Exam 4: HESI-A2-Reading

Trans fats Trans fats are unsaturated fats found in many processed foods. Though their prevalence makes them a part of many people's diet, excessive consumption of trans fats can lead to a variety of serious health problems. Certain trans fats are found naturally in some animal products, such as beef and milk. However, the main source of trans fats for many people is processed foods. Partially hydrogenated vegetable oils are trans fats that are often found in shortening, packaged baked goods, and fried foods. Restaurants and food manufacturers often choose to use partially hydrogenated oils because they are less expensive, have longer shelf lives, and require less refrigeration than non-hydrogenated oils. Although trans fats may be less expensive for food manufacturers to use, and thus cheaper for consumers to purchase, excessive intake of these substances can cause significant health risks. Like saturated fat, trans fat raises the level of LDL ("bad") cholesterol in the body. Unlike saturated fat, however, trans fat also lowers the amount of HDL ("good") cholesterol in the body. Therefore, trans fat has a far more negative overall effect on cholesterol levels in the human body than saturated fat. Studies have also linked consumption of trans fats to increased risk of heart disease, diabetes, obesity, cancer, liver dysfunction, depression, and memory disorders. Which is the best summary for the passage?

The Spread of Yellow Fever Yellow fever is a dangerous disease that is primarily found in tropical climates. Sometimes, people infected with yellow fever suffer only mild flu-like symptoms. In other cases, however, yellow fever can be much more serious, causing kidney problems, liver failure, and sometimes, even death. For many years, people believed that the disease was spread from person to person, much like the cold or flu. However, this was not the case. It took the dedicated research of a doctor named Carlos Juan Finlay to show people how to prevent a disease that was killing people by the thousands. In the 1800's, yellow fever was a serious threat to Cuba's population. Because people believed that the disease was spread from person to person, they tried to prevent the spread of the disease by quarantining people. However, this did not help. Dr) Finlay had a different hypothesis. He noticed the worst outbreaks of yellow fever happened when mosquitoes were most active. This led him to theorize that mosquitoes spread the disease, not people. This was a revolutionary idea; no one had considered the possibility of mosquitoes being vectors of disease. In fact, the idea was so revolutionary that no one believed Finlay for over 20 years. Eventually, Finlay's theory was proven. A team of military doctors led by Dr. Walter Reed conducted a series of experiments that proved once and for all that mosquitoes were indeed responsible for spreading yellow fever. Armed with this information, people took new measures to protect themselves from yellow fever. As a result of this discovery, yellow fever has almost completely disappeared from Cuba and many other nations. What is the best synonym for the word 'revolutionary' at the end of paragraph 3?

The Spread of Yellow Fever Yellow fever is a dangerous disease that is primarily found in tropical climates. Sometimes, people infected with yellow fever suffer only mild flu-like symptoms. In other cases, however, yellow fever can be much more serious, causing kidney problems, liver failure, and sometimes, even death. For many years, people believed that the disease was spread from person to person, much like the cold or flu. However, this was not the case. It took the dedicated research of a doctor named Carlos Juan Finlay to show people how to prevent a disease that was killing people by the thousands. In the 1800's, yellow fever was a serious threat to Cuba's population. Because people believed that the disease was spread from person to person, they tried to prevent the spread of the disease by quarantining people. However, this did not help. Dr) Finlay had a different hypothesis. He noticed the worst outbreaks of yellow fever happened when mosquitoes were most active. This led him to theorize that mosquitoes spread the disease, not people. This was a revolutionary idea; no one had considered the possibility of mosquitoes being vectors of disease. In fact, the idea was so revolutionary that no one believed Finlay for over 20 years. Eventually, Finlay's theory was proven. A team of military doctors led by Dr. Walter Reed conducted a series of experiments that proved once and for all that mosquitoes were indeed responsible for spreading yellow fever. Armed with this information, people took new measures to protect themselves from yellow fever. As a result of this discovery, yellow fever has almost completely disappeared from Cuba and many other nations. Based on the text, which is NOT true regarding yellow fever?

Lactose Intolerance Lactose intolerance is the inability to digest a sugar called lactose in milk and other dairy products. Adults in most of the world are lactose intolerant, although infants are not. This is because many adults lack an enzyme known as lactase. Lactase, which can be found in cells in the intestine, is the enzyme that breaks down lactose. Many individuals lose the ability to synthesize lactase after age six. However, not everyone does. Whether or not the body continues to produce lactase often depends on ethnicity. While only 5-15% of adults of European descent cannot digest lactose, 80-90% of adults of African and Asian descent are lactose intolerant. Research has shown that people of northern European ancestry contain a genetic mutation that allows the secretion of lactase in adulthood. The main symptom of lactose intolerance is gastrointestinal upset. Lactose intolerant people may experience diarrhea, bloating, abdominal pain, gas, and vomiting after consuming lactose-containing foods and beverages. Although there has been some research into gene therapy as a treatment for lactose intolerance, the current best treatment is either ingesting lactase supplements when consuming dairy products or simply avoiding foods containing lactose altogether. Question: What is the main idea of the passage?

The Science of Taste Have you ever looked at your tongue in a mirror? If so, you have probably noticed that it is bumpy. The bumps on your tongue are called papillae. Each one of the papillae contains hundreds of taste buds. You also have taste buds on the roof of your mouth and on your epiglottis, which is located at the top of your throat. The taste buds send messages to your brain that tell you about its basic flavor-that is, whether you are eating something salty, sweet, bitter, sour, or umami. Umami is hard to describe, but it is most often called a "meaty" or "savory" flavor. Foods with an umami flavor include meat broth, cheese, and soy sauce. Your mouth and tongue also have receptors that send information about things besides the basic flavors of food. Your mouth has temperature receptor cells that can tell whether a food is piping hot or ice cold. Other receptors give information about the texture of food or how spicy it is. But just being able to tell whether what you are eating is sour, cold, crunchy, or spicy is not truly tasting the food. For example, orange soda and root beer are both sweet, cold, and bubbly, but they do not taste the same. In order to get the full flavor of your food, you also need to use your sense of smell. The upper part of your nose contains special cells called olfactory receptors. They send messages about what things smell like to your brain. As you chew your food, chemicals quickly travel to the olfactory receptors in your nose. When your brain gets information from both the olfactory receptors and the taste buds, you experience the full flavor of what you are eating. Question: According to the text, which is NOT necessary in order to get the full flavor of food?

Preventing Heart Disease Heart disease is a life-threatening condition that kills millions of people every year. In fact, heart disease is the number one killer of human beings worldwide; over thirty percent of deaths every year are due to some form of cardiovascular disease. Although there are many different types of medications and surgical procedures that can treat heart disease, prevention is the most important factor in reducing the number of deaths. Proper nutrition is important in preventing heart disease. The recommended diet for a healthy heart is low in saturated fats, cholesterol, salt, and refined sugar. The diet should be high in fiber, whole grains, fruits, and vegetables. Smoking and excessive alcohol consumption should be avoided. Smoking increases the risk for heart disease at least ten-fold, and drinking too much alcohol can raise the levels of some fats in the blood and lead to high blood pressure and increase the risk of cardiovascular damage. Lack of physical exercise can also make a person more likely to suffer from heart disease. Participating regularly in aerobic exercise, which can include walking, jogging, dancing, or swimming, significantly reduces the risk of heart disease. Another contributor to heart disease is stress. Constant stress can expose your body to persistently elevated levels of the stress hormones cortisol and adrenaline. High levels of these hormones can increase blood pressure and damage artery walls. Engaging in yoga, meditation, or other relaxation techniques can be helpful in reducing stress and lowering the risk for heart disease. Question: Which would could best replace "persistently" in paragraph 5?

Synaesthesia Does the number five smell like lemons? Is the sound of a flute purple? Does the letter "R" taste like cinnamon? These questions might seem strange, but to people with synaesthesia, they make perfect sense. Synaesthesia is a neurological phenomenon where the senses get crossed. People with synaesthesia (also called "synaesthetes") experience this phenomenon in different ways. The most common form of synaesthesia is called color-graphemic synaesthesia. People who experience this form of synaesthesia associate letters and numbers with certain colors. For example, the letter "A" might always appear to be red and the number eight might always look blue. Another common form of synaesthesia is chromesthesia: the association of sounds with colors. Some people who experience this phenomenon see bursts of color when they hear everyday sounds, such as dogs barking or water dripping. Others associate specific colors with different musical notes. Although scientists do not yet understand what causes some people to experience synaesthesia, some researchers argue for something called the cross-activation theory. This theory suggests that the regions of the brain responsible for interpreting information from the different senses have become "crossed," that is, the neurons from one sense inadvertently activate the neurons from another sense. There is also evidence to suggest that synaesthesia is a genetic trait. While there is no treatment for synaesthesia, there is also not much demand for a treatment; most synaesthetes report that they find their condition rather pleasant. Question: Which of the following is NOT true about synaesthesia?

Autism and Vaccines Autism spectrum disorders (ASD) are a range of psychological conditions characterized by challenges with social interaction, behavior, speech, and nonverbal communication. While there is no general consensus among medical professionals about the underlying causes of ASD, theories range from genetic inheritance to environmental factors. One of the most controversial theories to have emerged in recent times is that ASD could be caused by the MMR [mumps, measles, rubella] vaccine that was first developed in the 1960s. The vaccine is a mixture of three live viruses and is administered via injection to children when they are one year old. By the late 1990s, this vaccination had led to the near-eradication of measles in countries that employed widespread inoculation. However, a combination of spurious scientific data and alarmist media attention led to an entirely preventable resurgence in measles cases in the early 21^st century. The first claims of a connection between the MMR vaccine and autism were made in 1998, when an article in The Lancet, a respected British medical journal, reported on eight cases of autism that could possibly be traced back to the administration of an MMR vaccine. An onslaught of media coverage followed the publication of this article. The popular press quickly seized upon this story; in 2002, over 1200 articles were written about the link between MMR vaccines and ASD. Less than 30% of these articles, however, mentioned that an overwhelming amount of scientific evidence suggested that these vaccinations were completely safe. Question: Which of the following is true according to the passage?

Hiccups At some point in your life, you have probably had the hiccups. Hiccups are caused by spasms in the diaphragm, a muscle located at the bottom of your chest. As we inhale, the diaphragm contracts, pulling air into the lungs. As we exhale, the diaphragm relaxes, pushing air back out through the mouth and nose. When we hiccup, the diaphragm jerks downward suddenly, pulling a quick burst of air into our lungs. As the air rushes into your body, it hits the voice box. This causes your vocal cords to snap shut, creating the sound we recognize as a hiccup. Hiccups can be triggered by many different things-eating too much, drinking too fast, sudden change of temperature, stress, fatigue, nervousness, and even excessive laughter can all cause the hiccups. While there are many home remedies for hiccups, there is no evidence to suggest that any of them are actually effective. In fact, most cases of the hiccups go away on their own. Although hiccups are usually harmless, they can be a sign of something more serious. Long-term hiccups might be a result of damage to the nerves that serve the diaphragm muscle. Persistent hiccups might also be caused by certain central nervous system disorders, traumatic brain injuries, drug abuse, or kidney disease. Question: What is the main idea of the passage?

Guide dogs Guide dogs are service animals that are specially trained to help visually impaired people. Most guide dogs are Labrador Retrievers, Golden Retrievers, or German Shepherds, breeds known for their intelligence, gentleness, and friendliness. Puppies that might become guide dogs are monitored from a very young age by trainers. Puppies that demonstrate a good temperament and willingness to learn begin their training at about 16 months of age. Puppies that have been selected for training live with their trainer's family for about a year. Trainers teach the puppies to walk in straight lines, avoid obstacles, and stop at curbs. The dog learns how to focus on the owner instead of distractions, such as food, toys, or other animals. Guide dogs learn how to obey their owners, but also when to refuse their owner's commands when it might lead to danger, such as crossing a busy street. When the dog is full-grown, the trainer brings it in for a final assessment. If the dog passes the test, it is placed with a visually impaired person in need of a service animal. If the dog fails the assessment, however, it often remains as a pet with the trainer's family. Although trainers might be sad to part with the dog that they have bonded with, they know that their former charge has become an invaluable resource for someone in need. What is the main idea of this passage?

Guide dogs Guide dogs are service animals that are specially trained to help visually impaired people. Most guide dogs are Labrador Retrievers, Golden Retrievers, or German Shepherds, breeds known for their intelligence, gentleness, and friendliness. Puppies that might become guide dogs are monitored from a very young age by trainers. Puppies that demonstrate a good temperament and willingness to learn begin their training at about 16 months of age. Puppies that have been selected for training live with their trainer's family for about a year. Trainers teach the puppies to walk in straight lines, avoid obstacles, and stop at curbs. The dog learns how to focus on the owner instead of distractions, such as food, toys, or other animals. Guide dogs learn how to obey their owners, but also when to refuse their owner's commands when it might lead to danger, such as crossing a busy street. When the dog is full-grown, the trainer brings it in for a final assessment. If the dog passes the test, it is placed with a visually impaired person in need of a service animal. If the dog fails the assessment, however, it often remains as a pet with the trainer's family. Although trainers might be sad to part with the dog that they have bonded with, they know that their former charge has become an invaluable resource for someone in need. Which would best replace 'temperament'  in paragraph 1?

Autism and Vaccines Autism spectrum disorders (ASD) are a range of psychological conditions characterized by challenges with social interaction, behavior, speech, and nonverbal communication. While there is no general consensus among medical professionals about the underlying causes of ASD, theories range from genetic inheritance to environmental factors. One of the most controversial theories to have emerged in recent times is that ASD could be caused by the MMR [mumps, measles, rubella] vaccine that was first developed in the 1960's. The vaccine is a mixture of three live viruses and is administered via injection to children when they are one year old. By the late 1990's, this vaccination had led to the near-eradication of measles in countries that employed widespread inoculation. However, a combination of spurious scientific data and alarmist media attention led to an entirely preventable resurgence in measles cases in the early 21^st century. The first claims of a connection between the MMR vaccine and autism were made in 1998, when an article in The Lancet, a respected British medical journal, reported on eight cases of autism that could possibly be traced back to the administration of an MMR vaccine. An onslaught of media coverage followed the publication of this article. The popular press quickly seized upon this story; in 2002, over 1200 articles were written about the link between MMR vaccines and ASD. Less than 30% of these articles, however, mentioned that an overwhelming amount of scientific evidence suggested that these vaccinations were completely safe. Question: What is the author's purpose in writing this passage?

Preventing Heart Disease Heart disease is a life-threatening condition that kills millions of people every year. In fact, heart disease is the number one killer of human beings worldwide; over thirty percent of deaths every year are due to some form of cardiovascular disease. Although there are many different types of medications and surgical procedures that can treat heart disease, prevention is the most important factor in reducing the number of deaths. Proper nutrition is important in preventing heart disease. The recommended diet for a healthy heart is low in saturated fats, cholesterol, salt, and refined sugar. The diet should be high in fiber, whole grains, fruits, and vegetables. Smoking and excessive alcohol consumption should be avoided. Smoking increases the risk for heart disease at least ten-fold, and drinking too much alcohol can raise the levels of some fats in the blood and lead to high blood pressure and increase the risk of cardiovascular damage. Lack of physical exercise can also make a person more likely to suffer from heart disease. Participating regularly in aerobic exercise, which can include walking, jogging, dancing, or swimming significantly reduces the risk of heart disease. Another contributor to heart disease is stress. Constant stress can expose your body to persistently elevated levels of the stress hormones cortisol and adrenaline. High levels of these hormones can increase blood pressure and damage artery walls. Engaging in yoga, meditation, or other relaxation techniques can be helpful in reducing stress and lowering the risk of heart disease. Question: What can be inferred from a person with constantly elevated stress levels, according to the passage?

Mercury in Fish Mercury is a highly toxic metal found in neon signs, fluorescent lights, older thermometers, and certain kinds of telescopes. It can also be found in something that many people eat on a regular basis: fish. The mercury we might find in a can of tuna is most likely an indirect result of the coal industry. Mercury, which is naturally found in coal, is released into the air when coal is burned. It finds its way into waterways via mercury-laced rain. Mercury accumulates in certain kinds of fish through a process called biomagnification. Biomagnification occurs when a substance enters the food chain in small amounts at the very bottom and then increases in concentration in animals higher up on the food chain. Once a fish eats another creature containing mercury, the mercury does not leave that fish's body, but instead is stored in fat. Therefore, the mercury continually accumulates as more mercury-contaminated fish are eaten. Despite the toxicity of mercury and the widespread nature of fish contamination, there is no need for the public to be overly apprehensive. Many popular fish, such as salmon, catfish, or tilapia, are generally safe to eat. Other fish, especially tuna and grouper, should only be eaten in moderation. Young children and pregnant women should be especially cautious about how many servings of mercury-contaminated fish they have per week. It is recommended that people in these groups not eat more than 2 servings of mercury-contaminated fish per week. Fish with the highest levels of mercury include shark, swordfish, and king mackerel. All people should avoid eating large amounts of these kinds of fish, and no one should eat these fish more frequently than once a month. Question: Which supporting detail is an example of a suggestion, rather than factual information?

Fibromyalgia Fibromyalgia is a chronic condition that affects an estimated 3-6% of the world's population. The disorder is characterized by both physiological and psychological symptoms, including nerve pain, fatigue, sleep and mood disturbances, headaches, bowel problems, and incontinence. The exact cause of fibromyalgia is unknown. For some people, fibromyalgia symptoms begin after some sort of physical or psychological stress. However, for others, the onset of symptoms is gradual. Research has shown that genetics may play a part, but there is also evidence that environmental factors can contribute. The wide variety of symptoms made it difficult to diagnose and treat for many years, though recent research has made some promising advances. Although a cure for fibromyalgia has not yet been developed, research has shown that some of the symptoms can be treated with pharmaceuticals, such as tricyclics or gabapentinoids, or non-pharmacological methods, such as meditation, mindfulness, and cognitive behavior therapy. The most successful pharmacological treatment for fibromyalgia has been tricyclic antidepressants, such as amitriptyline and nortriptyline. These drugs increase the levels of the neurotransmitters serotonin and norepinephrine, which are often found at decreased levels in the brains of people who suffer from chronic pain. By boosting endorphins and relaxing muscles, tricyclics can ease some of the musculoskeletal pain felt by people with fibromyalgia. Question: Which of the following can be inferred from information in the passage?

Does Low Body Temperature Cause Illness? As children, we are often told to dress warmly in the winter so we do not get sick. This is a common piece of advice, but is there any truth behind it? In fact, there is no scientific evidence to suggest that being cold can get you sick. Most illnesses are caused by viruses and bacteria. Illnesses like strep throat, influenza, and the common cold are only spread through contact with other infected people. How cold you are when you come into contact with the virus or bacteria has nothing to do with whether or not you will get sick. The effect of body temperature on contracting illness was tested on human beings in the 1950s. Researchers divided volunteers into two groups: half of them were kept in a warm room and the other half were kept in a cold room. Both groups were then exposed to rhinovirus-the virus responsible for the common cold. The researchers discovered that members of both groups developed colds at the same rate. Since that first experiment, there have been similar experiments performed with a variety of different illnesses. All have yielded the same result: being cold does not make a person more likely to get sick. Of course, it does seem that people do get sick more often when the weather is cold. However, this is because there is some evidence that people do get sick more often in cold weather, but it has nothing to do with forgetting to bundle up when it is chilly. When it is cold outside, people tend to stay inside. With so many people gathered closely together indoors, germs are spread more easily. Germs are spread from person to person, regardless of how cold or warm their bodies are. What is the main idea of the passage?

Father of Surgery Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi, also known as Albucasis, is considered by many people to be the "Father of Modern Surgery." Al-Zahrawi was born in Spain in 936 CE, a time when Spain was part of the Islamic empire. One of Al-Zahrawi's greatest contributions was the Kitab al-Tasrif, a 30-volume encyclopedia of medical information. The Kitab al-Tasrif took Al-Zahrawi over 50 years to complete. It contains information about a wide variety of illnesses, injuries, medical conditions, treatments, and surgical procedures. His book includes discussions of dentistry, obstetrics, ophthalmology, urology, and cranial surgery, among many others. He even provides illustrations for over 200 different surgical instruments. In the Kitab, Al-Zahrawi presents the first description of ectopic pregnancy and provides the first evidence that hemophilia is a genetic condition. Surgeons continued to use the information in the Kitab al-Tasrif well into the 1700s. In fact, some of Al-Zahrawi's practices are still being used to this very day. For example, Al-Zahrawi developed a technique to treat gynecomastia (enlarged breast tissue) in men that is still in practice today. Finally, the Kitab also includes something vital for all modern practitioners to keep in mind: a reminder that patients are human beings who must be treated regardless of their wealth or social status. Question: What is the correct meaning of the word 'vital' in paragraph 3?

Concussions Concussions are brain injuries that occur when a person receives a blow to the head, face, or neck. Although most people who suffer a concussion experience initial bouts of dizziness, nausea, and drowsiness, these symptoms often disappear after a few days. The long-term effects of concussions, however, are less understood and far more severe. Recent studies suggest that people who suffer multiple concussions are at significant risk for developing chronic traumatic encephalopathy (CTE), a degenerative brain disorder that causes a variety of dangerous mental and emotional problems to arise weeks, months, or even years after the initial injury. These psychological problems can include depression, anxiety, memory loss, inability to concentrate, and aggression. In extreme cases, people suffering from CTE have even committed suicide or homicide. The majority of people who develop these issues are athletes who participate in popular high-impact sports, especially football. Improvements in diagnostic technology have provided substantial evidence to link severe-and often fatal-psychological disorders to the head injuries players receive while on the field. Recent autopsies performed on the brains of football players who have committed suicide have shown advanced cases of CTE in every single victim. In response to the growing understanding of this danger, the National Football League (NFL) has revised its safety regulations. There is hope that these new regulations, coupled with advances in helmet design, will reduce the number of concussions player endure, and thus curb the number of CTE cases. Efforts by the NFL and other professional sports leagues are certainly laudable. However, new regulations at the professional level cannot protect amateur players, especially young people. Fatal cases of CTE have been reported in victims as young as 21. With appropriate equipment and form, tackling need not be dangerous. Proper tackling form-using the arms and shoulders to aim for a player's midsection rather than leading with the top of the head-should be taught at an early age. Youth, high school, and college leagues should also adopt safety rules even more stringent than the NFL's. Question: According to the text, what can be inferred in a case involving an athlete with chronic traumatic encephalopathy (CTE)?

Diabetes There are two types of diabetes: Type 1 and Type 2. Both types of diabetes can cause a variety of serious health risks if left untreated. Some of these health problems include kidney disease, blindness, heart disease, and strokes. About 5-10% of people with diabetes have Type 1 diabetes. Type 1 diabetes most commonly develops in young people. In Type 1 diabetes, the immune system destroys the cells in the pancreas that secrete insulin. Without insulin, the body's cells cannot absorb glucose, and thus cannot produce energy. Symptoms appear after about 90% of the cells have been destroyed. Although most cases of Type 1 diabetes are genetic, some have arisen in people who have had viral infections of the pancreas. Most people who have diabetes (90-95%) have type 2 diabetes, which most commonly develops in people over age 40. Type 2 diabetes results from the inability of tissues to respond to insulin-a condition called insulin resistance. As Type 2 diabetes progresses, the pancreas produces less and less insulin, resulting in a condition called insulin deficiency. There is no cure for either Type 1 or Type 2 diabetes. However, there are ways to manage both types. For Type 1 diabetes, treatment requires receiving regular insulin injections. Type 2 diabetes can also be treated with insulin injections, but can be also be managed with lifestyle changes, such as weight loss, exercise, and reducing intake of carbohydrates. Which detail provides scientific reasoning to support the idea that "diabetes can cause a variety of health risks if left untreated"?

Lyme Disease Lyme disease is caused by ticks. More specifically, Lyme disease is caused by Borrellia bacteria, which are carried by ticks. When ticks infected with this bacteria bite humans, the bacteria can be transmitted into the bloodstream, causing an illness known as Lyme disease. The symptoms of Lyme disease include fever, headache, fatigue, and joint and muscle pain. One of the most noticeable signs is a rash that looks like a series of red rings radiating out from the bite. This usually appears a week after the tick bite. However, not everyone with Lyme disease gets this rash. The good news is that Lyme disease can be treated with antibiotics. Most people recover quickly and fully. However, if Lyme disease is not treated properly, patients can suffer from debilitating symptoms weeks, months, and even years after the bite. This condition is known as post-treatment Lyme disease (PTLD) or chronic Lyme disease (CLD). To protect yourself from Lyme disease, always cover your skin with clothing or insect repellent when hiking or camping. If you get bitten by a tick, remove the tick right away; most cases of Lyme disease require the tick to be attached for 36 to 48 hours. If red rings appear, see a doctor right away. Lyme disease can be harmful, but it is preventable and treatable with early intervention. Question: Which of the following is included in the passage regarding tick bite symptoms?