Coronary heart disease, health, lifestyle and cancer – GCSE Biology exam questions with mark scheme

1Grade 1–3Foundation4 marks

Coronary heart disease (CHD) is a non-communicable disease.

(a) What does non-communicable mean? [1]

(b) Complete the sentence. Choose the answer from the box.

coronary arteries

pulmonary veins

vena cava

In CHD, layers of fatty material build up inside the ______ . [1]

(a) cannot be passed from one person to another
allow cannot be spread / caught / transmitted / is not infectious / not contagious
allow not caused by a pathogen(1)
(b) coronary arteries(1)
(c) (artery narrows so) less blood flows to the heart muscle
allow blood flow is reduced / blocked(1)
(c) so less oxygen reaches the heart muscle (cells)
allow (so) muscle cells cannot respire (aerobically) / release enough energy / may die
ignore 'heart cannot get blood' without reference to oxygen for the second mark(1)
Answer: (a) it cannot be spread from person to person (b) coronary arteries (c) the artery narrows, so less blood flows to the heart muscle, so it receives less oxygen (and may die).
Examiner tip: For (c), name oxygen: 'less blood to the heart' only gets one mark until you say what the blood was carrying.

2Grade 4–55 marks

A doctor can treat coronary heart disease with a stent or with statins.

(a) Describe how a stent increases the blood flow to the heart muscle. [2]

(b) Explain how taking statins reduces the risk of coronary heart disease getting worse. [2]

(a) (stent is) placed / inserted into the (narrowed) coronary artery
allow inserted into a blocked artery; allow 'tube' / 'mesh' for stent(1)
(a) it holds / keeps the artery open (so more blood can flow through)
allow widens the artery / pushes fatty material back against the wall
do not accept 'removes / dissolves the fatty material'(1)
(b) statins lower the (level of) cholesterol in the blood
allow (LDL) cholesterol for 'bad' cholesterol(1)
(b) so less fatty material builds up (in the coronary arteries)
allow slows the rate of build-up of fatty deposits / plaque
do not accept 'removes / unblocks the artery'(1)
(c) any one from:
• must be taken (every day) for a long time / for life
• may have side effects (e.g. muscle pain, liver problems)
• takes time to have an effect / does not open an artery that is already narrowed
• patient may forget to take them
ignore cost unless qualified(1)
Answer: (a) A stent is put into the narrowed coronary artery and holds it open. (b) Statins lower blood cholesterol, so fatty material builds up more slowly. (c) e.g. must be taken for life / side effects / slow to act.
Examiner tip: Statins slow the build-up of fatty material — they do not clear an artery that is already blocked, so 'removes the fat' loses the mark.

3Grade 4–55 marks

Some people have a faulty heart valve.

(a) A valve between the left atrium and the left ventricle leaks.

Explain why this means the heart pumps less blood to the body with each beat. [2]

The table gives information about two types of replacement valve.

Type of valve	Made from	Typical time before it needs replacing	Drugs needed after surgery
Mechanical	metal and carbon	more than 25 years	anticoagulant drugs for life
Biological	tissue from a pig or cow	10–15 years	no lifelong drugs needed

(b) Give one advantage and one disadvantage of a biological valve compared with a mechanical valve.

Use information from the table. [2]

(c) Anticoagulant drugs stop blood clotting. Suggest why a patient with a mechanical valve needs to take these drugs. [1]

(a) blood flows back(wards) into the (left) atrium (when the ventricle contracts)
allow valve does not close properly / backflow(1)
(a) so less blood is forced into the aorta (per beat)
allow less blood leaves the left ventricle (to the body) / less oxygen supplied to the body
ignore 'heart works harder' on its own(1)
(b) advantage: patient does not need to take (anticoagulant) drugs for life
allow fewer side effects / lower risk of bleeding from drugs(1)
(b) disadvantage: it wears out sooner / needs replacing after 10–15 years, so more operations are needed
allow some people may object to using animal tissue (for religious / ethical reasons)(1)
(c) blood clots could form on / around the (mechanical) valve
allow clots could block the valve / a blood vessel / cause a stroke(1)
Answer: (a) Blood flows back into the atrium, so less is pumped into the aorta. (b) Advantage: no lifelong drugs; disadvantage: needs replacing sooner (or ethical/religious objection to animal tissue). (c) Clots could form on the valve.
Examiner tip: In (b), an advantage of one valve is not automatically a disadvantage of the other — write one point for each, and say 'compared with'.

4Grade 6–76 marks

A patient has heart failure. Her heart can no longer pump enough blood around her body.

Doctors can treat heart failure with a heart transplant from a donor or with an artificial heart.

Information about the two treatments:

Heart transplant from a donor	Artificial heart
patients may wait many months for a suitable donor heart the patient must take drugs that suppress the immune system for the rest of their life many patients live for more than 10 years after the transplant	can be fitted without waiting for a donor no drugs are needed to suppress the immune system needs an external battery pack and tubes that pass through the skin usually used to keep a patient alive for a few months or years until a donor heart is found

Evaluate the use of a heart transplant from a donor and the use of an artificial heart to treat this patient.

Use the information and your own knowledge. [6]

Donor heart — advantage: a living heart works fully / long-term solution (often more than 10 years); patient can live a near-normal life with no external equipment(1)
Donor heart — disadvantage: shortage of donors / long waiting time, so the patient may die (or get worse) while waiting(1)
Donor heart — disadvantage: risk of rejection, because the immune system attacks the donor heart as foreign (antigens)(1)
Donor heart — disadvantage: immunosuppressant drugs needed for life, so the patient is more likely to get infections (immune defect increases risk of infection)(1)
Donor heart — disadvantage: major surgery with risks (e.g. bleeding, infection); some people have ethical / religious objections to transplants(1)
Artificial heart — advantage: available immediately / no waiting for a donor; not rejected because it has no (foreign) antigens / is not living tissue, so no immunosuppressants(1)
Artificial heart — disadvantage: usually a temporary measure until a donor heart is available(1)
Artificial heart — disadvantage: blood may clot on the device, so anticoagulant drugs may be needed; mechanical failure possible; tubes through the skin increase the risk of infection(1)
Artificial heart — disadvantage: battery pack limits everyday activity / quality of life; device is expensive(1)
A justified conclusion, e.g. an artificial heart first to keep her alive while she waits, then a donor transplant as the long-term treatment(1)

Level	Marks	What it looks like
Level 3	5–6	Weighs advantages and disadvantages of BOTH treatments, linking points to biological reasons (e.g. why rejection happens, why immunosuppressants raise infection risk), and reaches a conclusion that is supported by the points made.
Level 2	3–4	Gives advantages and/or disadvantages of both treatments with some explanation, OR a detailed account of one treatment. Any conclusion is not fully supported.
Level 1	1–2	Simple relevant points, mostly copied from the information, about one or both treatments, with little or no explanation and no conclusion.
No marks	0	No relevant content.

Answer: Donor heart: long-term, no external equipment, but long wait, rejection risk and lifelong immunosuppressants (more infections). Artificial heart: no wait and no rejection, but usually temporary, clotting/infection risk, battery pack. Conclusion: artificial heart to keep her alive until a donor heart is available.
Examiner tip: 'Evaluate' needs a conclusion — top-level answers say which treatment (or which order) is best for this patient and why, and explain rejection rather than just copying the table.

5Grade 4–5Foundation5 marks

Scientists studied the number of deaths from lung cancer in a large group of men.

The bar chart shows the results.

(a) What was the death rate from lung cancer for men who smoked 15–24 cigarettes per day? [1]

(b) How many times greater is the death rate for men who smoked 25 or more cigarettes per day than for men who did not smoke? [2]

(d) Some men who never smoked still died from lung cancer.

Suggest one reason why. [1]

(a) 150 (deaths per 100 000 men per year)(1)
(b) 250 ÷ 10 (correct values read from the chart)(1)
(b) 25 (times)
an answer of 25 scores 2 marks(1)
(c) something linked to an increased rate / chance of getting a disease
allow increases the likelihood / risk of getting a disease
do not accept 'causes the disease' on its own(1)
(d) any one from:
• breathing in other people's smoke / passive smoking
• exposure to (other) carcinogens, e.g. radon / ionising radiation / asbestos / air pollution
• genetic (risk) factors / inherited from family
ignore 'bad luck' / 'unhealthy lifestyle' unqualified(1)
Answer: (a) 150 per 100 000 (b) 25 times (c) something linked to a higher rate of a disease (d) e.g. passive smoking, other carcinogens (radon/radiation), genetics
Examiner tip: A risk factor is linked to a higher rate of disease — writing that it 'causes' the disease is the most common way to drop the definition mark.

6Grade 6–7Higher5 marks

Scientists collected data on obesity and Type 2 diabetes from eight different regions of a country.

The scatter graph shows the results.

(a) Describe the relationship shown by the graph. [1]

(b) A newspaper headline said: 'Data prove obesity causes Type 2 diabetes.'

Explain why these data alone do not prove that obesity causes Type 2 diabetes. [2]

Use the graph to calculate the number of adults in this region who have Type 2 diabetes. [2]

(a) positive correlation
allow as the percentage of obese adults increases, the percentage with Type 2 diabetes increases
ignore 'proportional'(1)
(b) correlation does not show cause / the data only show a link (between the two variables)(1)
(b) any one from:
• other factors (e.g. diet, exercise, age, genetics) were not controlled / could cause both
• the data are for whole regions, not for individual people (so we do not know if the people with diabetes are the obese people)
• only eight regions / one country sampled
allow there may be another variable involved(1)
(c) 9.0% read from graph and 2 400 000 × 9 ÷ 100 / 0.09 × 2.4 million(1)
(c) 216 000
allow 0.216 million
an answer of 216 000 scores 2 marks; allow error carried forward from an incorrect reading for 1 mark(1)
Answer: (a) positive correlation (b) correlation is not causation; other factors not controlled / regional not individual data (c) 216 000
Examiner tip: A scatter graph can only show a correlation — to explain why it is not proof you must name what else could be responsible (e.g. diet or lack of exercise).

7Grade 1–3Foundation5 marks

Cancer can cause tumours to form.

(a) Complete the sentence.

Cancer is the result of changes in cells that lead to ______ growth and division. [1]

(b) Tumours can be benign or malignant.

Give two differences between a benign tumour and a malignant tumour. [2]

(i) Name the liquid tissue that carries these cells to other parts of the body. [1]

(ii) What name is given to the new tumours these cells form? [1]

(a) uncontrolled
allow uncontrollable / unlimited / rapid and uncontrolled
ignore 'fast' on its own(1)
(b) benign tumours are contained (in one area) / usually within a membrane; malignant tumours are not
allow benign tumours stay in one place(1)
(b) malignant tumours invade (neighbouring) tissues / spread to other parts of the body (to form secondary tumours); benign tumours do not
allow malignant tumours are cancerous; benign tumours are not
both differences must be comparisons or clearly about one type of tumour each(1)
(c)(i) blood
allow bloodstream
do not accept plasma (part of the blood, not the tissue)
do not accept 'blood vessels' on its own(1)
(c)(ii) secondary tumours
allow secondaries(1)
Answer: (a) uncontrolled (b) benign: contained within a membrane and does not invade; malignant: invades tissues and spreads (c)(i) blood (ii) secondary tumours
Examiner tip: 'Malignant tumours spread' scores — but say what benign tumours do too (stay contained in a membrane) to be sure of both marks.

8Grade 6–76 marks

Different types of disease can interact with each other, and lifestyle can affect health.

(a) Long-term heavy drinking of alcohol damages two organs.

Name both organs. [1]

(b) People infected with HIV are much more likely to develop tuberculosis (TB) than people without HIV.

Explain why. [2]

(c) Girls in the UK are offered a vaccine against human papillomavirus (HPV). Doctors expect the vaccine to reduce the number of cases of cervical cancer.

Explain why. [2]

(d) A person has had a severe physical illness for several years.

Suggest how this could affect their mental health. [1]

(a) liver and brain (both needed for the mark)(1)
(b) HIV attacks / damages the immune system / white blood cells (lymphocytes)
allow HIV causes an immune defect / AIDS(1)
(b) so the body cannot fight / destroy the TB bacteria (pathogen) as effectively
allow fewer antibodies made / fewer pathogens ingested; ignore 'weaker' unqualified(1)
(c) (vaccinated) girls become immune / cannot be infected by HPV
allow the vaccine prevents HPV infection(1)
(c) HPV (a virus) can trigger (cervical) cancer / cause changes in cells that lead to cancer
allow fewer infections, so fewer cell changes that lead to cancer(1)
(d) (it could lead to) depression
allow anxiety / stress / low mood
ignore 'they will feel sad' unqualified(1)
Answer: (a) liver and brain (b) HIV damages the immune system (white blood cells), so the TB pathogen is not destroyed (c) the vaccine prevents HPV infection, and HPV can trigger cervical cancer (d) depression
Examiner tip: These are 'linking' questions — each 2-mark explain needs the first disease's effect AND how that leads to the second disease.

9Grade 8–9Higher6 marks

The diagram shows cross-sections through two coronary arteries.

The diameter of the lumen in the healthy artery A is 4.0 mm. Fatty material in artery B has reduced the diameter of the lumen to 1.6 mm.

(a) Calculate the percentage decrease in the cross-sectional area of the lumen from artery A to artery B.

The area of a circle $= \pi r^2$ [3]

(b) Explain why the person with artery B gets chest pain and tiredness when they climb stairs. [3]

(a) radii 2.0 mm and 0.8 mm used: area A $= \pi \times 2.0^2 = 12.6$ mm² and area B $= \pi \times 0.8^2 = 2.01$ mm²
allow use of diameters throughout (gives the same %): $(4.0^2 - 1.6^2)/4.0^2$(1)
(a) $(12.57 - 2.01) \div 12.57 \times 100$
allow correct method from their areas(1)
(a) 84 (%)
an answer of 84 scores 3 marks; 60 (from diameters not squared) scores 0 for this mark(1)
(b) less blood flows (through the narrowed artery) to the heart muscle(1)
(b) so less oxygen is delivered (when demand is higher during exercise)
allow less glucose and oxygen(1)
(b) so less aerobic respiration / less energy released for the heart muscle to contract
allow (some) anaerobic respiration, producing lactic acid (causing pain); heart pumps less blood so less oxygen to (leg) muscles (causing tiredness)(1)
Answer: (a) 84% (b) less blood reaches heart muscle, so less oxygen; less aerobic respiration so less energy for contraction (anaerobic respiration / lactic acid → pain)
Examiner tip: Area depends on radius squared — finding the percentage change in diameter (60%) instead of area is the classic slip.

10Grade 6–76 marks

Smoking during pregnancy increases the chance of a baby being born with a low birth mass.

(a) Tobacco smoke contains carbon monoxide. Carbon monoxide combines with haemoglobin in red blood cells.

Explain how carbon monoxide in the mother's blood can lead to a low birth mass. [3]

(b) In one country, the health service spends £2.6 billion each year treating diseases caused by smoking. There are 6.4 million smokers in the country.

Calculate the mean cost to the health service per smoker each year.

Give your answer to the nearest pound. [2]

(c) Give one cost of smoking-related disease to a local community that is not a cost to the health service. [1]

(a) less haemoglobin is available to carry oxygen / the mother's blood carries less oxygen
allow reduces the oxygen-carrying capacity of the blood
do not accept a restatement that carbon monoxide combines with haemoglobin(1)
(a) so less oxygen passes (across the placenta) to the fetus(1)
(a) so less (aerobic) respiration (in the fetus), so less energy for growth / cell division
allow less growth of fetus (as a consequence of less oxygen)(1)
(b) 2 600 000 000 ÷ 6 400 000
allow 2.6 × 10⁹ ÷ 6.4 × 10⁶(1)
(b) (£) 406
an answer of 406 scores 2 marks; 406.25 scores 1 mark (not to nearest pound)(1)
(c) any one from:
• people too ill to work, so loss of income for families / local businesses
• carers needed / family members have to care for the ill person
• grief / human cost of early death to families
ignore 'treatment costs' / 'NHS costs' (given in question)
ignore cost of cleaning up cigarette litter (not a cost of disease)(1)
Answer: (a) CO binds to haemoglobin, so less oxygen crosses the placenta, so less respiration and energy for fetal growth (b) £406 (c) e.g. loss of earnings / carers needed / grief for families
Examiner tip: Use the full numbers (2 600 000 000 and 6 400 000) — mixing billions and millions gives answers out by a factor of 1000; and in (a) link less oxygen to less respiration and so less energy for the fetus to grow.

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