Topic 1 SLOP Booklet

Lifestyle, Health and

Risk

Name:
Class:
Teacher:
 Water

Water plays many essential roles in living things.

Water has a very special structure. This is due to the atoms that make up a water or (H 2O)
molecule and how they bond together. The electrons in the outer shell of oxygen shares its
charges with the two electrons from the hydrogen atoms to form what are called strong covalent
bonds.

The oxygen end of the molecules has more electrons than the two
hydrogen ends and the whole molecule develops what we call a
polarity shown by the δ + and δ – signs.

This means that water molecules tend to rotate and attract each other
to form what are called hydrogen bonds. These are weak compared to the covalent bonds but
are in fact very important.

Important properties of water

Thermal

The specific heat capacity of water, the amount of energy in

joules required to raise the temperature of 1cm3 of water by 1˚c,
is very high. This is because in water, a large amount of energy is
required to break the hydrogen bonds. This is extremely useful for organisms, helping them to
avoid rapid changes in their internal environment. We notice this in that the land can warm up
and cool down very much within the course of a day whereas it can take months for lakes to
change their temperature very much.

The high thermal capacity of water makes a good place for animals to cool down and the
energy needed for it to evaporate makes it an excellent coolant. We feel this very much when
our evaporating sweat cools our skin and body down. This is also important for the leaves of
plants.

1. How many electrons in a hydrogen atom?

2. How many electrons in an oxygen atom?
3. What is the name of the bond formed between the hydrogen and oxygen atom?
4. Why does this bonding occur?
5. How many electrons are shared between the oxygen and hydrogen atom in each bond
6. Draw the covalent structure of water
7. What is the name of the bonding that occurs between water molecules?
8. Which bond is stronger, hydrogen or covalent?
9. Complete the diagram to show the dipole nature of water
 10. State the unit for energy
11. Define specific heat capacity
12. To raise the temperature of water, what bonds need to be broken?
13. If water has a high specific heat capacity does this mean a lot of energy or little energy is
required to break bonds?
14. Describe how the thermal nature of water is important in the blood
15. If it is 50˚c outside, will the lake’s temperature rise to 50 ˚c?
16. Explain your answer above
17. Explain how the thermal properties of water are useful for aquatic organisms

Density

Water’s lower density in its solid form is due to the way hydrogen bonds are oriented as it freezes.
Specifically, in ice, the water molecules are pushed farther apart than they are in liquid water.
That means water expands when it freezes.

These characteristic mean that water is often a good habitat for living things as it keeps a
reasonably steady temperature and allows many to survive over winter at the bottom of ponds
and lakes.

18. Draw the particle model for the 3 states

19. Which state has the lowest density?
20. Which state has the highest density?
21. Is water less dense as a solid or liquid?
22. Is oil less dense as a solid of liquid?
23. How are the water molecules arranged in it’s solid form?
24. If I filled a water bottle to the very top and then put it in the freezer, what would I expect to
happen?
25. If the temperature outside is 0˚c, does the water in a lake freeze?
26. What part of the lake would be frozen?
27. Are ice bergs that form in the sea less or denser to water
28. Why is this characteristic of water vital to aquatic organisms in the winter?

Cohesive properties

The hydrogen bonds between water molecules means that water sticks together to form droplets,
forms a surface skin on ponds and lakes. This allows many insects to walk on its surface or larvae to
cling to this surface. Water also climbs up and along small tubes like the root systems of plants.
Adhesion is the attraction of molecules of one kind for molecules of a different kind, and it can be
quite strong for water, especially with other molecules bearing positive or negative charges.

Solvent properties

Many chemicals dissolve easily in water due to their dipole nature allowing vital biochemical
reactions to occur in the cytoplasm of cells. This means chemicals are free to move around and
can react, often with water itself being involved in the
reactions for example in hydrolysis and condensation
reactions. The dissolved substances can be
transported around organisms, in animals by the
blood and lymph systems, and in plants through the
xylem and phloem.

Ionic substances, such as sodium chloride (NaCl),

dissolve easily in water. The negative Cl- ions are
attracted to the positive ends of the water molecules
while the positive Na+ ions are attracted to the negative ends of the water molecules.

29. Define cohesion

30. What bonds are responsible for the strong cohesive force in water?
31. What forces are responsible for creating surface tension on
water? A

The diagram to the left shows surface tension in the water

suspended in a spider’s web. B

32. Is surface tension greater in A or B

33. Explain the reason for your answer
34. Define adhesion
35. What forces are responsible for the movement of water through a tree
36. What is a solute
37. What is a solvent
38. What is an aqueous solution
39. If something is water soluble what does it mean?
40. State two properties that make water an excellent solvent
41. Are polar molecules water soluble?
 42. Are non polar molecules water soluble?
43. Why are fats and oils unable to dissolve in water?
44. Is NaCl a polar molecule?
45. Explain your answer
46. Explain how NaCl behaves in water
47. If vitamin C is water soluble, what bonds are being formed between water and vitamin C?
48. This means vitamin C is a __________ molecule
49. Explain how the properties of water make it an ideal transport medium in 3 points.
Blood plasma contains glucose dissolved in water. Glucose is a polar molecule that is taken
up by muscle cells and used in the synthesis of glycogen.
50. Explain why water is a good solvent.
51. What property of water allows it to stick to a dry surface, such as a wooden countertop?
52. How does water help cells keep an even temperature despite temperature changes in the
environment?
53. Predict what will happen if some drops of water-soluble dye were added to a water-oil
mixture. Oil is non-polar; it is hydrophobic (water-repelling).
54. Explain why water forms large, round drops as it falls from a faucet with a slow leak

55. In a water molecule,

A All of the atoms have a slight B the oxygen atom has a slight positive
positive charge charge and the hydrogen atoms
have a slight negative charge

C The oxygen Atom has a slight D all of the atoms have a slight negative
negative charge and the hydrogen charge
atoms have a slight positive charge

56. When sodium chloride is dissolved in water, the sodium ions

A are attracted to the oxygen atoms B are attracted to each other

of water molecules

C are attracted to the hydrogen D do not dissociate from the sodium

atoms of water molecules chloride

57. hydrogen bonds

A form between hydrogen atoms in B hold water molecules to one another

different molecules

C are strong bonds D hold the two hydrogen atoms

together in a molecule of hydrogen
gas, H2

58. When a glass is filled to the brim with water, the water appears to bulge from the sides of the
glass due to

A capillarity B adhesion

C thermal energy D cohesion

59. When liquid water is heated, most of the energy that the water initially absorbs is used to

A raise temperature of water B make the water boil

C break the covalent bonds between D break the hydrogen bonds between
the hydrogen and oxygen atoms in the water molecules
water

Carbohydrates

Carbohydrates are an important energy source for plants and animals. They are a large family of
compounds containing Carbon, Hydrogen and Oxygen atoms. They following a general ratio of
C: 2H: O. Sugars are either monosaccharides, disaccharides or polysaccharides.

Monosaccharides

These are single sugar units with the general formula(CH2O)n. Monosaccharides provide a rapid
source of energy.
 Monosaccharid
Structure Function
e

Known as alpha glucose. Main sugar used for

respiration. Starch and glycogen are polymers of
Glucose
glucose. Is absorbed and transported in the
bloodstream to cells.

Galactose

Mainly in our diet as part of lactose disaccharide.

Fructose
Sugar found naturally in fruit, honey and some
vegetables.

Condensation and hydrolysis reactions

Condensation is a reaction joining 2 molecules. This is where a water molecule is released as the
two molecules combine in the reaction. Water is formed from the loss of a Hydrogen (H) atom
from one and a Hydroxyl group (OH) from the other molecule.

Two glucose molecules (each is a monosaccharide) will join to make a disaccharide.

A glycosidic bond is formed to make a disaccharide. The

bond is known as a 1,4 glycosidic bond.

The glycosidic link between two sugar units in a

disaccharide can be split by hydrolysis. This is the
reverse of condensation: Water is added to the bond
and the molecule splits into two. Hydrolysis of
carbohydrates takes place when carbohydrates are
digested in the gut and when carbohydrate stores in a
cell are broken down to release sugars.
 Disaccharide Constituent One role in living
monomers organisms
Lactose  Galactose+ glucose Carbohydrate source in mammalian milk

 Maltose Glucose + glucose Found in germinating seeds. Intermediate in breakdown

of starch

 Sucrose Fructose + glucose Form in which sugars are transported in plants

1. State the 3 elements found in carbohydrates

2. State the name of the 3 monosaccharides
3. Draw the structure of glucose
4. Number the carbon atoms 1-6 in the correct order
5. State the word and symbol equation of respiration
6. Describe the functions of glucose
7. What property would glucose need in order to be soluble in water?
8. Explain how the properties of water make it an excellent solvent to transport glucose.
9. What is fructose?
10. Explain why monosaccharides are rapidly absorbed

11. What is a condensation reaction?

12. What are the products of the condensation of glucose
13. Where in the glucose molecule does the water come from?
14. What is the name given to a single unit of sugar?
15. What is the name given to two units of sugar joining?
16. State the name of the bond formed when two glucose molecules join together
17. Explain the reasoning behind the name of the bond
18. State the name of the molecule formed from:
a. Two glucose molecules
b. galactose and glucose
c. Fructose and glucose
19. Describe the function of the xylem
20. Describe the function of the phloem
21. Name a role of sucrose in the plant
22. How is glucose stored in the plant?
23. Explain the uses of glucose in the plant
24. What is maltose?
25. Explain how sucrose is transported around the plant after photosynthesis

Polysaccharides

There are three main types of polysaccharide found in food: starch and cellulose in plants and
glycogen in animals.

Starch and glycogen act as energy storage molecules within cells. Polysaccharides are suitable
for storage because they are compact molecules with low solubility in water. This means that they
do not affect the concentration of water in the cytoplasm and so do not affect movement of
water into or out of the cells by osmosis.

 Name Monomers Structure Function

Starch Amylose & Amylose is a straight chain of
amylopectin glucose molecules with 1,4
glycosidic bonds between
adjacent glucose molecules.
Position of bonds cause the chain
to coil into a spiral shape.
Amylopectin is a polymer of
glucose but has side branches. A
1,6 glycosidic link holds each side
Major source of energy in our
diet, common in many foods.
Occurs naturally in fruit and
veg. The compact spiral
structure of starch and its
insoluble nature make it an
excellent storage molecule. It
does not diffuse across the
cell membranes and has very
little osmotic effect.

branch onto the main chain.

Glycoge Glucose Made of many monomers of Used by bacteria, fungi and
n glucose. Compact. animals instead of starch as
an energy store. It’s numerous
side branches mean that it
can be rapidly hydrolysed,
giving easy access to stored
energy.

Cellulose Β glucose It is a polymer of glucose. All the
glycosidic bonds are 1,4. Long
unbranched molecule
Indigestible in the human gut,
cellulose has an important
function in the movement of
material through the digestive
tract.

26. What are the monomers of starch?

27. What monomers make up amylose and amylopectin?
28. Describe the structure of amylose
29. What bonds are present in amylopectin?
30. Describe its structure
31. Explain why starch cannot diffuse across the cell membrane?
32. Describe the structure of starch and explain why this structure makes it a suitable molecule
for storing energy (4)
33. Where is glycogen stored in animals?
34. Which hormone catalyses the breakdown of glycogen?
35. What is glycogen broken down into?
36. Describe the structure of glycogen
37. Explain how carbohydrates are broken down in our digestive system
38. Explain how glucose enters our cells from the food we eat
39. Explain why there is a large store of glycogen in our muscles
40. Glycogen is inert, suggest what this means.
41. Which property of glycogen allows it to store a lot of energy
42. Explain the advantages of glycogen as an energy storage molecule in the human body (3)
43. Cellulose only has 1,4 glycosidic bonds, what does this tell us about it’s shape and structure.
44. Which would cause a higher spike in blood sugar when eaten, glucose or starch?
45. Explain your answer
46. Describe the fluid-mosaic model
47. How are carbohydrate incorporated in the cell membrane?
48. What is the function of carbohydrates in the cell membrane?
49. Explain how the structures of amylopectin and glycogen make them suitable for storing
energy. (3)

50. Endurance athletes, such as marathon runners, often 'carb load' before an event. This
involves eating food containing large quantities of starch. Explain why it is useful for
marathon runners to 'carb load'. (4)

51. Draw a diagram to show the molecules produced when two molecules of R join together
during a condensation reaction (3)

Lipids
Lipids are a mixed group of hydrophobic compounds composed of the elements carbon,
hydrogen and oxygen. Lipids are generally composed of fatty acids and glycerol.

Lipids are organic molecules found in every type of cell. They are insoluble in water but soluble in
organic solvents such as ethanol.

There are eight major functions of lipids:

Function Explanation

Energy storage Lipids form excellent energy storage molecules, e.g. as lipid deposits in the
stroma of the chloroplast and as fats in seeds and adipose tissue of
vertebrates. They yield more energy per unit mass than other compounds
so are good for energy storage. Carbohydrates can be mobilised more
quickly, and glycogen is stored in muscles and liver for immediate energy
requirements.

Structural Phospholipids usually make up 40% of cell membranes where their

components amphipathic nature (having a polar and a non-polar end) enable them to
contribute to the spontaneous formation of the bilayer. Cholesterol is also
a major component of animal cell membranes

Thermal insulation Fat conducts heat slowly and therefore the triglycerides, which are stored
as subcutaneous fat in vertebrates, are important for maintaining optimum
temperature for metabolism.

Mechanical e.g. of delicate organs, such as kidneys.

protection

Electrical insulation e.g. Sphingomyelin is a specialised phospholipid in the myelin sheath of

nerve axons.

Waterproofing e.g. The waxy cuticle on the leaf epidermis or as oils on birds’ feathers.

Buoyancy Since fat is less dense than water, fat reserves provide buoyancy for
aquatic animals

Precursors of many E.g. gibberellins – plant growth substances e.g. carotenes,

cell constituents
photosynthetic pigments, coloration pigments, steroid hormones e.g.
 testosterone.

How do animals obtain lipids?

Since all cells contain lipids, any animal that eats a plant or animal cell will take in some lipid.
Triglycerides and phospholipids are hydrolysed by lipase into glycerol and fatty acids. Since lipids
do not dissolve in water, they are not easy to digest and their digestion is accelerated in
vertebrates by the secretion of bile salts, which emulsify them into smaller particles, greatly
increasing the surface area on which lipase can act.

Saturated fats

If the fatty acid chains in a lipid contain the maximum

number of hydrogen atoms, they are said to be saturated. In
a saturated fatty acid, the hydrocarbon chain is long and
straight. They have a high melting point. There is no carbon to
carbon double bonds in the saturated fatty acid chain and
no more hydrogen can be added to it.

Animal fats from meat and dairy products are major sources
of saturated fats straight, saturated hydrocarbon chains
compact together closely. The strong intermolecular bonds
between triglycerides made up of saturated fatty acids results in fats that are solid at room
temperature.

Unsaturated fats

Mono unsaturated fats have one double bond between

two of the carbon atoms in each fatty acid chain.
Polyunsaturated fats have a larger number of double
bonds. A double bond causes a kink in the hydrocarbon
chain. These kinks prevent the unsaturated hydrocarbon
chains packing closely together. Increasing the distance
between the molecules weakens the intermolecular
forces between the unsaturated triglycerides resulting in
oils that are liquid at room temperature. They have a low
meltin point. Olive oil is particularly high in
monounsaturated fats. Most other vegetable oils, nuts
and fish are good sources of polyunsaturated fats.
Triglycerides

Most of the lipids we eat are triglycerides

which are used as energy stores in plants
and animals.

Triglycerides are made up of three fatty

acids and one glycerol molecule linked
by condensation reactions. The bond
that forms between each fatty acid and
the glycerol is known as an ester bond.
Three ester bonds are formed in a
triglyceride. Each is formed in a
condensation with the release of a water molecule.

Cholesterol

Cholesterol is a short lipid molecule which is essential for good health. It’s the vital component of
cell membranes with roles in their organisation and functioning. The steroid sex hormones such as
progesterone and testosterone and some growth hormones are made from cholesterol. Bile salt,
involved in lipid digestion and assimilation, are also formed from cholesterol. Cholesterol is made
in the liver from saturated fats and also obtained in our diet. It is found associated with saturated
fats in foods such as eggs, meat and dairy products.

Phospholipids

Phospholipids have a similar structure to triglycerides, but with a phosphate group in place of one
fatty acid chain. There may also be other groups attached to the phosphate. Phospholipids have
a polar hydrophilic "head" (the negatively-charged phosphate group) and two non-polar
hydrophobic "tails" (the fatty acid chains). This mixture of properties is fundamental to biology, for
phospholipids are the main components of cell membranes.

When mixed with water, phospholipids form droplet spheres with the
hydrophilic heads facing the water and the hydrophobic tails facing
each other. This is called a micelle.

1. Name the elements that make up lipids

2. What are lipids made of?
3. Name two examples of lipids
4. Where are lipids found in plants?
5. Which is a better store of energy, lipids or carbohydrates?
6. Explain your answer
7. Which hormone facilitates the conversion of glucose to lipids
8. Draw the structure of glucose
9. Explain why glycogen is a good store of energy
10. Explain why triglycerides make good insulators
11. Describe the thermal properties of water
12. What is the role of the leaf epidermis?
13. What is buoyancy?
14. Explain why lipid stores are useful for aquatic organisms
15. Name the enzyme that digests lipids
16. Describe two functions of lipids in animals
17. What properties are required to be soluble in water?
18. Suggest why lipids are insoluble in water
19. Which organ releases bile
20. How does the digestive system overcome the insolubility of lipids?
21. Explain the advantage of storing lipids in seeds.

22. What are saturated fats?

23. Name two sources of saturated fats
24. What state are saturated fats typically found in?
25. Describe the structure of saturated fats
26. What is melting point?
27. Explain why saturated fats have high melting points
28. What are monounsaturated fats?
29. What are polyunsaturated fats?
30. What state are unsaturated fats typically found in?
31. What do carbon double bonds cause to happen in the hydrocarbon chain?
32. Explain how the above affects the structure of unsaturated fats
33. Explain why unsaturated fats have a low melting point
34. Describe how the physical appearance of an unsaturated triglyceride would look in
comparison to a saturated one.
35. Suggest what we could add to unsaturated fats to make them more solid at room
temperature.
36. Compare the structures of saturated and unsaturated fats
37. Compare the melting points of saturated and unsaturated fats
38. Lipids can be saturated or unsaturated, explain the differences between these types of
lipids.
39. Explain why most polyunsaturated oils are liquid at room temperature.

40. Describe the structure of triglycerides

41. Draw the structure of a triglyceride
42. Name the bond formed in a triglyceride
43. Lipids are insoluble in water because they are ......................................................A triglyceride is
one type of lipid. A triglyceride consists of one.................................................... molecule with
three .....................................................molecules joined to it by.....................................................
bonds. Triglycerides have important roles in living organisms, including waterproofing
and......................................................
44. What is cholesterol?
45. Where is cholesterol made?
46. Where is cholesterol found in the body?
 47. State the gland that releases testosterone
48. What triggers the release of progesterone
49. What is the function of progesterone?
50. What are phospholipids composed of?
51. Compare the structure of phospholipids with the structure of triglycerides
52. Describe the polarity of a phospholipid
53. Explain how phospholipids interact with water
54. Explain why the pH in the small intestine would change after
lipase hydrolyses lipids (2)
55. Explain how the structure of a phospholipid molecule
contributes to the partial permeability of a cell surface
membrane (3)
56. State how an unsaturated lipid differs from molecule C.
57. Draw a diagram to show the molecules produced from the
complete hydrolysis of this triglyceride.

58. Sort the statements into properties of fats (lipids) and properties of carbohydrates

Immediately usable in respiration Supply more energy per unit mass

Insoluble in water but soluble in Provide body insulation

organic solvents e.g. ethanol

Used as an energy reserve for Glucose monomers

respiration

Soluble (apart from insoluble stores Stored supply of energy

such as starch)

Can exist as fats, oils and waxes Consist of two molecules, glycerol,
and fatty acids
59. Using the image below tick the relevant box

60. Two molecules of P can be joined together by

A A hydrogen bond B A hydrophobic interaction

C An ionic bond D A peptide bond

61. A condensation reaction between two molecules of Q forms

A An ester bond B A glycosidic bond

C A hydrogen bond D A peptide bond

62. Molecule R is

A A fatty acid B An amino acid

C deoxyribose D glucose

63. One of the products of the hydrolysis of molecules S is

A A triglyceride B An amino acid

C glycerol D water

Mass Transport
Why do most multicellular organisms need a mass transport
system?

The bigger an organism is, the lower its surface area to

volume ratio. Substances needed by a large organism could
not be supplied through its exposed external surface. Oxygen
passing through an external surface would be rapidly used
up before reaching the many layers of underlying cells.
Similarly, waste substances would not be excreted quickly
enough. This problem has been solved, through evolution, by
specially adapted tissues and organs.

Surface area: volume ratio

• This determines if diffusion alone will allow substances to move in and out of all cells.

• The bigger the organism gets the smaller the SA:V ratio becomes.

• The time taken for diffusion would be much longer.

In a mass transport system, all the substances move in the same direction at the same speed
(mass flow). Across the range of multicellular organisms found in the living world are a number of
mass transport systems, e.g. the mammalian circulatory system and the vascular system of a plant.
Mass transport systems are just as important for the rapid removal of waste as they are for supplies.
Supplies include an immense number of substances, e.g. glucose, oxygen and ions. Even
communication from one cell to another can take place via a mass transport system, e.g.
hormones in a blood stream. The greater the metabolic rate of an organism, the greater the
demands on its mass transport system.

Different types of circulatory systems

Most organisms that are beyond a certain size have a circulatory system. These systems may be
open or closed.

Insects have an open circulation. The blood is in the body cavity called the haemocoel. It does
not circulate in blood vessels but a dorsal tube-shaped heart maintains movement of the blood in
the chamber. Earthworms have a closed circulation. Five of the blood vessels act like hearts,
pumping the blood through the main two blood vessels. In vertebrates, the pumping of the blood
is performed by a specialised heart. Fish have a single circulatory system. This means
that the blood flows through the heart once on each circuit of the body.

Mammals have a double circulatory system. This means that as blood enters the
heart it is pumped to the lungs, exchanges carbon dioxide for oxygen, and returns
to the heart where further pumping propels it through the rest of the body. The
blood moves through the heart twice during each cardiac cycle. This means the
blood flows through the heart twice for each complete circuit.

The heart gives the blood returning to the heart an extra ‘boost’ that reduces the time taken for
blood to go around the whole body. This allows birds and mammals to have a high metabolic
rate, as oxygen and food substances required for metabolic processes can be delivered more
rapidly.
 1. Define diffusion
2. State and explain a use of diffusion in the body
3. State and explain a use of diffusion in plants
4. Define osmosis
5. Draw the polar structure of water
6. Give three reasons for water's suitability as the basis of transport systems.
7. Explain the role of osmosis in plants
8. Define active transport
9. Describe why this process requires energy
10. Explain the role of active transport in plants

11. What is the purpose of the circulatory system?

12. What vital substances are carried in the blood
13. Why does amoeba not need a transport system?
14. Work out the surface area, volume and surface area to volume ratio for each of the
‘organisms’ below.

15. Describe the relationship between the size of the organism and the SA:V ratio
16. Describe the relationship between the rate of diffusion and the SA:V ratio
17. Explain the above
18. Name two exchange surfaces in the body
19. How are these surfaces adapted for exchange of substances?
20. How can an organism increase in volume while still managing to exchange enough
nutrients by diffusion?
21. What is an open circulation system?
22. What is meant by a double circulatory system?
23. Why is a closed circulatory system more efficient?
24. Fill in the blanks using the key words below
Cell ................................ creates a constant demand to obtain .............................. for
aerobic respiration and release .................................. from aerobic respiration.
Gas ........................... is the transfer of ................... (oxygen and carbon dioxide between
the organism and the environment.
Gas exchange takes place in the ...................... across the cell ........................ by
simple ......................
Animals need to maintain a ................................................. across their exchange surfaces.
Mammals achieve this through ........................... and blood ........................

25. What
carbon is mass
dioxide flow? – concentration gradient – ventilation - gases - respiration –
- lungs
 26. Explain why mammals need a transport system

Application questions

27. In mammals, blood passes through the heart twice for each circulation of the body.
Suggest how this type of circulation enables mammals to carry out effective gas exchange
[3]

28. Flatworms do not have a heart or a circulatory system. Explain why many animals need a
heart and a circulatory system.
[4]

29. Explain, using the term surface area to volume ratio, why large, active organisms need a
specialised surface for gaseous exchange
[2]

scale: A B C

0.075 mm

surface area / mm2 0.28 3.1 23

volume / mm3 0.02 0.59 11.3

surface area to
14:1 5:1 2:1
volume ratio

30. None of the organisms A, B or C has a transport system.

Explain why organisms larger than organism C need to have transport systems
[3]

31. The diagram below shows a mammal and a unicellular organism. The transport system in
mammals is a double circulatory system driven by a pump (the heart), whilst unicellular
organisms have no need for special transport systems.

i. Explain what is meant by a double circulatory system

[2]
 ii. Explain two reasons why mammals need a circulatory system whilst unicellular organisms,
such as that shown in the diagram, do not
[4]

Structure of the Heart

The heart is a double pump and is made of

cardiac muscle. The right side of the heart receives
deoxygenated blood from the body and pumps it
to the lungs. The left side receives oxygenated
blood from the lungs and pumps it to the body.

The heart is divided into four chambers:

The two atria: these are the upper two chambers.

They have thin walls which receive blood from
veins.

The two ventricles: these are the lower two chambers. They have thick, muscular walls which
pump blood through the arteries.

The heart is divided longitudinally into two sides

by means of muscular walls called the septum.

Each atrium is connected to its own ventricle

through an opening which is guarded by
atrioventricular valves. Blood is permitted to flow
only from the atrium into the ventricle, not in the
reverse direction. The right valve (the tricuspid
valve) is made up of three flaps. The left valve
(the bicuspid valve or the mitral valve) has two
flaps.

There are tendons that attach each ventricle to its atrioventricular valve. These tendons stop the
atrioventricular valves from inverting when blood pressure builds up in the ventricles during
ventricular contraction.

The semi-lunar valve can be found where the heart connects with both the aorta and pulmonary
artery. They are formed of (three) half-moon-shaped flaps.

Also present on the hearts surface is a network of arteries known as coronary arteries.These supply
the heart with oxygenated blood to ensure the heart continues to pump.

1. What muscle is the heart made of?

2. What type of blood does the left side of the heart receive?
3. What type of blood does the right side of the heart receive?
4. Name the blood vessels that supply deoxygenated blood to the heart
5. Which chamber does the above blood vessel enter
6. State the function of the pulmoary artery
7. State the function of the pulmomary vein
8. What is the function of the tendons that connect the atrioventricular valves and the
ventricle walls?
9. Which ventricle has thicker muscle?
10. Explain why
11. What is the function of the atrioventricular valves
12. Why is the atrioventricular valve in the right ventricle called the tricuspid valve and the
atrioventricular valve in the left ventricle called the bicuspid valve?
13. What is the function of the semi lunar valves
14. If water were poured into the vena cava, through which vessel would it emerge from the
heart?
15. Draw the structure of a triglyceride
16. Describe the structure of a triglyceride
17. Suggest a reason for the presence of adipose tissue on the heart
18. Describe the function of the coronary artery
19. Explain why a blockage in the coronary artery could be fatal
20. State the role of the septum
21. Explain the effects a hole in the septum would have on the concentration gradient set up
in the lungs
22. Explain how a hole in the septum can lead to lack of energy
23. Fill in the blanks

The heart muscle in the walls of the heart is called ...................................muscle.

The ..............................valves control the flow of blood between the chambers of the heart
The chamber of the heart that receives oxygenated blood from the lungs is named
the ............................ .
Deoxygenated blood is transported back to the lungs in the ........................................... .
Backflow of blood into the heart is prevented by ....................................................... valves.

24. Explain how the heart is adapted for it’s function

[5]
25. Read each of the following statements and write the correct on:
a. The pulmonary vein carries blood from the heart to the lungs.
b. The aorta is the major vein leaving the heart.
c. Atrio-ventricular valves prevent backflow of blood from the arteries into the
ventricles.
d. The semi-lunar valves prevent backflow into the atria.
e. The right side of the heart is thicker, as it pumps blood further.

26. The diagram below shows the external appearance of a human heart.
a. Identify structures A,B,C,D,E
b. State the functions of the part labelled E
 27. A baby was born with an abnormal heart. The diagram shows the heart of this baby. There
is a hole in the septum between the two ventricles.
a. Identify the problem with the blood vessels of
this heart
b. The baby survived because of the hole in the
septum of the heart.
Explain how the hole in the septum allowed
this baby to survive.
[3]

Pressure Changes

The chambers of the heart alternately contract [systole] and relax [diastole] in a rhythmic cycle.
One complete sequence of filling and pumping blood is called a cardiac cycle, or heartbeat.
During systole, cardiac muscle contracts on the heart pumps blood out through the aorta and
pulmonary arteries. During diastole, cardiac muscle relaxes and the heart fills with blood.

Pressure 

As a chamber fills with blood, the pressure is going to rise.

When a chamber contracts, the pressure is going to rise.
Changes in pressure affect whether a valve is open or
closed. Fluids always move from areas of high pressure to
areas of low pressure.  

Heart Valves 
Heart valves function to ensure a one-way flow of blood through the heart. The valves are not
made of muscle, but rather are composed of sheets of tough connective tissue that act like flaps.
The heart valves open and close passively because of pressure differences on either side of the
valve. When pressure is greater behind the valve, the flaps are blown open and the blood flows
through the valve. However, when pressure is greater in front of the valve, the flaps snap shut, and
blood flow is stopped.  

Atrioventricular (AV) and Semilunar Valves 

The atrioventricular valves (AV valves), which separate the atria from the ventricles, allow blood
to flow from the atria to the ventricles, but prevent flow in the opposite direction. The opening
and closing of the AV valves are dependent on pressure differences between the atria and
ventricles. When the ventricles relax, atrial pressure exceeds ventricular pressure, the AV valves
are pushed open and blood flows into the ventricles. However, when the ventricles contract,
ventricular pressure exceeds atrial pressure causing the AV valves to snap shut. 

The semilunar valves are one-way valves that separate the ventricles from major arteries. As the
ventricles contract, ventricular pressure exceeds arterial pressure, the semilunar valves open and
blood is pumped into the major arteries. However, when the ventricles relax, arterial pressure
exceeds ventricular pressure and the semilunar valves snap shut.

1. Name the blood vessel that enters the right atrium

2. Describe the movement of blood through the right side of the heart
3. Describe what happens to the blood in the lungs
4. Name the blood vessel that enters the left atrium
5. Describe the movement of blood through the left side of the heart
6. Define diastole
7. Define systole
8. Describe the relationship between pressure and contraction of chambers
9. When pressure is greater behind the valve what happens?
10. When pressure is greater in front of the valve what happens?
11. Where are the tricuspid and bicuspid valves found?
12. What causes the atrioventricular valves to open?
13. What causes the atrioventricular valves to close?
14. What is the function of tendons in the heart?
15. Where are the semilunar valves found?
16. What causes the semilunar valves to open?
17. What causes the semilunar valves to close?
18. Describe what happens to the valves in the heart when the ventricles contract
19. When pressure in the aorta is higher than the ventricles, what happens?
20. When pressure in the atrium is higher than ventricles what happens?
21. Complete the table

Valves State of valve

Atrium pressure > ventricle

Atrioventricular pressure

Valves Atrium pressure < ventricle

pressure

Ventricle pressure< aortic

pressure
Semilunar Valves
Aortic pressure < ventricle
pressure
 22. The following pressures occur in the heart during a complete cardiac cycle, 0 mm Hg, 20
mm Hg and 180 mm Hg. Which of these pressures do you think is associated with: Atrial
systole, Ventricular systole, and Cardiac Diastole?

The Cardiac Cycle

Cardiac diastole

The atria and ventricles relax during cardiac diastole.

Elastic recoil of the relaxing heart walls lower pressure in
the atria and ventricles. Blood under high pressure in the
pulmonary arteries and aorta is drawn back towards the
ventricles, closing the semilunar valves and preventing
further backflow of blood into the ventricles.

The coronary arteries fill during diastole

Low pressure in the atria helps draw blood into the heart
from the veins. AV valves open once atrial pressure is
higher than ventricle pressure. Ventricles fill passively
with blood.
Atrial systole

When the atria are full, their walls contract (atrial systole) pushing blood through the open
atrioventricular valves into the relaxed ventricles. Blood cannot pass back into the veins because
they contain valves which prevent backflow, and the contracting of the atrial walls partly closes
off the entries of the venae cava and pulmonary veins to the atria

Ventricular systole

After a short delay, the ventricles contract from the apex upwards, forcing the blood at high
pressure into the arteries. At this time, the atrioventricular valves slam shut, preventing backflow of
blood to the atria, and the semilunar valves open to allow the passage of blood the arteries.

1. What are the three phases of the cardiac cycle?

2. Label the diagram below
3. How is the pressure lowered in the atria?
4. Name the blood vessels entering the atriums
5. In the cardiac cycle, what causes pressure to rise?
6. Why is there a difference in pressure between the left and right ventricles?
7. What features of the heart allow it to withstand this high pressure on the left side?
8. Fill in the gaps:

During diastole blood flows into the atria from the _____________ _____________ and
_____________ _____________. Elastic recoil of the atrial walls generates low pressure in the
atria, helping to draw blood into the heart.
Initially the atrioventricular valves are open/closed.
As the ventricles begin to relax, blood tends to fall back from the aorta and pulmonary
artery causing the _____________________ valves to close. This causes the second heart
sound ‘dub’.
9. Using your knowledge of the cardiac cycle and information from the graph to explain what
causes:
a. The rise in both atrial and ventricle pressure at about 0.3s
b. The atrioventricular valve to close at about 0.45 seconds
c. The semilunar valve to open at about 0.5 seconds
d. The rise in aorta pressure after the semilunar valve opens
e. The closing of the semilunar valve at about 0.75 seconds
10. Describe the events that occur during ventricular systole
11. Explain the events the occur during atrial systole
12. Explain when and why the AV valves close
13. Explain when and why the semi lunar valves close
14. Describe the importance of the coronary arteries
15. At what stage do the coronary arteries fill with blood?
16. What substances dissolve in the blood that are transported in the coronary arteries?
17. Recall the structure of glucose
18. What is the advantage of having a closed circulatory system?
19. Explain the importance of valves in the heart
20. Write out the following statements in order:
Blood is pushed into the arteries
Ventricles contract
Blood is forces into the ventricles
Chambers are refilled with blood from the veins
One complete sequence of filling and pumping blood is called a cardiac cycle
Elastic recoil as the heart relaxes causes low pressure in the heart
The atria contract
21. Complete the following:
a. The cardiac cycle is important so…
b. The cardiac cycle is important but…
c. The cardiac cycle is important because…

22. Explain how changes in the volume of the chamber control flow of blood

Application questions

23. The graphs below show the changes in pressure in the aorta and in the left and right
ventricles of the heart, during the cardiac cycle. Time 0 indicates the start of atrial
contraction.
(a) Compare the changes in pressure in the left ventricle with those in the right ventricle,
giving reasons for the differences
[4]
(b) Compare the changes in the pressure in the aorta with those in the left ventricle, giving
reasons for the differences.
[3]
(c) On the graph of changes in pressure in the aorta and left ventricle, show by means of
an arrow when the aortic semilunar valve closes.
[1]
24. The diagram shows a section through a human heart.

a. Which of the blood vessels labelled A to D

i. takes blood from the heart to the muscles of the arms and legs [1]
ii. is a vein which contains oxygenated blood?
[1]
 25. The graphs show some changes in pressure and volume during part of a cardiac cycle.

a.Describe what the graphs show about the pressure and volume in the
ventricle between times X and Y [1]

b. At point Y, the valve between the aorta and the ventricle opens. Use
the information about pressure on the graph to explain why.
[1]
c. Explain the changes in the volume of the ventricle between times X
and Z.
[3]

25. The diagram shows variations in blood pressure in different parts of the circulatory
system.

i. Complete the table with ticks to show whether each of the valves is open
or closed at the point indicated with the letter A on the diagram.
[2]

Valve located between Open Closed

left atrium and left ventricle

left ventricle and aorta

right atrium and right ventricle

right ventricle and pulmonary artery

ii. Pulse can be felt when the fingers are placed over an artery that is close to the
surface. Explain why a pulse cannot be felt when the fingers are placed over a
vein which is close to the surface.

iii. What causes the blood pressure to increase at the point

 indicated with a letter B on the diagram?
[1]

Cardiac Cycle Calculations

The left and right ventricles each pump the same volume of blood through the aorta
and pulmonary artery.

The volume of blood pumped through each ventricle per minute can be calculated as
cardiac output.

Cardiac output can be calculated using the following equation:

Cardiac Output=Stroke Volume× Heart Rate

Units:

CO - ml per minute (ml/min) or l per minute (l/min)

SV - ml or l

HR - beats per minute (bpm) (beats/min)

Stroke volume is the volume of blood pumped out of each ventricle each time the
heart beats

Heart rate is the number of beats per minute and is the same as your pulse rate.

If the heart rate increases, cardiac output increases. Also, if stroke volume increases,
cardiac output will increase.

1. The table shows the volume of blood in a man’s right ventricle at different times during
one cardiac cycle.
 

Time / s Volume of blood / cm 3

0.0 125

0.1 148

0.2 103

0.3 70

0.4 56

0.5 55

0.6 98
 0.7 125

a.       Use the data in the table to calculate the man’s heart rate.

  Heart rate = ............................................. beats per minute

b.  Use the data in the table and your answer to part [a] to calculate the man’s cardiac
output. Show your working.

    Cardiac output = ........................................ cm per minute

3

[3]

(c)     Use information from the table to complete the table below to show whether the
valves are open or closed at each of the times shown. Write open or closed in the
appropriate boxes.
 

Time / s Valve between right Valve between right

atrium and right ventricle and pulmonary
ventricle artery

0.2    

0.6    
[2]

2. The table shows pressure changes in the left side of the heart during one cardiac
cycle.
 

  Blood pressure / k Pa

Time / s Left atrium Left ventricle

0.0 0.7 0.3

0.1 1.0 2.0

0.2 0.2 12.5

0.3 0.2 15.3

0.4 1.0 4.5

0.5 0.5 1.0

 0.6 0.6 0.3

0.7 0.7 0.3

(a)     Between which times is the valve between the atrium and the ventricle closed?

Explain your answer.

Times ............................. s and ............................. s

Explanation ..................................................................................................
[2]

(b)     The maximum pressure in the ventricle is much higher than that in the atrium. Explain
what causes this.
[2]

(c)     Use the information in the table to calculate the heart rate in beats per minute.
[1]

 
3. The pressure of the blood passing through the heart can vary. Graph A shows the changes
in blood pressure in one side of the heart. Graph B shows the changes in blood pressure in
the other side of the heart over the same time period.
Calculate the heart rate.

 
 
4. The diagram shows a section of a human heart and blood vessels.

A scientist investigated the volume of blood pumped by the heart of a healthy individual.
The graph shows the volume of blood measured in the left ventricle.

a.  Calculate the heart rate.

b. Calculate the volume of blood, in dm3, pumped by the left ventricle each minute.

5. The graph shows changes in the volume of blood in the left ventricle as the heart beats.

(a) (i) The horizontal line labelled A on the graph shows when blood is leaving the
 ventricle. Explain, in terms of blood pressure, why blood does not flow back
into the atrium during this period.
[2]

(ii) Draw a horizontal line on the graph, to show the period in one cardiac cycle
when the muscle in the wall of the ventricle is relaxed. Label this line with the
letter B.
[1]

(b) (i) Draw a horizontal line on the graph to show one complete cardiac cycle.
Label this line with the letter C.
[1]

(ii) Use line C to calculate the number of times the heart beats in one minute.
Show your working.
[2]

(c) The table shows the blood flow to different parts of the body at rest and during a
period of vigorous exercise.

3 –1
Part of the body Rate of blood flow/cm minute

at rest during exercise

Brain 750 750

Heart muscle 300 1 200

Gut and liver 3 000 1 400

Muscle 1 000 16 000

All other organs (except 1 550 1 550

lungs)

i. Use the figures in the table to calculate the cardiac output at rest.
[1]

ii. Give two ways in which cardiac output is increased during a period of
vigorous exercise.
 Core Practical 1- Investigating effect of caffeine concentration on Daphnia

In humans, caffeine acts as a stimulant drug, causing increased amounts of stimulatory

neurotransmitters to be released. It increases your blood level of adrenaline. At high levels of
consumption caffeine has been linked to restlessness, insomnia, and anxiety, causing raised stress
and blood pressure. This can lead to heart and circulation problems.

Why use Daphnia?

Daphnia (otherwise known as water fleas) are very common

and so there is no real threat to the species’ existence or its
dependent species (via food webs). There is also no threat to
Daphnia reproduction because they reproduce asexually as
genetic clones – hence no loss of genetic variation. Daphnia
possess a less developed nervous system compared to humans,
so they have a reduced awareness of pain. Finally, Daphnia
are transparent and so the heart is visible, which avoids the need for dissection.

Ethical considerations

Daphnia are most likely not complex enough to suffer physical and mental stress. Nevertheless,
there is still debate over whether animals should possess rights as humans do. Due to a lack of
consent from the Daphnia, we can instead try to minimise the amount of suffering by considering
animal welfare. The purpose of the investigation can be justified if the Daphnia doesn’t suffer as
much. We can minimise the suffering by:

● Returning the Daphnia to their natural habitat after use

● Storing the Daphnia in conditions that replicate their natural environment
● Working at a good pace to minimise time Daphnia are under any possible stress
● Turning off the microscope lamp when not in use, as Daphnia are poikilotherms (cold-
blooded)
● Not using an excessive amount/concentration of caffeine

1. What is the aim of the investigation?

2. State the dependent variable
3. State the independent variable
4. Describe 3 control variables
5. What is the role of cotton wool?
6. How will you record you results?
7. Why are daphnia used for this practical?
8. State two ethical reasons people would be against use of daphnia
9. What ethical considerations will you undertake during your practical?
10. What results do you predict for your investigation?
11. Explain your prediction
12. Recall method for viewing specimen under a microscope
13. Explain why we would not use an electron microscope for this practical
14. Recall the equation for calculating magnification

15. Using the equipment listed below write out your method:
● Culture of Daphnia (water fleas)
● Cavity slides
● Dropping pipettes
● Distilled water
● Caffeine tablets
● Cotton wool
● Standard glassware (beakers, measuring cylinders, etc.)
● Stop clock
● Paper towels or filter paper
● Microscope.

16. How could you improve the precision of your results?

17. How could you improve the reliability of your results?
18. Evaluate the sources of error in your investigation
19. Explain the effect of caffeine on heart rate
20. How do you calculate heart rate?
21. What conclusion can you draw from your investigation?

22. A friend of a student suggested that herbal tea might have a lower caffeine content than
these drinks. The student decided to use Daphnia to compare the caffeine content of
herbal tea with the caffeine content of these other drinks.

a. Describe an experiment that the student could perform, using Daphnia, to confirm
that herbal tea has the lowest caffeine content.
[5]
b. The friend did not agree with using Daphnia in this experiment. Give one ethical
reason for the use of invertebrates and one ethical reason against the use of
invertebrates in experiments of this type.
[2]

23. The photograph below shows Daphnia (a water flea). Daphnia can be used to
investigate the effect of chemicals on heart rate.
a. Give two reasons why Daphnia is a suitable organism for investigating the
effect of chemicals on heart rate.
[2]
b. State two variables that you would need to control for a valid investigation
into the effect of caffeine on the heart rate of Daphnia.
Describe how to control each of these variables.
[4]
 24. A student investigated the effect of caffeine on human heart rate.
Three males of the same age were given cups of coffee containing caffeine. Their heart
rates were measured 10 minutes after drinking the coffee.

Two hours later they were given cups of coffee with no caffeine and after 10 minutes their
heart rates were measured.
The results are shown in the table.

a. The student concluded that caffeine increases human heart rate.

Analyse the data to explain why these results may not support the conclusion.
[3]

b. Describe how this investigation could be improved.

[3]

25. An investigation was carried out to study the effect of caffeine on the heart rate of a chicken
embryo.
The heart from a chicken embryo was removed and placed in a glucose solution. The heart
rate was determined and recorded as the base heart rate.
The experiment was repeated using glucose solutions containing five different concentrations
of caffeine.
The heart rate was determined and recorded as a percentage of the base heart rate for
each solution.
The graph below shows the results of this investigation.
a. Suggest why glucose was included in the solutions.
[2]

b. Suggest how the caffeine solutions were prepared to obtain valid results.
[1]

c. State how these results could be made more reliable.

[1]

d. Using the information in the graph, describe the effect of caffeine on the heart rate of the
chicken embryo.
[3]

e. Describe how this investigation could be carried out using Daphnia instead of chicken
embryos.
[4]

f. Suggest one ethical issue in the use of chicken embryos in this investigation.
[1]
 Blood Vessels

Arteries and veins can easily be distinguished. The walls of both vessels contain collagen, a tough
fibrous protein, which makes them strong and durable. They also contain elastic fibres that allow
them to stretch and recoil. Smooth muscle cells in the walls allow them to constrict and dilate.

Arteries:

Arteries carry the blood away from the heart to respiring tissues at high pressure. Arteries have
specific features than enable it to withstand the high pressure.

Arteries have thick elastin fibres and smooth muscle which largely depends on the distance from
the heart. Arteries close to the heart such as the aorta have a large amount of elastin fibres. This
allows the aorta to carry out its function. For instance, when blood is pumped to the aorta after
the ventricles have contracted the elastin fibres, allows the aorta to expand rather than burst
under high pressure. Secondly, the use of large amounts of elastin fibres allows the arteries to
create a recoil action allowing the blood to be maintained at a high pressure and kept at a
forward direction when the heart relaxes. On the other hand, arteries further away from the heart
contain less amount of elastin fibres, however, have a higher proportion of smooth muscle.

● The outermost layer, with its collagen fibre provides the artery with a tough outer layer.
● Overall thickness of the wall is large within arteries. arteries have relatively small lumen in
relation to the thickness of the wall.
● There are no valves in the arteries since the pressure is so high there is not a tendency for
the blood to flow backwards.

Arterioles:
 ● Connect arteries and capillary beds.
● Have thinner muscular walls and elastic layers
● Smooth muscle around the arterioles allow vasoconstriction and vasodilation to control
blood flow into tissues.

Veins:

Veins main function is to transport blood under low pressure from tissue back to the heart. Blood
within the vein are full of carbon dioxide and now needs to be replenished. The low pressure
begins at the venules and then to the veins. The vein
walls are not very thick and the lumen space is very
wide to maximise the blood flow. Valves are only
found in the veins as the pressure is low, there is a
tendency of blood flowing backwards. Valves ensure
the blood is flowing in the correct direction

● Endothelium is very thin in the veins as the low

pressure within the veins will not cause the veins
to burst. Also there is very few elastin fibres as
there is no need to re-coil and stretch in the veins as the veins are carrying the blood away
from the tissue and the constriction and dilation of the veins cannot control the flow of the
blood.
● Tough outer layer for the veins which consists of collagen fibres, to prevent them from
bursting. It is the skeletal movement that compresses the veins to allow the flow of blood to
be pushed along the vein.
● Venules are smaller version of veins and lack valves and they specifically deliver the
oxygen and nutrients from the capillary beds to the veins

Capillaries:

Capillaries have very small, thin walls that consist of a single-layer of endothelium. This allows
for oxygen and carbon dioxide to be easily diffused. The lumen of the capillaries are very
narrow that allows the red blood cells to be squeezed against the endothelium to allow for a
short diffusion distance for the transfer oxygen and nutrient exchange. Initially the blood is at
high pressure in the arterioles, as it spreads out in the
capillaries, the blood pressure drops, the flow of blood
drops causing the leakage of blood to be reduced. This
is all occurring in the capillary beds due to the increased
resistance due to all the blood being at close contact
with the walls of the capillaries as it enters the tissues.
Capillaries are highly branched and numerous in number
which provides a large surface area for diffusion.

● They have a large SA:V ratio for diffusion.

● They are only 1 cell thick so there is a small diffusion distance.
● Total area of capillary bed > total area of arterioles, so pressure drops causing blood to
move slower to allow more time for diffusion.
1. Name the blood vessel that carries deoxygenated blood away from the heart
2. Name the blood vessel that carries deoxygenated blood to the heart
3. Name the blood vessel that carries oxygenated blood to the heart
4. Name the blood vessel that carries oxygenated blood to the body
5. Define tissue
6. Is blood a cell, tissue, or organ?
7. State the 4 components of the blood
8. Describe the role of each of the above
9. Explain how red blood cells are adapted for their function
10. Compare the lumen sizes of the arteries and veins
11. State the role of smooth muscle cells in blood vessels
12. Draw the structure of a protein
13. What is collagen?
14. State 2 features that allow arteries to withstand high pressure
15. Describe the role of the elastic fibers in the arteries
16. Explain how the structure of an artery is related to its functions.
17. Describe how the structure of arteries change as they go further away from the heart
18. What are arterioles?
19. Describe how the structure of arterioles compare to arteries
20. How is blood flow controlled in arterioles?
21. State the main function of veins?
22. Describe the structure of veins in relation to their function
23. How is blood pushed along the veins?
24. Describe the importance of capillaries having a narrow lumen
25. Explain the relationship between surface area to volume ratio and diffusion
26. Explain why mammals have a double circulatory system
27. Describe how low pressure is achieved in the capillaries
28. Recall Fick’s law
29. Describe how capillaries are adapted for rapid gas exchange
30. State the equation for calculating magnification
31. Compare use of a light microscope vs an electron microscope
32. Describe in steps how you could calculate the actual size of a red blood cell under a
microscope.
33. Convert 150mm into µm
34. Convert 20 µm into mm
35. Convert 10m into µm
36. Convert 5000nm into mm

37.
a.A student calibrating her eyepiece graticule (epg) found 5 units measured 3.5 units
on the stage micrometer, which
are each 1mm in length. Work
out the length of one eyepiece
graticule unit in µm
 b. Using the same epg. The width of the artery wall in the photo was measured 0.2 epg
units as its widest point.
i. What is the width in µm?
ii. Calculate the magnification in the figure above

38. The table below compares some features of different blood vessels from a dog.

a. What is the thickness of one of the endothelial cells lining these blood vessels? Give your
answer in µm [1]
b. Explain why an arteriole may be described as an organ. [2]
c. Use the information in the table to explain how the structure of the walls of arteries,
arterioles and capillaries is related to their function. [6]

39.
a. Explain how the structure of the aorta relates to its function. [3]
b. Describe two differences between the structure of a capillary and the structure of a
vein. [2]

40. Cardiovascular disease can occur in blood vessels

in organs such as the brain and the heart. The
diagram shows a human heart.
 a. Which is the correct label for a coronary artery?
b. Which is the correct label for the blood vessel carrying deoxygenated blood under
the lowest pressure?
c. State the blood vessel that has no collagen in its wall

41. Marfan syndrome is a disorder that affects elastic tissue. Mutations in the FBN1 gene can
cause Marfan syndrome. The FBN1 gene codes for a protein called fibrillin-1.
Fibrillin-1 is involved in the formation of elastic fibres in the walls of blood vessels.

Explain how Marfan syndrome affects the structure and function of an artery.
[2]

42. The diagram below shows a cross-section of an artery.

The diameter of the lumen of this artery is 1.9 mm.

Calculate the cross-sectional area of the lumen. Show your working. Give your answer in
mm2
The area of a circle is calculated using the formula πr2, where r is the radius of the circle
and π = 3.14 [2]

The Blood Clotting Cascade

Rapid blood clotting is vital when a blood vessel is damaged. The blood clot seals the break in the
blood vessel and limits blood loss and prevents entry of pathogens through any open wounds.
When platelets, type of blood cell without a nucleus, come into contact with the damaged vessel
wall they change from flat and disc to spheres with long thin projections. The cell surfaces
change, causing them to stick to the exposed collagen in the wall and each other to form a
temporary platelet plug. They also release substances that activate more platelets.

The direct contact of blood with collagen within the damaged blood vessel wall also triggers a
complex series of chemical changes in the blood. A cascade of changes results in the formation
of a blood clot.
 The clotting cascade:

1. Platelets and damaged tissue release a

protein called thromboplastin
2. Thromboplastin activates an enzyme that
catalyses the conversion of the protein
prothrombin into an enzyme called thrombin.
Several other protein factors, vitamin K and
calcium ions must be present in the blood
plasma for this conversion to happen.
3. Thrombin then catalyses the conversion of
the soluble plasma protein, fibrinogen, into
the insoluble protein fibrin.
4. A mesh of fibrin that traps more platelets and red blood cells to form a clot

1. Name the components in the blood responsible for clotting

2. Describe the structure of the above component
3. Define pathogen
4. Describe how white blood cells respond to pathogens
5. What is the endothelium lining?
6. Compare the endothelium lining in capillary’s and arteries
7. State how the endothelium lining can get damaged
8. Name the monomers that make up proteins, lipids, and starch
9. Draw the zigzag structure of a triglyceride
10. Describe the food tests for each of the above biological molecules
11. How is a platelet plug formed?
12. Describe the structure of collagen
13. What triggers the blood clotting cascade?
14. State the role of the blood clotting cascade in the body
15. Where is thromboplastin released from?
16. Describe the role of thromboplastin
17. State the factors required the production of thrombin
18. Where are these factors found?
19. Define enzyme
20. Describe how enzymes speed up the rate of reaction
21. Which biological molecule makes up enzymes?
22. Describe the lock and key model, draw a diagram.
23. Define optimum
24. Describe how increasing temperature affects enzyme reactions
25. Define insoluble
26. Define soluble
27. Describe the solubility of fibrin vs fibrinogen
 28. Describe the role of thrombin in the blood clotting cascade
29. Describe the role of fibrin in the blood crossing cascades
30. Hemophilia is caused by a mutation in one of the genes that provides instructions for
making the clotting factor proteins needed to form a blood clot. Explain how this would
affect the blood clotting cascade.
31. Describe the blood clotting cascade in five point
32. State if the following are true or false:
a. Fibrin in soluble, fibrinogen in insoluble.
b. Thrombin converts into thromboplastin.
c. Thromboplastin is an enzyme.
d. Ca+ ions are needed for the clotting cascade to occur.
33. Correct the above false statements
34. Complete the statements below
a. The blood clotting cascade is important because…
b. The blood clotting cascade is important so…
c. The blood clotting cascade is important but…

35. Draw a diagram/story board to explain the clotting process

36. From your diagram, which molecules involved are enzymes?
37. From your diagram, which molecules involved are soluble and which are insoluble

38. A Platelet

A is a protein that forms an insoluble B is an enzyme that converts

mesh to trap red blood cells prothrombin into thrombin

C is a cell fragment that releases D is a cell fragment that releases

thromboplastin fibrinogen

39. Thrombin is

A an enzyme that changes fibrinogen B an enzyme that changes fibrin into

into fibrin fibrinogen

C an insoluble protein that forms a D a protein that sticks to collagen in

mesh to trap red blood cells damaged walls of arteries

40. Fibrinogen is

A an insoluble protein that forms a B a soluble plasma protein

mesh to trap red blood cells

C an enzyme that converts D a clotting factor released by

prothrombin into thrombin platelets
 41. Complete the gaps in the following:
The cell fragments called ........................................................... stick to the site of damaged
tissue.
This causes thromboplastin to be released, resulting in ...........................................................
being converted into an enzyme. This enzyme catalyses the conversion of a
soluble plasma protein into long, insoluble strands of ............................................................
This insoluble protein traps red blood cells to form a clot.

42. The photograph shows the tropical rattlesnake, Crotalus durissus terrificus.

This snake produces a toxin called convulxin (CVX), which activates platelets leading to blood
clotting.
The effect of four different concentrations of CVX on thrombin production was investigated.
The graph shows the results of this investigation, with bars showing the standard deviation.

a. Analyse the data to assess the effect of CVX on the rate of blood clotting.
[5]

b. There are many venomous snakes in the world. Many of the venoms from these snakes
affect the blood clotting process.

Describe the blood clotting process

[4]
 Atherosclerosis

The term of Atherosclerosis is of ancient Greek origin where “athero” refers to mush and “sclerosis”
means the hardening. Atherosclerosis is a complex disorder that refers to the hardening of the
arteries due to the accumulation of lipids (particularly cholesterol). It describes the build-up
of plaques also known as fatty deposits in the inside of arteries that cause the disorder to be
progressive as it can either block the artery or increase the chance of an artery being blocked. If
blood supply is not restored very quickly, the affected cells are permanently damaged.

Step 1- Endothelial damage

The first step to the formation of an atherosclerotic plaque (also known as “atheroma”) is damage
to the endothelium lining of an artery. People who are most likely to develop atherosclerosis are
those who have a high blood pressure and high levels of cholesterol in their diet.

The damage can also occur due to several other risk factors listed below:

● Tobacco smoke
● High blood pressure
● High cholesterol levels – LDL
● Hypertension
● diabetes
● obesity
● Family history of heart disease
● old age due to the decreasing flexibility of arteries

Once the damage has happened, a lesion begins to occur within the endothelium where lipids
and fats begin to become deposited in the arterial wall. It is important to remember this process is
not a superficial process as plaques end up having a strong hold within the arterial wall rather
than on the arterial wall

Step 2- Inflammatory response

Endothelial damage to the arterial wall causes an

inflammatory response. It causes the recruitment of
various white blood cells around the body, where
white blood cells leave the bloodstream and move
into the arterial wall.

Monocytes are a type of white blood cell. The

migration of monocytes beneath the endothelium
causes the monocytes to differentiate (become)
macrophages. These cells attempt to degrade the
cholesterol deposits by engulfing them. Many macrophages die in the process as they have a
build-up of cholesterol within them causing them to transform into foam cells.

More cholesterol begins to accumulate and become deposited within the arterial wall. This
deposit is also known as an atheroma.

Step 3 – plaque formation

The next step is the formation of plaque (figure below). Fibrous tissue also present within the arterial
wall alongside calcium salts become accumulated. This swells up and hardens the plaque making
the lumen of the artery very narrow due to reduced elasticity. This causes the smooth muscle to
become exposed where platelets present within the blood form a fibrous “cap” structure over the
plaque deposition, sealing it into the arterial wall, further solidifying the plaque.

Step 4- Lumen of artery narrows

Plaques present within the arterial wall cause the narrowing of the lumen, making it difficult for the
heart to pump blood effectively around the body. This leads to strenuous stress on the heart and
blood pressure is raised. This high blood pressure increases the chance of an individual to acquire
further atherosclerosis as there is a higher chance that a plaque will form again due to the high
blood pressure. This shows there is a positive feedback response in the disease.

The consequences of atherosclerosis

Narrowing of coronary arteries limits oxygen-rich blood reaching the heart muscle. This may result
in angina. Angina is experienced during exertion when the cardiac muscle is working harder and
needs to respire more. Because the heart muscle lack oxygen, it is forced to work anaerobically. It
is thought that this results in chemical changes which trigger pain.

If a fatty plaque in the coronary arteries ruptures, collagen is exposed

which leads to rapid clot formation. The blood supply to the heart
may be blocked completely. The heart muscle supplied by these
arteries does not receive any blood, so it is said to be ischaemic
(without blood). If the affected muscle cells are starved of oxygen for
long, they will be permanently damaged This is what we call a
myocardial infarction.

In the arteries supplying the brain it results in stroke. Narrow of arteries

to the legs can result in tissue death and gangrene (decay).

An artery can burst where blood builds up behind an artery that has
been narrowed as a result of atherosclerosis. The artery bulges as it fills
with blood and an aneurysm form. These are likely to rupture and the resulting blood loss and
shock can be fatal.

1. Name the blood vessels supplying cardiac muscle with blood

2. What is cholesterol
3. What is atherosclerosis?
4. Name 3 factors that increase your risk of developing atherosclerosis
5. Describe why increasing age is a risk factor for atherosclerosis
6. What do lesions to the endothelium cause to happen?
7. What are monocytes?
8. What do macrophages do?
9. What are foam cells?
10. What is an atheroma?
11. What causes the hardening of the plaque?
12. Where are plaques deposited in the artery?
13. Describe how the ‘fibrous cap’ is formed
14. Define homeostasis
15. Define negative feedback
16. Give an example of negative feedback
17. Define positive feedback
18. What is the lumen of an artery?
19. Describe the structure of an artery
20. Describe how an atheroma affects blood flow in the artery
21. Describe flow of blood during cardiac diastole
22. Describe how high blood pressure affects atheroma formation
23. Explain why is plaque formation described as positive feedback?
24. How does the atheroma affect the lumen of the artery?
25. Describe and explain the differences in pressure in arteries and veins
26. Suggest why only arteries get atherosclerosis
27. Summarize the events leading to atherosclerosis in 5 points
28. Name the enzyme involved in the blood clotting process
29. Describe the blood clotting process
30. Describe how a blood clot could form from atherosclerosis
31. Using the key words and phrases, create a complete description, a flow chart, or an
annotated diagram of the processes of atherosclerosis and blood clotting.

Large white Platelets

Hard plaque Tangled Inflammatory Atheroma
Fibrin cells enter become
forms mesh response forms
wall sticky

Calcium salts Cascade Blood cells

Cholesterol and fibrous of trapped, a
Thrombin Prothrombin Atherosclerosis
accumulates tissue chemical blood clot
accumulate changes forms

Platelets in Platelet Rising blood Artery Wall elasticity Fibrinogen

Artery
contact with plug forms pressure wall reduced
 damaged damage
narrows
artery wall d

32. State the word and symbol equation for respiration

33. State the word equation for anaerobic respiration in animals
34. What is an oxygen debt?
35. What is angina?
36. Describe why angina occurs
37. What is arrythmia
38. What is a myocardial infarction?
39. Explain how this occurs
40. If a cell is ischaemic, what does this mean?
41. Explain why a myocardial infarction is not always fatal?
42. Describe how a stroke can occur
43. Research and state 4 symptoms of a stroke
44. What is an aneurysm
45. Why can these be fatal?

46. Atherosclerosis is responsible for many deaths that result from cardiovascular disease (CVD).
The diagram below shows an external view of a human heart. The position of an atheroma
(plaque) is shown and a region of dead heart muscle is shaded.

a. Explain how the structure of the aorta relates to its

function.
[3]
b. Describe two
differences between
the structure of a
capillary and the
structure of a vein.
[2]
c. Suggest how the location of the atheroma results in the
position and size of this region of dead heart muscle.
[3]

47. Atherosclerosis is more likely to occur in arteries due to the higher blood pressure in these
blood vessels. A person with very high blood pressure has an increased risk of developing
atherosclerosis.

a. Describe how very high blood pressure could result in atherosclerosis.

 [3]
b. Explain how atherosclerosis in one part of an artery could increase the likelihood of it
developing in another part of the same artery.

[2]

48. A clinical trial was carried out to investigate the effect of a drug on the volume of plaques in
patients with atherosclerosis.

Forty patients with atherosclerosis were divided into two groups of twenty. Each patient had
the volume of their plaque determined. One group was the control group and the treatment
group took the drug daily for two months.

At the end of the two months, the volume of the plaque in each patient was determined
again. The mean change in volume of the plaque was calculated.
The results of the clinical trial are shown in the graph below.

a. Using the information in the graph,

describe what the results of this trial
show.
[2]
b. Suggest two reasons why the results of this trial do not
indicate that this drug could be useful in treating patients
with atherosclerosis.
[2]

CVD Risk Factors

The chance that a person will suffer from cardiovascular disease is rarely a consequence of genetic
inheritance alone. It is known as being multifactorial, with heredity, the physical environment, the
social environment and lifestyle behavior choices all contributing to the risk. The combination of risk
factors experienced by the individual determines their risk of developing the disease.

Smoking as a risk factor

● Carbon monoxide in smoke increases deposition of cholesterol in atheroma formation.

● Increases heart rate and causes vasoconstriction to increase blood pressure which increases
risk of damage to lining of arteries which in turn increases risk of atherosclerosis.
 ● Carbon monoxide combines irreversibly with haemoglobin to produce carboxyhaemoglobin
which cannot carry oxygen therefore the oxygen-carrying capacity of blood is reduced
● If blood flow is reduced due to atherosclerosis tissues get even less oxygen which can
increase risk of cell damage/death.
● Nicotine also increases stickiness of platelets so increases risk of blood clots, especially in the
coronary arteries. It also stimulates release of adrenaline.
● Reduces levels of HDLs
● Contents in smoke (e.g. free radicals) which get into blood stream can damage
endothelium lining of blood vessels

The role of antioxidants

Free radicals are highly reactive chemicals (atom with an unpaired electron) produced by some
normal metabolic reactions in the body. They act as an oxidising agents and can damage DNA,
proteins, and other molecules. Damage is cumulative over time, so associated with ageing.

Oxidised LDLs more readily taken up by white blood cells involved in atherosclerosis.

Antioxidants help prevent damage caused by free radicals by providing hydrogen atoms to pair up
with the unpaired electron. Good sources of dietary antioxidants include:

● Vitamin C - citrus fruits, broccoli, tomatoes

● Vitamin E- wholegrain cereals, bread, peanuts, fish
● Beta-carotene - used to make vitamin A, found in carrots, sweet potatoes, spinach,
peaches, mangoes

Risk Description
In general terms our diet contains too much salt, especially in all the processed
foods we eat. Only 6g per day recommended (most people normally eat > 10 g
Salt per day!) A high salt diet causes the kidneys to retain too much water. A higher
fluid content in the blood increases blood volume which increases blood pressure
which can increase risk of CHD.

Women have naturally higher HDL levels reducing their risk of atheroma. This is due
Gender to higher oestrogen levels. Oestrogen also increases the blood flow to the muscles
(including the heart).

Arteries become less elastic with age which can increase blood pressure and the
Age
risk of blood vessel damage.

This causes the release of adrenaline which increases the heart rate and constricts
Stress the arteries resulting in raised blood pressure. People with stressful jobs (the 3 most
stressful statistically are: miners, emergency services and teachers) are most at risk.

Genetics Some alleles increase the risk of CVD, these are inherited from family members.
These alleles may cause a variety of problems e.g. valve weakness, high blood
pressure, high LDL and cholesterol levels. Some can be beneficial e.g. high HDL
 levels which helps lower cholesterol.

Alcohol decreases the blood flow to the muscles (including the heart), this can
lead to coronary heart disease. It increases blood pressure by constricting the
arteries. Alcohol also influences the rhythm on the heart which can lead to
Alcohol arrhythmia. Being calorie rich it can also lead to obesity.

High levels of alcohol can also damage liver cells which will impair the liver’s ability
to remove glucose and lipids from the blood.

Exercise improves coronary circulation, which decreases the risk of CVD. Exercise
also increases HDL levels which helps to lower bad cholesterol (LDL’S). Lower levels
Exercise
of exercise make the heart inefficient, as the cardiac output is reduced, the heart
rate increases, and the artery walls become less elastic.

1. What is a multifactorial disease?

2. What is coronary heart disease?
3. What is an atheroma?
4. Describe how an atheroma forms
5. Recall the difference between saturated and unsaturated fats
6. Why is fat important in the body?
7. Which type of fat is good for you?
8. Explain your answer to the above
9. Name the harmful substances contained in cigarettes
10. Describe effects of carbon monoxide on the body
11. Nicotine stimulates the release of which hormone?
12. Describe the difference between chemical and nervous control in the body
13. How is adrenaline released?
14. Explain the effects of adrenaline on the body
15. Explain why increasing heart rate can increase CHD risk
16. Describe negative feedback
17. Name some examples of negative feedback in the body
18. Is adrenaline an example of negative feedback? Explain your answer
19. Cigarettes contain substances that damage the endothelial lining, explain how this increases
risk of CHD
20. What are free radicals?
21. Describe how free radicals in the body can increase risk of CHD
22. Describe the role of antioxidants in the protection from free radicals
23. Describe the relationship between gender and CHD
24. Explain how being in a stressful job can increase your risk of CHD
25. Describe the structure of an artery
26. Explain how the above changes with age
27. State the role of the liver
28. How does excessive alcohol intake affect functioning of the liver
29. State two properties of water
30. Explain how water can dissolve salt
31. Explain how salt can increase risk of CHD
32. Define genotype
33. Define phenotype
34. Define genome
35. Define allele
36. Describe the difference between gene, DNA and allele
37. Explain how genetics can increase risk of CHD

38. Graph A shows a correlation between systolic blood pressure and the percentage
of stroke patients having a second ischaemic stroke within a few months.

Graph B shows the effect of a high salt diet on systolic blood pressure.

Graph C shows the effect of additional risk factors on the number of deaths due to
cardiovascular disease (CVD).

Men who smoke have an increased risk of having an ischaemic stroke.

a. Analyse the data to discuss what advice could be given to a smoker, who has had one
ischaemic stroke, to reduce his risk of having another stroke.
[6]

b. A stroke can be caused by cardiovascular disease (CVD) affecting arteries leading to the
brain. Callum's family has a history of strokes.
 i. Explain why a blood clot in an artery leading to the brain could cause a stroke.
[3]
ii.  Suggest two lifestyle changes Callum could make to reduce his risk of suffering a
stroke in later life.
[2]

c. Obesity and high blood pressure are also factors that increase the risk of CVD.
The graph below shows the percentage of people with CVD who have high blood pressure
or have high blood cholesterol or are obese for the period 1960 to 1990.

i. Using the information in the graph, describe the overall changes that have occurred in
these risk factors during this period.
[3]
ii. Suggest two reasons for the overall change in high blood cholesterol as a risk factor.
[2]
iii. State two factors, other than obesity, high blood pressure and high blood cholesterol, that
increase the risk of CVD.
[1]

39. The effect of salt in the diet on blood pressure was investigated. This investigation involved
15 males and 5 females, all between 20 and 30 years old. They were split into two groups, A
and B, each of 10 people.

Group A had a diet containing 3 g of salt per day. Group B had a diet containing 9 g of salt
per day. The systolic blood pressures, measured in mmHg, were recorded during one year.

The results are shown in the graph.

 a. Determine the effects of salt in the diet on systolic blood pressure in this investigation.
[3]
b. Explain the effect that a diet high in salt could have on a person's risk of developing
cardiovascular disease.
[5]

Vitamin C required practical

The quantity of vitamin C in food and drink can be determined using a simple colour test. Vitamin
C decolourises the blue dye DCPIP as it as electron acceptor. Vitamin C is an antioxidant and
reduces the DCPIP. DCPIP changes from blue to colourless (or slightly pink) as it becomes
reduced.

You will have:

● 1% DCPIP solution
● 1% vitamin C solution
● A range of fruit juices
● Test tubes
● Pipette to accurately measure 1 cm3
● Pipette or burette.
● White tile

1. What is DCPIP
2. What is a free radical?
3. What is an antioxidant?
4. Explain why DCPIP is decolourised by vitamin C
5. State sources of vitamin C in your diet
6. What is the aim of your investigation?
7. State the dependent variable
8. State the independent variable
9. Describe the variables you will control
10. Draw a diagram to show the set up of your equipment
11. Explain your method
 12. What is the purpose of the white tile?
13. Identify any risks in your practical investigation

Juice tested Average Vitamin C

volume of content of
Volume of juice required to
juice juice mg/cm-3
decolourise 10cm of 0.1% DCPIP
required
solution (cm3)
(cm3)

Mass of vitamin C to decolourise 1cm³ of DCPIP = 10mg × volume of vitamin C used

Mass of vitamin C in fruit juice sample = mass of vitamin C to decolourise 1cm³ of DCPIP ×
volume of sample required to decolourise 1cm³ of DCPIP

14. Complete table of results and calculations

15. Draw a bar chart with your results
16. How did you ensure your results were accurate?
17. How could you increase the precision of your results?
18. Identify any sources of error in your practical.

19. Vitamin C is important in the growth and repair of skin tissue because it helps in the synthesis
of a protein called collagen.

For this reason, the food given to hospital patients after surgery should contain vitamin C to
help their recovery. A hospital chef suggested that the cooking time of vegetables affects
their vitamin C content.

An investigation was carried out on the effect of cooking time on the vitamin C content of
five different vegetables. The results are shown in the graph.
a. Analyse the data to explain the effect of cooking time on the vitamin C content in
vegetables.
(3)

b. Analyse the data to conclude which of the vegetables should be given to patients
recovering from surgery.
(2)

20. Broccoli is a green vegetable. A food company investigated the effect of storage
temperature on the vitamin C content of frozen broccoli.

The broccoli was harvested and frozen on the same day. The storage temperatures used
were: −7°C, −15°C and −25°C.

The vitamin C content of samples of broccoli were measured at harvest and every 10 days
during storage.

The graph below shows the results of this investigation.

 a. Using the information from the graph, describe the effect of storage temperature on the
vitamin C content of frozen broccoli.
[3]

b. Identify one anomalous result from the graph.

[1]

c. Suggest the action the investigators could take, having identified this anomalous result.
[1]

d. State one variable that needs to be controlled in this investigation.

[1]
      
e. Suggest the effect of not controlling this variable on the results.
[1]

f. Name the chemical that can be used to measure the vitamin C content of samples of
broccoli.
[1]

g. Describe how this chemical can be used to measure the vitamin C content of samples of
broccoli.
[3]

CVD Treatment
Various drugs are used to treat cardiovascular diseases.

Examples of
Medication How it helps Side effects
medication
 These medicines are used to
reduce high blood pressure. Beta blockers
Headache, drowsiness,
Antihypertensives These drugs reduce the Vasodilators
amount of sodium in the nausea, kidney failure
blood by increasing urine Diuretics
output.

Muscle pain, diabetes,

These reduce the cholesterol
Statins headaches, and nose
level in blood
bleeding

Warfarin excessive bleeding,

Anticoagulants These reduce blood clotting
allergic reactions, swelling

Reduces stickiness of platelets

Platelet Inhibitory rashes, nausea, excessive
and likelihood of clot Aspirin
Drugs bleeding
formation

1. Name 3 common cardiovascular diseases

2. State 3 risk factors for CVD
3. Describe why high blood pressure increases CVD risk
4. State the name given to medication used to lower blood pressure
5. Explain how beta blockers work
6. Describe how vasodilators would help treat high blood pressure
7. How do diuretics affect your kidneys?
8. Explain how diuretic aid in decreasing blood pressure
9. Explain how increased blood pressure leads to atherosclerosis
10. What is cholesterol?
11. Describe how statins work
12. Explain how lowering blood cholesterol levels can reduce the risk of CVD.
13. State the side effects of statins
14. Name an anticoagulant
15. What is the role of thromboplastin in the blood clotting cascade?
16. Explain how warfarin works to reduce blood clotting
17. State the side effects of anticoagulants
18. Describe how aspirin works
19. Recall how smoking increases risk of CHD
20. Name one type of drug that would be useful for treating a smoker at risk of developing CVD
and explain how it works to prevent CVD.

21. What medication and advice would you prescribe/give to the following?
a. Reeta- Age 32.
Has had a mini stroke due to a small blood clot in one of the arteries in the brain.
She needs something that is going to reduce the likelihood of another blood clot forming.

b. Will- Age 44
A lot of people in his family have had heart attacks. During his routine check-up his blood
 cholesterol was found to be above normal at 0.7mmol/L.
c. Jill- Age 53
Jill is in a high stress, high risk job.
She has come in complaining of severe headaches. You measure her blood pressure and
find that her reading is 140/90mmHG.

22. James has a high risk of heart attack and is discussing drug treatments with his doctors. What
information would they have to consider before deciding about the best drug to use.

23. A variety of drugs can be used to reduce blood pressure. These drugs may cause side effects
in some people.
State two possible side effects of taking drugs to reduce blood pressure.
[2]
24. It is possible to reduce the risk of CVD by taking medication or changing diet.
Explain the role of antihypertensive drugs in reducing the risk of atherosclerosis.
[4]
25.
a. Fill in the most appropriate words to complete the passage

The heart muscle in the walls of the heart is called ........................................................ muscle.

The ........................................................ valves control the flow of blood between the chambers
of the heart.

The chamber of the heart that receives oxygenated blood from the lungs is named
the ........................................................

Deoxygenated blood is transported back to the lungs in the .......................................................

Backflow of blood into the heart is prevented by ....................................................... valves.

b. Anticoagulants, such as warfarin, are used to treat cardiovascular disease (CVD).

iii. Explain how anticoagulants can help reduce the effects of CVD.
[2]
iv. State one risk associated with the use of anticoagulants.
[1]

b. Over 20% of the population of the UK is classified as obese. Obesity is a significant risk factor
in the development of cardiovascular disease (CVD).

Suggest one piece of medical advice that could be given to someone who does not have
high blood pressure but who is obese.

Explain why this will help to reduce their risk of developing CVD.

[3]
 Cholesterol and CVD

There is a considerable amount of evidence to show that the higher your blood cholesterol level,
the greater your risk of coronary heart disease. Like all lipids, cholesterol is not soluble in water. To
be transported in the bloodstream, insoluble cholesterol is combined with proteins to form soluble
lipoproteins.

Low density lipoprotein

Triglycerides from fats in our diet combine with cholesterol and protein to form LDLs which
transport the cholesterol to body cells. LDLs circulate in the bloodstream and bind to receptor sites
on cell membranes before being taken up by cells where cholesterol is involved in the synthesis
and maintenance of cell membranes.

LDL cholesterol is sometimes called as the bad cholesterol. That is because it circulates and may
lodge in the walls of blood vessels and becomes oxidized when engulfed by circulating white
blood cells. As a result, more white blood cells act on it causing arterial wall inflammation. Over
time, more LDL cholesterol and cells deposit at the site resulting in blood vessel blockages or
atherosclerosis. This in turn increases the risk for the development of cardiovascular diseases.1

High density lipoprotein

HDLs have a higher percentage of protein and less cholesterol compared with LDLs, hence their
high density.
HDLs take excess fat molecules (such as cholesterol, phospholipids, and triglycerides) from cells.
Thus, high-density lipoprotein cholesterol pertains to HDLs that carry excess cholesterol from cells
and move the cholesterol to the liver for processing. HDLs also remove cholesterol molecules from
the walls of blood vessels. Therefore, HDL cholesterol is sometimes referred to as the good
cholesterol. HDL cholesterol carries the excess cholesterol back to the liver for processing. The
higher HDL cholesterol level the more cholesterol is presumed to being removed from sites that
otherwise may lead to health risks, such as cardiovascular diseases.

1. Recall 3 main roles of lipids

2. What is cholesterol
3. Where does cholesterol come from
4. What is cholesterol’s role in the body?
5. What are lipoproteins
6. Compare the structural difference of HDL and LDL
7. What is the role of HDLs in the body?
8. What is the role of LDLs in the body?
 9. Name 3 blood lipids
10. Suggest a relationship between saturated fat in the diet and levels of HDLs and LDLs
11. How does saturated fats affect the activity of LDL receptors?
12. What causes high levels of LDLs in the blood
13. What factors influence the balance between HDL and LDL
14. Describe the role of LDLs in atherosclerosis

15. Using the data below comment on the relationship between serum cholesterol levels
and the risk of death and coronary heart disease

16. Up until the menopause, women generally have higher HDL:LDL ratios than men. What
consequences would you expect this to have for the incidence of coronary heart
disease in women compared with men?
17. A person stops eating butter on their toast and start using a ‘lighter’ butter instead that
contains 25% vegetable oil. What effect will this have on their blood LDL levels? Explain
your answer
18. It been suggested that HDLs may reduce platelet aggregation. Explain why this might
reduce the risk of a heart attack occurring.
19. Using the data in Table 1, suggest the possible significance to health of different types of
blood cholesterol.

Women Men
CHD No CHD CH No CHD
D
Number of participants 216 6691 509 4923

mean total cholesterol/ mmol l –1

5.96 5.59 5.72 5.40
mean LDL cholesterol/ mmol l –1
3.89 3.48 3.91 3.56
mean HDL cholesterol/ mmol l –1
1.30 1.51 1.07 1.18
mean triglycerides/ 1.68 1.30 1.63 1.44
mmol l–1

19.Explain how you can lower blood cholesterol levels

20. Lipoprotein lipase is a biological catalyst and is involved in the hydrolysis of triglycerides.

For each of the statements below, put a cross in the box that corresponds to the
correct statement.
 a. A catalyst

   A    decreases the rate of reaction by increasing the activation energy

   B    decreases the rate of reaction by reducing the activation energy
   C    increases the rate of reaction by increasing the activation energy
   D    increases the rate of reaction by reducing the activation energy

b. Hydrolysis results in bonds between glycerol and a fatty acid

   A    being broken and water being formed

   B    being broken and water being used
   C    being formed and water being formed
   D    being formed and water being used

c. A triglyceride is made from

   A    one glycerol and one fatty acid

   B    one glycerol and three fatty acids
   C    three glycerols and one fatty acid
   D    three glycerols and three fatty acids

d. A type of bond found in a triglyceride is

   A    an ester bond

   B    a glycosidic bond
   C    a hydrogen bond
   D    a phosphodiester bond

21. Some people have a mutation in the gene coding for lipoprotein lipase.
The table below shows the mean concentration of some types of lipid in the blood of people
without the mutation and in the blood of people with the mutation.

It has been suggested that people with this mutation may be more at risk of developing
cardiovascular disease (CVD).
 a. Give two reasons why the information in the table does not support this suggestion.
[2]
b. Name the type of drug that could be given to people with this mutation, to reduce
the risk of developing CVD.
[1]

c. State one health risk associated with using this type of drug.
[1]

22. The diagram shows a triglyceride molecule.

The triglyceride in the diagram can combine with protein to form a lipoprotein.
Explain the effect that large quantities of this lipoprotein would have on blood cholesterol
levels.
[4]
23. LDL cholesterol found in plasma binds to receptor proteins and is taken into cells by
endocytosis.
A gene found on chromosome 19 is responsible for making LDL receptor proteins in human cell
membranes.

* Familial hypercholesterolaemia (FH) is an inherited condition.

The recessive allele (f) makes normal LDL receptor proteins.
The dominant allele (F) makes LDL receptor proteins that do not function.
Explain why people who inherit the dominant allele have an increased risk of dying early.
[6]
 Energy Budgets and Obesity Indicators

You need a constant supply of energy to

maintain your essential body processes,
such as the pumping of the heart,
breathing and maintaining a constant
body temperature. These processes go
on all the time, even when you are
completely at rest. The energy needed
for these essential processes called the
basal metabolic rate and varies between
individuals. BMR is higher in males, heavier
people, younger people, more active
people.

The balance between energy input and energy output determines whether the body maintains,
gains, or loses weight.

 
1. What is your basal metabolic rate?
2. What hormone controls metabolism
3. Which gland secretes this hormone?
4. Describe how your metabolic rate is controlled.
5. State three properties of water
6. Which property of water is helpful when cooling down the body?
7. Explain the above
8. What factors can influence your metabolic rate?
 9. How does the heart get the substances it requires for energy production?
10. What we mean by an energy budget?
11. What lifestyle choices can affect energy input and use?
12. What health issues can being underweight cause?
13. What health issues can being overweight cause?

The National Institute for Health and Care Excellence (NICE) recommends the assessment of
health risks due to being overweight or obese should be based on both Body Mass Index (BMI)
and waist circumference. It recommends the use of the two measures because although BMI
takes account of height, it does not differentiate between mass due to muscle development and
mass due to body fat. In addition, BMI does not consider fat distribution, which has been identified
as contributing to increased health risk.

The health risk consequences of obesity can be significant; an obese man is five times more likely
to develop type 2 diabetes and a woman is 13 times more likely. Obese men and women are
about three times more likely to develop cancer of the colon, and both have increased risk of a
number of other diseases including cardiovascular disease (CVD).

BMI is used to classify a person’s body mass relative to their height. It gives an indication of
whether a person is underweight, normal weight, overweight or obese.

BMI is calculated using the formula:

BMI =
Calculate your BMI and decide your category of bodyweight using the table
below.

BMI Classification of bodyweight

<18.5 underweight
18.5–24.9 normal
25.0–29.9 overweight
30.0–39.9 obese
>40.0 severely obese

14. What is BMI

15. How do you calculate BMI?
16. What are the units for BMI?
17. Why is BMI not necessarily a great diagnostic tool?
18. Describe how blood glucose levels are controlled when they get too high in the body
19. What is type II diabetes?
20. Calculate the BMI of a person with a body mass of 85kg and height of 1.68m. How would
you describe the body weight of that person?
21. Rajesh is 191cm tall. His BMI is 30. How much does he weigh in kg
22. Edgar is 165 cm tall and weighs 65 kg. Work out his BMI. What advice would you give him
regarding his weight?
23. A fully grown adult man has a daily energy requirement of approximately 3052 kcal and has
a daily energy intake of about 3500 kcal. What will be the consequences for his BMI if he
maintains this energy budget?
 24. Explain why doctors would advise patients with BMIs above 30 to reduce their weight.

Waist-to-hip ratio has been identified as a better measure of obesity. There is a positive correlation
between waist-to-hip ratio and risk of heart attack.
Waist-to-hip ratio is calculated by dividing waist circumference by hip circumference. Women’s
waist-to-hip ratio should not be greater than 0.85, men’s should not exceed 0.90. The higher the
value above these figures, the greater the risk.

25. What is waist-to-hip ratio

26. How do you calculate waist-to-hip ratio?
27. Why is a waist-to-hip ratio a better alternative to BMI?
28. A 45-year-old man has a waist measurement of 91cm and a hip measurement of 115cm.
Calculate his waist-hip-ratio and comment on his risk of heart disease.
29. Two female friends measure their waist and hip circumferences. One has a waist
measurement of 76 cm and hips of 102 cm, the other has a waist circumference of 110
cm and hips of 138 cm. Calculate their waist-to-hip ratio and decide if either should be
concerned. The two friends are the same height, 170 cm.
30. David has a hip measurement of 85 cm and waist of 90 cm. Would your advice remain
the same as that given in response to question 1?
31. Suggest why waist-to-hip ratios combined with BMI are better than BMI alone as an
indicator of obesity and heart disease risk.

32. A woman is 154 cm tall and has a mass of 61 kg. Her body mass index is calculated using
the following formula. Calculate her BMI to one decimal place.
[2]

33. The incidence of obesity is increasing in some populations. High levels of sugars, such as
fructose, in processed food could be contributing to this increase.
Explain why high levels of sugars in a person's diet could lead to obesity.
[3]

34. The development of childhood obesity is affected by many factors. Breastfeeding can
affect the development of childhood obesity.
The graph shows the relationship between obesity in six-year-old children and the number
of months that they were breastfed as babies.
 a. Describe the relationship between the number of months of breastfeeding and childhood
obesity.
[2]
b. A six-year-old child can be classified as obese based on their body mass index (BMI) being
over 19 kg m–2.
BMI is calculated using the following formula.

A six-year-old child is 115 cm tall with a BMI of 20. Calculate the mass of this child to one
decimal place.
[2]

c. People in this category are more likely to develop high blood pressure than people with a
healthy weight.
Explain why someone who has a high blood pressure is at a significantly higher risk of
developing CVD.
[4]

29. Scientists investigated the BMI (Body Mass Index) of male office workers aged 40 and the
type of breakfast they ate most regularly.
30. The graph below shows the results of their investigation.

Put a cross in the box to complete each of the following statements.

a. The graph shows that people who ate
[1]
            A    dairy products have a lower mean BMI than those people who ate bread.
            B    fruit and vegetables have the lowest mean BMI
            C    no breakfast have a higher mean BMI than those people who ate meat and eggs
            D    ready-to-eat cereal have a higher mean BMI than those people who ate cooked
cereal
b. The graph shows that the mean BMI for
[1]
            A    every group sampled in the investigation indicates that they were overweight
            B    those who ate bread for breakfast indicates that they were a healthy weight
            C    those who ate cooked cereals for breakfast indicates that they were underweight
            D    those who ate dairy products for breakfast indicates that they were obese

c. The units for mean BMI are

[1]
            A    kg m2
            B    kg m−2
            C    m2 kg
            D    m kg−2

d. The scientists ensured that their data were reliable by repeating the investigation with
[1]
            A    a larger sample size
            B    female office workers aged 40
            C    more types of breakfast
            D    male footballers

e. Suggest how the scientists ensured that their investigation was valid.
[2]

f. Some people avoid eating breakfast in an attempt to lose weight.

Using information from the graph, suggest why eating no breakfast is unlikely to lead to weight
loss.
[2]
g. Cooked cereal, such as porridge, contain a high proportion of dietary fibre. This helps to lower
blood cholesterol levels.

Using the information in the graph and your knowledge of blood cholesterol, suggest why a
breakfast of cooked cereal could reduce the chances of developing cardiovascular disease
(CVD).
[3]

Design of Studies
Large scale studies have been undertaken to find the risk factors for many common diseases,
including cardiovascular disease. Epidemiologists look for correlation between a disease and
specific risk factors.

Cohort studies

Cohort studies follow a large group of people overtime to see

who develops the disease and who does not. These types of
studies are prospective; at the start of the study none of the
participants have the disease. Researchers are interested in
what happens to them in future. During the study people’s
exposure to suspected risk factors and where they developed
the disease is recorded so any correlation between the risk
factors and disease development can be identified. It takes a
long time for the condition to develop so these studies can
take years and be very expensive.

Case control studies

In a case control study, a group of people with the disease (cases)

are compared with a control group of individuals who do not have
the disease. Information is collected about the risk factors that they
have been exposed to in the past, allowing factors that may have
contributed to development of the disease to be identified these
types of studies are retrospective.

The control group should be representative of the population from which the case group was
drawn. Sometimes controls are individually matched to cases; known disease risk -factors, such
as age and sex, are then similar in each case and control pair. This allows scientists to investigate
the potential role of a known risk factors.

Features of a good study:

● Clear aim
● Representative sample to avoid selection bias.
● Valid and reliable results
● Sample size is large enough to produce results that could not have occurred by chance.
● Controlling variables to ensure that only the factor under investigation is influencing the
outcomes

1. What is the difference between a retrospective and prospective study?

2. Describe a cohort study
3. Describe a case control study
 4. Name the study that each of these statements is referring to:
a. Observes people to see if they get the disease
b. Follows people who do not have the disease but have been exposed to risk factors
c. Ask patient’s questions about their past
d. This study is taken over a long period of time
e. This study is more expensive
f. Investigates the risk factors that could have contributed to someone having the
disease.
5. What are the features of a good study?
6. Why are large amounts of data needed in studies?
7. Why is controlling variables important?
8. Why is a large sample size important?

MMR vaccination and autism

A large number of studies have investigated if the MMR (measles, mumps and rubella)
vaccination is a risk factor for the development of autism or other developmental disorders. Some
of these studies are outlined below. Read the summaries and then answer the questions that
follow.
Autism is a developmental disorder. People with autism have difficulties with communications and
social interactions, displaying repetitive and rigid behaviour. In most cases, signs of abnormal
development can be recognised by the time a child is two years old. The MMR vaccination is
given to about 600 000 UK children each year, mostly when they are about two years old.

1998 Wakefield Study

In 1998 a link between the MMR vaccination and autism was suggested by Dr Andrew Wakefield
and his co-workers from the results of an uncontrolled case study of 12 children that had been
referred to the hospital’s gastroenterology group with intestinal symptoms (diarrhoea, abdominal
pain, bloating and food intolerance) and development disorder. They had been developing
normally, but then lost some of their acquired skills. Medical and developmental histories were
obtained for each child, including details of immunisations and exposure to infectious diseases.
Neurological and psychiatric assessments were completed. Clinical and laboratory investigations
were completed, including endoscope investigations of the bowels with tissue samples taken for
analysis. The researchers suggested that the chronic bowel symptoms might be linked with autism.
They noted that in most cases (eight), onset of symptoms was after MMR immunisation and further
investigations were needed to examine this syndrome and its possible relation to the MMR
vaccine.

1998 Finnish Study

In the same year, 1998, the results of a long-term vaccination project to eliminate MMR diseases
from Finland were published. The project launched in 1982 saw all children vaccinated twice, at
age 14–18 months and 6 years. Any children who had adverse reactions to the vaccine were
reported to the Institute. By the end of 1996 about three million vaccinations had been given to
children and some adults. Thirty-one children developed gastrointestinal symptoms after
vaccination; none went on to develop signs of autism.
2004 UK General Practice Research Database Study
Results of a matched case-control study conducted using data from the General Practice
Research Database (GPRD) were published in The Lancet in 2004. This database contains detailed
information about every consultation by over 280 medical practices serving over two million
people selected to be representative of the whole UK population. 1294 children affected by
autism or other developmental disorders were identified from the database. Two child psychiatrists
using 10 diagnostic criteria for autistic disorders reviewed the medical information for each child.
Some children with medical disorders that are thought to have a causal association with autism,
such as fragile X disorder, phenylketonuria or congenital rubella, were excluded. For each of these
affected children up to five matched controls were also identified from the database, children
with no record of developmental disorders matched on age, sex and medical practice. A
questionnaire to parents of all cases and controls included questions about the family size,
socioeconomic status, education of parents and medical history. The following dates were
recorded for each affected child.
● First attendance to the GP with symptoms.
● First concerns or symptoms recorded in hospital letters.
● Definitive diagnosis from hospital letters.
● Parents’ first concern about symptoms of autism collected retrospectively.
● MMR vaccination from GP records.
1294 cases and 4469 controls were included in the study. 1010 cases had MMR vaccination
recorded before diagnosis, 3671 controls had MMR vaccination before the age at which their
matched case was diagnosed. The study concluded that MMR vaccination was not associated
with an increased risk of autism or other developmental disorders.

Wakefield Study Fraud identified

The findings by Wakefield and colleagues were widely reported by the media, creating a vaccine
scare, which led to a decline in vaccinations. Over the following decade epidemiological studies
found no evidence of a link between MMR vaccine and autism. The paper was retracted by The
Lancet in 2011 after a General Medical Council hearing. It had been shown that the study did not
have ethical approval and when Wakefield wrote the final version of the paper he fraudulently
altered information about patients’ medical histories to support his claims. Wakefield was struck off
the Medical Register barring him from practicing medicine in the UK. Vaccination rates have
improved since the scandal was exposed; 92.3% of two year olds were vaccinated in 2012–13.
However, this coverage is below the 95% level recommended by the World Health Organisation to
ensure herd immunity and hundreds of thousands of children are unprotected against measles,
mumps and rubella.

9. Wakefield suggested a causal association between the MMR vaccine and a new syndrome of
chronic inflammatory bowel disease and autism. On publication in 1998, the study and its
conclusions were widely criticised. Suggest some of the weaknesses that the critics identified in
this epidemiological study. At this time they were unaware of the fraud.
10. Explain how the Finnish study provided more reliable results than those of the Wakefield study.
11. Why were children with conditions such as fragile X syndrome excluded from the GPRD study?
12. Explain why the GPRD questionnaire was sent to all participants?
13. In the GPRD study which of the data recorded for each affected child are more reliable for
investigating the relationship between the timing of the MMR vaccination and development of
autism?
14. A working party of the UK Committee on Safety of Medicines undertook a study to assess
reports of children who had developed autism or similar disorders following MMR vaccination.
The parents of all children included had sought legal advice about possible damage as a result
of vaccination. How might this method of selecting participants affect the results of the study?
15. Suggest how the Wakefield MMR scandal could have been avoided.

All papers submitted to academic journals are peer reviewed, that is, the papers are sent to
experts who decide if they are suitable for publication. Read the description below of an
epidemiological study undertaken to investigate whether blood cholesterol concentrations can
be used to predict stroke.

16. Decide whether or not you would publish the paper based on this study in the medical journal
for which you referee papers.

A prospective cohort study by the Korean National Health Service to determine risk factors for
stroke and heart attack was completed. 661 700 male and 125 742 female public servants were
included in the study. They were all between 30–64 years of age, with a mean age of about 42.
They had a health check by the Korean Medical Insurance Company, one of the main national
health insurance providers who provide medical insurance services for all public servants and their
unemployed family members. Information about exposure to risk factors came from the medical
examination and a self-administered questionnaire.

The study found that high concentrations of blood cholesterol were associated with ischaemic
stroke (associated with atherosclerosis). Low blood cholesterol was associated with haemorrhagic
stroke (not associated with atherosclerosis).

17. There are many products that may increase the ability of sperm to swim. One of these products
contains zinc sulphate.
Devise an investigation to obtain valid data to show whether taking zinc sulphate tablets
affects the ability of sperm to swim.
[6]

18. The effect of salt in the diet on blood pressure was investigated.
This investigation involved 15 males and 5 females, all between 20 and 30 years old. They were
split into two groups, A and B, each of 10 people.
Group A had a diet containing 3 g of salt per day. Group B had a diet containing 9 g of salt per
day.

The systolic blood pressures,

measured in mmHg, were
recorded during one
year.
The results are shown in the
graph.
Explain how the validity of this investigation could be improved.

[3]

19. A student investigated the effect of caffeine on human heart rate.

Three males of the same age were given cups of coffee containing caffeine. Their heart rates
were measured 10 minutes after drinking the coffee.
Two hours later they were given cups of coffee with no caffeine and after 10 minutes their
heart rates were measured.
The results are shown in the table.

a. The student concluded that caffeine increases human heart rate. Analyse the data to
explain why these results may not support the conclusion.
[3]
b. Describe how this investigation could be improved.

[3]

20. Researchers collected data to study the relationship between the time spent watching
television and coronary heart disease (CHD).
 A total of 12 608 men and women, aged between 45 and 79 years, took part. None of them
had previously had a stroke or heart attack.

a. The table below shows the categories in the questionnaire that each person completed.

i. Suggest why people who had not had strokes or heart attacks were selected for this
study.
[1]
ii. Suggest why people were asked to provide the researchers with information based on
the categories shown in the table.
[2]

b. The table below shows the categories in the questionnaire that each person completed.

i. Suggest why these data were collected.

[2]

ii. Suggest why these data might be considered to be more accurate than the information
in the questionnaire.

c. This study was funded by the government and charities supporting research into heart
diseases and strokes.

Suggest why it was important that none of the funding came from drug companies or
television manufacturers.
[2]
d. The researchers carried out the study over a period of 10 years.

They found that there was a positive correlation between the number of hours spent watching
television and the risk of developing coronary heart disease.
 A journalist wrote an article about the results of this study with the title 'Watching television
causes heart disease's
Is this statement valid? Explain your answer.
[3]

Probability and Risk

Risk is defined as ‘ the probability of occurrence of some unwanted event or outcome’. It is usually
in the context of hazards, that is, anything that can potentially cause harm, such as the chance of
contracting lung cancer if you smoke.

Probability can be calculated to give a numerical value for the size of the risk.

1. In a year 5 class of 30 pupils, six children caught head lice in one year.
Work out the probability of catching headlice.
2. In 2011 there were 727 724 recorded births in England and Wales. Of these, 3811 were still
births.
a. Work out the chance of having a stillbirth in 2011

In 2012 there were 733 232 recorded births. There were 6.6% fewer still births than in 2011.

b. Calculate how many still births there were in 2012.

c. Calculate the probability of having a still birth in 2012

3. Look at the causes of death below and put them in order,from most likely to least likely.
Have a go at estimating the percentage probability of some in the UK dying from each
cause during the year.

● Accidental poisoning
● Heart disease
 ● Injury purposely inflicted by another person
● Lightning
● Lung cancer
● Railway accidents
● Road accidents

When estimating risk people frequently get it wrong. People will overestimate or underestimate
the risk of something happening based on the criteria below:

Reasons people:

Underestimate if risk is Overestimate risk if it is

Undertaken voluntarily Undertaken involuntarily

natural Unnatural

Familiar Unfamiliar

Not feared Feared

Fair Unfair

Common Rare

4. It is not unusual for people to overestimate the risk of death from train accidents. Suggest
reasons for this overestimation.
5. It is not unusual for people to underestimate the risk to their health of smoking. Suggest
reasons for this underestimation.
6. A World Health Organisation preliminary investigation suggested that high levels of
background noise (for example, traffic noise) can affect your risk of heart disease.

a. Suggest other factors that may account for the increased incidence of heart disease in
areas with high levels of background noise.
b. Suggest how noise could increase the risk of heart disease.

Disease Incidence of Number of deaths in % of total deaths Probability of

disease in 2012 in 2012 developing disease in
2012 2012
All cancers 299 147 142 107

Lung cancer 38 273 30 273

Breast cancer 44 851 10 373

Prostate cancer 39 555 9698

Chlamydia 99 086 _ _

7. Study the year 2012 incidence (number of new cases) and number of deaths data for
England and Wales in Table 2 and then answer the questions below. The 2012 population of
 England and Wales was 56 567 800. The total number of deaths in England and Wales
during the year 2012 was 499 331.
a. Calculate the percentage of total deaths in England and Wales in 2012 that resulted
from each of the five categories of disease
b. Use the 2012 data to estimate the probability of an average person in England and
Wales developing each of the diseases. Express your answers as 1 in x values

8. In a school of 1300 students, in one term 10 students contracted verrucas from the school
pool. In a letter to parents the headteacher said there was less than 1% chance of any
child catching a verruca in any term.
Was the figure she quoted correct and what assumptions had she made in making this
statement?

9. In 2013, 208 755 cases of chlamydia were reported in England, with 43 386 of these cases
being reported in London. One newspaper wanted to write a front page headline claiming
that there was a higher risk of contracting this sexually transmitted infection in the capital
compared with the rest of the country.
The population of England in 2013 was 53.5 million; the population of London was 8.3
million.
Would they have been correct? Support your answer with calculated risk values.

Identifying risk factors

To determine what the risk factors are for a particular disease, scientists look for correlations
between potential risk factors and the occurrence of the disease. There is a correlation between
two variables when a change in one variable is accompanied by a change in the other. A lot of
data is needed to ensure a correlation is statistically significant.

Positive correlation: one variable increase as the other increases.

Negative correlation: As one variable increases the other decreases.

Two variables are causally linked when a change in one is responsible for a change in the other.

10. Strong correlations have been reported between the following variables. In each case,
decide if it is positive or negative correlation and if there is likely to be a causal link
between the variables or not.
Suggest a possible reason for the correlation:
a. Shark attacks and ice cream sales
b. Children’s foot sizes and their spelling abilities
c. Lung cancer and smoking
d. Number of alcoholic drinks consumed and manual dexterity

11. State 3 risk factors for CVD

12. Explain two of the above
13. Describe how a cohort study can identify risk factors for a particular disease
14. Describe how a case control study can identify risk factors for a particular disease
15. Compare the probability of a man and woman risk of getting CVD and explain why
16. Compare the probability of a young and old person’s risk of getting CVD and explain why

17. The graph below shows the number of deaths from colon cancer plotted against the mass
of dietary fibre consumed.

a. Describe the relationship between dietary fibre and mortality from cancer of the
colon
[2]
b. Outline why increasing the intake of dietary fibre may affect the incidence of
cancer of the colon
[3]
18. Trials have been conducted on people who have already had one heart attack to
investigate the effect of soluble dietary fibre on reducing their blood cholesterol levels.
The table shows the reduction in plasma cholesterol according to the amount of soluble
fibre and initial cholesterol levels.

Amount of soluble dietary Reduction in plasma cholesterol level mmol/dm 3

fibre g/day
Initial value < 5.9 Initial value > 5.9

Less than 3 0.08 0.26

More than 3 0.12 0.40

a. Give two reasons why the results of investigations such as this are difficult to Interpret
[2]
b. Using these data, comment on the possible relationship between soluble dietary
fibre intake and coronary heart disease
[2]

19. Cirrhosis is a disease of the liver that is associated with alcohol abuse.
Two studies, study A and study B, were carried out to determine the relative risk of
 developing cirrhosis in relation to the mass of alcohol consumed each day by men and
women.

The graph below shows the results of these two studies.

a. The results of these studies indicate that there is a correlation between alcohol
consumption and cirrhosis.
Explain how these results indicate that there is a correlation between alcohol consumption
and cirrhosis.
[1]

b. Using the information in the graph, compare the results for women in studies A and B.
[2]
      
c. Suggest two reasons for the differences between the results for women in these two studies.
[2]

d. Describe the evidence shown in the graph that suggests that the risk of developing cirrhosis
depends on gender.
[2]

e. Comment on the reliability of these results

[2]
      
f. It is possible that the men and women in these studies underestimated their alcohol
consumption.
Suggest one reason for this.
[1]