1.

(a)

Describe how an atheroma is formed and how it can lead to a myocardial infarction.
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(6)

(b)

Warfarin is a drug that inhibits blood clotting. A trial was carried out using 508 patients
aged 30 or over who were at risk of thrombosis. They were randomly assigned to two
groups. One group received warfarin and a control group received a dummy pill
containing no medication (a placebo). The results obtained were as follows:
Treatment

Number
in
gro
up

Number developing
thrombosis
after
treatment was
started

Warfarin

255

14

Placebo

253

37

(i)

Explain what is meant by randomly assigning patients into two groups.

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(1)

Wellington College

(ii)

Why is it necessary for the control group to receive a placebo instead of warfarin?
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(1)

(iii)

Calculate the reduction in percentage risk of thrombosis for the patients given
warfarin. Show your working.

(2)

(c)

The graph shows the clotting time for samples of blood which have had different amounts
of heparin added.

100
90
80
70
C lo ttin g
tim e /
seconds

60
50
40
30
20
10
0

(i)

0 .1
0 .2
0 .3
0 .4
0 .5
0 .6
H e p a rin c o n c e n tra tio n / a rb itra ry u n its

Describe the effect of adding heparin to samples of blood.

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(2)

Wellington College

(ii)

Heparin is added to samples of blood used for blood transfusion. This stops clots
forming. Explain why it is important that blood used for transfusion does not
introduce blood clots into the patient.
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(1)

(iii)

Blood samples which are low in calcium ions are very slow to clot. Use your
knowledge of blood clotting to explain why.
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(2)
(Total 15 marks)

2.

Read the following passage.

Once in the body the human immunodeficiency virus (HIV) infects and multiplies in many
cells. Infected cells include a type of lymphocyte known as a helper T-lymphocyte. Inside the
cells, (HIV) uses an enzyme to make a DNA copy of the HIV RNA. This HIV DNA then
becomes part of the cell DNA, but only becomes active when the cell divides or makes
5 proteins.
When the HIV DNA becomes active, it directs the manufacture of HIV proteins. Some of
these proteins are incorporated into the plasma membrane. Here they can be recognised by
other T-lymphocytes and B-lymphocytes.
Soon, the body makes an immune response. Killer T-lymphocytes recognise and destroy
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cells infected with the virus. Helper T-lymphocytes not infected with HIV
activate
B-lymphocytes into producing antibodies against HIV At this stage an infected person is
said to be HIV positive.
Despite the immune response, many infected helper T-lymphocytes produce new viruses
before the cells can be destroyed. The viruses are released into the blood and infect other
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helper T-lymphocytes. However, new helper T-lymphocytes are produced to replace
those
infected and destroyed. This phase where the rate of production of new helper T-lymphocytes
matches the rate of infection and destruction can last for up to twenty years. Eventually, the
rate of production cannot keep pace with the rate of destruction of infected cells. The number
of viruses in the body rises rapidly. The person now begins to show symptoms of AIDS.

Wellington College

(a)

Give two ways in which HIV can enter the body

1 .................................................................................................................................
2 .................................................................................................................................
(1)

(b)

Suggest how a person may be diagnosed as being HIV positive (lines 11-12).
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(1)

(c)

Describe how the virus is able to make HIV DNA from viral RNA (line 3).
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(3)

Wellington College

(d)

Complete the flow chart to show how infection of a helper T-lymphocyte by HIV can lead
to the destruction of that cell.

H IV in f e c ts h e lp e r T ly m p h o c y te

H I V p r o te in s s y n th e s is e d

H e lp e r T ly m p h o c y te d e s tro y e d
b y a k ille r T ly m p h o c y te
(4)

Wellington College

(e)

Symptoms of AIDS include developing bacterial diseases like pneumonia and

tuberculosis. Suggest why these conditions can develop in a person with AIDS
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(6)
(Total 15 marks)

3.

People considered at risk are offered a vaccination against influenza each year. The bar chart
shows the number of people in the UK population aged 65 and over and the percentage of those
who were vaccinated against influenza each winter.
100

10

80

P e rc e n ta g e o f
p e o p le a g e d
65 and over 60
v a c c in a te d
th a t w in te r

40

P o p u la tio n
aged 65 and
o v e r / m illio n s

P e rc e n ta g e
20

(a)

1990
1991

1995
1996

1998
1999
Year

2000
2001

2002
2003

P o p u la tio n

Suggest one reason to explain the change in the percentage of people aged 65 and over
being vaccinated.
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(1)

Wellington College

(b)

(i)

Calculate the change in the total number of people aged 65 and over being
vaccinated between 1990/91 and 2000/01. Show your working.

Answer .................................
(2)

(ii)

A student suggested that some people aged 65 and over were being vaccinated
every year. Explain how the information in the bar chart supports this suggestion.
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(2)

(iii)

Suggest why it is advisable for people to be vaccinated against influenza every year.
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(2)

(c)

An influenza virus consists of a protein coat surrounding nucleic acid. The influenza
vaccine consists only of the protein coat of the virus. Explain how the influenza vaccine
produces immunity in the body.
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(2)

Wellington College

(d)

Describe how the human immunodeficiency virus (HIV) enters the body and causes
disease.
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(6)
(Total 15 marks)

4.

(a)

The Human Immunodeficiency Virus (HIV) contains reverse transcriptase. What is the
function of reverse transcriptase?
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(2)

(b)

(i)

Tenofovir may be used to treat patients with HIV. A tenofovir molecule has a
similar shape to a DNA nucleotide. Suggest how this drug may be effective in
delaying the spread of HIV round the body.
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(2)

(ii)

People with HIV are usually given a combination of several drugs, rather than just
one drug. Suggest a reason for this.
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(1)

Wellington College

(c)

Tuberculosis is more common among people who are infected with HIV than in people
who are not infected with HIV. Explain why.
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(2)
(Total 7 marks)

5.

(a)

Describe how Kochs postulates could be used to prove that a particular bacterium is
responsible for causing a particular disease.
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(4)

(b)

Common symptoms of tuberculosis (TB) are coughing up blood and chest pains.
Tuberculosis is spread by droplet infection. Explain how the common symptoms of
tuberculosis are related to this method of spread.
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(2)

(c)

Give two ways in which HIV infection can spread.

1 ..................................................................................................................................
2 ..................................................................................................................................
(1)

Wellington College

(d)

Suggest why people infected with HIV have an increased likelihood of dying from TB.
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(1)
(Total 8 marks)

6.

(a)

What is an antigen?
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(2)

(b)

Describe how B-lymphocytes respond when they are stimulated by antigens.

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(4)

Wellington College

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(c)

The diagram shows some components of a human immunodeficiency virus (HIV).

R e v e rs e tra n s c rip ta s e
P h o s p h o lip id

G ly c o p ro te in

RN A
(i)

Suggest which labelled component of the virus is most likely to act as an antigen.
Give a reason for your answer.

Component ...............................................................................................................
Reason ......................................................................................................................
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(1)

(ii)

A cell that HIV infects is 15 m in diameter. Calculate how many times larger in
diameter this cell is than an HIV particle. Show your working.

Answer ...................................... times larger

(2)
(Total 9 marks)

Wellington College

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