EVOLVE REACH (HESI) A2 PRACTICE TEST - MODULE 1

Neonatal Jaundice.... 47. What is the meaning of the word ACCUMULATION as used in the second paragraph of the passage? A) Buildup B) Hoard C) Addition D) Swelling

A) Buildup An accumulation of bilirubin is the same as a buildup of bilirubin.

Pinkeye... 33. Which statement could be inferred by the reader from the last paragraph of the passage? A) Conjunctivitis does not need to spread throughout a household. B) People who wear contact lenses are in danger of conjunctivitis. C) Certain eye drops can make a case of conjunctivitis worse. D) Conjunctivitis may accompany a runny or stuffed-up nose.

A) Conjunctivitis does not need to spread throughout a household. The question refers only to the last paragraph in the passage, which states that "a modicum of care can prevent the infection from spreading throughout the family and beyond." In other words, the disease does not need to spread, if a modicum of care is used.

Pinkeye... 31. Which of the following is NOT listed as a detail in the passage? A) Conjunctivitis is most common in school-age children. B) Washing hands can help stop the spread of pinkeye. C) The symptoms of pinkeye may include itchy eyes. D) Conjunctivitis is spread via the drainage from the eye.

A) Conjunctivitis is most common in school-age children. Although choice A may be true, it is not mentioned in the passage. Choice B is mentioned in paragraph 5, choice C in paragraph 2, and choice D in paragraph 4.

Getting the Most Nutrition from Vegetables.... 15. What is the main idea of the passage? A) Cooking and eating vegetables correctly can enhance their nutritional value. B) Raw vegetables are best, but quick-cooked vegetables are also nutritious. C) Vegetables are easiest to eat when cooked in a little water with a bit of oil. D) The less you cook vegetables, the more nutrition you will retain.

A) Cooking and eating vegetables correctly can enhance their nutritional value. This choice best covers all of the information in the passage without being either too specific or too vague.

Superfood of Super Marketing Ploy?.... 44. What is the overall tone of the essay? A) Dubious B) Puzzled C) Infuriated D) Optimistic

A) Dubious The author is not angry about the labeling of foods, as choice C would suggest, but she is doubtful, or dubious, about the value of calling certain foods "superfoods," making choice A the best answer.

Compassionate Care: Cicely Saunders and Hospice..... 27. What is the meaning of the word RELIEVE as used in the second paragraph? A) Ease B) Release C) Replace D) Dispel

A) Ease The word RELIEVE has a variety of meanings, but the one that best fits paragraph 2 is EASE (choice A).

Treatments for Hypertension..... 9. Choose the best summary of the passage. A) Hypertension has serious repercussions, but there are a number of different methods of treatment that work in different ways. The correct therapy depends on the situation and the patient. B) Hypertension is largely let untreated due to its lack of symptoms, but the results can be deadly. Doctors often prescribe a change in diet or some form of medicine. C) Heart patients can benefit from a variety of drugs that bring blood pressure down and protect the vessels and heart. The most frequently prescribed drugs attach plaque in the arteries. D) ACE inhibitors and vasodilators act in similar ways to lower blood pressure, but they may not be used by all patients. Luckily, diuretics and beta-blockers often work on patients for whom the other drugs are too potent.

A) Hypertension has serious repercussions, but there are a number of different methods of treatment that work in different ways. The correct therapy depends on the situation and the patient. A summary should select the most critical parts of the essay and put them together to review the main ideas. Choice A does this without being overly specific or injecting information or opinions not included in the essay.

Treatments for Hypertension..... 8. Identify the overall tone of the passage. A) Objective B) Casual C) Impassioned D) Personal

A) Objective An objective essay is one that sticks to the facts without inserting the author's bias or excessive opinions. That is the best description of this fact-based essay.

Mitochondrial Intervention..... 25. What is the author's primary purpose in writing this essay? A) To inform readers of a new methodology B) To persuade readers to reject this new science C) To entertain readers with a true medical mystery D) To reflect upon medical discoveries and their effects

A) To inform readers of a new methodology The author may not be convinced of the procedure's value, but there is no call upon the reader to reject it (choice B). The story is true, but it is not a mystery (choice C). Primarily, the purpose is informational -- to give facts about a new procedure and to allow readers to draw their own conclusions.

Superfood of Super Marketing Ploy?.... 45. What is the author's primary purpose in writing this essay? A) To persuade readers to look beyond superfoods for nutrition. B) To entertain readers with amusing anecdotes about superfoods. C) To inform readers of the potential dangers of superfoods. D) To analyze the effect on consumers of labeling superfoods.

A) To persuade readers to look beyond superfoods for nutrition. Although much of the passage is informative, the author is not informing readers of dangers (choice C). The main goal is to show that other foods can offer just as much nutritional value as superfoods, making choice A correct.

Compassionate Care: Cicely Saunders and Hospice..... 30. Which statement could NOT be inferred by the reader? A) Without Saunder's intervention, end-of-life care would still inevitably take place in hospitals. B) In Saunders's time, morphine was a known and regularly used drug for pain control. C) St. Christopher's was the first establishment of its kind in the city of London. D) Saunders's work as a nurse, social worker, and doctor all contributed to her ideas about end-of-life care.

A) Without Saunder's intervention, end-of-life care would still inevitably take place in hospitals. It is possible to know whether Saunders's work is wholly responsible for the removal of end-of-life care from hospitals. Someone else might have developed hospice if she had not done so. Choice A goes beyond the specifics of the passage, but choices B, C, and D all have support in the passage.

New casts from 3-D Printing...... 38. Identify the overall tone of the essay. A) Cautionary B) Unconvinced C) Enthusiastic D) Unmoved

C) Enthusiastic The author uses words such as AMAZING, BENEFITS, STURDY, COMFORTABLE, and ADVANCEMENTS to indicate an attitude of enthusiasm for this new technology.

Biosimilars....... ⒈ What is the main idea of the passage? A) Generic drugs remain the cheapest & easiest drugs for patients to use & doctors to prescribe. B) A new type of drug, manufactured from living cells & similar in most ways to brand name drugs, will soon develop a significant market share. C) Biosimilars, which are made by the same companies that manufacture generic drugs, have yet to find a market in the United States. D) In order for biosimilars to take over the market, they will need to come down in price and prove their worth to the FDA.

B) A new type of drug, manufactured from living cells & similar in most ways to brand name drugs, will soon develop a significant market share. (Remember that the main idea is the most important theme, one that carries throughout the passage. If someone asked you what this passage was about, you would be most likely to answer "biosimilars and their future marketing," making B the best answer.)

Pinkeye... 32. The word MODICUM as used in the last paragraph of the passage can best be defined as ____________________________. A) A progression B) A small measure C) A restraint D) A balance

B) A small measure A modicum of care is a small amount of care.

Getting the Most Nutrition from Vegetables.... 18. Which of the following is NOT mentioned as a benefit of chopping vegetables? A) Better absorption of magnesium B) Better absorption of potassium C) Better absorption of calcium D) Better absorption of iron

B) Better absorption of potassium Find the part of the essay that mentions chopping vegetables (paragraph 4) & look for the minerals listed.

Superfood of Super Marketing Ploy?.... 43. Which is NOT listed as an example of a superfood? A) Pomegranates B) Collard Greens C) Blueberries D) Chia Seeds

B) Collard Greens Collards (choice B) are merely listed with "most dark vegetables," contrasted with kale, which is a superfood.

Neonatal Jaundice.... 46. Which of the following is NOT listed as a detail in the passage? A) Bilirubin is a byproduct of red blood cell breakdown. B) Jaundice may result from an infection or deficiency. C) Yellow feet indicate high levels of bilirubin. D) Phototherapy may cure jaundice in newborns.

B) Jaundice may result from an infection or deficiency. Although choice B is true, it is never mentioned in the passage.

Mitochondrial Intervention..... 23. What is the meaning of the word PROGRESSIVE as used in the second paragraph? A) Advanced B) Radical C) Ongoing D) Piecemeal

C) Ongoing A progressive disease is one that is ongoing and getting worse over time.

New casts from 3-D Printing...... 39. Which detail is NOT given as a benefit of the new casts? A) Lightness B) Low cost C) Open weave D) Comfort

B) Low cost The cast is described as lighter than fiberglass (choice A), with openings that allow the skin to breathe (choice C) and a design that is sturdy and comfortable (choice D). The cost (choice B) is never mentioned.

Neonatal Jaundice.... 48. Which of the following statements is an opinion? A) The March of Dimes estimates that 60% of newborns have the condition. B) Parents really ought not to panic if they see a bit of yellow in their baby's eyes or skin. C) All babies have a high level of red blood cells, which rapidly break down and are replaced. D) As the light excites the bilirubin molecules, they react with oxygen, & the byproduct is rapidly excreted in urine.

B) Parents really ought not to panic if they see a bit of yellow in their baby's eyes or skin. An estimate (choice A) is not an opinion. Choices C & D can be tested. The word OUGHT (choice B) is a judgment word that signals an opinion.

Pinkeye... 34. Which statement about pinkeye is a fact? A) Pinkeye is an annoying condition. B) Pinkeye is spread through human contact. C) Pinkeye is a good description of the disease. D) Pinkeye should be referred to as conjunctivitis.

B) Pinkeye is spread through human contact. The words ANNOYING (choice A), GOOD (choice C), and SHOULD (choice D) are all judgment words that indicate a writer's opinion. Choice B can be proved on way or the other, and thus it is a fact.

Getting the Most Nutrition from Vegetables.... 16. What is the meaning of the word RETAINED as used in the second paragraph? A) Recollected B) Preserved C) Engaged D) Protected

B) Preserved Find the word in context: "Artichokes retained antioxidants through all cooking methods...." The clearest synonym is choice B: "Artichokes PRESERVED antioxidants through all cooking methods."

Superfood of Super Marketing Ploy?.... 42. Based on this passage, what can the reader infer about dried cranberries? A) They have high concentrations of anthocyanins & other antioxidants. B) They may be called "superfoods," but they have fewer nutritional benefits than raisins do. C) They are neither as popular nor as nutritionally beneficial as blueberries are. D) They lack the public relations panache of fruits such as pomegranates.

B) They may be called "superfoods," but they have fewer nutritional benefits than raisins do. The author compares cranberries to raisins in paragraph 4 while comparing superfoods to ordinary foods. You can conclude that dried cranberries are superfoods, even though raisins have more nutrients.

New casts from 3-D Printing...... 36. What conclusion is suggested by this essay? A) Three-D printed casts will soon be used for everyone from infants to the elderly. B) Three-D printing is being applied to many areas of medicine. C) Three-D printed casts are replacing fiberglass casts in the United States. D) Three-D printing is especially useful for building prosthetics.

B) Three-D printing is being applied to many areas of medicine. A conclusion must be supported by details in the essay. Choice A goes beyond what the writer suggests, as does choice C. Choice D is a judgment the author never makes. Choice B, however, has support in the final paragraph of the essay.

Biosimilars....... 3. What is the author's primary purpose in writing this essay? A) To persuade B) To inform C) To entertain D) To analyze

B) To inform The author is not trying to convince you of anything, as a persuasive essay might do (choice A). The basic purpose here is to provide information on a topic.

Compassionate Care: Cicely Saunders and Hospice..... 28. The author describes each of these aspects of St. Christopher's EXCEPT ____________________. A) Research opportunities B) Training in social work C) Available home care D) Bereavement services

B) Training in social work In this sort of question, you must look for the one detail that does not appear in the passage. Cicely's training in social work is mentioned, but it is not an aspect of St. Christopher's, making choice B correct.

New casts from 3-D Printing...... 37. What is the meaning of the word ATROPHYING as used in the third paragraph? A) Shattering B) Wasting away C) Shielding D) Turning around

B) Wasting away If a limb atrophies, it weakens and withers from lack of use.

Treatments for Hypertension..... 5. As used in the third paragraph, what does the term DILATE mean? A) Elucidate B) Widen C) Elaborate D) Bloat

B) Widen Find the word in context: "....ACE inhibitors dilate the blood vessels, which increases blood flow and lowers pressure". To release pressure and increase flow, the vessels must be widened, making choice B the correct answer.

Superfood of Super Marketing Ploy?.... 40. What is the main idea of the passage? A) The term "superfood" applies to foods of all types that offer loads of vitamins, minerals, and antioxidants. B) People tend to choose foods that they have seen promoted rather than looking for genuine healthful qualities. C) Although certain foods labeled "superfood" have high nutritional value, they are not necessarily better than other nutritional foods. D) It makes little sense to label kale differently than you would any other dark green, leafy vegetable in terms of nutritional benefit.

C) Although certain foods labeled "superfood" have high nutritional value, they are not necessarily better than other nutritional foods. Think about the choice that fits every aspect of the passage. Choice A is not the focus of the passage -- it is about superfoods but not about their benefits. Choice B and D are too limited to be the main idea. Choice C is precisely the focus of the passage.

Biosimilars....... 4. Which statement would NOT be inferred by the reader? A) Biosimilars are new B) Biosimilars are expensive C) Biosimilars are foreign D) Biosimilars are effective

C) Biosimilars are foreign Options A, B and D all find support somewhere in the passage, but option C has no support at all.

Pinkeye... 35. What is the main idea of the passage? A) Conjunctivitis is referred to as pinkeye because of its symptoms. B) People with conjunctivitis should be careful not to spread it around. C) Conjunctivitis is an eye condition that is common and easily spread. D) Although conjunctivitis looks nasty, it is not particularly dangerous.

C) Conjunctivitis is an eye condition that is common and easily spread. What is the passage mostly about? It is about a condition that is common and easily spread. Choice A, B, and D are too narrowly focused to be main ideas.

Treatments for Hypertension..... 6. What is the main idea of the passage? A) Patients with vascular disease of heart failure often started off with a mild case of hypertension. B) It is clear that personal lifestyle and choices may be contributing factors in hypertension. C) Doctors may prescribe from a variety of drugs and therapies to treat hypertension. D) Treatments for hypertension work by opening the blood vessels and easing pressure on the heart.

C) Doctors may prescribe from a variety of drugs and therapies to treat hypertension. Choices A, B, and D all have some support in the passage, but they are details rather than the main idea. Choice C covers every aspect of the passage and could apply to any part of it.

The Short but Powerful History of Zika.... 10. What is the meaning of the word ISOLATED as used in the first paragraph? A) Inaccessible to all B) Exceptional and rare C) Separated in pure form D) Quarantined for health reasons

C) Separated in pure form In the case of a word that has multiple meanings, you must always look back at the word in context. Here, the author is telling about a virus being isolated, meaning discovered and separated from other viruses or from surrounding living matter -- possibly grown in a pure culture.

The Short but Powerful History of Zika.... 11. Choose the best summary of the passage. A) As with most of the most contagious virus infections, Zika arose in Africa and traveled around the globe. Soon we can expect cases of Zika to show up in North America. B) Doctors have long had trouble differentiating Zika from other viruses. Today they are able to recognize it by its effects, including microcephaly in newborns. C) The Zika virus started off slowly as a minor infectious agent in Africa and then in Asia. Recently it has changed both its range and its potency to become a real danger to the newborn children of infected mothers. D) The Zika virus was discovered by accident and then forgotten for decades. Suddenly it is in the news again as multiple cases in Brazil indicate that it is transmitted sexually as well as by mosquitoes.

C) The Zika virus started off slowly as a minor infectious agent in Africa and then in Asia. Recently it has changed both its range and its potency to become a real danger to the newborn children of infected mothers. Choice A contains information not implied by the passage. Choice B is on topic but not comprehensive enough for a summary. Choice Dis more specific than a summary should be and does not include the important fact that the virus has changed its range and its danger to humans.

The Short but Powerful History of Zika.... 14. Which of the following is NOT listed as a detail in the passage? A) The date of Zika's discovery B) The typical symptoms of Zika C) The average age of Zika patients D) The methods of Zika transmission

C) The average age of Zika patients Choice A is found in the first paragraph, Choice D appears in paragraph 4, and choice B is discussed throughout. The average age of patients is never mentioned.

The Short but Powerful History of Zika.... 12. What is the author's primary purpose in writing this essay? A) To entertain B) To analyze C) To inform D) To persuade

C) To inform The author is not trying to convince the reader of anything, as choice D would indicate. The essay primarily transmits facts.

Compassionate Care: Cicely Saunders and Hospice..... 29. What is the author's primary purpose in writing this essay? A) To persuade readers to support the efforts of hospice B) To analyze the effects of hospice on patient care C) To inform readers of the early development of hospice D) To reflect on the good that hospice has done over time

C) To inform readers of the early development of hospice The passage is largely informational and describes how one woman developed the idea of hospice.

Neonatal Jaundice.... 50. Choose the best summary of the passage. A) Because the liver does not function fully in a newborn, bilirubin accrues, which may lead to brain damage. Phototherapy is one good way to address this problem. B) Jaundice causes yellowing of the skin and sclera. If it causes the soles of the feet to turn yellow, parents should rush their babies to the doctor for phototherapy. C) Within days of birth, babies may develop jaundice due to excess bilirubin. It is usually harmless and clears up quickly, but at times it requires intervention. D) The yellow skin of jaundiced babies may be frightening for parents, but health care professionals know that it is nothing to worry about and will go away in time.

C) Within days of birth, babies may develop jaundice due to excess bilirubin. It is usually harmless and clears up quickly, but at times it requires intervention. Choice A is much more sensational than the essay seems to be. Choice B is quite narrow. Choice D almost covers everything but does not include the fact that sometimes intervention is required. Only choice C is all-inclusive.

Treatments for Hypertension..... 7. Which of the following statements is an opinion? A) Although hypertension is frequently an inherited condition, lifestyle can contribute to patient risk. B) The drug therapies for hypertension range in type and mechanism. C) Aldosterone receptor antagonists work by stimulating receptors in the brain to open peripheral arteries. D) All patients at risk should receive regular screenings for damage to the heart, arteries, & eyes that may be related to hypertension.

D) All patients at risk should receive regular screenings for damage to the heart, arteries, & eyes that may be related to hypertension. A statement of fact can be proved or checked. A statement of opinion is what someone thinks or believes. In this case, statements A, B, and C could be proved scientifically, but statement D is simply someone's belief. The word SHOULD is a clue that this is a judgment rather than a fact.

Compassionate Care: Cicely Saunders and Hospice..... 26. What is the author's attitude toward the subject of this essay? A) Critical B) Mocking C) Awestruck D) Appreciative

D) Appreciative The author does not use fawning adjectives that would indicate being awestruck (choice C), but the attitude toward Saunders is definitely appreciative (choice D).

Biosimilars....... 2. Which of the following is NOT listed as a detail in the passage? A) Biosimilars cost a good deal to manufacture. B) Generic drugs are not made the same way that biosimilars are. C) The FDA must approve any factory that makes biosimilars. D) Current biosimilars are primarily cancer-fighting drugs.

D) Current biosimilars are primarily cancer-fighting drugs. Details A and B appear in paragraph 3, and detail C is in the last sentence of paragraph 2. Detail D is never mentioned or implied.

Mitochondrial Intervention..... 21. What conclusion can a reader draw about the experimental process described in this passage? A) It works best if the mitochondrial DNA comes from a maternal relative. B) It succeeds only when mutation percentages are under 30% C) It is a simple solution for parents who carry the disease. D) It is controversial and has unpredictable results.

D) It is controversial and has unpredictable results. Choices A, B, and C are unsupported by details in the passage. Choice D is close to being the main idea.

Getting the Most Nutrition from Vegetables.... 17. Identify the overall tone of the essay. A) Idealistic B) Dramatic C) Indifferent D) Matter-of-Fact

D) Matter-of-Fact Think about the author's attitude toward the subject matter. The tone is not idealistic (choice A), which would imply a dreamy sort of romanticism. Nor is it dramatic (choice B), which would indicate intensity. Rather than seeming uncaring, or indifferent (choice C), the author seems to be straight-forward, or matter-of-fact (choice D).

Mitochondrial Intervention..... 22. Which of the following statements is an opinion? A) Mitochondrial disease are genetic disorders that occur when the mitochondria cannot produce enough energy for cells to function correctly. B) Symptoms of mitochondrial disease range from lack of growth and developmental delays to loss of muscle coordination & Seizures. C) Previously, the same woman had given birth to two children who died from mitochondrial disease in early childhood. D) Proponents of the technique suggest that it will render mitochondrial disease extinct, which is unlikely.

D) Proponents of the technique suggest that it will render mitochondrial disease extinct, which is unlikely. Calling the conclusion of proponents "unlikely" is the writer's personal opinion, not a statement of fact.

Neonatal Jaundice.... 49. Identify the overall tone of the essay. A) Disheartened B) Exasperated C) Agitated D) Soothing

D) Soothing The author's point is that jaundice in babies is not serious and is easily cured. This is a soothing message for parents.

The Short but Powerful History of Zika.... 13. What is a conclusion that a reader could draw from this passage? A) The World Health Organization should have posted an alert years earlier. B) Although it started in Africa, Zika is now found on six of seven continents. C) Zika is only dangerous to humans if it is transmitted to infants. D) The Zika of today differs from the Zika discovered in Uganda.

D) The Zika of today differs from the Zika discovered in Uganda. It is not clear that having WHO post an alert earlier would have made a difference (choice A). Choice B is not supported by the facts in the essay, and choice C is belied by facts in the essay. The conclusion that is best supported is choice D.

Superfood of Super Marketing Ploy?.... 41. What is the meaning of the word CONCENTRATIONS in the second paragraph of the passage? A) Collections of living things. B) The actions of focusing effort. C) Strength gathered by removing water. D) The amounts of substances per volume.

D) The amounts of substances per volume. This is a specific use of the word CONCENTRATIONS -- here it is used to describe antioxidants within blueberries.

Mitochondrial Intervention..... 24. What is the author's attitude toward the use of mitochondrial intervention? A) Reassuring B) Scornful C) Accepting D) Unconvinced

D) Unconvinced The writer seems to be interested in the procedure, but the fact that "the technique comes with no guarantees at present" emphasizes that the writer remains unconvinced that it will be a true panacea for parent carriers.

Getting the Most Nutrition from Vegetables.... 19. Which of the following statements is an opinion? A) In general, pressure-cooking and boiling led to the greatest losses of antioxidants. B) Spinach, for example, loses most of its B vitamins when boiled, but it retains nutrients when microwaved. C) Finally, the faster vegetables get from farm to table, the more nutrients they preserve. D) You are better off eating frozen vegetables in winter than eating fresh ones flown in from South America.

D) You are better off eating frozen vegetables in winter than eating fresh ones flown in from South America. An opinion cannot be checked or proved. Here, choice D may seem true, but it is impossible to prove because "better off" is such a vague description.

Getting the Most Nutrition from Vegetables.... 20. Which is NOT a conclusion a reader might draw from the essay? A) Microwaving vegetables may be better than boiling them. B) Frozen vegetables can be surprisingly nutritious. C) Cooked tomatoes have more antioxidants than raw ones. D) You are better off eating frozen vegetables in winter than eating fresh ones frown in from South America.

D) You are better off eating frozen vegetables in winter than eating fresh ones frown in from South America. Choices A, B, and C have support in the paragraph, but choice D is contradicted in paragraph 2.

Biosimilars Generic drugs are usually identical to the original pharmaceutical on which they are based. Biosimilars, on the other hand, are not required to be exactly the same as the reference product. However, they must provide the same therapeutic benefit to patients that the reference product does. The FDA will not approve a biosimilar unless it has the same dosage form, strength, and mechanism of action as the reference product it imitates. It must be proved to have the same safety and effectiveness as the original, with no additional risks or downsides. The FDA must also approve the factories and laboratories in which the biosimilars are manufactured. Whereas generic drugs are made through chemical synthesis, biosimilars are produced from living cells. Because of the high costs of testing and manufacturing biosimilars, they will rarely be as inexpensive as generic drugs. However, as the patents on reference products run out, pharmaceutical companies will rush to fill that gap with biosimilars, and the cost will come down as competition grows. Analysts expect biosimilars, despite their complexity compared to generic drugs, to occupy a significant segment of the pharmaceutical market in the years to come.

Questions 1-4

The Short but Powerful History of Zika The zika virus is not new; it was first isolated in 1947 in Uganda, by scientists studying yellow fever. The first human cases were seen in Africa in 1952, and in 1964, a scientist who fell ill with Zika recorded his symptoms, which included a mild fever and a generalized rash. Limited outbreaks occurred in Asia and Africa over the next few decades. Only in 2013 did scientists start to link the virus to more serious effects in patients in the Pacific Islands. They recorded effects from paralysis to autoimmune problems to microcephaly in children born to patients with Zika infections. Still, Zika infection was rare enough that doctors in Brazil did not suspect that particular virus when patients started presenting with neurological disorders after having flu-like symptoms. By 2015, the cases in South America were confirmed as Zika, and the World Health Organization posted an alert. It was the sudden, shocking upsurge in babies born with underdeveloped brains and small heads that led to Zika's notoriety. By the end of 2015, Brazil reported nearly 3,000 such cases, proving that Zika was not only unexpectedly widespread but also extremely dangerous. The growth of Zika infection from a handful of cases in Africa and Asia to tens of thousands of cases in South America and the Caribbean indicated to scientists that Zika had mutated, improving its ability not only to travel but also to infect. The disease continues to be transmitted mainly through the bites of two types of mosquitoes, and most people still have mild symptoms that vanish within a week. However, it seems clear that pregnant women can transmit Zika to a fetus during pregnancy or birth, and there is also recent proof that Zika may be passed on sexually. Although only a few people end up with neurological symptoms, the dangers to fetuses are grave enough to call for vigilance and protection in all areas where Zika is known to be present.

Questions 10-14

Getting the Most Nutrition from Vegetables It might seem logical to thing that eating vegetables raw maximizes their nutritional value, and that the more you cook vegetables, the less nutritious they are. The facts are not quite that simple. A 2009 study used a variety of cooking methods on a variety of vegetables and measured the antioxidants that remained. Artichokes retained antioxidants through all cooking methods, and green beans and garlic did fairly well whether they were fried, boiled, baked, or microwaved. Celery and peppers lost hydroxyl radicals when cooked. Carrots actually increased antioxidant values during all cooking methods. In general, pressure-cooking and boiling led to the greatest losses of antioxidants. Eating raw tomatoes is great, but eating them with a little oil is even better, because the oil helps you to digest the nutrients in tomatoes. Cooking actually increases the antioxidant content of tomatoes. Chopping and cooking vegetables releases nutrients in the cell walls of those vegetables. It also increases the body's ability to absorb the vegetables' calcium, iron, and magnesium. The rule seems to be that cooking at low temperatures for short times with the least liquid possible preserves the most nutrients while making vegetables east to consume. Contrary to popular belief, microwaving is a good way to maintain nutrients in vegetables -- it allows for a very brief cooking time with little water. Spinach, for example, loses most of its B vitamins when boiled, but it retains nutrients when microwaved. Finally, the faster vegetables get from farm to table, the more nutrients they preserve. If they are picked unripe and allowed to ripen on a store shelf, they will not be as nutritious as vegetables picked ripe and sold that day at a farmers' market. They will not even be as nutritious as frozen vegetables, which are picked at the peak of ripeness and flash-frozen. You re better of eating frozen vegetables in winter than eating fresh ones flown in from South America.

Questions 15-20

Mitochondrial Intervention You know of mitochondria as the "powerhouses of the cell", the tiny organelles that create the majority of all cellular energy. Mitochondrial diseases are genetic disorders that occur when the mitochondria cannot produce enough energy for cells to function correctly. Symptoms of mitochondrial disease range from lack of growth and developmental delays to loss of muscle coordination and seizures. Typically, the disease is progressive and incurable. In 2016, a mother who carried the disease gave birth to a healthy infant via a process called mitochondrial intervention. Previously, the same woman had given birth to two children who died from mitochondrial disease in early childhood. According to a report in MEDSCAPE, the children had the mutation in more than 95% of their mitochondria, compared to their mother's 24.5 %. In the intervention, which faces ethical challenges & remains controversial, the nucleus from the mother's oocyte was transferred to a donor oocyte before being fertilized. The resulting egg has most of its DNA from the mother, mitochondrial DNA from a healthy donor, & DNA from the father, in what some people have called a "three-parent" intervention. The resulting newborn has the mutation in fewer than 2% of his mitochondria & is expected to survive disease-free. Proponents of the technique suggest that it will render mitochondrial disease extinct, which is unlikely. It does open up possibilities for parent carriers, but the technique comes with no guarantees at present. It remains to be seen whether mitochondrial intervention is a fad or a fix.

Questions 21-25

Compassionate Care: Cicely Saunders and Hospice Cicely Saunders trained as a nurse during World War II at St. Thomas's Hospital Nightingale School of Nursing in London. Her relationship with a patient who was dying of cancer helped to interest her in end-of-life issues. She began working in a home for the dying poor and after obtaining a degree in social work decided to purse a career as a doctor. She researched pain control and developed a philosophy of "total pain," which involved not only the physical, but also the emotional and spiritual pain patients may endure when they are seriously ill. After qualifying as a doctor, Cicely wrote an article calling for a holistic approach to the end of life, one in which health care professionals worked as a team to "relieve where they cannot heal." She advocated using pain medicine to reduce anxiety as well as physical pain. After many years of planning, Cicely opened a hospice based on her principles of holistic care and pain relief. Her hospice, St. Christopher's, is considered the first of the modern hospice. It featured a teaching component & opportunities for research as well as patient care. It offered home care, which was then a radical change in care for the dying. Researchers at St. Christopher's studied morphine & other approaches to pain control. Cicely's training in social work contributed to the hospice's development of bereavement services for families and loved ones. By the end of her life, this one-time wartime nurse had received the title Dame Commander of the Order of the British Empire along with the world's greatest humanitarian award, the Conrad N. Hilton Humanitarian Prize. To this day, hospices around the world rely on the philosophy she developed.

Questions 26-30

Pinkeye Its real name is conjunctivitis, but parents and children know it as pink-eye. When it is caused by bacteria or viruses, this common inflammation of the eye's mucous membranes is powerfully contagious and can spread through a family in a matter of hours. Although bacteria cause some cases of pinkeye, most conjunctivitis is caused by adenoviruses, so pinkeye often follows a cold. Symptoms include redness and swelling in and around the eye; thick, sometimes sticky drainage; and a burning or itching in the eyelids. Often victims of pinkeye do not know they have it until they wake up with eyes gummed shut. Bacterial conjunctivitis may disappear quickly with the use of medicated eye drops or creams. Viral conjunctivitis is harder to get rid of, but warm or cool compresses may ease the itching and soreness. The most notable feature of conjunctivitis is how easy it is to spread. Any contact with drainage from the eye can spread the infection. Moving a compress from one eye to the other can spread the infection. Sharing a pillow can spread the infection. Shaking hands can spread the infection. It is critical to wash hands frequently when a case of conjunctivitis is in the household. Do not share eye drops, and don't wear contact lenses. Discard tissues immediately after using them. A modicum of care can prevent the infection from spreading throughout the family and beyond.

Questions 31-35

New casts from 3-D Printing In the old days, which were not so long ago, a broken leg might be sealed inside a plaster cast for weeks. Today, it is not uncommon to put a broken leg in a waterproof, fiberglass cast that resembles a ski boot. But the cast of the future looks like a lace bootie, and it has a number of benefits for the patient. The new cast uses amazing 3-D printing technology to scan the patient's broken limb and build a cast from the bottom up that is specifically personalized to the patient's needs. The final cast is made of plastic, is even lighter than a fiberglass cast, and has round openings that permit easy viewing of the broken limb. Doctors can check skin color and health, and physical therapists can use ultrasound or other treatments to stimulate the limb. Most important for the patient, the cast openings allow the skin to breathe, so the uncomfortable, itchy moistness of skin in plaster or fiber-glass casts will be a thing of the past. Right now, prototypes exist mainly for arm casts. The finished product is sturdy and comfortable. Designers believe that the customized 3-D casts may cut rehabilitation time in half, both because the cast is specific to the patient & because the openings in the cast may help to prevent the limb from atrophying. As 3-D printing technology becomes more commonly used to design prosthetics, medical models, synthetic skin, and even heart valves, we can expect simple casts for broken bones to join the ranks of advancements in medicine through 3-D printing.

Questions 36-39

Superfood of Super Marketing Ploy? Are certain nutritionally dense foods truly "superfoods"? Should we be basing our diet on these magical berries, juice, and grains? There is no doubt that certain foods are better for you than others. However, although foods such as blueberries have high concentrations of anthocyanins and other antioxidants, no studies have proved that blueberries are any healthier overall than, say, cranberries. It is the lack of scientific backing that leads many nutritionists to suggest that the lens of "superfood" is not a helpful way to look at overall diet. Yes, we should probably eat foods high in vitamin C and rich in antioxidants, but it is not clear why kiwis are labeled superfoods and other citrus fruits are not. Kale is called a superfood, but most dark vegetables -- spinach, collards, broccoli -- offer similar levels of vitamins A, C, and K, along with minerals and fiber. Often, superfoods seem more faddish than healthful. For example, it is not obvious that black soybeans are better than ordinary soybeans or that chia seeds are better than flax seeds -- and raisins definitely have more nutrients than dried cranberries do. So how do you get to be a superfood? Mostly, it seems, you need a good public relations agent. The European Union will no longer let a food be labeled that way unless the claim is supported scientifically. That is not to say that acai berries and pomegranates are not wonderfully nutritious. It is merely to suggest that you can probably find equal nutrition in cheaper, less trendy products.

Questions 40-45

Neonatal Jaundice A baby is born with ten fingers, ten toes, and a healthy cry, but in a day or two, he develops a yellow tinge to the eyeball and face. What is going on? The physical examination nearly every newborn receives will provide the answer. The health care worker checks for cataracts, heart murmurs, and hip dysplasia, but she will also look for signs of jaundice, the cause of such yellowing in the skin and sclera. Jaundice is very common. The March of Dimes estimates that 60 % of newborns have the condition. It is caused by an accumulation of bilirubin, a yellow substance that is produced as red blood cells break down. All babies have a high level of red blood cells, which rapidly break down and are replaced. Normally, the liver takes care of removing bilirubin. However, in newborns, the liver is immature and not fully functioning. Parents really ought not to panic if they see a bit of yellow in their baby's eyes or skin. Usually, jaundice is mild and disappears in a matter of days or weeks. Nevertheless, any jaundice should probably be checked out by a doctor, especially in cases where the soles of the feet turn yellow, an indication of high levels of bilirubin. If left untreated, high levels of bilirubin may cause complications from deafness to brain damage. Such complications are quite rare, though. If bilirubin levels do not decrease on their own, the jaundiced baby is whisked away and placed under fluorescent light in a process called phototherapy. As the light excites the bilirubin molecules, they react with oxygen, and the byproduct is rapidly excreted in urine.

Questions 46-50

Treatments for Hypertension Hypertension, or high blood pressure, rarely manifests symptoms. Nevertheless, it puts patients at risk for stroke, heart failure, vascular disease, coronary artery disease, and even blindness. Although hypertension is frequently an inherited condition, lifestyle can contribute to patient risk. For that reason, patients with high blood pressure are often counseled to quit smoking or drinking and to lose weight and avoid salt. Stress reduction is also often beneficial to patients with hypertension. The drug therapies for hypertension range in type and mechanism. For example, ACE inhibitors dilate the blood vessels, which increases blood flow and lowers pressure. Calcium channel blockers slow the movement of calcium into the cells that line the heart and blood vessels, easing the heart's pumping and widening the blood vessels. Diuretics release excess water and salt through urine, making it easier for the heart to pump. Beta-blockers block the effects of epinephrine on the heart, causing it to beat more slowly. Vasodilators relax the walls of the arteries, allowing blood to move more smoothly through them. Aldosterone receptor antagonists work by stimulating receptors in the brain to open peripheral arteries. The choice of drug depends on a variety of factors, from the patient's age and other diseases to the immediate cause of the hypertension. Patients are often taught to monitor their own blood pressure at regular intervals. All patients at risk should receive regular screenings for damage to the heart, arteries, and eyes that may be related to hypertension.

Questions 5-9