Open Topic 1, Unit 1

Dedication and Thanks!
Special thanks for my beloved daughter and assistant:
Dr. Mariam Sayed
To my dear assistant, Thank you for being a part of this

endeavor throughout this journey. Your willingness to go above
and beyond in ensuring that the notes were well-written and
comprehensive is truly appreciated.
Your attention to detail and ability to grasp complex concepts

have been instrumental in creating a syllabus that is both
informative and accessible to our students.
With heartfelt appreciation,
Dr. Gehan Fares.

Index
Topic 1 – Molecules, Transport and Health.
Circulation -------------------------------------‐--------- Page 2

Blood components -------------------------------------‐- Page 5
Transport of gases-------------------------------------- Page 7

Blood clotting -------------------------------------‐----- Page 12
Blood vessels -------------------------------------‐------ Page 13
Mammalian heart and cardiac cycle-------------------- Page 17
Cardiovascular diseases -------------------------------- Page 24
Treatments of Cardiovascular diseases---------------- Page 33
Bonds and water molecules ----------------------------- Page 40
Nutrients types -------------------------------------‐---- Page 44

Carbohydrates -------------------------------------‐----- Page 47
Lipids -------------------------------------‐--------------- Page 56
Proteins -------------------------------------‐------------ Page 60

Risk, correlation and cause------------------------------ Page 67
Designing studies ---------------------------------------- Page 69

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TOPIC 1
Circulation
Mass transport system: In a mass transport system, all the substances move in
the same direction at the same speed
Living organisms can be classified into:
• organisms that do not require a transport system
• organisms that require a transport system
1)Organisms that don’t require a transport system
Small unicellular organisms do not need a transport system, because substances

move by diffusion. Diffusion in single-celled organisms can occur directly between
the external environment and the cell, this is known as simple diffusion as it occurs
only through the cell membrane. This can only occur in unicellular or very small
multicellular organisms due to:
• Large surface area to volume ratio

• Small distance of diffusion
• Steep concentration gradient.
• Lower energy requirements.
So, there are no limitations of diffusion in small organisms
Dr Gehan Fares +201001980232

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2)Organisms that require a transport system
For larger organisms, like us humans, we have a small surface area to volume
ratio, meaning diffusion would be too slow to supply all cells with the nutrients
they need and this is why larger organisms have mass transport systems that
supply all cells with vital substances.
Q) Why mammals have a heart and circulation

Mammals have a small surface area to volume ratio, they require a high
nutritional intake as well as a high oxygen intake, large amounts of waste and
excretory products need to be removed all at a sufficient pace, the heart is a
mass transport system that provides all that and helps overcome the limitations
of diffusion which by itself is insufficient.
Types of circulation:
➢ Open circulation: only a heart (hollow muscular tube) is present and there are
no blood vessels (blood circulating in large open spaces).
➢ Closed circulation: a heart and blood vessels are present (blood is enclosed
inside vessels). There are 2 types of closed circulation:
1)Single Circulation (e.g. in Fish):
• Blood passes by the heart once per cycle.
• Blood is pumped from the heart to the gills for gas

exchange (oxygenation) then to tissues then
deoxygenated blood returns back to the heart.

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2)Double Circulation (e.g. in Birds and Mammals):
• Blood passes by the heart twice per cycle.
• It consists of:
• Pulmonary circulation: between heart and lungs.
In pulmonary circulation, deoxygenated blood is pumped

from the right side of the heart to the lungs where
oxygenation takes place. Then, oxygenated blood is
returned to the left side of the heart.
• Systemic circulation: between heart and body tissues.
In systemic circulation, oxygenated blood is pumped from

the left side of the heart to all body tissues. Then,
returned back as deoxygenated blood to the right side.
Advantages of a double circulation:
1. Complete separation of the deoxygenated and oxygenated blood.
2. The left ventricle pumps blood at a relatively higher pressure for a longer
distance to ensure delivery of oxygen and nutrients to all body tissues.
3. The right ventricle pumps deoxygenated blood at a relatively lower pressure to

prevent damage of the thin and delicate capillaries surrounding alveoli.

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Components of the blood
1)Plasma
A transparent yellow liquid in which blood cells are floating, over 50% of your
blood volume is plasma. 90% of plasma is water and 10% are dissolved substances:
1. Digested food products (e.g. glucose, amino acids)

from small intestine to the liver then to all the parts
of the body for immediate use or storage.
2. Antibodies. Produced by lymphocytes
3. Hormones produced by endocrine glands.
4. Urea dissolved in plasma produced by liver cells from

deamination of excess amino acids.
5. CO2 produced during respiration, transported as hydrogen carbonate in plasma
6. Plasma protein e.g. fibrinogen made by liver cells
7. Plasma help to maintain a steady body temperature by transferring heat

produced by respiration process of all cells especially liver and muscle cells
2)Red blood cells (erythrocytes)
Transport oxygen from lungs to all cells
They are well adapted for their function:
• They are small and flexible so they can fit through narrow vessels
• They have a bi-concave shape which maximises their surface area to absorb
oxygen
• They have a thin membrane so gases easily diffuse through
• They contain haemoglobin which binds to oxygen to allow oxygen transport
• no nucleus (to make room for more haemoglobin)

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3)White blood cells
Several types, made in bone marrow, their main function is to defend the body
against infection, also very important in the inflammatory response of the body
when an area of the tissue is damaged
4)Platelets
They are tiny fragments of large cells called megakaryocytes which are found in
bone marrow, they are involved in blood clotting. (you will learn more about blood
clotting in this unit)
Haemoglobin
It consists of Amino acids arranged in four polypeptide chains held together by
sulfur bridges. There are two types of polypeptide chains; Alpha (α) chain and Beta
(β) chain
Each chain is arranged around an iron containing “Haem group”
-Haemoglobin has a high affinity to bind with oxygen so it is packed in red blood
cells to transport oxygen.
-Each haemoglobin molecule can pick up four molecules of oxygen

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Transport of oxygen:
Oxygen in lungs:
-The concentration of oxygen in the red blood cells when blood enters the lung is
relatively low.
-Oxygen moves into the red blood cells from the air in the lungs by diffusion.
-The free oxygen concentration in the cytoplasm of red blood cells stays low;
because oxygen is picked up and bound to the haemoglobin.
-Therefore a steep concentration gradient is maintained between the air in the

lungs and red blood cells.
-More oxygen diffuses in and is loaded onto the haemoglobin.
Haemoglobin and oxygen:
Before proceeding, you need to be familiar with two terms
1)Partial pressure:This term refers to the pressure that would be exerted by

one of the gases in a mixture if it occupied the same volume on its own.
2)Oxygen dissociation curve: The oxygen dissociation curve is a graph with oxygen
partial pressure along the horizontal axis and oxygen saturation on the vertical axis

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-In the lungs the PO2 is high so oxygen binds to haemoglobin readily.
-In the respiring cells the PO2 is low so oxygen is released.
-It is hardest for the first O2 molecule to bind to haemoglobin.
-It binds, then alters the shape of the haemoglobin, making it easier for the next
two O2 molecules to bind.
Oxygen in body tissues:
-The levels of oxygen in body tissues are relatively low.
-The concentration of oxygen in the cytoplasm of the red blood cells is higher
than in the surrounding tissues.
-Oxygen moves out into the body cells by diffusion down its concentration
gradient.
-At rest and during gentle exercise; only about 25% of the oxygen carried by the
haemoglobin is released into body cells.
-75% acts as a reserve in the transport system to be used when body is active.
Adult haemoglobin:
-The graph is shallower at the top because it

is hard to bind the final O2 molecule as most
binding sites are occupied.
More molecules bind as the oxygen partial

pressure increases until the maximum amount
that can be bound is reached. As this limit is
approached, very little additional binding occurs
and the curve levels out as the hemoglobin becomes saturated with oxygen
Adult haemoglobin has a lower affinity for oxygen (Oxygen more readily
dissociates from haemoglobin at the respiring cells).

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Fetal haemoglobin
Fetal haemoglobin has higher affinity

for oxygen than the adult haemoglobin
of the mother so it can take oxygen from
the mother’s blood and deliver it to the
growing fetus
The strong affinity of oxygen means

that a small change in the proportion of
oxygen in the surrounding environment
can have a big effect on the saturation
of blood with oxygen

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Transport of carbon dioxide:

-Carbon dioxide diffuses from respiring body cells into the blood along a
concentration gradient.
-Carbon dioxide dissolved in blood reacts slowly with water forming carbonic acid
(H2CO3). The rate of this reaction is controlled by enzyme carbonic anhydrase.
The carbonic acid separates to form H+ and HCO3 .

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▪In body tissues:
There is a high concentration of carbon dioxide in the blood, so carbonic

anhydrase catalyzes the formation of carbonic acid.
▪In lungs:
There is a low concentration of carbon dioxide in the lungs, so carbonic

anhydrase catalyzes the reverse reaction and free carbon dioxide diffuses out of
the blood into the lungs.
The Bohr Effect: -The effect of CO2 on Oxygen dissociation curve.
-The hydrogen ions compete for the space on the haemoglobin originally taken up
by oxygen.
-The hydrogen ions displace the oxygen

making the oxyhaemoglobin dissociate
faster.
Therefore,the dissociation curve shifts

toward right. In this condition, blood
saturation level with oxygen for a given
pO2 decreases (release of oxygen is
more). This phenomenon is known as the
Bohr effect.
-More CO2 → more H+ ions → more freely O2 dissociates from oxyhaemoglobin

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Blood clotting:
Blood clotting is important as it seals damaged vessels to minimize blood loss and
prevent pathogens getting in
Mechanism of blood clotting:
1-When a blood vessel is torn plasma, blood cells and platelets flow from the cut
vessel.
2-Contact between platelets and tissue (collagen fibers in skin) causes increase
number of platelets.
3-Platelets release several substances, two of them are particularly important:
▪Serotonin: -Causes contraction of smooth muscles in blood vessel wall, which

narrows the blood vessel cutting off the blood flow to damaged area.
▪Thromboplastin: -An enzyme which sets in progress a cascade of events that
leads to formation of a clot.
c- More platelets and red blood cells get trapped in fibrin mesh which forms a
clot.
d- Special protein in the platelets contract making a clot tighter and tougher to
form a sca

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Structures of different types of blood vessels
1)Artery:
Arteries are blood vessels that carry blood away from

the heart. Most arteries carry oxygenated blood (the
exceptions include the pulmonary artery). The blood
pressure inside arteries is high.
Structure:
1) Narrow lumen
2) It has a thick wall, which consists of three layers:
➢ Tunica intima: a single layer of cells (endothelium)
➢ Tunica media: consists of smooth muscles, connective tissue and elastic fibres
➢ Tunica adventitia: consists of smooth muscles, connective tissue and collagen
fibres
3) No valves
How these structures are related to the function of arteries?
• Narrow lumen helps to maintain a high blood pressure

• The endothelial lining is smooth, so it reduces friction with moving blood. The
endothelial lining is also folded to avoid damage when the wall stretches
• The smooth muscles in tunica media and tunica adventitia contract and relax,
thereby regulating blood flow to target tissues
• The elastic fibres in tunica media allow the wall to stretch during ventricular
systole to prevent pressure from getting too high and recoil during diastole to
prevent pressure from getting too low.
• The collagen fibres in tunica adventitia help to withstand high blood pressure
and they protect arteries from bursting or external traumas.

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The Aorta is a special artery that has unique adptations, including:
1) Relatively large lumen to accommodate the large volume of blood.
2) The aortic semilunar valve is present to prevent backflow of blood during

diastole & atrial systole.
EXAM QUESTION
MARK SCHEME

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2)Vein:
Veins are blood vessels that carry blood towards

the heart. Most veins carry deoxygenated blood
(the exceptions include the pulmonary vein). The
blood pressure inside veins is low.
Structure:
1) Wide lumen
2) Unlike an artery, a vein has a thin wall. But, the
walls of a vein consist of three layers like an
artery. (tunica intima, tunica media, tunica
adventitia). The walls of a vein have less eslastic fibres and smooth muscles
than an artery
3) It has valves
How these structures are related to the functions of a vein?
• Wide lumen and less elastic and smooth muscles help to maximise blood flow
to the heart since blood pressure is low
• Valves prevent backflow of blood since there is low pressure in veins
(prevent blood flowing in the wrong direction).
Factors ensuring blood flow in veins :
• Blood flow through the veins is helped by contraction of the body muscles
surrounding them
• Presence of valves
• Negative pressure in the thorax during inspiration causes suction of blood

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3)Capillaries:
Capillaries are delicate blood vessels that exist throughout your body. Capillaries
are the smallest blood vessels in your vascular system. The blood pressure in
capillaries is higher than veins but lower than arteries.
Structure:
• Narrow lumen
• One cell thick wall
• No elastic fibres or smooth muscles
• No valves
• Has capillary pores
How these structures are related to the functions of a capillary?
• Capillary pores facilitate the exchange of substances between blood and

body cells
• One cell thick wall reduces diffusion distance , to allow faster rate of
diffusion
Causes of reduced blood pressure in capillaries:
• Leakage of fluids out of capillaries through capillary pores

• Long distance from the heart
• Large total surface area of capillaries (large number of capillaries)
The graph alongside shows the

differences in pressure, velocity
and total area of different
types of blood vessels

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The mammalian heart

Function of the heart (Mass flow)
Transport of substances from high pressure to low pressure over a long distance.
This mass transport helps large multicellular organisms overcome the limitations of
diffusion
Structure:
• Made of cardiac muscle
Special Features of the

Cardiac Muscle:
➢ The strongest muscle

in the whole body as it
is the only muscle that
keeps beating
throughout life.
➢ Can initiate its rhythm
through the SAN
(Sino-Atrial Node) in the right atrium (Pacemaker).
• 4 Chambers: right atrium, right ventricle, left atrium and left ventricle.
• 4 Blood Vessels: pulmonary artery, vena cava, pulmonary vein and aorta.
• 4 Valves: right AV valve (tricuspid valve), left AV valve (bicuspid valve),
pulmonary SL valve and aortic SL valve.
• Septum separating the right side from the left side. The left side contains
oxygenated blood while the right side contains deoxygenated blood.
• Supply of blood: coronary arteries.
• It contains myoglobin, a respiratory pigment which has a stronger affinity
for oxygen than haemoglobin. It stores oxygen for the respiration needed to
keep the heart contracting regularly

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Blood circulation:
The right side of the heart The left side of the heart
• Inferior vena cava collects • Pulmonary veins (low pressure after
deoxygenated blood from lower passing in lung capillaries) bring
parts of the body, while the oxygenated blood from the lungs to
superior vena cava collects the left atrium in the heart
deoxygenated blood from head, • Left atrium (thin walled chamber)
neck, arms and chest. This contracts and forces blood into the
deoxygenated blood enters the left ventricle through bicuspid valve
right atrium (Atrioventricular valve with two
• Right atrium (thin muscular wall-low flaps).
pressure) contracts, causing the • Left ventricle (thick wall to move
tricuspid valve (Atrioventricular blood to all body extremities and to
valve with three flaps) to open overcome arteries elastic recoil) is
which allows blood to move from the filled with blood under high
right atrium to the right ventricle pressure and contracts to force
but not the other direction. blood out of the heart into aorta.
• Right ventricle (thin wall as lung is The semilunar valve opens to allow
close to heart) contracts to force this.
blood out of the heart, into the • Aorta is the major artery of the
pulmonary artery. The semilunar body which carries blood under high
valve opens to allow this. pressure to major arteries,
• Pulmonary artery carries backflow of blood is prevented by
deoxygenated blood to the lungs semilunar valves.
Scan this QR Code for

further explanation!!

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Stages of the cardiac cycle
Your heart beats around 70 times a minute. The cardiac cycle is the sequence of
events which makes up one heartbeat.
There are three stages in this cycle.

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Details of Valves:
• They are structures that allow blood flow in one direction and
prevent its backflow in the opposite direction.
• Mechanism of action: a valve opens when pressure before the
valve is higher than pressure after the valve and vice versa.
-A.V. Valves: Allow blood flow from the atria into the ventricles during atrial
systole and prevent backflow during ventricular systole. Tendinous
cords(heartstrings) connect the papillary muscles to the tricuspid valve and the
mitral valve in the heart to prevent their inversion into atria during ventricular
systole.
-Semilunar Valves: Allow blood from the ventricles into major arteries during
ventricular systole. During diastole, pressure in arteries is slightly higher than
ventricles so blood collects in the pockets closing the valve.

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The COCO curve
• The lower 2 are bicuspid valves, higher 2 are semilunar valves.
• Label 1,2,3,4 starting from down left in a clockwise pattern: Close – Open – Close
– Open
•1: Bicuspid valve closes – Pressure in ventricle > Pressure in atrium
• 2: Semilunar valve opens – Pressure in ventricle > Pressure in aorta
• 3: Semilunar valve closes – Pressure in aorta > Pressure in ventricle
• 4: Bicuspid valve opens – Pressure in atrium > Pressure in ventricle

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Examples of questions you might be asked in this topic:

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➢ When you are asked to calculate the length of the cardiac cycle using
pressure / volume changes table, look for the time between two successive
repeated figures. If a graph is given, look for the distance between two
successive peaks on the x-axis.
Control of the heart rate:
1-Intrinsic rhythmicity: -It is maintained by a wave of electrical excitation

similar to a nerve impulse which spreads through special tissue in heart muscles.
2-Cardiovascular center (in brain): -It responds to variable level of carbon

dioxide in the blood (e.g. exercise) -Receptors in the blood vessels sends signal to
CV center which send signal to the heart -One nerve speeds up heart rate another
nerve slows down heart rate
3-Hormones: -Adrenaline speeds up heart rate (3Fs)
Factors affecting heart rate:
1-Physical exercise increases heart rate (tissues need more oxygen and glucose
and to remove waste products)
2-Stress, excitement increase heart rate
3-Rest and relaxation lowers heart rate
4-Drugs, caffeine, nicotine, illegal drugs.

2 The cardiac cycle describes the events that take place in the heart during one
complete heartbeat.
(a) The diagram shows a heart in one of the stages, stage F, of the cardiac cycle.
(i) What is the name of the blood vessel labelled G?

(1)
A aorta
B pulmonary artery
C pulmonary vein
D vena cava
(ii) Which row of the table identifies the stages before and after stage F?
(1)
Stage before stage F Stage after stage F
A atrial systole cardiac diastole
B atrial systole ventricular systole
C ventricular systole atrial systole
D ventricular systole cardiac diastole
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(b) The graph shows pressure changes in the left ventricle of a person.
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14
12
10
Pressure
8
/ kPa
6
0
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4
Time / s
(i) Calculate the heart rate of this person.

Express your answer to 3 significant figures.
(2)
Answer ......................................................... ..... beats min–1
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*P69498A0628* 
(ii) Another line could be drawn on this graph to show the pressure changes in
the right ventricle.
Describe the shape and position of this line.
Give reasons for your answer.
(3)
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
(Total for Question 2 = 7 marks)
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 *P69498A0728* Turn over
Question Answer Additional guidance Mark
number
1(b)(iii) The correct answer is C
A is incorrect because the molecular mass is 180 + 180 – 18 = 342

B is incorrect because the molecular mass is 180 + 180 – 18 = 342 (1)
D is incorrect because the molecular mass is 180 + 180 – 18 = 342

number
2(a)(i) The correct answer is B
A is incorrect because the aorta takes blood away from the left hand side of
the heart
C is incorrect because pulmonary vein returns blood to the left hand side of
the heart (1)
D is incorrect because the vena cava returns blood to the right atrium

number
2(a)(ii) The correct answer is A
B is incorrect because stage F which is ventricular systole

C is incorrect because F is ventricular systole (1)
D is incorrect because F is ventricular systole
number
2(b)(i)
• values read from the graph and subtracted to give the 0.8 / any pair of values that give 0.8
time for one heart beat (1) when subtracted
• 75.0 (1) DO NOT ACCEPT 75

ECF from mp 1 if values correspond
to readings from graph
Bald answer of 75.0 = 2 marks (2)

Bald answer of 75 = 1 mark
number
2(b)(ii) An answer that includes three of the following points: NB ‘It’ refers to the line for the right
ventricle
NB accept converse where
appropriate
• graph will be {the same / similar in} {shape / position} (1) ACCEPT line
• because the left hand side and right hand side beat ACCEPT description e.g. both
simultaneously (1) ventricles contract at the same time
• peaks will be lower (1) IGNORE graph lower down
• because pressure in right hand side is lower ACCEPT because right ventricle has
{as blood is only pumped to lungs / to prevent damage to {less muscle / thinner walls} as blood
alveoli} (1) is only pumped to lungs
less force to lungs
NB If candidate says that there is

something drawn on the graph you (3)
must send it to review
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Cardiovascular Diseases
1. Abnormal Blood Pressure
Blood pressure is the pressure exerted by blood on the walls of blood vessels
and it is measured using a Sphygmomanometer.
Normal blood pressure is about 120/80 mmHg.
However, it varies according to:
• Age
• Level of activity
• Position of the person
• Time of the day
Hypertension:
A chronic disease characterized by blood pressure reading above 140/90 mmHg

sustained and measured at rest.
Hypotension:
Sustained blood pressure reading below 90/60 mmHg at rest.
N.B.: To count on a blood pressure reading, it must be sustained (3 successive

readings) and at rest.

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2. Atherosclerosis
A disease characterized by thickening and hardening of a blood vessel (coronary

artery) wall as well as narrowing of the lumen due to the presence of a Fibro-Fatty
Plaque.
(Fibro-Fatty Plaques block an artery or increase its chances of being blocked by a

blood clot.)
Fatty deposits = Atheroma
Blood clot formed = Thrombus which may detach forming embolism
Pathology of Atherosclerosis
1) Damage of endothelial lining

of blood vessels, due to:
a. Hypertension.
b. Cigarette smoking (Tar).
c. Free radicals.
This stimulates an
inflammatory response.
2) WBCs move to the damaged
area followed by
accumulation of cholesterol.
This is called Atheroma.
3) Fibrous tissue and calcium
salts build up around the
atheroma turning it into
hardened plaque.
4) Collagen fibers are then laid
down forming a Fibro-Fatty
plaque, this causes narrowing
of the blood vessel. This is known as atherosclerosis.

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Atherosclerosis causes hypertension which stimulates further damage (perpetual

cycle).
N.B.: Atherosclerosis may stimulate the coagulation cascade causing blood

clot formation (Thrombus).
Consequences/complications of Atherosclerosis
• Incomplete block of blood vessels → reduced blood supply (Ischemia) → Angina

pectoris.
• Complete block of blood vessels supplying:
Heart → Myocardial infarction.
Brain → Stroke.
Vein →deep venous thrombosis (DVT), it usually happens in leg veins, it can
be caused by prolonged inactivity e.g. during long flights, risk increases with
age.
• Weakness of blood vessels → widening at a specific site → Aneurism (which

may rupture).
Angina Pectoris
Incomplete block of a blood vessel supplying the heart (coronary artery), causing
reduced blood supply, this lead to anaerobic respiration and lactic acid
accumulation.
Symptoms:
• Sever chest pain during exercise.
It is relieved by rest & vasodilators
Prevention:
1-Eating low fat diet. 3-Weight loss.
2-Regular exercise. 4-Stop smoking.

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Treatment:
1-Drugs that cause rapid dilation of the coronary blood vessels to supply the
cardiac muscle with enough oxygen.
2-Heart bypass surgery.
Myocardial Infarction
Complete block of coronary arteries causing death of the cardiac muscles.
Explanation:
• Complete obstruction of the lumen of a

coronary artery.
• No blood delivered to the cardiac muscle so no

oxygen or glucose delivered.
• No aerobic respiration.
• Anaerobic respiration occurs instead.
• Lactic acid is produced from anaerobic

respiration. This lowers pH
• Enzymes denature.
• Death of the part supplied by the blocked artery
Symptoms:
• Sudden severe chest pain occurring at rest. It is not relieved by Vasodilators

(angina)
The extent of the damage depends on the site and size of the blocked artery.
The larger the size of the artery affected, the greater the damage.
The higher the obstruction, the greater the damage.
This occurs as all the area downstream the obstruction is deprived of blood.

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Note: Be clear that angina and myocardial infarction are caused by reduced blood
flow to the cardiac muscle - if you say 'to the heart' this suggests reduced flow in
the veins carrying blood into the atria rather than arteries carrying oxygenated
blood to the muscle itself
Stroke
Complete block of a blood vessel supplying the brain (Cerebral artery), causing
death of the part supplied by the blocked vessel.
It may happen due to bleeding from damaged capillaries.
Symptoms:
• Vary according to damaged area:
• Paralysis.
• Blindness.
• Loss of speech (Slurred speech).
• Deafness.
• Dizziness.
• Confusion.
Aneurysm
The artery bulges and the wall is under more pressure than usual (due to building
up of blood behind the blockage) which weakens the wall of the artery which may
split open leading to massive internal bleeding.
-Happens in brain and aorta (abdomen)
-Massive blood loss drops blood

pressure and is fatal.
-Aneurysm can be diagnosed and

treated by surgery before they burst.

29
Risk factor of atherosclerosis
Non-modifiable
1) Genes, some families or ethnic groups have genetic tendencies for the disease.
The arteries can be easily damaged, or they have a problem in the metabolism
of cholesterol
2) Age, old people lose elasticity of their arteries which increases the risk of
atherosclerosis
3) Gender, before the age of 50, men are more likely to get the disease more than
women. Because oestrogen before the menopause reduces the chance of
building up of plaques.
Modifiable
1) Hypertension, it is a cause and a result at the same time, if the blood pressure
is regularly above 140/90, this means the person may develop a plaque hence
the blood pressure could rise further as a result.
2) Smoking, smokers are more likely to develop cardiovascular disease than non-
smokers who have the same lifestyle.
➢ Nicotine in cigarettes has more than 400 chemical factors that affect
health and damage the arterial lining. It also stimulates the adrenalin
release, hence, increase the heart rate and result in vasoconstriction
(narrowing of the artery), theses 2 factors will raise the blood pressure
and lead to clot formation
➢ In addition, the carbon monoxide, Hb has a higher affinity to CO than O2,
which results in the formation CarboxyHb which reduces of the ability of
Hb to carry oxygen to the cells, including heart cells.
3) Activity, having regular exercises decrease blood pressure, obesity, cholesterol
level, stress and liability to diabetes.

30
4) Obesity, it can raise blood pressure and cause type 2 diabetes, which can
damage the blood vessel lining.
Obesity indicators such as waist-to-hip ratio or BMI (body mass index) can be
used to assess if people are overweight or obese.
Waist-to-hip ratio is calculated using

this formula:
BMI is calculated using this formula:
A ‘normal’ BMI for adults is between 18 and 25
5) Stress releases a chemical called cytokine, which speeds the inflammatory

response in the artery and hence speeds up the plaque formation. Stress also
can cause hypertension
6) Dietary issues:
1. Diet high in lipids, lipids transport around the body in the form of lipoproteins.
There are 2 types of High-density lipoproteins HDL, low-density lipoproteins
LDL.
HDL are good lipoproteins. They are made from cholesterol, unsaturated fats
and proteins,
They carry the cholesterol from the body to the liver so it breaks it down.
Hence it reduces blood cholesterol levels.
It also removes simple plaques and prevents them from getting bigger.
LDL are harmful lipoproteins. They are made from cholesterol, saturated fats
and protein,
They transport lipids around the body and bind to the cell membrane before
being taken into the cell
If there are high levels of LDL the cell membrane becomes saturated and so
more cholesterol remains in the blood. Therefore risk of CVD increases.

31
➢ Monounsaturated fats (olive oil-olives-peanuts) improve the balance of LDLs

and HDLs.
➢ Polyunsaturated fats (corn oil-sunflower oil) are better than monounsaturated
fats in reducing cholesterol levels.
➢ The link between a diet high in saturated fats and a raised incidence of CVDs
shows a correlation but not a cause.
2. Diet with High salt intake can raise blood pressure.
3. Alcohol, excessive intake of alcohol will raise blood pressure and the formation
LDL in the blood
4. Protein in milk:
-Casein (80% of milk protein) is formed from beta-casein A1 and A2.
-A1 might link to CVDs.
-Correlation between the highest consumption of A1 and the levels of heart
diseases.
5. Amino acid homocysteine:

-Problems in homocysteine metabolism can cause CVDs.
-Vitamin B6 and folic acid in diet allows homocysteine to be metabolized
instead of building up in blood vessels.

32
6. Dietary antioxidants:
Oxidant stress: - Oxidant stress is believed to be an important contributor to cell

death in myocardial infarction.
Oxidant stress is an imbalance in cellular reduction-oxidation status in which net

oxidative factors exceed net reduction factors.
Or in other words, Oxidative stress is an imbalance between free radicals (a by-

product of metabolism) and antioxidants in your body
Dietary antioxidants: - Dietary antioxidants most often refer to those found in

fruits, vegetables, and other foods (nuts, oils, seeds).
The most common dietary antioxidants include betacarotene and related

carotenoids (many with vitamin A activity), ascorbic acid or vitamin C, and the
various forms of vitamin E
Anti-oxidants (vitamin C, E, A) supply Hydrogen atoms to the cell in order to

stabilize free hydrogen radicles. Unstable radicals are highly reactive so they can
damage the cells.
Antioxidants prevent or repair the cell damage that free radicals cause,
including damage to the innermost layer of the arteries.
They help lower the risk of heart attacks by preventing the formation of plaque
in the arteries and the oxidation of LDL cholesterol
People with a diet with low antioxidants can have a high risk of heart diseases and
cancer.

33
Treatments of CVDs
1) Anti-hypertensive drugs
• Diuretics
Diuretics decrease blood volume by increasing the flow of urine, so, getting rid of
a large amount of water in the blood and ions in the plasma which lowers the
pumping of the blood, hence, reduce blood pressure and the load on the cardiac
muscle
• Beta-blockers
Interference with normal system of controlling the heart, they block the response
of the heart to hormones, the purpose of that is to prevent adrenaline from
raising the heart rate and blood pressure
They also result in the contraction of the heart to be less strong, so, lowering
blood pressure
• Sympathetic nerve inhibitors
They prevent the sympathetic nerves from the central nervous system to signal
the body parts. Sympathetic nerves are responsible for the vasoconstriction of the
arteries. Nerve inhibitors will inhibit the sympathetic nerves and hence dilating
the arteries and reducing blood pressure
• ACE (Angiotensin-converting enzymes) - inhibitors
Angiotensinogen is an inactive hormone secreted from the liver. The hormone is

converted to angiotensin (another hormone responsible for vasoconstriction) by
the help of the ACE enzyme. The ACE inhibitors will then stop angiotensin from
doing its job, causing a dilation of the arteries.
Risks of anti-hypertensive drugs
➢ Low blood pressure (leads to falls and injuries, life threatening in old people)
➢ Side effects : • Tiredness • Fatigue • Coughing • Swelling in ankle

34
2) Blood-cholesterol lowering drugs

• Statins
It is a natural drug produced by a kind of fungi.
They lower the cholesterol level by stopping the liver from producing it. The drug
blocks the enzyme responsible for cholesterol synthesis in the liver.
Hence, decrease the production of LDL.
When the LDL: HDL ratio decreases, the inflammatory response slows down.
Common Side effect
o Joint and muscle pain
o nausea
o constipation or diarrhea
o Liver problems
Rare side effect
o Fatal muscular inflammation
o If the patient didn’t stick to a low cholesterol diet the statins will have no effect
• Stanols & Sterols
They are plant in origin and can be present in everyday products like yoghurt and
spread cheese.
They have a very similar structure to cholesterol; the liver will think there is
enough cholesterol in the blood and stop producing it.
Additionally, Sterols decreases the absorption of cholesterol in the intestine.

Hence the amount of cholesterol and LDL will decrease
Regular intake of products containing stanols and sterols will decrease the risk
of heart diseases by 25%

35
3) Drugs that prevent blood clotting

• Anticoagulant
Warfarin is an example of an anticoagulant that prevents the formation of

prothrombin (an important enzyme in clot formation process) in the liver. As a
result, clot formation is decreased in the whole body, which is a dangerous side
effect if someone got a large wand. The patient consuming this drug should have
regular check-ups to ensure there is no internal bleeding.
• Platelets inhibitory drugs
Aspirin & Clopidogrel are examples of platelet inhibitory drugs.
They affect the platelets and make them less sticky so reduce the clotting ability
of the blood.
The aspirin can be only taken after eating because it has an irritating material
that affects the stomach lining and causes it to bleed. And since Aspirin
reduced the clot formation, the bleeding won’t stop.
Aspirin combined with Clopidogrel can reduce the risk of developing cardiovascular
diseases by 20- 25%, in low-risk patients.
Further studies showed that that combination has a higher risk of a side effect
rather than using Aspirin or Clopidogrel alone

36
Surgical treatments to restore blood flow
Coronary angioplasty (Balloon catheter)
The catheter is a very thin tube used by the doctor to reach the coronary artery
through the arm or the leg. The catheter is traced inside the body by the X-ray.
When the catheter arrives at the blocked coronary artery, the balloon is inflated.
This action will push the plaque down. Hence, the artery is dilated.
This treatment alone is not enough, a stent should be applied to the artery to
prevent the plaque from forming again.
The stent is a tiny tube made from

stainless steel or refined plastic.
If the patient didn’t stick to low

cholesterol diet the plaque can form
again even with the stent, and the
procedure may be repeated after 6
months
If the artery is completely blocked with a hard thrombus, a bypass surgery should
be operated

7 The risk of developing cardiovascular disease (CVD) is affected by two groups
of factors:
• lifestyle factors that can be changed
• non-lifestyle factors that cannot be changed.
Methods to reduce the risk of developing CVD include drug treatments and
lifestyle changes.
(a) (i) Which row of the table identifies one lifestyle factor and one
non-lifestyle factor?
(1)
Lifestyle factor Non-lifestyle factor

A body mass index (BMI) age
B gender high alcohol intake
C genetics high blood pressure
D high blood cholesterol inactivity
(ii) Explain why a person might have to take several types of drugs to reduce the
risk of CVD.
(2)
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
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. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
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. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
22
*P69498A02228* 
(b) Nutritional studies have shown that dietary antioxidants can reduce the risk
of CVD.
(i) Explain why antioxidants in the diet reduce the risk of CVD.
(3)
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
(ii) Some studies do not assess the nutritional quality of the diet of
the participants.
Explain why the results of these studies have to be treated with caution.
(3)
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
23
 *P69498A02328* Turn over
(iii) Explain why changes in diet, other than antioxidants, can reduce the risk
of CVD.
(2)
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
(Total for Question 7 = 11 marks)
24
*P69498A02428* 
Question Answer Mark
number
7(a)(i)
The only correct answer is A
B is incorrect because a person can modify their alcohol intake

C is incorrect because a person can modify their blood pressure (1)
D is incorrect because a person can change their level of activity

number
7(a)(ii) An explanation that includes the following points:
• because many factors cause CVD (1)
• different drugs treat different conditions (1) ACCEPT two named drugs and what
they treat (2)
IGNORE wrong drugs
number
7(b)(i) An explanation that includes the following points:
• because antioxidants reduce free radicals (1) ACCEPT neutralise / donate

electrons to / break down / stabilise
• therefore {cell damage / damage to lining of blood IGNORE incorrect consequences

vessels / oxidative stress} will be reduced (1)
• therefore reducing {plaque / atheroma} formation (due

to decreased free radicals ) (1) (3)

number
7(b)(ii) An explanation that includes the following points: IGNORE non-dietary factors
• {study / data} will not be valid (1) IGNORE reliability / accuracy
• diet has an impact on CVD (1) ACCEPT {increase risk / decrease

risk} in correct context
• credit an example explained (1) e.g. high salt causes high blood
pressure
high fibre reduces cholesterol
absorption
(3)
number
7(b)(iii) An explanation that includes the following points: IGNORE non-dietary examples
• because diet affects a number of risk factors (1)
• credit example of change in diet and the risk factor it e.g. salt intake can be reduced to
reduces (1) lower blood pressure
{saturated / animal} fats can be
• credit a second example of change in diet and the risk reduced to reduce {cholesterol
factor it reduces (1) levels / atheroma formation}
unsaturated fats can be
increased to reduce {cholesterol
levels / atheroma formation} (2)

number
8(a)(i)
• GUG ACCEPT guanine uracil guanine / CAC
/ cytosine adenine cytosine (1)
IGNORE val / valine
37
CORE PRACTICAL 2
Investigating the Vitamin C Content of Food & Drink
• Vitamin C is found in green vegetables, fruits, and potatoes and is essential for
a healthy diet
• The chemical name for vitamin C is ascorbic acid
• Vitamin C is an antioxidant (supplies hydrogen to cells to stabilize free radicals)

so it is a good reducing agent and therefore it is easily oxidised
• Methods for the detection of vitamin C involve titrating it against a solution of

an oxidising agent called DCPIP. DCPIP is a blue dye that turns colourless in the
presence of vitamin C
• Titration is a method of chemical analysis that involves determining the

quantity of a substance present by gradually adding another substance; in this
case the concentration of vitamin C is determined by gradual addition of a
vitamin C solution to DCPIP
Method
1. Make up a series. e.g. six, of known vitamin C concentrations
This can be done by serial dilution. (You will learn more about serial dilution
later in this unit)
2. Use a measuring cylinder to measure out 1 cm 3 of DCPIP solution into a test

tube
3. Add one of the vitamin C solutions, drop by drop, to the DCPIP solution using a
graduated pipette or burette

38
4. Shake the tube for a set period of time using a stop watch
o It is important to keep the shaking time the same for each concentration;
this is a control variable
5. When the solution turns colourless record the volume, in number of drops, of
vitamin C solution added
6. Repeat steps 2-5 for the same concentration twice more and calculate an
average
7. Repeat steps 2-6 for each of the known

concentrations
8. Results can be plotted as a line of best fit showing

the average volume of vitamin C needed to
decolourise DCPIP against the concentration of
vitamin C
o This is a calibration curve and can be used to

find the concentration of vitamin C in unknown
samples such as fruit juices
Risk assessment
• DCPIP is an irritant
o Avoid contact with the skin
o Wear eye protection

39
Results
• The volume of vitamin C solution required to decolourise DCPIP

should decrease as the concentration of the vitamin C solution increases
• The results of the experiment can be plotted on a graph of volume of vitamin C

needed to decolourise DCPIP against the concentration of vitamin C
o The line of best fit for such a graph is known as a calibration curve; which
can be used to estimate the concentration of vitamin C in fruit juices

40
Molecules, transport and health
Ionic bonds
Atom involved in the reaction give or receive electrons, one atom gains one or
more electrons and become an anion (negative ion). The other atom loses
electron or more and becomes a cation (positive ion). The strong force of
attraction called ionic bonds holds the oppositely charged ions together
Covalent bonding
Atoms involved in this type of bonding share electrons. Covalent bonds are very
strong and molecules formed are usually neutral
Polar molecules
However, in some covalent compounds, the molecules are slightly polarized; this
means that the electrons in the covalent bonds are not evenly shared. Consequently,
the molecule has a part that is slightly negative and a part that is slightly
positive. This separation of charge is called dipole. The molecule containing a dipole
is described as a polar molecules. This polarity is particularly common if the bond
involves one or more hydrogen atoms

41
Water molecules
Importance of water
1-Excellent solvent:
The polar nature of water molecule makes water cohesive and a good solvent.
These properties make water good at transporting substances. ( eg: transport of
glucose, amino acids, hormones, etc. in blood.)
Polar substances: Charged or polar molecules such as salts, sugars and amino acids
dissolve readily in water but not in organic solvents as such as ethanol, and so are
called hydrophilic ("water-loving").
When placed in water, ionic substances dissociate (positive and negative ions
separate) and become surrounded by water molecules which keep them in solution.

42
Non-polar substances : Uncharged or nonpolar molecules, such as lipids, do not

dissolve well in water and are called hydrophobic ("water-fearing")
Insoluble particles forms
• Emulsions [tiny droplets of one liquid suspended in another liquid] (fat)

• Suspension [a solid mixed with a liquid in which the particles will separate
out if the mixture is not constantly stirred or moved] (blood)
2. Amphoteric:
Keeps constant pH as it can act both as acid [H+ proton donor] and as a base [OH-
ions a proton acceptor]
Water acts as a buffer to prevent reactions from changing the pH inside the cell.
3. Transparent:
Allows marine life to exist due to passage of sunlight and photosynthesis.
4. Low Density:
Ice floats on the surface insulating the lower water which allows for the continuity
of marine life.

43
5. High specific heat capacity (SHC):
Water takes more energy to overcome the attractive forces of all the hydrogen
bonds. It is slow to absorb and release energy (it has a high specific heat
capacity)
This keeps water temperature within narrow limits and allows for proper enzyme
activity of aquatic organisms.
6- High surface tension (As if the surface is covered by thin elastic skin)
Water hydrogen bonds tend to pull water molecules down and together(No
attraction between the different molecules where water and air meet, so water
layer holds together forming a thin skin of surface tension).
Definitions:
Dipole: The separation of charge in a molecule when the electrons in covalent

bonds are not evenly shared
Polar molecule: a molecule containing a dipole
Scan this..Once again ;)

44
Diet and energy

Types of nutrients:
1) Macronutrients:
1-Carbohydrates
• Provide energy (by cellular respiration of glucose)

• Stored as glycogen in liver, muscle and brain.
• Excess is stored as fat.
2-Lipid
• Source of energy
• Effective energy store (contain more energy per gram than carbohydrates
or proteins)
• Role in cell membranes.
• Protective function (fat around kidney).
• A good insulator (fatty sheath insulates nerves so electrical impulse travel
faster)
• A good insulator (insulates animals against heat loss)
3-Proteins
• Growth and repair of cells

• Broken down into amino acids which are rebuilt to proteins which the body
needs in protein synthesis
• Essential amino acids (found in animal proteins -body can’t make them) so
they are essential part of diet

45
2) Micronutrients: (needed in a small amount)
1-Mineral salts
• Calcium (dairy products-fish-hard water)

a- Formation of skeleton and teeth.
b- Muscle contraction.
c- Blood clotting.
• Sodium
a- Proper work of nerves and maintaining salt levels in the body
b- Muscle contraction and maintaining heartbeat
2-Vitamins
-Complex organic substances absorbed directly in the blood stream from the gut.
-Fat soluble vitamins are absorbed with fat eaten.
-Food source: fresh vegetables and fruits.
Vitamin C: Needed for formation of connective tissue in the body (bones, teeth,
skin. endothelial lining of blood vessels). Lack of vitamin C causes scurvy (bleeding
gums, easy bruising, painful joints, atherosclerosis)
Vitamin B: Needed to prevent heart diseases
3) Others
1-Water
• Important to keep life
2-Fibre (roughage)
• Not digested by human so it provides bulk for the intestine to work on.
• Lack of fibres causes constipation, hemorrhoids, bowel cancer.

46
Organic compounds:
Organic compounds contain carbon atoms (also contain atoms of hydrogen, oxygen
and less frequently nitrogen, sulphur and phosphorus)
Each carbon atom can make four bonds with other four atoms which are arranged
in a tetrahedral shape which leads to three dimensional shapes of organic
molecule.
Small molecules of carbon compounds (monomers) bond with other similar units to
make a very large molecule (polymer)
General Formula: Show how many atoms in a molecule and their types.
Displayed formulae: Show what the molecules look like and why it behaves as it
does.

47
SECTION 1: Carbohydrates
Chemical elements: Carbon, Hydrogen and Oxygen
General Formula: Cx(H2O)Y
Types of carbohydrates:
They can either be Monosaccharides, Disaccharides or Polysaccharides
Mono means 1
Di means 2
Poly means many
Saccharides means sugars
1) Monosaccharides:
• General formula: (CH2O)x

• They are the building unit of all Carbohydrates
• They are Simple, Sweet, and Soluble
Types of monosaccharides:
When classified according to the number of carbon atoms in each molecule, the
main types of monosaccharides are:
• Trioses (3C)
• Pentoses (5C) as Ribose and Deoxyribose in nucleic acids
• Hexoses (6C) as Glucose, Galactose and Fructose
➢ Glucose: used in respiration.
➢ Fructose: found in fruits.
➢ Galactose: forms lactose of milk.

48
Glucose
Formula of glucose: C₆H₁₂O₆
Glucose exists in both linear and ringular form
Linear:
Ringular:
The ring structure is made by joining C1 with C5
Ring structure has 2 isomers: α and β
It depends on the
hydroxyl group (OH)
of C1.
• If it is at bottom
(clockwise) then it is
alpha
• If it is on top then
it is beta
(anticlockwise)

49
How to draw a-glucose:
1) Draw an empty ring. 2) Draw carbon number 6.
3) Add your OHs (All down except 3 up).
4) Add your missing Hs.
Roles of Monosaccharides:
1-Source of energy in respiration.
This is due to the large number of carbon–hydrogen bonds. These bonds can be
broken to release a lot of energy. This energy is used to make ATP from ADP and
Phosphate.
2-Building blocks for larger molecules
• Glucose is used to make the polysaccharides starch, glycogen and cellulose.

• Ribose is one of the molecules used to make RNA (ribonucleic acid) and ATP.
• Deoxyribose is one of the molecules used to make DNA
Some terms you need to be familiar with before proceeding:
Glycosidic bond: a covalent bond between the two monosaccharaides
Condensation reaction: In a condensation reaction, two hydroxyl (–OH) groups

line up alongside each other. One combines with a hydrogen atom from the
other to form a water molecule. This allows an oxygen ‘bridge’ to form between
the two molecules, holding them together. The bridge is called a glycosidic bond.
Hydrolysis: The reverse of condensation is the addition of water, which is known

as hydrolysis. It refers to the breakdown of molecules using water.

50
2) Disaccharides:
• General formula: CnH2n-2On-1

• They are formed by condensation reaction between 2 monosaccharides. This
reaction forms bonds called glycosidic bonds.
You need to know 3 disaccharides:
1) Maltose
Maltose is a disaccharide formed by joining two α-Glucose molecules by one 1-4

glycosidic bond via a condensation reaction and removal of one molecule of H2O.
2) Sucrose
Sucrose is a disaccharide formed by joining one α-glucose molecule with one β-

fructose molecule by one 1-2 glycosidic bond via condensation reaction

51
3) Lactose
Lactose is a disaccharide formed by joining one glucose molecule and one galactose
molecule by one 1-4 glycosidic bond via condensation reaction
In theory any two –OH groups can line up and a bond can be formed by
condensation reaction. Since monosaccharides have many –OH groups, there are a
large number of possible disaccharides. The shape of the enzyme controlling the
reaction determines which –OH groups come alongside each other. Only a few of
the possible disaccharides are common in nature.
3) Polysaccharides:
General formula: Cx(H2O)Y
Polysaccharides are polymers whose subunits (monomers) are monosaccharides.

They are made by joining many monosaccharide molecules by condensation reaction
joined by glycosidic bonds
Polysaccharides have high molecular weight, are tasteless & insoluble
Types of polysaccharides:
a-Oligosaccharides (3-10 monosaccharaides)
b-Polysaccharides (11 or more monosaccharaides)
Examples of polysaccharides:
Starch: Storage form in Plants

Glycogen: Storage form in Animals
Cellulose: Structural unit that makes up the cell walls in plants

52
• Starch:
Starch is a mixture of two substances – amylose and

amylopectin
1-Amylose: (20-30%)
• Consists of 200 to 5000 α-glucose molecules
joined by 1,4 glycosidic bonds
• Unbranching so it releases glucose more slowly
over a longer period of time because enzymes
work on each end of the amylose molecule to
release glucose.
• It has a coiled structure, making it a compact molecule that is suitable for
storage
• It is a long molecule so it can not diffuse out of cells
• It is an insoluble molecule so it doesn’t have an osmotic effect in cells, making it
suitable for storage since
2-Amylopectin: (70-80%)
• Consists of α-glucose molecules joined by

1,4 and 1,6 glycosidic bonds
• The chains are shorter than in amylose, and
branch out to the sides. Branches are found
at intervals of 24-30 glucose molecule. The
branches are formed by 1,6 linkages. Since
it has many branches, there are many end-
points that enzymes can work on releasing many glucose molecules
simultaneously
• It is a compact molecule so more glucose molecules
can be stored in less space
• It is a long molecule so it can not diffuse out of cells
• Insoluble so no effect on water potential

53
• Glycogen:
Glycogen is used as an energy store in animals (in liver and muscles only)
• Glycogen, like amylopectin, is made of chains of 1,4 linked α-glucose with 1,6
linkages forming branches. Glycogen molecules tend to be even more branched
than amylopectin molecules. A branch every 8-10 glucose molecule, so even more
end-points for enzymes to work on releasing more glucose simultaneously
• Large molecule so wouldn’t diffuse out of cells
• Insoluble so no effect on water potential
• Compact; takes less space
• High energy content
Adaptations of Starch and Glycogen for their Storage Function *Very important*
1. Large molecules: to store a lot of energy.
2. Compact: to store a large number of glucose molecules while occupying less
space.
3. Insoluble: doesn’t affect osmotic pressure.
4. Non-reactive: doesn’t interfere with any metabolic reactions in the cells.
5. Rapidly hydrolyzed by enzymes: as the a 1,6 glycosidic bond is easily broken
down.

54
CORE PRACTICAL 1
The Benedict's Test for Reducing Sugars
Reducing sugars are mono or disaccharides that can donate electrons, acting as
reducing agents, whereas non-reducing sugars can not donate electrons.
Method
Benedict’s reagent is usedto test for reducing sugars. Benedict’s reagent is blue in
colour as it contains copper (II) sulfate.
If a reducing sugar is present, a coloured precipitate will form as copper (II)

sulfate is reduced to copper (I) oxide which is insoluble in water
The degree of the colour change colour indicates the concentration of reducing
sugars.
Colour changes:
1) Pale blue = no glucose
2) Green = traces of glucose 0.5%
3) Yellow = low concentration of glucose 1%
4) Orange = moderate concentration of glucose 1.5%
5) Brick red = high concentration of glucose >or =2.0%
It is important to ensure that an excess of Benedict’s solution is used so that

there is more than enough copper (II) sulfate present to react with any sugar
present

55
Semi-quantitative Benedict's test
A semi quantitative test is a test whose result gives a broad range/ an estimation
for the substance being tested
• A semi-quantitative test can be carried out by setting up standard solutions

with known concentrations of reducing sugar (such as glucose)
These solutions should be set up using a serial dilution of an existing stock

solution
• Each solution is then treated in the same way: add the same volume of
Benedict’s solution to each sample and heat in a water bath that has been
boiled (ideally at the same temperature each time) for a set time (5 minutes or
so) to allow colour changes to occur
• Any colour change observed for each solution of a known concentration in that
time can be attributed to the concentration of reducing sugar present in that
solution
• The same procedure is carried out on a sample with an unknown concentration

of reducing sugar which is then compared to the stock solution colours to
estimate the concentration of reducing sugar present

56
SECTION 2: Lipids
Chemical elements: carbon, hydrogen, oxygen (Lower proportion of oxygen than
carbohydrates).
All lipids dissolve in organic solvents but are insoluble in water.
Types:
1) Triglycerides
• Fats (solid at room temperature)
• oils (liquid at room temperature)
2) Phospholipids
3) Cholesterol
NB: The most common form of lipids is triglycerides
1) Triglycerides:
Triglycerides are formed of one glycerol head and 3 fatty acid tails joined by
condensation reactions forming ester bond.
1) Glycerol:
Chemical formula: C3H8O3
Mono-, di-, or triglycerides: formed by combination of

glycerol with one, two or three fatty acids.

57
2) Fatty acids:
They have a two main parts
• A carboxyl group (-COOH) at one end.

• A long hydrocarbon chain
All fatty acids consist of the same basic

structure, but the hydrocarbon tail varies.
The tail is shown in the diagram with the
letter R
The hydrocarbon chains vary in their:
1. Length: They frequently contain between 15 and 17 carbon atoms

2. Whether they are saturated or unsaturated:
• Saturated (each carbon atom is joined to the one next by a single covalent
bond)
• Unsaturated (the carbon chains have one [monounsaturated] or more
[polyunsaturated] double bonds in them)

58
Comparison between the types of fatty acids:
Formation of triglycerides:
2) Like carbohydrates, triglycerides are formed by condensation reactions and

broken up by hydrolysis reactions.
3) The bonds in triglycerides are formed between the carboxyl (COOH) of a fatty
acid and one of the hydroxyl groups (OH) of glycerol and a water molecule is
produced. The bonds formed are called ester bonds. (esterification)

59
4) The reverse happens in hydrolysis — a molecule of water is added to each ester

bond to break it apart, and the triglyceride splits up into three fatty acids and
one glycerol molecule
Note:
• All fats are hydrophobic

• Since fats are hydrophobic, they cannot dissolve in the water of plasma. To be
transported in blood, fats must be coated by proteins (hydrophilic), forming
lipoproteins.
2) Phospholipids:
› Same as Triglycerides, but one of the FAs attached to glycerol is replaced by

phosphate group.
› Formed of a polar hydrophilic head (phosphate group) and 2 non-polar

hydrophobic tails (fatty acids).
› Form an important part of cell membrane, the Phospholipid Bilayer.
3) Cholesterol:
› Short lipid molecule with a structure different to Triglycerides.
› Cholesterol is an important part of the cell membrane (between phospholipids)
› It is used for the synthesis of sex hormones and bile salts

60
SECTION 3: Proteins
Chemical elements: C, H, O and N (± phosphate and sulfur).
They are polymers of amino acids formed by condensation reactions.
Amino Acids
› There are only 20 types of AAs. However, by using different numbers, sequences
and combinations, a huge number of proteins can be produced.
› Humans can only make 12 AAs in their bodies. The others must be supplied in
diet, so they are called essential Amino
acids.
› All amino acids have the same backbone

consisting of a central carbon attached
to H, carboxyl group on one side and
amino group on the other side as well as
a variable R group.
›The only thing that differentiates

between the amino acids are the R-
groups. So, the R-groups:
• Determine the properties of the Amino acid.

• Determine the function of formed proteins.
• Determine types of bonds that hold proteins in the 3ry and 4ry structures.
(you will learn more about this point in the next page)

61
Formation of proteins:
For proteins to be formed, peptide bonds are formed between amino acids via
condensation reactions.
The Carboxyl group loses –OH and the amino/amine group loses –H .
Water (H2O) and a peptide bond are formed.
› Like carbohydrates and lipids, the peptide bonds in proteins are broken by
addition of H2O (Hydrolysis reaction).
One last code..I promise 🫶

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Levels of Protein Structure:
There are four levels of protein structure. These are:
1) Primary Structure:
The primary structure is the number, type and sequence

of amino acids in a polypeptide chain. This sequence is
determined by the genetic code on DNA. The primary
structure determines the secondary, tertiary or
quaternary structure of a protein.
2) Secondary Structure:
The folding of the polypeptide chain ( primary structure)

into α-helix or β-pleated sheets, due to the formation of
hydrogen bonds between the amino and carboxyl groups in
the backbone of amino acids.
R-groups are not involved in the 2ry structure.
Backbones are similar, so the 2ry structure is not specific

for particular proteins.
3)Tertiary Structure:
The bending and folding of the polypeptide chain into a precise,

complex and unique 3D shape through the formation of bonds
between R-groups results in the tertiary structure. The bonds
are of the following types:
1. Hydrogen bonds
Hydrogen bonds are weak bonds between a slightly positively-charged hydrogen

atom in one molecule and a slightly negatively-charged atom in another molecule

63
2. Ionic bonds
These are attractions between negative and positive charges on different parts of
the molecule. Ionic bonds are stronger than H bonds but weaker than disulfide
bonds.
3. Disulfide bonds
Whenever two molecules of the amino acid cysteine come close together, the
sulfur atom in one cysteine bonds to the sulfur in the other cysteine, forming a
disulfide bond. Disulfide bonds are the stronger than other bonds.
4. Hydrophobic and hydrophilic interactions:
These are not considered as real bonds. When hydrophobic (water-repelling)

groups are close together in the protein, they tend to clump together. This means
that hydrophilic (water-attracting) groups are more likely to be pushed to the
outside, which affects how the protein folds up into its final structure.
The term “Denaturation of Proteins” refers to the loss of the complex precise
3D shape leading to loss of the function (Loss of tertiary structure).
› Causes:
1. Very high temperature: breaks H-bonds only.
2. Major changes in pH: breaks H-bonds and ionic bonds.
3. Reducing agents: break disulfide bonds.
4)Quaternary structure:
More than one polypeptide chain linked together to form a

complex functioning protein. Such as Insulin hormone (2
chains) and Hemoglobin (4 chains).
Chains are linked by the same types of bonds of the Tertiary

structure.

64
Describe how the 1ry structure determines the 3ry structure & properties of
an enzyme?
The primary structure determines the type, number & sequence of AAs in the
polypeptide chain so it determines the arrangement of the R groups and
consequently the bonds to be formed between those are groups such as Hydrogen
bonds, ionic bonds or disulfide bridges.
Those bonds are responsible for bending & folding of the polypeptide chain to
arrive at a precise 3ry structure with a specific shape of the active site
(complementary to a certain substrate) leading to enzyme specificity.
Moreover, the intact primary structure guarantees that the 3ry structure will have
proper positioning of the hydrophilic R groups outwards and hydrophobic R
groups inwards ensuring enzyme solubility.
Conjugated proteins: Proteins having a non-protein

part called prosthetic group, such as: Glycoproteins,
Lipoproteins and haemoglobin.
You thought I wouldn’t add

another one? Scan it! 🫶

65
Types of proteins:
1)Fibrous proteins
• They are made up of long, straight, parallel, polypeptide chains that are
tightly coiled round each other to form a rope shape
• They are usually primary or secondary structure
• They are insoluble
• They have structural functions
• They have a repetitive amino acid sequence
• Examples:
• Keratin in skin and nails
• Collagen fibre in connective tissue (You will
learn more about collagen in this topic)
2)Globular protein:
• They are round, compact proteins made up of multiple polypeptide chains

• They are usually tertiary or quaternary structure
• The chains are coiled up so that hydrophilic (water-attracting) parts of
chains are on the outside of the molecule and hydrophobic (water-repelling)
parts of chains face inwards. 3) This makes the protein soluble.
• They usually have metabolic functions
• They DON’T have a repetitive amino acid sequence
• Examples:
• Haemoglobin
• Enzymes and hormones

66
Collagen
Collagen is a fibrous protein that gives strength to tendons, ligaments, bones and
skin.
It has three polypeptide chains, each upto 1000 amino acids long. The primary
structure of these chains is a short repeating sequence of an amino acid called
glycine with two other amino acids- often proline and hydroxyproline. The three
polypeptide a-chains are arranged in a unique triple helix, held together by a very
large number of hydrogen bonds. Collagen is extremely strong due to this triple
helix
Collagen is insoluble because it consists of hundreds of amino acids and many

hydrophobic R groups

5 Collagen is a component of the wall of the aorta.
(a) (i) Describe the structure of collagen.
(3)
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
(ii) Explain the role of collagen in the wall of the aorta.

(2)
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
. .. .. .. .. . .. .. .. . .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. ... .................................................................................................................................. .............. ......................
13
 *P69498A01328* Turn over
number
4(c) An answer that includes three of the following points:
• couples (both) carrying one copy of the mutation can be ACCEPT couples who are (both)
identified (1) heterozygous / have a CF allele
• they can then make (an informed) {decision / choice} DO NOT ACCEPT choose which embryos
(about having a child) (1) to implant
• credit an example of their options (1) e.g not having a child / adoption / IVF
DO NOT ACCEPT have an abortion
• resulting in fewer babies being born who are ACCEPT two copies of the mutation (3)
homozygous (1) fewer heterozygous babies born

number
5(a)(i) A description that includes three of the following points:
• fibrous protein (1)
• (protein) composed of {three polypeptide chains /

three-stranded / triple} helix (1)
• held by hydrogen bonds (between the chains) (1)
• credit details of the chains (1) e.g every third amino acid is a glycine,
repeating sequences of amino acids, high (3)
content of {glycine / proline / hydroxyproline}
number
5(a)(ii) An explanation that includes the following points:
• gives (the wall) (tensile) strength (1) IGNORE refs to elastic properties and recoil
• so that the aorta {does not get damaged by / can IGNORE prevents aorta from collapsing
withstand} pressure (of the blood leaving the heart)
(1)
(2)
67
Risk, correlation and cause

Risk: The probability that a particular event will happen.
• Actual Risk/ Relative Risk:
Probability that a particular event will happen at a given time. Probability is the
mathematically calculated chance of a certain event. This is used to compare
with other groups.
Imagine you have six coloured balls –red, blue, green, yellow, orange and purple- in a
black cloth bag. If you reach in and pull out a single ball, the probability (risk) of
getting, say, a green ball can be expressed in one of three ways:
• 1 in 6
• 0.16666 recurring (0.17)
• 17%
In the same way, it is possible to work out your risk of developing certain specified
diseases or of dying from specified cause.
• Perceived Risk:
The perceived risk is not always the same as the mathematically calculated risk,
it’s the perception of the community about a certain risk factor.
Personal perception of a risk depends on:
1. how familiar you are with this activity?
2. Do you enjoy it?
3. Do you approve of it?
For Example: The risk of dying from a car accident is 1 in 237 while the risk of
dying from a motorbike accident is 1 in 1020. Yet, people still consider motorbikes
more dangerous than cars.

68
Reasons for misjudging risk:
• People can underestimate the risk of CVDs associated with smoking, obesity,
lack of exercise or high salt diet IF they know people having all risk factors and
are not suffering from CVDs.
• Nicotine of cigarettes is addictive so it is hard to quit.
• Peer pressure.
• Personal experience.
• Considering the immediate benefit (pleasure) more important than remote risk
of CVDs. For instance, it has been scientifically proven that there is a strong
link between obesity and developing CVDs, but people find eating enjoyable and
become obese.
• Some people use smoking as a way not to put weight. (Health risk of obesity is
overestimated in comparison to smoking)
Causation: It means that a change in one variable/factor directly results in a

change in another variable/factor
Correlation: -The link or relationship between two factors, whn one variable
changes, the other variable tends to change as well. This doesn’t prove that one is
the cause of the other. Correlation is not the same as causation.
To assess the correlation between a risk factor and a disease using two graphs,
look for the pattern of change. If the pattern of the risk factor graph obeys and
precedes the disease graph, this suggests a correlation.
Epidemiology: A branch of medical science that deals with the incidence,

distribution and control of diseases in a population. i.e. it focuses on groups rather
than individuals (community-based approach). Epidemiology is good at establishing
risk and correlation.

69
Designing studies:
Hypothesis:
Null Hypothesis: The opposite of your working hypothesis: i.e. that the
independent variable has no effect on the dependent variable. You aim to disprove
this hypothesis in your experiment.
Experimental Hypothesis: The working hypothesis that the independent variable

does have an effect on the dependent variable. By disproving the Null Hypothesis
you can accept your Experimental Hypothesis
Variables:
Control Variable: A factor that is kept constant so that its effects on the
dependent variable are consistent throughout all experiments
Independent Variable: The factor that affects the dependent variable. The factor
you change.
Dependent Variable: The factor that is affected by the independent variable. The
factor you measure.
Types of Studies:
1. Case Control Study
› One group is having the disease (Cases) while the other group is not having the
disease (Control).
› Both groups are asked about the past history of exposure to risk factors.
2. Cohort Study or Longitudinal Study
› Start with normal population and divide into two groups.
› One group is exposed to the risk factor while the other group is =.
› Follow up over a long period of time.

70
Errors in scientific studies:
• Random Error: A mistake in the method or malfunction in the equipment which

leads to the production of a single anomalous result, inconsistent with the
trend. Once spotted, a random error should be either repeated or ignored.
• Systematic Error: Usually down to an uncontrolled factor, a systematic error
affects the entire experiment, usually shifting the results by a consistent
amount each experiment. Systematic errors always produce inaccurate results,
but in some cases the data produced may still be reliable; and, as a trend may
still be observable, valid to a degree.
Important factors in scientific studies:
• Reliability: The same results are recorded if the experiment is repeated.

Standard deviation and / or standard error are excellent measures of
reliability.
• Accuracy: There is little difference between your results and the recorded
“true” results.
• Validity: A combination of accuracy and reliability. Valid results are
representative and can be used to make accurate predictions.
Criteria of a good study:
1-Big sample size.
2-Large amount of data.
3-Controlled variables (not easy in human due to difference in lifestyles).

71
Evaluating scientific researches (Papers):
The scientific community share and discuss the validity/reliability of their

researches in several ways, including:
1)Peer Review
➢ Definition:
Peer: Is someone (“scientists” or “experts”) with at least as much experience in
the science involved as the people writing the paper.
Review: To check the {paper / results} to see if {correct / valid / original /
significant / reliable}
➢ Before scientists can get their work published in a journal it has to undergo
something called the peer review process. This is when other scientists who
work in that area (peers) read and review the work to check its validity.
➢ Peer review is used by the scientific community to try and make sure that any
scientific evidence that’s published is valid and that experiments are carried
out to the highest possible standards.
2)Scientific journals:
➢ Scientific journals are academic magazines where scientists can publish

articles describing their work.
➢ They’re used to share new ideas, theories, experiments, evidence and
conclusions.
➢ Scientific journals allow other scientists to repeat experiments and see if they
get the same results using the same methods.
➢ If the results are replicated over and over again, the scientific community can
be pretty confident that the evidence collected is reliable.

72
3)Conferences:
➢ Scientific conferences are meetings that scientists attend so they can discuss
each other’s work.
➢ Scientists with important or interesting results might be invited to present
their work in the form of a lecture or poster presentation. Other scientists
can then ask questions and discuss their work with them face to face.
➢ Conferences are valuable because they’re an easy way for the latest theories
and evidence to be shared and discussed.
How to describe results of a study
1) Describe the data

You should include description of the trend, pattern & data manipulation
(subtraction, division or percentage change). Don’t make theoretical
assumptions except if you were asked to explain the changes shown by the
graph.
2) Draw a conclusion based on the given data
3) Comment on validity, reliability and/or accuracy
• Validity
To comment on the validity of the study always look for:
› Sample size: a larger sample size shows variation within the population so it is
more representative.
› Sample selection: controlled variables such as age, gender, level of activity,
etc…
› Duration of the study: the longer the duration the better the study (But
ONLY in longitudinal studies)

73
• Reliability
➢ See if the investigation was repeated. Repetition of methodology makes it
more reliable.
➢ Avoid biased studies (who carried out the study, who funded it, where
published)
➢ Comment on error bars if given.
Error bars show the spread of data around the mean as they connect
the highest value to the lowest value. The larger the error bar, the lower
the reliability & vice versa.
• Accuracy:
See if measurement is carried out with precision.
Keep in mind!!
The evidence from one study alone wouldn’t usually be enough to conclude that a
factor is a health risk. Similar studies would be carried out to investigate the link.
If these studies came to the same conclusion, the conclusion would become
increasingly accepted.
However, sometimes studies come up with conflicting evidence though — evidence

that leads to a different conclusion than other studies. For example, one study
may conclude that a factor isn’t a health risk, whereas another study may conclude
that the same factor is a health risk
Because the two studies have produced conflicting evidence, more results would
be needed in order to fully assess if the factor is an important health risk

74
Additional important notes:
Morbidity = disease presence, Mortality = Death from the disease. Differences

in morbidity or mortality rates in different populations are usually attributed to
differences in health education & awareness, the presence of new medications, the
presence of different risk factors & sticking to protective measures.
Morbidity and mortality rates are calculated as a number per 100,000 as

population sizes are different so this allows for a valid comparison.
Placebo is a control drug that doesn’t have the active ingredient but looks similar
to the real drug. It could be for example a starch tablet or a water capsule. It is
used to compare its effect with the effect of the real drug and to eliminate
the psychological impact of being on a medication.

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Dedication and Thanks!

Special thanks for my beloved daughter and assistant:

Dr. Mariam Sayed

To my dear assistant, Thank you for being a part of this

Your attention to detail and ability to grasp complex concepts

With heartfelt appreciation,

Dr. Gehan Fares.

Circulation -------------------------------------‐--------- Page 2

Transport of gases-------------------------------------- Page 7

Blood vessels -------------------------------------‐------ Page 13

Mammalian heart and cardiac cycle-------------------- Page 17

Cardiovascular diseases -------------------------------- Page 24

Treatments of Cardiovascular diseases---------------- Page 33

Bonds and water molecules ----------------------------- Page 40

Nutrients types -------------------------------------‐---- Page 44

Lipids -------------------------------------‐--------------- Page 56

Proteins -------------------------------------‐------------ Page 60

Designing studies ---------------------------------------- Page 69

Living organisms can be classified into:

• organisms that do not require a transport system

• organisms that require a transport system

1)Organisms that don’t require a transport system

Small unicellular organisms do not need a transport system, because substances

• Large surface area to volume ratio

So, there are no limitations of diffusion in small organisms

Dr Gehan Fares +201001980232

2)Organisms that require a transport system

Q) Why mammals have a heart and circulation

1)Single Circulation (e.g. in Fish):

• Blood passes by the heart once per cycle.

• Blood is pumped from the heart to the gills for gas

Dr Gehan Fares +201001980232

2)Double Circulation (e.g. in Birds and Mammals):

• Blood passes by the heart twice per cycle.

• Pulmonary circulation: between heart and lungs.

In pulmonary circulation, deoxygenated blood is pumped

• Systemic circulation: between heart and body tissues.

In systemic circulation, oxygenated blood is pumped from

Advantages of a double circulation:

1. Complete separation of the deoxygenated and oxygenated blood.

3. The right ventricle pumps deoxygenated blood at a relatively lower pressure to

Dr Gehan Fares +201001980232

Components of the blood

1. Digested food products (e.g. glucose, amino acids)

2. Antibodies. Produced by lymphocytes

3. Hormones produced by endocrine glands.

4. Urea dissolved in plasma produced by liver cells from

5. CO2 produced during respiration, transported as hydrogen carbonate in plasma

6. Plasma protein e.g. fibrinogen made by liver cells

7. Plasma help to maintain a steady body temperature by transferring heat

2)Red blood cells (erythrocytes)

Transport oxygen from lungs to all cells

They are well adapted for their function:

Dr Gehan Fares +201001980232

3)White blood cells

Each chain is arranged around an iron containing “Haem group”

-Each haemoglobin molecule can pick up four molecules of oxygen

Dr Gehan Fares +201001980232

-Therefore a steep concentration gradient is maintained between the air in the

-More oxygen diffuses in and is loaded onto the haemoglobin.

Haemoglobin and oxygen:

Before proceeding, you need to be familiar with two terms

1)Partial pressure:This term refers to the pressure that would be exerted by