PCAT Critical Reading Practice Test

Below is our free PCAT Critical Reading practice test. The reading section includes 48 questions that are based on 6 passages. You will have 50 minutes to answer all of the questions. The skills tested are reading comprehension, analysis, and evaluation. Try our PCAT Reading questions to see if you are fully prepared for your exam.

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Question 1
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
The main idea of the passage could best be summarized as:

A
The progression of a tubercular infection and how the body’s immune system responds to it.
B
How bacilli maintain growth inside of the body.
C
The human body’s reaction to a bacterial infection.
D
The progression of a tubercular infection.
Question 1 Explanation: 
The correct answer is (A). In the first paragraph, the author describes the point of tubercular infection, the progression of the infection, and the ways in which the body fight the infection. The second paragraph continues the description of the infection’s progress. While answer choice (B), (C), and (D) are true, each misses a major component of the passage. Only answer choice (A) includes both major parts of the passage.
Question 2
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
Which description best characterizes the tone of this passage?

A
Subjective and biased
B
Objective and unbiased
C
Scientific and caring
D
Clinical and respectful
Question 2 Explanation: 
The correct answer is (B). The author treats the subject in a matter-of-fact and scientific manner absent of both opinion and emotion. The absence of an emotional response eliminates answer choices (A) and (C), and while the treatment of the subject can be described as clinical, describing it as respectful is awkward.
Question 3
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
It is true that bacilli:

A
are insensible to outside influence.
B
attack lymph nodes first.
C
produce toxins harmful to the body.
D
do not destroy surrounding tissue.
Question 3 Explanation: 
The correct answer is (C). The passage states that the body tries to defend itself with the production of substances that are antagonistic to “toxins produced by the bacilli.”
Question 4
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
Based on the information in paragraph 1, it is likely that sneezing would

A
Expedite the progression of the infection
B
Impede the growth of the bacteria
C
Aid the body in the removal of the infection
D
Obstruct further passage for the bacteria
Question 4 Explanation: 
The correct answer is (A). At the end of paragraph 1, the passage reads, “This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing.” Given that a sneeze is mechanically similar to coughing, it is likely that a sneeze would have a similar effect as a cough. Only answer choice (A) describes the effect of a cough.
Question 5
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
What causes tissue to convert into soft semi-fluid material?

A
The attacking bacilli breaking through the cicatricial tissue
B
Air distributed through the bronchi in the lungs
C
Further extension by the lymphatics
D
Additional movement caused by coughing
Question 5 Explanation: 
The correct answer is (A). Immediately following the discussion of the cicatricial tissue and how it blocks the progression of infection, the passage states, “In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place.”
Question 6
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
In context, efficacious, in the middle of the first paragraph, most closely means:

A
active
B
ineffective
C
potent
D
competent
Question 6 Explanation: 
The correct answer is (C). The combination of the antagonistic substances and the dense masses of cicatricial tissue is very effective in terminating the progress of the bacilli. Potent, which means having great influence or effect, is closest in meaning to efficacious.
Question 7
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
The author is considering the addition of another paragraph. Which of the following would serve as the best topic sentence of the added paragraph?

A
After leaving the abdominal cavity, the sputum makes its way to the bloodstream, where it can further infect the organism.
B
The lymphatics serve many purposes in facilitating the growth of the bacilli within the body.
C
While it may seem as if the body has given up the fight at this point, this is not the case.
D
It is within the abdominal cavity that tubercular infection finds its biggest obstacle.
Question 7 Explanation: 
The correct answer is (C). Paragraph 2 begins with the bacilli’s progression from the lungs to further expansion by way of the lymphatic system. The paragraph does not mention the body’s response to this development of the infection and its advancement as sputum. Answer choice (C) would be the best topic sentence for an added paragraph because of its appropriate transition word and its return to the body’s response to the infection. The other answer choices either jump ahead without explaining the intermediate steps, as in choice (A), or switch to an earlier subject unexpectedly, as in choice (D).
Question 8
Questions 1-8 are based on this passage.

The primary seat of tubercular infection is generally in the upper part of the lung. The invading organisms settle on the surface here and cause a multiplication of the cells and an inflammatory exudate in a small area. With the continuous growth of the bacilli in the localized region, adjoining areas of the lung become affected, and there is further extension into the immediate vicinity by means of the lymphatics. Small nodules form and then coalesce to create a larger area. The body primarily defends itself with the formation of dense masses of cicatricial tissue, which function to wall off the affected area. This results in unfavorable growth conditions for the bacilli. This mode of defense, combined with the production of substances antagonistic to the toxins produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. In certain cases, however, the growth of the bacilli in the focus area is unchecked, then the surrounding tissue is killed and converted into a soft semi-fluid material; further extension then takes place. All parts of the enormous surface of the lungs are connected by a system of air tubes or bronchi, and as a result, the bacilli have favorable opportunity for distribution. This opportunity is facilitated by sudden movements of the air currents in the lung produced by coughing. The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. On the inner surface of these cavities there may be a rapid growth of bacilli.

From the lungs, the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. The extension across surfaces continues and the abundant sputum, which is formed in the lungs and contains large numbers of bacilli, becomes the vehicle of transportation. The windpipe and larynx may become infected, as the back parts of each are more closely in contact with the sputum and are the parts most generally infected. A large part of the sputum is swallowed and infection of the intestine takes place with the lesions taking the form of large ulcers. From the intestinal ulcers there is further extension by means of the lymphatics to the large lymph nodes in the back of the abdominal cavity.
 
According to the passage, which of the following is true about tubercular infection?

A
It can be stopped in the lungs, but not once it attacks the rest of the body.
B
It can always be stopped before fatality.
C
It can be checked until it reaches the intestines, but not after.
D
It can sometimes be checked in an advanced stage, but not always.
Question 8 Explanation: 
The correct answer is (D). The end of the first paragraph states, “The body’s defense; however, can still keep pace with the attack, and even in an advanced stage, the infection can sometimes be permanently checked; in other cases the check is temporary…” Accordingly, the infection can be stopped, even in an advanced stage, but this is not always the case.
Question 9
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
Which statement from the passage is an opinion of the author?

A
“…some health care professionals are also concerned about…” in paragraph 4
B
“Chronic pain is pain that lasts for 3 to 6 months…” in paragraph 4
C
“…episodes of pain vary from patient to patient…” in paragraph 2
D
“By increasing awareness … and promoting…” in paragraph 1
Question 9 Explanation: 
The correct answer is (D). When a question references a specific line, always be sure to revisit the specified line in order to gain the context within which the line is embedded. Context is crucial in fully understanding both the question and the answer choices. This question, in particular, cannot be answered without getting the full context of the quotes. The full sentence of answer choice (D) is “By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope…” Without the addition of statistical evidence, the statement provided is an opinion of the author.
Question 10
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
Out of this group, which of the following demographic is the LEAST likely to have SCD?

A
African-American men
B
Mediterranean women
C
Middle Eastern women
D
Caucasian men
Question 10 Explanation: 
The correct answer is (D). The passage states, “While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait.” The only group from this list not mentioned here is that of Caucasian individuals.
Question 11
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
The word “hallmarks” in paragraph 2 most likely means?

A
labels
B
signals
C
features
D
badges
Question 11 Explanation: 
The correct answer is (C). As stated earlier, when answering questions referring to a specific line or word, it is imperative to first get the full context within which the word is used. In this case, it is the “recurring episodes of acute and severe pain” that are the hallmarks of SCD. These can be thought of as characteristics, markers, or attributes of SCD. Consequently, in context, ‘features’ is the best synonym for hallmarks.
Question 12
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
In response to a doctor’s question, a patient says, “It usually occurs all of a sudden, but I’ve noticed it happen when I’m stressed out and tired from work. And I’d say that it’s been ongoing for a few months now.”

Of the following, which is this patient probably describing?

A
Acute pain
B
Chronic pain
C
Mixed pain
D
Severe pain
Question 12 Explanation: 
The correct answer is (C). The passage describes 3 types of pain associated with SCD: acute, chronic, and mixed. The patient describes an abrupt onset of pain that is linked with stress and fatigue, both of which are features of acute pain, but the patient is also goes on to state that the pain has been ongoing for a few months, which is indicative of chronic pain. Consequently, mixed pain best describes the patient’s pain.
Question 13
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
What steps can health care professionals take to help patients and their families cope with SCD?

A
Raising awareness and advocating patient education
B
Overestimating the number of individuals affected by SCD
C
Focusing on the potential for addiction and adverse effects
D
Distinguishing the difference between chronic and acute pain
Question 13 Explanation: 
The correct answer is (A). The final sentence of the first paragraph reads, “By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.”
Question 14
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
According to the passage, the major difference between acute pain and chronic pain is

A
The severity of the pain involved
B
The duration of the pain involved
C
The side effects of the pain involved
D
The methods of managing the pain involved
Question 14 Explanation: 
The correct answer is (B). While there are minor differences between acute and chronic pain, the major difference between the two is the pain’s duration. Acute pain is abrupt and short lived. However, if acute pain lasts for longer than 3 months, it is categorized as chronic pain.
Question 15
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
The passage as a whole can best be described as a

A
Narrative
B
Persuasive essay
C
Expository essay
D
Scientific article
Question 15 Explanation: 
The correct answer is (C). An expository essay is also known as an informative essay. Expository essays provide clear and concise descriptions of a particular topic. In this case, the essay is an exposition on sickle cell disease and its variants. The passage lacks the formality of a scientific article, does not tell a story, and is not attempting to persuade opinion on an issue.
Question 16
Questions 9-16 are based on this passage.

Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell trait. While SCD is known to primarily affect individuals of African American descent, individuals from South America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By increasing awareness about SCD and promoting patient education, health care professionals can help patients and their families cope with SCD and better manage the associated pain.

Recurring episodes of acute and/or severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point, most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted to manage the pain.

An acute pain event is the most common type of pain, and the onset is typically abrupt. It is often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold climates, menstruation, and fatigue.

Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of potential addiction and adverse effects. Many studies report that some health care professionals are also concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
 
Which of the following is NOT a possible cause of chronic pain in SCD patients?

A
aseptic necrosis
B
leg ulcerations
C
changes in altitude
D
osteomyelitis
Question 16 Explanation: 
The correct answer is (C). “Changes in altitude” is described by the passage as a cause of acute pain, not chronic pain. The other three answer choices are all listed as possible causes of chronic pain in the passage.
Question 17
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
The tone of the passage could best be described as?

A
erudite
B
gloomy
C
intimate
D
didactic
Question 17 Explanation: 
The correct answer is (D). Throughout the passage, the author attempts to eliminate misconceptions and myths about Alzheimer’s disease while elucidating factual details about it. The author covers the public’s views of the disease as well as its progression and the difficulties faced by those impacted by the disease. The passage as a whole is very instructive.
Question 18
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
Which of the following is NOT something pharmacists can provide information about?

A
myths about AD
B
truths about AD
C
cures for AD
D
treatments for AD
Question 18 Explanation: 
The correct answer is (C). The passage states, “Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.” The passage mentions that Alzheimer’s is currently incurable.
Question 19
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
In paragraph 2, “harbinger” most nearly means?

A
token
B
precursor
C
messenger
D
problem
Question 19 Explanation: 
The correct answer is (B). The author states that “AD’s harbinger is language difficulties.” A harbinger, by definition, is a messenger or forerunner of information. In this case, the language difficulties indicate the arrival of the more serious symptoms of the disease. These difficulties act as a precursor to these more serious issues.
Question 20
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
A patient with Alzheimer’s might show language difficulties by describing a computer as:

A
a desktop
B
a laptop
C
a computer
D
an information-giver
Question 20 Explanation: 
The correct answer is (D). The second paragraph discusses how some AD patients invent new descriptions for objects, such as calling a pencil a “list writer,” or a key a “door turner.” It is likely that a computer would be described by way of its function.
Question 21
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
The author’s attitude toward Alzheimer’s disease is best summarized by which of the following?

A
Pessimistic about the future prospects surrounding the disease and potential treatments.
B
Accepting of the disease’s inevitabilities and forthright about the extent of different treatments’ effectiveness.
C
Critical of the treatment methods utilized by health care professionals.
D
Apathetic toward developing new treatments for the disease.
Question 21 Explanation: 
The correct answer is (B). Senility, cognitive decline, and normal aging are all explicitly mentioned in the passage as things that AD is mistaken for in its early stages. The author mentions that “AD is complex and relentlessly progressive,” and that “[AD] ends with death; AD has no cure.” However, the author also mentions the different strategies health care professionals utilize to help patients and families deal with the difficulties associated with AD. The author treats the disease with seriousness and respect, with an acceptance of what the disease entails.
Question 22
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
The final paragraph primarily serves to

A
Detail the transition from early stage Alzheimer’s to the severe stages of the disease.
B
Outline the different treatment options available to patients.
C
Explain how patients decide which treatment to pursue.
D
Describe how health care professionals decide when to terminate treatment.
Question 22 Explanation: 
The correct answer is (D). In many cases, the purpose of a paragraph can be gleaned from the topic sentence of the paragraph. This is true for this case: “Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging.” Because the paragraph continues to describe the difficulties associated with termination of treatment, answer choice (D) is correct.
Question 23
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
Acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists can do which of the following to help AD patients?

A
monitor progression
B
decrease disruptive behavior
C
stop disease progression
D
delay cognitive function
Question 23 Explanation: 
The correct answer is (B). The passage states, “A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors.”
Question 24
Questions 17-24 are based on this passage.

For most Americans, the words “Alzheimer’s disease” (AD)—often mispronounced purposefully or accidentally as “old timers’ disease”—signify devastating memory loss and stigma. The information about AD—often learned solely through the media—may lead individuals to believe that AD is inevitable (it isn’t), and possibly think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may envision a future burdened with more dementia patients and fewer societal resources to help support them (a real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent information about AD’s myths, realities, and available symptomatic treatments.

AD’s harbinger is language difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or severe depending on the patient’s cognitive and memory impairment, communication problems, personality changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive decline or senility—in other words, “normal” aging. For this reason, most people don’t seek treatment and are diagnosed in the late-mild to early-moderate stage.

In the severe stage, difficulty swallowing elevates the risk of aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death; AD has no cure. A handful of pharmacologic treatments—acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists—alter the decline trajectory. These treatments slow disease progression, enhance cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these medications, but experts generally believe that those who do will show mild to moderate improvements for 6 months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly enable independence.

Determining when medications stop providing a therapeutic benefit and should be discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools, patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns. Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective behavioral strategies are much preferred.
 
The side note, “often mispronounced purposefully or accidentally as ‘old timers’ disease,” best functions in what way in the first paragraph?

A
Give a relatable anecdote for the reader to begin a description of a serious topic.
B
Make a joke about a serious topic.
C
Provide background details about Alzheimer’s disease.
D
Teach the reader a nickname of the disease.
Question 24 Explanation: 
The correct answer is (A). An effective strategy for grabbing the attention of a reader is to incorporate an anecdote or joke that stands out. This is referred to as the ‘hook’ of the introductory paragraph. In this case, the writer is providing a detail that may or may not be known by the reader that enables the writer to relate with the reader and carefully open up the discussion about a serious topic.
Question 25
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
A diagnosis of mycoplasma may be suspected in cases in which

A
fever, congestion, and fatigue were never present
B
fever, congestion, and fatigue were present initially, but then went away
C
fever, congestion, and fatigue remain constant during the cough
D
fever, congestion, and fatigue go away with the cough
Question 25 Explanation: 
The correct answer is (B). The passage states, “Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago.” A lingering cough after the resolution of the other symptoms is a key marker in suspecting mycoplasma.
Question 26
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
The primary purpose of this passage is

A
to give background information about mycoplasma
B
to describe the dangers of mycoplasma
C
to provide details on how mycoplasma primarily infects children
D
to trace the cause of the common cold
Question 26 Explanation: 
The correct answer is (A). The passage starts with a possibly unknown connection between a lingering cough and mycoplasmic bacteria. It then moves into a description of mycoplasma, its size, shape, and prevalence, before then describing who it infects and where these infections are likely to occur. All of this serves as general, background information of mycoplasma.
Question 27
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
It is probable that mycoplasma pneumonia is most common in crowded areas because

A
they evolved from eubacteria primarily infect children.
B
they lack a cell wall, they glide freely, and they produce hydrogen peroxide.
C
they require no oxygen or host cell, they are very small, and they are able to burrow between cilia.
D
they have no identifiable risk factor and incubate over 3 weeks.
Question 27 Explanation: 
The correct answer is (C). As the passage states, mycoplasma “require no oxygen or host cell,” “glides freely,” and “uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium.” It is implied that mycoplasma’s point of contact with humans is via the respiratory tract. In crowded areas, large groups of people share a small amount of air, and sneezes, coughs, etc., can very easily lead to the transmission of mycoplasma.
Question 28
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
Approximately what percentage of known mycoplasma species live in human beings?

A
2
B
15
C
35
D
100
Question 28 Explanation: 
The correct answer is (B). The passage states, “Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans.” While the passage does not specify the exact number of mycoplasma species, given the numbers included, it is likely that there are not many more than 100. Fifteen percent is the best approximation given that 15/100 = 15%.
Question 29
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
Within the context of the passage as a whole, paragraph 2 serves what purpose?

A
Give a general description of mycoplasma.
B
Provide specific details of mycoplasma and how it relates to the common cold.
C
Describe the progression of “walking pneumonia” in humans.
D
Define the characteristics of mycoplasma pneumoniae.
Question 29 Explanation: 
The correct answer is (A). Passage 2 primarily describes the physical characteristics of mycoplasma, its requirements for survival, and the number of species known to man. All of these serve as a general description of the bacteria.
Question 30
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
The tone of the passage can best be described as

A
contemptuous
B
judgmental
C
matter-of-fact
D
solemn
Question 30 Explanation: 
The correct answer is (C). For the most part, the author refrains from injecting personal opinion or emotion and solely deals with the topic of mycoplasma and its pathogenesis in an objective manner. Statistics and facts are presented without additional commentary on those facts. This is indicative of a matter-of-fact treatment of the subject.
Question 31
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
In paragraph 2, “symbiotic” most nearly means

A
independent
B
cooperative
C
divided
D
shared
Question 31 Explanation: 
The correct answer is (B). The full context of this word is a description of the “normal symbiotic flora” that lives inside the human gut. This “normal” flora is contrasted with mycoplasma pneumonia, which is described as pathogenic in humans. Given that some of the species take up residence in the human gut, without causing issue, it is likely that this symbiotic relationship is one of cooperation.
Question 32
Questions 25-32 are based on this passage.

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace. Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms—fever, congestion, and fatigue—resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of lingering cough: atypical pneumonia caused by mycoplasma.

Mycoplasma—pleomorphic bacteria that lack a cell wall—are the smallest and simplest self-replicating organisms known to humans. They probably evolved from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora. Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans.

Mycoplasma pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5, approximately 65% of children have been infected. Nearly all adults have been infected at least once, often repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest incidence is found in the 5- to 9-year age group.

The risk of contracting mycoplasma pneumonia is greatest for people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term care units, and military and prison environments. However, many people who develop mycoplasma infections have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.
 
Which of the following is NOT true about mycoplasma infection?

A
It can be contracted without an identifiable risk factor.
B
It has an incubation period of over three weeks.
C
It can be diagnosed without laboratory testing.
D
It can cause nausea, vomiting, or diarrhea in children.
Question 32 Explanation: 
The correct answer is (C). The final paragraph of the passage states that mycoplasma infection CANNOT be diagnosed without laboratory testing, “This infection cannot be diagnosed based on symptoms alone; laboratory testing is essential.”
Question 33
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
In the first sentence, “omnipresent” most nearly means?

A
extensive
B
unlimited
C
infinite
D
pervasive
Question 33 Explanation: 
The correct answer is (D). By definition, “omnipresent” indicates something that exists everywhere; however, in this case, given the negative consequences resulting from lead in the environment, the best description should possess a negative connotation. Pervasive best captures this negative connotation.
Question 34
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
The passage as a whole primarily serves to

A
outline the prevalence of lead and provide a description of lead poisoning, its causes, diagnosis, and effects.
B
raise awareness of the dangers of lead poisoning.
C
describe the causes and effects of lead poisoning.
D
detail the history of lead and lead poisoning.
Question 34 Explanation: 
The correct answer is (A). This answer choice describes the exact progression of the passage. While some of the other answer choices are true statements, they do not give a full list of the major topics covered in the passage.
Question 35
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
The inclusion of what evidence would best support the author’s claim in the first paragraph that “civilization has been unable to prevent or control it satisfactorily.”

A
A quote from a well respected doctor.
B
A survey of 10,000 randomly selected people.
C
A collection of statistics stating the number of deaths from lead poisoning.
D
A series of anecdotes describing lead poisoning.
Question 35 Explanation: 
The correct answer is (C). In the absence of any factual evidence, the author’s claim stands out; however, if there were concrete details supporting this claim, the author’s argument would be stronger. Of the possible choices, a collection of statistics would best support the idea that civilization has been unable to control lead poisoning satisfactorily. While the other answer choices may prove effective in supporting the author’s claim, they would not be as effective as inarguable numbers.
Question 36
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
Why are infants and children more vulnerable to lead poisoning?

A
They can absorb a greater fraction of lead than adults with the same exposure.
B
The CDC announced a new, lower reference value for children.
C
They can become exposed through prenatal maternal-fetal transmission.
D
Because 450,000 American children have BLLs >5 mcg/dL.
Question 36 Explanation: 
The correct answer is (A). The passage mentions that children exposed can absorb a “higher fraction of lead.”
Question 37
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
Which of the following best explains the “many tests [used] to identify lead poisoning?”

A
the disproportionate number of lead hazards found in low-income housing
B
the 450,000 American children who have BLLs > 5 mcg/dL
C
the unpredictable variety, and occasional absence, of symptoms
D
lead’s environmental omnipresence
Question 37 Explanation: 
The correct answer is (C). Given that lead poisoning does not always present symptoms in the same form or fashion, and that on occasion these symptoms can be entirely absent, it is important that health care professionals have many options available for diagnosing lead poisoning.
Question 38
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
Which of the following is true about lead?

A
Humans require some of it to survive.
B
It is non-toxic in small quantities.
C
It has properties that made it attractive to certain manufacturers.
D
It affects only certain organ systems upon exposure.
Question 38 Explanation: 
The correct answer is (C). The passage states that a variety of industries utilized lead in manufacturing products. This directly supports the statement in answer choice (C). Additionally, the remaining choices are directly contradicted by the passage.
Question 39
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
What is NOT a test to detect lead poisoning?

A
aminolevulinic
B
blood smear
C
BLL
D
radiographs
Question 39 Explanation: 
The correct answer is (A). This is not the name of a test or a method for detecting lead poisoning. It may be a word from the passage, but it does not answer the specific question posed. The other answer choices are all mentioned as tests for detecting lead poisoning.
Question 40
Questions 33-40 are based on this passage.

Lead—non-biodegradable, soft, malleable, as well as heat and corrosion resistant—is environmentally omnipresent. Its known properties make it an ideal metal for automobiles, paint, smelting, ceramics, and plastics. Not many years ago, it was also utilized in the toy industry. Unfortunately, lead is toxic to humans. Humans neither need lead nor derive benefits from it. Although lead toxicity has been a global concern since the industrial revolution in the late 1800s, civilization has been unable to prevent or control it satisfactorily. Overall incidence of lead poisoning among American children has fallen from 4.4% in the early 1990s to 1.4% in 2004. In 2002, around 10 out of every 100,000 of adults had lead toxicity.

Venous blood lead levels (BLLs) of 10 mcg/dL and 25 mcg/dL were considered toxic in children and adults, respectively. But, since any level of lead can cause toxicity, the CDC announced a new, lower reference value for children in June 2012: 5 mcg/dL. Infants and children absorb a higher fraction of lead than adults do when exposed, increasing their vulnerability. Approximately 450,000 American children have BLLs >5 mcg/dL. Consequently, lead poisoning is still a problem.

Lead exposure can start with prenatal maternal-fetal transmission. Outside the womb, children may inhale (or eat) lead dust, often present in street debris, soil, and most frequently, aged house paint. Lead-based paint was phased out in the 1970s, lowering, but not eliminating, risk of exposure. Old pipes sometimes leach lead into drinking water. Lead hazards are disproportionately found in low-income housing. Adults rarely develop lead poisoning, but risk is increased for industrial workers who use or manufacture lead-based products.

Health care providers use many tests to identify lead poisoning. In addition to the BLL, a blood smear may show basophilic stippling ribosomal clusters. Increased urinary aminolevulinic acid concentrations are also reliable indicators. Plain film radiographs can reveal visible lead lines in patients’ long bones. Astute clinicians sometimes diagnose lead poisoning after seeing a blue line along patients’ gums (Burton’s line) that forms when lead reacts with sulfur ions released by oral bacteria.

Lead affects every organ system and causes an unpredictable variety of symptoms. The nervous system is most sensitive (centrally in children, peripherally in adults), but lead affects hematopoietic, hepatic, and renal systems, producing serious disorders. Acute lead poisoning’s classic symptoms include colic, encephalopathy, anemia, neuropathy, and Fanconi syndrome (abnormal glucose, phosphates, and amino acid excretion). Sometimes, classic signs and symptoms are absent, confusing the clinical picture.
 
In context, which of the following expresses an opinion of the author?

A
“Unfortunately, lead is toxic to humans.” in paragraph 1.
B
“Overall incidence of lead poisoning…has fallen from 4.4%...to 1.4%” in paragraph 1.
C
“Lead exposure can start with prenatal maternal-fetal transmission.” in paragraph 3.
D
“Sometimes, classic signs and symptoms are absent…” in paragraph 5.
Question 40 Explanation: 
The correct answer is (A). The inclusion of the word “unfortunately” characterizes this statement as an opinion and not a fact. In the absence of the word “unfortunately,” this would convey a measurable and factual statement.
Question 41
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
Awareness of cardiovascular disease (CVD) among women was partially limited because:

A
The American Heart Association did not do enough to raise awareness prior to 1997.
B
There was a prevailing misconception that AVD was a “man’s disease.”
C
The Guidelines for Prevention of Cardiovascular Disease in Women was not published until 1997.
D
The AHA was ill-informed about the statistics of CVD occurrence in men and women.
Question 41 Explanation: 
The correct answer is (B). The passage states, “the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased.”
Question 42
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
Throughout the passage, it is implied that which of the following will lead to fewer deaths resulting from CVD?

A
Finding a cure for CVD.
B
Raising awareness and understanding of CVD.
C
Teaching women about the consequences of CVD.
D
Educating men and women about heart attacks.
Question 42 Explanation: 
The correct answer is (B). In the introductory paragraph, the author stresses the importance of raising awareness of CVD in the general public, presumably as a means of reducing the overall number of deaths resulting from CVD. This implication continues in the body paragraphs.
Question 43
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
The main idea of the passage can best be summarized as

A
raising awareness of the dangers of CVD to women.
B
educating Americans on the importance of cardiovascular health.
C
providing women with statistics regarding CVD.
D
describing the causes, effects, and treatment of CVD.
Question 43 Explanation: 
The correct answer is (A). While the introductory paragraph states the importance of raising awareness in the general public, it also mentions the misconception that CVD is a “man’s disease,” and goes on to describe the subtle differences between the experiences of males and females when suffering from CVD. The author makes a point of these differences and highlights the importance of educating women in particular on the subject.
Question 44
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
Of the following, which is an opinion expressed by the author?

A
“…only 13% of women perceive CVD as a health threat.” In paragraph 1.
B
“…the misconception that CVD is a ‘man’s disease’…” in paragraph 1.
C
“Unfortunately, many women may not always recognize…” in paragraph 4.
D
“…43% did not experience any type of chest pain…” in paragraph 5.
Question 44 Explanation: 
The correct answer is (C). While it may be true that many women do not recognize the warning signs and symptoms of a heart attack, the inclusion of the word “unfortunately” categorizes this remark as an opinion of the author, and not necessarily and indisputable fact.
Question 45
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
In context, the word “pivotal” in paragraph 3 most nearly means

A
determining
B
crucial
C
important
D
central
Question 45 Explanation: 
The correct answer is (D). The author describes pharmacists as being in a pivotal position to educate and inform patients of the risks associated with CVD due to their accessibility. While pharmacists are certainly important in transmitting this information, because of their accessibility, they are crucial, or central, to raising awareness of CVD.
Question 46
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
The author relies upon all of the following EXCEPT which of the following to make his/her argument?

A
Direct quotation
B
Survey
C
Anecdotal evidence
D
Research studies
Question 46 Explanation: 
The correct answer is (C). In the first paragraph, the author provides a direct quotation. In the fifth paragraph, the author describes research that also acts as a survey of those who participated. The author does not rely on anecdotal evidence to support his or her argument.
Question 47
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
Why are women often unaware of their CVD symptoms?

A
Their symptoms are less obvious than those of men.
B
The majority of them do not believe they are susceptible to CVD.
C
They are misinformed by the majority of the media.
D
They are not correctly informed by their pharmacists and health care professionals.
Question 47 Explanation: 
The correct answer is (A). According to the passage, “Many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.” The key word subtle indicates that the symptoms women experience are not as obvious as the symptoms men experience.
Question 48
Questions 41-48 are based on this passage.

Since 1997, the American Heart Association (AHA) has attempted to increase awareness about cardiovascular disease (CVD) among women. Fortunately, great progress has been made to educate individuals about CVD and its consequences. According to the AHA’s 2011 Guidelines for Prevention of Cardiovascular Disease in Women, the misconception that CVD is a “man’s disease” has been somewhat disproved, as awareness among the general public increased from 30% in 1997 to 54% in 2009.

Unfortunately, CVD continues to be the leading cause of death in the United States for both men and women. Since 1984, the number of deaths related to CVD in women exceeded those in men. In the United States, CVD death rates among women aged 35 to 54 years appear to be increasing by 1% annually, which is most likely attributable to the escalating obesity epidemic. According to the AHA, even though CVD is the number 1 cause of death among women, only 13% of women perceive CVD as a health threat. CVD is responsible for more deaths among women than the next 3 leading causes of death combined, including all forms of cancer.

Due to the ongoing prevalence of CVD, increasing awareness and understanding of CVD, especially among the female population, is still a top priority for many health care professionals. As one of the most accessible health care professionals, pharmacists are in a pivotal position to educate and inform their patients of the risks associated with CVD, possible drug therapies, and preventive measures. The AHA has set a goal for 2020 to improve cardiovascular health in all Americans by 20%, while reducing deaths from CVD and stroke by 20%.

According to the American Heart Association, in the United States a woman dies of some form of CVD every minute and more than 1 in 3 females have some form of CVD. Studies have demonstrated that gender differences may play an important role in the diagnosis, treatment, and prevention of CVD. Unfortunately, many women may not always recognize the warning signs and symptoms of a heart attack because they sometimes appear more subtle when compared with those typically experienced by men.

Results from a study of 515 women who had heart attacks report that 43% did not experience any type of chest pain or pressure during the heart attack. Although the classic symptoms include chest pain, tingling in the left arm, sweating, and shortness of breath, women may also experience some “atypical” symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back. By learning and recognizing the warning signs, women can take a proactive approach to their cardiovascular health and get treatment earlier to prevent further complications.
 
Which of the following is NOT a symptom most men experience during a heart attack?

A
perspiration
B
chest pain
C
left arm tingling
D
nausea
Question 48 Explanation: 
The correct answer is (D). The final paragraph of the passage described the “classic symptoms” including “chest pain, tingling in the left arm, sweating, and shortness of breath,” and then goes on to describe “some ‘atypical’ symptoms, such as extreme fatigue, nausea, dizziness, indigestion, vomiting, and pain in the neck or back,” which usually occur only in women.
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