyl CoA and enter the TCA cycle.
Branched chain amino acids are preferentially oxidized- meaning they are oxidized first for energy. Leucine, isoleucine and valine are the three branched chain amino acids.
42
Are there any specific recommendations for vitamins for athletes?
Highly active individuals may have higher vitamin needs, but there are currently no recommendations specific to athletes.
Most athletes are not deficient in vitamins because they have relatively high kcal intake.
Athletes who are restricting calories are at risk for low vitamin intake.
If an athlete is deficient in a vitamin, he/she will likely experience decreased performance. Resolving this deficiency will aid the athlete’s performance.
43
Where should you get your vitamins?
It’s best to get vitamins from natural sources, but if a supplement is needed or desired, a multivitamin is recommended. Choose a multivitamin with lower levels that fall within the RDA and look for the quality control ‘USP’ label.
44
Where do we get vitamin D and how does deficiency affect us?
Athletes and the general population are often deficient in vitamin D, especially during the winter months, when sun exposure is limited. Sunlight is the greatest source of vitamin D for most people. UV radiation penetrates the skin and can then be converted to a usable form of Vitamin D. We also get vitamin D from some food sources such as some fish, fortified milk, and other fortified foods.
Sub optimal vitamin D levels can result in poor immune health, calcium absorption, and may decrease muscle function/recovery. See references for more information on this.
45
What are the B vitamins? What is their function
Niacin- is a precursor to NADH
Riboflavin- is a precursor to FADH2
Panthothenic Acid- is a precursor to coenzyme-A (CoA)
Vitamin B12 – essential for DNA synthe sis. Of concern for vegetarian and vegan athletes.
46
RDA for Calcium
1,000 mg adults, 1,200 mg post-menopausal women
47
Sources of Calcium
Dairy products such as milk, cheese and yogurt are the main sources in the American diet. Some vegetables such as broccoli and kale provide calcium. Grains have a small amount of calcium, but when they are consumed frequently that amount can add up.
48
What facilitates the absorption of Calcium?
Lactose and vitamin D
49
What inhibits calcium absorption?
phytates and oxalates (found in legumes and dark leafy green vegetables) inhibit absorption.
50
Which individuals are at risk of low calcium intake?
post menopausal women, athletes experiencing the female athlete triad, athletes restricting calories, or athletes avoiding dairy.
51
What is osteoporosis?
major risk from consuming too little calcium. Osteoporosis occurs when there is a thinning and weakening of bones, which increases fracture risk.
52
What should invidividuals at high risk of calcium deficiency do?
Individuals at high risk of osteoporosis may want to take calcium supplements and should engage in impact exercises to increase (or prevent a further decrease) in bone mineral density. Hormone replacement therapy may be recommended for post-menopausal women by a health care provider. Elderly individuals should also engage in strength, flexibility, and coordination exercises to help prevent falls.
53
Osteoporosis is a _______ disorder diagnosed in \_\_\_\_\_\_\_\_\_
pediatric, adulthood
54
When is calcium deposited the most in our life? What can we do to capitalize on that?
Prevention is the best way to avoid osteoporosis. Calcium is deposited into bones primarily during youth with peak bone mineral density occurring at about 30 years. Children and teens should engage in impact activities and should have adequate calcium intake. Osteoporosis is therefore a pediatric disorder because low bone mineral density in youth greatly increases the risk of osteoporosis. However, it doesn’t manifest until late adulthood.
55
What is the iron RDA?
8 mg men/postmenopausal women, 18 mg women, 27 mg during pregnancy.
56
How much dietary iron do we actually absorb? What aids/inhibits Iron absorption?
Only 5-15% of dietary iron is absorbed.
Vitamin C, vitamin A, acid and ‘meat factors’ aid in iron absorption while phytates, polyphenols, calcium and vegetable peptides inhibit iron absorption.
57
What are the 2 types of Iron? How are they different?
heme and non-heme. Heme iron is found in animal sources and is absorbed well. Non-heme iron is found in fortified foods and plants. It’s not absorbed as well, but absorption is more regulated based on the body’s iron status and needs.
58
What is Iron's role?
Iron plays many important roles in the body including participating in redox reactions, red blood cell production, neural and immune functions and as cofactors in the electron transport chain. Iron overload can occur, which can negatively impact health and increase cellular oxidative stress.
Of particular interest to athletes is the role iron plays in hemoglobin and myoglobin where it binds to and aids in O2 transport.
59
Iron depletion; with and without anemia
can present with or without anemia (low red blood cell count).
Iron depletion without anemia results in decreased athletic performance, general fatigue, and hormone imbalances.
Iron depletion with anemia results in lower aerobic capacity, lower work efficiency, and decreased training and performance abilities.
60
Iron deficiency due to diet
Inadequate intake can be due to low kcal intake, vegetarianism, and athletes on high carbohydrate diets. Individuals who fall into one or more of these categories should take special care to consume adequate iron.
61
Iron deficiency due to high volume of activity
As training volume increases, iron stores decrease. This occurs because of higher iron loss in sweat, gastrointestinal bleeding, blood loss due to injury, and foot strike hemolysis (red blood cell rupture due to foot strike during running).
62
Sports anemia
during the onset of endurance training, blood plasma increases, causing a decrease in red blood cell concentration. This is a transient phase and not a true form of anemia.
63
Iron replenishment
Dietary interventions are very slow to restore iron levels, usually taking 2-3 years.
Supplemental iron can restore levels in about 3 months.
Injections can quickly restore levels, but may cause anaphylactic shock and iron overload.
Iron overload can occur with supplemental intake and injections. Consult a health care professional before starting either of these treatments.
64
Which vitamins have coenzyme functions?
B vitamins
65
What do anti-oxidants do? What vitamins are antioxidants?
—neutralize free radicals. • Beta‐Carotene (Vitamin A). • Vitamin C. • Vitamin E
66
What are the fat soluble vitamins?
A
D
E
K
67
Water soluble vitamins
Thiamin. • Riboflavin. • Niacin. • Vitamin B6. • Vitamin B12. • Folate. • Biotin. • Pantothenic acid. • Vitamin C. • Choline (vitamin‐like substance).
68
Sedentary fluid recommendations
30-35 ml/kg or
2.7 L/day for women and 3.7 L/day for men- note that 250 mL = about 1 cup
Requirements can increase drastically due to temperature and exercise.
69
How is fluid distributed throughout the body?
70
Difference between intracellular and interstitial
Intracellular: inside the cell, Extracellular: outside the cell
Interstitial: Between cells/tissues, Plasma: in the blood stream
71
What is osmolality?
The concentration of solutes (electrolytes- Na+, K+) in a solution (water).
72
Isotonic solution
The concentration of solutes is equal inside the cell (intracellular fluid) and outside the cell (extracellular fluid). Water moves equally in and out of the barrier (cell membrane). This is the normal situation inside our bodies.
73
Hypotonic solution
The concertation of solutes outside the cell is lower than the inside. The fluid outside the cell is hypotonic in reference to the fluid inside the cell. This makes water flow into the cell. This can happen in the blood by overhydrating during exercise
74
Hypertonic solution
The concentration of solutes outside the cell is higher than the inside. Water flows out of the cell. This can happen in the blood during severe dehydration
75
Mechanism of ADH
Due to heat and or exercise, excessive water is lost through sweat.
This water loss comes from the blood, creating a hypertonic solution (higher solute/electrolyte concentration) in the blood.
The hypothalamus detects this change in blood osmolality and releases ADH.
ADH travels to the kidney and stimulates increased water reabsorption.
Reabsorbed water from the kidney returns to the blood.
Blood osmolality returns to normal. Body water and blood volume are maintained.
76
What are the ways to determine adequate hydration?
Thirst: This is the easiest mechanism to determine if you are hydrated, but is not always accurate. As we age, our thirst drive decreases, which increases our risk for dehydration.
Urine color: deep yellow typically indicates dehydration. However, riboflavin can cause a deep yellow color in your urine. So be aware of this if you take a multivitamin.
Rapid body weight changes: This is due to body water loss or gain.
Body weight varies by less than 1% in people who are in energy balance.
For the most consistent numbers, weight should be taken in a fasted state, in the morning, after using the toilet.
A baseline for hydration status should be averaged over at least 3 consecutive days. More days may be needed for menstruating women (due to hormonal changes in water balance)
77
Aspects of Sodium as an electrolyte
AI = 1500 mg, UL = 2300 mg. Western diets typically provide excess sodium to our needs.
This is the major electrolyte in extracellular fluids. It’s important for nerve conduction and to initiate muscle contraction.
Essential to control fluid balance and maintain blood volume and pressure.
78
Aspects of Potassium as an electrolyte
AI = 4700 mg, no UL. Western diets are typically deficient in potassium. Potassium can be found in fruits, vegetables and dairy products.
This is the major electrolyte in intracellular fluids. It’s also important for electoral impulses and nerve conduction.
Potassium levels are closely maintained and having a deficiency or excess are rare.
79
Aspects of Chloride as an electrolyte
AI = 2300 mg. Chloride is found in combination with sodium and potassium.
Also important for maintaining water balance and in nerve conduction.
Helps form hydrochloric acid for digestion in the stomach.
80
Normal body temp and body temp during exercise
Normal body temperature: 36-38˚C or 96.8-100.4˚F.
During exercise, temperature can increase to 38-40˚C or 100.4-104˚F.
Above about 40˚C, central fatigue occurs causing heat exhaustion and then heat stroke. Heat stroke can result in passing out and organ damage.
81
What % body weight loss is worrisome and is considered involuntary dehydration?
2% body weight loss
82
Describe involuntary dehydration
In cold environments, up to 3% body weight loss has only minimal effects.
In warm or hot environments, 2% or more body weight loss has adverse effects. These symptoms include increased perceived effort and physiologic strain.
Dehydration causes a decrease in sweat rate, which impairs the athlete’s ability to dissipate heat and increases core body temperature (see body temperature regulation below).
Dehydration reduces blood volume and skin blood flow.
Dehydration increases the rate of glycogen use.
83
What is the process of finding sweat rate?
Weight before exercise
80.2 kg
Weight after exercise
78.9 kg
Change in weight (1-2)
80.2-78.9 = 1.3 kg = 1300 ml
Volume fluid consumed
750 ml
Urine produced
300 ml
Sweat loss (3+4-5)
1300 + 750 - 300 = 1750
Exercise time
120 min
Sweat rate (6/7)
1750/120 = 14.6 ml/min
84
What is the osmolality of sweat relative to blood?
Sweat is hypotonic relative to blood (and other body fluids). The major electrolytes in sweat are sodium, potassium and chloride. There are several other minor components of sweat including some vitamins, minerals and amino acids. The composition of sweat varies depending on heat acclimation status.
85
Electrolyte replenishing after exercise
Since sweat is hypotonic (lower concentration of electrolytes), sweating during exercise without fluid replacement will cause blood electrolyte levels to increase. The blood is losing more water than electrolytes.
If improper fluid replacement occurs (too much or too little), blood electrolyte imbalances can occur.
Electrolytes do need to be replenished or a deficiency will occur over time. Our normal diet is typically sufficient to replenish electrolytes. Consuming some electrolytes after completing long athletic events will aid in quick recovery.
For most athletic events, it is not necessary to replace electrolytes during exercise. Some replacement may be necessary in the case of ultra-endurance events- such as ultra-marathons.
While not necessary, some electrolyte intake during endurance exercise can help prevent heat illness and increase fluid retention.
86
Is carbohydrate composition important for sports drinks? If so, what percentage of the sports drink should contain carbohydrate?
Carbohydrate is important for extended events (90 minutes plus). Popular sports drinks contain 6-8% carbohydrate, which is optimal for absorption.
87
What is gastric emptying?
How slowly or quickly foods and fluids leave your digestive system.
Fluid volume
temperature
exercise intensity
dehydration
osmolality
88
How does fluid volume affect gastric emptying?
larger volumes of fluid (but not larger than 700 ml) facilitate faster gastric emptying.
89
How does temperature affect gastric emptying
cold fluids empty more rapidly.
90
How does exercise intensity affect gastric emptying
moderate intensity facilitates emptying, but high intensity (\>~75% VO2 max) decreases emptying rate.
91
How does dehydration affect gastric emptying?
Greater than 3% body weight loss results in slower emptying rates.
92
How does osmolality affect gastric emptying?
Lower osmolality empties faster. 6%-8% (6% = 60g /L) solution of CHO is optimal (this is what is found in most sports drinks). High osmolality (severely hypertonic) fluids such as soda will actually cause water to leave the circulation and enter the small intestine. This will cause gastric distress and result in slower gastric emptying. Fluids that are only slightly hypertonic- such as sports drinks- are not severe enough to slow gastric emptying.
93
What is hyponutremia? What are the important numbers to remember?
Low blood sodium.
Normal blood sodium levels are 140 mmol/L. Measurements of sodium lower than 135 mmol/L indicate clinical hyponatremia.
94
What is hyponutremia usually a result from?
Hyponatremia is due primarily to excessive replacement of hypotonic fluids during exercise. This intake is usually sufficient to cause weight gain during exercise.
A common misconception is that hyponatremia results from losing too much sodium through excessive sweating. Since sweat is hypotonic to blood, excessive sweat loss will actually result in an increase in blood sodium levels, not a decrease. In cases of ultra-endurance events (such as an iron man triathlon), enough sodium can be lost to contribute to hyponatremia, but this is rare.
95
Risk factors for hyponutremia
Biggest factor: Excessive consumption of hypotonic fluids (urine production is decreased during exercise, so excess water is often not excreted), usually resulting in weight gain during the event. This is a big reason why 0% weight loss is not recommended for athletes during an event.
Events lasting over 4 hours.
Low sweat rate
Very low or high BMI
96
Swelling relating to the body and tissues
Cellular swelling is the biggest problem in the brain where cells are surrounded by bone and don’t have space to expand. This is called cerebral edema and can lead to brainstem herniation and death.
Fluid can also accumulate in the lungs, called pulmonary edema, and cause poor gas exchange and hypoxia.
97
Symptoms of hyponutremia
Headache, vomiting
Swollen hands/feet
Restlessness or undue fatigue
Confusion or disorientation
Wheezy breathing, respiratory arrest
Seizure
Coma
Brainstem herniation
Death
98
Prevention and treatment of hyponutremia
## Footnote
Athletes should not be advised to drink as much as possible during an event. Instead, athletes should drink according to thirst and not more than 400-800 ml/hour unless in very hot conditions.
Athletes should estimate (or calculate) their sweat rates and avoid consuming fluids in excess of their sweat rate.
There is not good evidence that consuming sports drinks prevents hyponatremia.
Athletes may be asymptomatic or have only mild symptoms. In such cases, athletes will need to abstain from fluids until sodium levels are back to normal.
Ideally, medical professionals will be available to screen athletes for hyponatremia. Mild hyponatremia should be treated with fluid restriction and not with intravenous solutions (IV bag).
In severe cases, hospital treatment is needed to slowly restore sodium levels with hypertonic fluids.
99
Fluid recommendation before exercise
For moderate events, no special recommendations are needed. However, if the event is long or if the athlete is dehydrated, slowly drink 5-7 ml/kg at least 4 h before exercise. If the athlete doesn’t produce urine, or if the urine is dark, drink another 3-5 ml/kg 2 hr before the event.
100
Fluid recommendation during exericse
0.4-0.8 L/h is a crude estimate of requirements.
101
What is the goal for fluid intake during exercise?
The goal is to prevent excessive weight loss- not more than 1-2% body weight (change in pre exercise weight versus post exercise weight weight).
102
Fluid recommendation post-exercise
Consume about 1.5 times weight loss.
Water loss estimation: water balance = fluid loss – fluid intake
For every kg weight loss, consume 1.5 L fluid. Extra fluid needs to be consumed because of obligatory urine losses
Carbohydrate and electrolyte consumption will also aid in a quick recovery.
103
Adaptations that come from heat acclimitization
Increased blood volume
Increased sweat rate
Increased sweat gland size
Decreased body core temperature
Decreased heart rate
Decreased sodium concentration
104
How long does heat acclimation take
Heat acclimation takes about 2 weeks
105
Can adaptations from heat acclimation happen if someone is NOT hydrated?
No
106
Are you going to do well on this test?
Duh
