Académique Documents
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01S
Student
Procedure
The two passages below are Marks and Peters own accounts of their experiences with
cardiovascular disease. As you read each account, note down relevant information about:
a symptoms
b diagnostic tests
c treatments
d any features of each persons lifestyle that you think might have contributed to
their development of the disease.
When identifying information in this way, try and be selective and concise in the notes
you make.
Marks story
By Mark Tolley
Im 21 now, but 6 years ago something momentous happened that changed my life.
On 28th July 1995, I was sitting in my bedroom playing on my computer when I started
to feel dizzy with a slight headache. Standing, I lost all balance and was feeling very
poorly. I think I can remember trying to get downstairs and into the kitchen before
fainting. People say that unconscious people can still hear. I dont know if its true but I
can remember my Dad phoning for a doctor and that was it. It took five minutes from
me being an average 15-year-old to being in a coma.
I was rushed to Redditch Alexandra Hospital where they did some reaction tests on me.
They asked my parents questions about my lifestyle (did I smoke, take drugs, etc.?).
Failing to respond to any stimulus, I was transferred in an ambulance to Coventry
Walsgrave Neurological Ward. Following CT and MRI scans on my brain it was
concluded that I had suffered a bleed on my brain. My parents signed the consent form
for me to have an operation lasting many hours. I was given about a 30% chance of
survival.
They stopped the bleed by clipping the blood vessels that had burst with metal clips,
removing the excess blood with a vacuum. I was then transferred to the intensive care
unit to see if I would recover. Within a couple of days I was conscious and day by day
regained my sight, hearing and movement (although walking and speech was still
distorted). They had shaved all my hair off!
I had a remarkably quick recovery considering the severity of the operation. I was
talking again (although slurred and jumbled) within 5 days. By the end of the week, I
was transferred back to Redditch Alexandra Hospital to continue the rest of my recovery.
There I received occupational therapy, physiotherapy, and speech and language therapy
to improve my co-ordination, speech and strength. Within 7 days I could walk aided and
talk better I was then discharged to complete my recovery at home. I was given a
wheelchair and was admitted for therapy as an outpatient. The occupational therapy
trained my ability to perform everyday tasks. They made me make tea, do jigsaws, etc.
to improve my cognitive skills.
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Another effect that the haemorrhage had on me was that the whole right-hand side of
my body was weakened (the haemorrhage happened on the left side of my brain) and
things that I took for granted before became a challenge. My left hand compensated for
the weakness and gradually I became stronger, albeit on my former weaker side!
Three weeks later I returned to Coventry Walsgrave for an angiogram, where an X-ray
dye was injected into my veins which showed up my blood vessels on a scan. However,
this showed that there was still a bleed occurring and so I was prepared for surgery
once again.
The operation was lengthy, but not an emergency. However, I was still warned of the
dangers of such surgery. The operation did not leave me with much disability this time,
and I woke up within a day of being transferred back into the intensive care unit again.
Speech and movement were regained quickly. I was discharged to outpatients within
3 weeks, after undergoing another angiogram, and MRI and CT scans on my brain.
Embarrassingly, they had shaved only half of my hair off this time!
The following Wednesday I was called back to the Coventry & Warwick Hospital where
my neurosurgeon held a clinic. He said that there was still a small bleed that needed to
be clipped. So I was transferred to Walsgrave for my third operation. This one not being
as severe, I woke up minutes after the operation was completed with my faculties fully
intact. I could talk and walk aided. Following more scans, the next week I was
discharged again to complete my recovery at home. This was now late October 1995.
Things such as stair climbing became easier and I no longer required my wheelchair.
I have had no further episodes of brain haemorrhage activity apart from occasional
headaches. I am on anti-convulsant tablets (phenytoin) as I am now at a much higher
risk from epileptic seizures because of the surgery (although I have not had a fit since
the operations). I completed physiotherapy in around November 1995, by doing
exercises that improved my stamina, motor skills and co-ordination.
Although I have never been told a full reason why I suffered my stroke, I am certain that
it was due to being born with weak blood vessels in my brain that gave way after years
of increasing pressure. Im glad I was at home when it happened; I could have been
swimming or walking in the countryside with nobody around!
Returning to school in November, I found reading, writing and walking a challenge. I
was treated differently from other students, which I found difficult as I wanted to fit back
into my normal routine.
I passed my GCSE exams with lots of effort and went on to the 6th Form. I did a 1-year
course in Health and Social Care which aided my recovery and gave me the strength and
confidence to go to college to further my education. The course also showed me how to
express myself in a way that would make everyone look beyond my disabilities.
I recovered the most in the first 2 years following the stroke, now it has been a gradual
improvement. I do sport and go dancing and play music like normal people my age. My
memory is back to normal, only faltering occasionally. Nobody knows about my stroke
unless they question the huge scar on my head, so I must have recovered pretty well!
I found online organisations such as Different Strokes helpful because I met some
people who were in the same boat as me. It really helps to share experiences.
Well thats my story. I go trekking around the world in 10 weeks time. I dont know
what the future has in store for me; I dont really want to know either. I just look
forward to it with hope.
Thank you for reading this.
Mark xx
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Peters story
By Peter Kempson
I remember clearly the first time I held a hockey stick at school; football wasnt on the
sports programme, so it became hockey, rugby and cricket in each of the terms.
During my time at the school I developed a keen interest in all sports, representing the
school in hockey and athletics. It did not distract me from my school work but seemed
to make me more attentive and kept my mind more active.
After leaving school I still maintained my sporting interest, representing Bedfordshire at
hockey and taking part in the athletics team at my place of work.
In 1961, aged 23, I got the first indication of cardiovascular problems. I was told that I
had high blood pressure. I didnt really take much notice. Well you dont think much
about that at 23, do you? My father had died at the age of 53 from a heart attack but as
he was about 4 stone overweight, had a passion for fatty foods and smoked 60 full
strength cigarettes a day, I didnt compare his condition to mine.
Throughout the rest of my working life I continued to play sport, mainly hockey, and
was never overweight. I must admit that I probably drank too much at times and didnt
bother too much about calories and cholesterol in food.
As I got older I found it more difficult to keep fit during the summer break between the
hockey seasons and so reverted to road running. I ran my first marathon in Leeds at the
age of 42 and I subsequently did another five, including two in London.
All was going well I thought, until having a medical for a new job showed my blood
pressure reading to be 240 over 140. The doctor could not believe that I was still
walking around, let alone running, and sent me straight to my G.P. Since then I have
taken tablets for blood pressure and have also reviewed my dietary intake.
I did continue running and completed the Great North Run at the age of 63. A few
months later and thinking about doing the Great North Run again, I was running 8 miles
a week and playing hockey, when my 8 day holiday in Ireland became 3 days touring
and 12 days in hospital.
At 2 oclock in the morning of May 8th I woke up with a terrific pain in my chest. I was
sweating profusely and looking very pale. My wife rang the hotel reception and within
10 minutes a doctor had arrived, checked me over, and pronounced that I had had a
heart attack. Within an hour I was in intensive care and being closely monitored. At
5 am I had a second attack and a specialist inserted a temporary pacemaker to keep my
heart rate up as it was dropping below 40.
After 5 days in intensive care I was transferred to the general ward for recuperation. I
gradually increased my walks each day and was watched by the Lifestyle Nurse while I
climbed stairs. The nurse also discussed my lifestyle. Did I smoke? No. Did I eat fatty
foods? Yes. Did I exercise? Yes. Was I overweight? No. Did I have a history of cardiac
problems in my family? Yes! This then appeared to be the possible cause. I was told that
it was possible that had I not looked after myself I might have had a heart attack much
earlier in life.
After 10 days I was given a stress test which involved running on a treadmill to
determine my ability to cope with normal life. Having passed the test I was brought
home by the travel insurance company, escorted by a doctor.
On returning to Huddersfield I eventually had an angiogram and was told that I needed
a triple bypass operation, but that my heart might not be strong enough to take it. The
specialist at Leeds General, Mr McGoldrick, gave me a detailed analysis of the situation
and the operation, but the final decision was up to me.
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I found it very difficult to walk more than 100 yards without using my Nitro-spray. This
was very difficult to cope with considering that 9 months earlier I had been so active.
The decision was easy, I would have the operation.
I have to say it was not pleasant, but I had decided that it was necessary and I would
cope with anything that happened if it would get me back to a decent lifestyle. Well the
operation, a quadruple bypass, was a success and after 8 days I was back home.
Recuperation involved plenty of walking and visits to the Cardiac Rehab. At that time I
was introduced to Heartline, which is a group of people who have suffered cardiac
problems, encouraging exercise and recuperation by being able to talk to others with
similar experiences. I go swimming once a week and have increased my distance from 2
lengths at first to 40 lengths after 12 weeks. Although I feel fit enough to resume running
I think I will put it on hold for a while. I dont think I will ever play hockey again.
There again, at 66 thats probably not a bad decision!
Peter Kempson
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Student
Questions
Q1 Explain how the ammonia moves along the tube with sealed ends and comment on the speed
of diffusion.
Q2 Explain how each of these factors would affect the rate of diffusion:
a higher concentration of ammonium hydroxide
b higher temperature
c larger molecules replacing ammonium hydroxide.
Q3 Explain what is happening in the tube without bungs and how the model is similar to mass
flow in a transport system such as the mammalian circulatory system.
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Student
Procedure
1 Before starting the dissection, use the textbook to help you label the heart diagram
on page 3.
2 Locate the four main blood vessels attached to the heart. The two thicker walled
vessels are the arteries; they leave the heart at the more rounded front (ventral) side.
The thinner walled veins enter the heart at the top of the back (dorsal) side. They are
often damaged on removal of the heart from the animal.
3 Looking at the front side of the heart, identify the following external features using
Figure 1 to help:
a) right and left atria
b) right and left ventricles
c) coronary arteries and veins.
4 Draw a sketch of the heart and show the position of the atria and ventricles.
pulmonary artery
Q1 Why are the right and left sides aorta
apparently on the wrong side? left atrium
Q2 a Can you distinguish coronary right atrium
arteries and veins?
b What are their functions?
c Make a sketch showing how
they branch across the surface
of the heart. left ventricle
right ventricle
Figure 1 Ventral (front) view of the heart. The pulmonary vein and vena cava enter
the atria on the dorsal (back) side of the heart so are not visible on this diagram.
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5 If your heart is undamaged you can identify which vessel is the aorta by attaching a
rubber tube to a water tap and inserting it into the pulmonary vein. Allowing water
to flow through the heart (gently!) it will emerge from the aorta. The same procedure
can be used with the anterior vena cava after clamping the posterior vena cava shut.
Q3 In this case from which vessel will the water emerge?
Q4 What does this tell us about the internal structure of the heart?
6 To inspect the internal structure of the heart, cut through the ventricle walls, along
the lines shown in Figure 1. This is best done with a sharp scalpel or a pair of sharp
scissors. Be careful at this stage only to cut through the ventricle walls, leaving the
walls of the atria intact.
Q5 Look carefully inside each ventricle and answer these questions:
a Which ventricle has thicker walls?
b Estimate their thickness.
c Suggest why the ventricle walls are of different thicknesses.
Q6 Locate and carefully observe the atrioventricular valves between the atrium and ventricle on
each side of the heart.
a Why is the valve in the right ventricle called the tricuspid valve?
b Why is the valve in the left ventricle called the bicuspid valve?
Q7 Locate the semilunar valves at the entrance to the aorta and pulmonary artery. Why are these
valves called semilunar?
Q8 Identify the tendons that stretch between the atrioventricular valves and the ventricle walls.
a What is the function of these valves and what is the role of the tendons in their operation?
b Work out how you can test your ideas about valves by inverting the heart and using some
water.
Q9 Cut open the atria and examine their internal structure. Explain the relative difference in size
between the atria and ventricles.
7 Locate the opening of the coronary vein in the wall of the right atrium.
8 Cut open the aorta and locate the opening to the coronary artery just above the
semilunar valve.
Q10 Examine the openings to the vena cava and pulmonary vein. Do these entry points to the
heart contain valves? If not, why not?
Q11 Describe the safety precautions you took during the practical.
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This activity is a modification of one in King, T., Reiss, M. with Roberts, M. (2001) Practical Advanced
Biology, Cheltenham, Nelson Thornes.
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Student
Procedure
Complete the activity by referring to diagrams and photographs in textbooks and the
animation that accompanies this activity. There are also some useful websites in the
weblinks for this activity.
1 Draw a sketch of the external features of the heart viewed from the front (ventral)
side. The two thicker walled vessels are the arteries; they leave the heart at the front
(ventral) side. The thinner walled veins enter the heart at the top of the back (dorsal)
side. You should draw and label the following features:
the right and left atria
the right and left ventricles
the four main blood vessels
coronary arteries and veins.
2 Label the vertical section diagram of the heart on page 2. Add arrows to show the
route of blood flow through the heart.
Questions
Q1 Why are the right and left sides apparently on the wrong side?
Q3 If water were poured into the vena cava, through which vessel would it emerge from the heart?
Q4 What does this tell us about the internal structure of the heart?
Q6 Suggest why the walls of the left and right ventricle are of different thicknesses.
Q7 Why is the atrioventricular valve in the right ventricle called the tricuspid valve and the
atrioventricular valve in the left ventricle called the bicuspid valve?
Q9 Why are the valves at the entrance to the aorta and pulmonary artery called semilunar?
Q10 What is the function of the tendons that connect the atrioventricular valves and the ventricle
walls?
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Student
Microscope
Benches should be thoroughly cleaned Histology book for microscope images
with 1% Virkon or other suitable and notes
disinfectant. Drawing paper
Procedure
Part A: Elastic recoil in arteries and veins
1 Suspend a ring of artery from a hook on a clamp stand. Use a metre rule to record
the length of the ring once the mass carrier has been attached to the free end of the
ring.
2 Attach a 10 g mass (see Figure 1) and record the length of the ring after the mass is
added.
3 Remove the mass and record the length of the ring.
4 Repeat steps 2 and 3 using 20, 30, 40 and 50 g masses. Record the length with and
without the masses each time.
clamp stand
hook
ring of tissue
mass carrier metre rule
10 g masses
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6 Enter your results into an appropriate table. Remember that a good table of results
should have:
an informative title
the first column containing the independent variable (the factor that is varied by
the experimenter; in this experiment it is the mass)
the second and subsequent columns containing the dependent variables (The
value of the dependent variable depends on the value of the independent
variable. In this case the length of the ring depends on how much mass is added,
so ring length is the dependent variable.)
informative column headings; each column should have a descriptive heading
units in the heading, not next to the numerical data
Additional columns can be added to include calculations based on raw data such as
% change in length, etc.
7 Plot two appropriate graphs, one for artery, one for vein. Remember that the most
appropriate type of graph should be chosen to represent data, e.g. bar chart, pie
chart, histogram or line graph.
A bar chart is used when the independent variable is non-numerical or discontinuous,
e.g. the different stages of mitosis.
A pie chart can be used to display data that are proportions or percentages.
A histogram is used when the independent variable is numerical and the data are
continuous, but classified into groups, e.g. number of leaves of different lengths.
A line graph can be used to show relationships in data which are not immediately
obvious from tables. Both the dependent and independent variables are continuous. The
independent variable normally goes on the x-axis.
Remember to include:
an informative title
sensible scales on each axis, if appropriate
labels on both axes
units on both axes, if appropriate
a key.
(For more detail on presenting data see Alan Cadogan (ed.) (2000) Biological
Nomenclature: Standard terms and expressions used in the teaching of biology,
3rd Edition, Institute of Biology ISBN 0900490365)
In this experiment plot % change in length against mass.
Values for adding and removing masses should be plotted on the same graph. (You
could colour-code the points to show which are adding and which removing masses.)
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Questions
Q1 How do the results for artery and vein compare when looking at:
a % change in length on loading?
b return to the original length on unloading?
Q2 What are the main properties of:
a elastic fibres
b collagen?
Q3 Explain any trends or patterns in the data, supporting your ideas with evidence from the data
and your biological knowledge of the histology of arteries and veins.
Q4 Explain how the properties of arteries and veins that you have investigated link to the
functions of arteries and veins in the body.
Q5 State two ways in which the structure of a capillary is related to its function.
Q6 What is the role of smooth muscle in blood vessel walls?
Q7 Comment on any safety issues that should be considered when performing this experiment.
Q8 Suggest variables that should ideally be controlled in this experiment.
Remember that the independent variable is the factor that you vary. You may be able to choose the
range of values of the independent variable. The dependent variable depends on the value of the
independent variable. Any other variables that may affect the dependent variable should be
controlled (kept constant) where possible, in order to produce results that are reliable.
Q9 Suggest modifications to the experimental procedure that would ensure that more reliable
and valid results are produced. Remember that reliable and valid results are produced through
precise, repeatable measurements made with apparatus and experimental procedures that are
suitable for the task.
Reliability means that the same results are recorded if the activity is repeated. This
partly depends on the number of measurements or observations that were taken. Ideally,
a large number of replicates (repeat measurements) should be taken, and any readings
that vary considerably from the others should be repeated or discounted. A mean or
some other average (e.g. a median) can be calculated to be representative of the set of
results. The pressure of time usually puts a limit on the number of replicates that can be
taken.
Validity means that the experimenter succeeds in measuring what he or she intended to,
in other words that there is little or no difference between the actual values and the
recorded values.
Precision is the closeness of repeated measurements to each other. Precision involves
the choice of apparatus and the skill with which it is used. Precise readings are not
necessarily accurate. A faulty piece of equipment or an incorrectly used piece of
apparatus may give very precise readings (repeated values close together) but inaccurate
(not valid) results. To be accurate, a measurement should be close to the true value.
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Student
Procedure
1 Cut up the pictures on the separate sheet and stick these into the
correct boxes on the right to match the order of descriptions
below.
2 Complete the descriptions and make deletions as appropriate, i.e.
when you are provided with two alternatives separated by a /.
3 Add arrows to each diagram to show blood flow.
Atrial systole
As the atria fill with blood, the pressure in the atria increases/
decreases, the atrioventricular valves are pushed open and blood
flows into the relaxing ventricles. The two atria contract
simultaneously, forcing the remaining blood into the ventricles.
Ventricular systole
After a slight delay, the ventricles contract. This increases/decreases
the pressure in the ventricles so the atrioventricular valves
open/close. This causes the first heart sound lub.
Blood is forced into the and
.
The semilunar valves are open/closed.
Blood begins to flow into the relaxing .
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Student
Effects of atherosclerosis
Atherosclerosis is the name given to the process that occurs within arteries, causing them
to narrow. This can lead to coronary heart disease. A patient may only be aware that
they have coronary heart disease when their blood flow is restricted causing angina
pain associated with a lack of oxygen in the heart muscle. Ultimately atherosclerosis can
result in thrombosis the blockage of an artery by a blood clot. If the blood supply to
the heart muscle cells is stopped, they are said to be ischaemic, i.e. without blood. The
cells will die if they are starved of oxygen and nutrients for an extended period.
Procedure
Cut up the table below to give a set of cards with key words and phrases written on
them. Sort the cards into a sequence that follows the events in the development of
atherosclerosis and thrombosis. Using the key words, create a complete description, a
flow chart or an annotated diagram of the processes of atherosclerosis and blood
clotting.
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Student
Procedure
Read your textbook and watch the interactive tutorial for Activity 1.8 before completing
this sheet.
1 Fill in the gaps to correctly identify the major parts of the hearts conduction system.
2 Draw an arrow to show the path taken by the wave of depolarisation as it spreads
across the atria.
3 Draw arrows of the route of the electrical impulse as it travels through the ventricles.
4 Draw arrows to show the direction of blood flow at the entry to each of the blood
vessels of the heart. Colour-code your arrows to show oxygenation, red for
oxygenated and blue for deoxygenated.
The _____________
conducts the impulse
to the apex (base) of the The impulse spreads upwards through
heart. the ____________ into the ventricle
walls causing the muscle to contract
from the base upwards.
Questions
Q1 Why is there a non-conducting layer between the atria and ventricles?
Q2 Why are impulses conducted to the base of the heart before moving up through the ventricle
walls?
Q3 Where are impulses temporarily delayed within the conduction system?
Q4 Why are these impulses delayed?
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Student
The electrocardiogram
The electrocardiogram (ECG) records the electrical activity of the heart. Normally a
patient will have 12 electrodes attached to their body, each giving a different view of the
heart, but in this activity only a single trace will be used.
P wave R T wave
Q
S
QRS complex
Procedure
1 Using the textbook and/or the interactive tutorial in Activity 1.8, label the ECG trace
diagram (Figure 7) on page 3. Label each part of the trace and annotate the diagram
to indicate what is happening in the heart at each stage.
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Questions
Q1 What is the heart rate of the person whose ECG trace is shown in Figure 2?
5 large squares
Figure 2
Q2 Bradycardia can be perfectly normal for fit athletes, particularly during sleep. With training,
the amount of blood the heart can hold and pump out with each beat increases; therefore at rest
fewer beats are required to pump enough blood around the body to meet demand for oxygen and
nutrients.
Is the person whose ECG trace is shown in Figure 3 bradycardic, i.e. do they have a heart rate of
less than 60 beats per minute?
Figure 3
Q3 Calculate the heart rate using the trace in Figure 1.21c in your textbook. This is an example of
tachycardia, a heart rate of over 100 beats per minute, something most of us will experience with
exercise, fever or fear, although it can be one symptom associated with heart disease or other
medical conditions.
Q4 Which one of the waves is missing from the ECG trace in Figure 4? Where might there be a
problem within the heart? What could this problem be?
Figure 4
Q5 A patient who suffers chest pain, that may be due to development of atherosclerosis in the
coronary arteries giving rise to angina, will show abnormal-shaped waves on their ECG. During the
period of pain the ST segment lies below the normal position and there may be inversion of the T
wave. Sketch what an ECG trace with these features would look like.
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Extension questions
Q6 In patients with ischaemic heart disease, the PR interval on the ECG trace can be longer than
normal, over 0.2 seconds, due to a problem with conduction in the heart. Where might the
impulses be delayed to cause the extended PR interval?
Q7 In patients with pulmonary hypertension, blood pressure in the lungs is much higher than
normal. Their ECG trace has a large P wave, similar to the one in Figure 5. Suggest which part of
the heart will be enlarged in a person with this condition? Give at least one reason for your answer.
Q8 Each lead used with an ECG looks at the heart from a different angle. The positions of six
leads are shown in Figure 6. Mr Wilson, a patient who has had a heart attack, has abnormal ECG
traces from leads 1 to 4. From the position of the leads on the chest, suggest whether the damaged
heart muscle that caused the abnormal traces is in the anterior or posterior side of the heart, and
give a reason for your answer.
1 2
3 6
4 5
Position of
leads 1 to 6
Figure 5
Figure 7
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Student
Table 1 Causes of death in England and Wales, 2000. Table 2 Causes of death in the UK, 2000.
Murder
Pregnancy
Railway accidents
Thalassaemia
Q2 Your teacher/lecturer will provide you with the actual number of deaths that occurred in 2000
due to each of the causes in Table 1. The figures come from the Office of National Statistics.
Compare your estimates with these figures. If there are discrepancies between your estimates and
the official statistics, try and explain why you may have overestimated or underestimated the risks.
Q3 It is not unusual for people to overestimate the risk of death from train accidents. Suggest
reasons for this overestimation.
Q4 It is not unusual for people to underestimate the risk to their health of smoking. Suggest
reasons for this underestimation.
Study the year 2000 causes of death data for the UK in Table 2 and then answer the
questions that follow. The total number of deaths in the UK during the year 2000 was
610 579.
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Q5 a Calculate the percentage of total deaths in the UK in 2000 that resulted from each of the
eight categories of disease in Table 2. (Hint: The number of deaths due to a particular
disease is divided by the total number of deaths for the year 2000 and multiplied by 100 to
give a percentage. So the % of total deaths in the year 2000 due to accidents is
12 960 610 579 100.)
b Use the 2000 data to estimate the probability of an average person dying from each of the
diseases in any year. Express your answers as 1 in ? values or as decimals. The population of
the UK in 2000 was 58 817 000. (See your textbook the section on risk if you need
help in getting started with the calculations.)
c The probabilities you have calculated are for the population as a whole. Why is it that the
probability for each individual will typically be very different?
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Source:
Modified from Rossman, A.J. (1994) Televisions, Physicians and Life Expectancy, Journal of Statistics Education, 2(2).
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Q1 What was the chance of a 15-year-old male in the Q2 What was the chance of a 15-year-old female in
UK dying from a haemorrhagic stroke during 1995? the UK dying from a haemorrhagic stroke during 1995?
Express your answer as a probability. Express your answer as a probability.
Table 3 Death rates per 100 000 population of England and Wales due to coronary heart disease.
Q3 Comment on what happens to the average risk of Q5 a Compare the incidence of CHD deaths in men
death due to coronary heart disease as you get older. and women.
Q4 a Describe the trend in the number of deaths b Suggest reasons for any differences described.
from coronary heart disease between Q6 Use the data to produce an appropriate graph to
19802000. show clearly the gender differences for a particular year.
b Suggest reasons for this trend. Q7 a Has this gender difference changed over the
time period shown?
b Suggest reasons for any changes observed.
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In November, 1995, Sergei Grinkov, an Olympic arteries were narrowed by accumulation of fatty
gold medalist in pairs figure skating, collapsed substances and that a blood clot formed and
and died of sudden cardiac arrest while training completely blocked a coronary artery, resulting in
at Lake Placid, NY. An abbreviated necropsy his death. Further information about the gene can
report appears in the June 29 issue of the medical be obtained from an article in the April 25 issue
journal Lancet. Grinkov had such severe of The New England Journal of Medicine.
cardiovascular disease that his coronary arteries
It is estimated that about 20% of individuals in the
looked like those of a 70-year-old. Although
US population carry the harmful form of the
Grinkov had never complained of any chest pain,
platelet antigen gene. The presence of this gene
evidence indicated that he had a heart attack
will not necessarily cause a heart attack, but it
about 6 hours before his death. What is puzzling
does increase the probability of attack. If
about this sudden death is that Grinkov was an
researchers can devise a simple test for the
athlete in good physical condition, did not smoke
presence of this gene, then those identified as
or use drugs, did not have high blood pressure or
carrying it may be able to adjust their lifestyles to
diabetes mellitus, nor did he have high
reduce the risk of cardiovascular problems.
cholesterol levels. However, his family medical
history was significant: his father had died In a large study of athletic death, Barry Maron, a
suddenly at age 52. cardiologist at the Minneapolis Heart Institute
Foundation, and his colleagues collected
Researchers at Johns Hopkins University read
information on 158 deaths in young athletes from
about Grinkovs death in the newspapers and
1985 to 1995. His groups report in the Journal of
wondered if it had any relationship to a genetic
the American Medical Association indicated that
flaw they had just described. Samples of
the most common cause of death among young
Grinkovs blood were obtained and DNA was
athletes was a condition known as hypertrophic
extracted from the white blood cells. Analysis of
cardiomyopathy (HCM) caused by mutations in
the DNA indicated that Grinkov had inherited a
any one of several genes. The effect of these
form of a gene, called the platelet antigen gene,
mutated genes is to produce an abnormally thick
which greatly increased his chances of heart
wall in the left ventricle. Only about 2% of those
attack. This form of the gene causes platelets to
in his study were thought to carry the gene for
be overly active in forming blood clots and may
the abnormal platelet antigen, indicating that
cause cholesterol to bind to endothelial cells
sudden cardiac failure may be due to a number
lining blood vessels. The Johns Hopkins
of factors.
researchers speculate that Grinkovs coronary
Questions
Q1 Explain in detail how possession of this form of the anti-platelet antigen gene affects the process of
atherosclerosis and can result in sudden death
Q2 Why might having an abnormally thick left ventricle wall create a problem? To find out more information about
cardiomyopathy you can visit the Cardiomyopathy Association website. See the weblinks for this activity.
To explore the personal side of this tragedy, use a search engine to look for references to Sergei
Grinkov. You should receive a listing of several hundred documents describing this obviously well-liked
person and the tragedy of his death.
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Blood pressure
Blood pressure is one of the easiest and quickest measures used by the medical
profession to check the health of your heart and circulation system.
If you have ever had your blood pressure taken or seen it done on one of the many TV
hospital dramas, you will know that an inflatable cuff is generally put around your upper
arm and held loosely in place with velcro. Air is pumped into the cuff inflating it and
measurements are taken as the cuff is deflated.
Normal blood pressure is often quoted in books as 120/80 mmHg, but how many
people actually have this blood pressure? Find out by using a sphygmomanometer or
digital blood pressure monitor to determine the blood pressure of several members of
your group. Are they all the same? Are there any patterns within the values obtained?
The interactive tutorial that accompanies this activity can help you understand exactly what is
happening when blood pressure is measured. It can be used as an alternative to measuring
blood pressure with a sphygmomanometer, which is difficult to use.
Safety
Never use a sphygmomanometer or blood pressure monitor unsupervised.
Do not over-inflate the cuff or leave it inflated for longer than necessary.
Do not worry if your blood pressure seems too high or too low. This is not a definitive medical
measurement of blood pressure, just an estimate.
You should not use one of these monitors if:
You know you suffer from heart rhythm disorders, or you already suffer from severe
atherosclerosis unlikely unless you are a mature student or you have a cardiac pacemaker.
Procedure
1 Make yourself comfortable and try to relax before
having your blood pressure taken.
2 Remove any clothing with tight sleeves: it is important
that blood flow is not constricted. If you push up your
sleeve, make sure that it doesnt become so tight that it
impedes blood flow.
3 Most sphygmomanometers or digital meters have a cuff
that must cover the brachial artery in the upper arm.
The cuff must be closed firmly so that the artery is
well covered, as shown in Figure 1.
4 Try to lay your arm on a surface such as your lab
bench, ensuring that the cuff is at approximately the
same height as your heart. (Think why!) The palm of
your hand should be facing upwards.
Figure 1 Using a sphygmomanometer and
stethoscope to measure blood pressure.
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Using a sphygmomanometer
5 With traditional sphygmomanometers use a stethoscope to listen for the sound of
blood flow in the brachial artery. The stethoscope is positioned on the inside forearm
below the elbow as shown in Figure 1.
6 Pump air into the cuff, inflating it until the pulse sound disappears.
7 Deflate the cuff until the sound of blood can be heard as it starts to push through the
artery.
8 Take a reading at this point. This first reading gives systolic pressure.
9 Further deflate the cuff. As the sound disappears take a second reading. This gives
diastolic pressure, a measure of the pressure in the artery when the heart is relaxed.
The overall blood pressure is given in mmHg. It is usually expressed as systolic over
diastolic e.g. 120/70 mmHg.
Unless you are an experienced nurse or paramedic, it is often difficult to recognise the
change in sound of blood flow. The animation lets you see what should happen.
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Questions
Q1 What do you think the beeps made by a digital pressure monitor at step 8 of the procedure
represent?
Q2 What is happening to blood flow in the brachial artery at step 9 (both procedures)?
Q3 Comment on your results if you have taken several readings from different people within the
group.
Q4 A person has a blood-pressure reading of about 170/95 mmHg. Would this be classed as high
blood pressure?
Q5 Why can elevated blood pressure increase the risk of cardiovascular disease?
Extension question
Q6 Blood pressure can vary between individuals and can change through the day. What effect
might posture and relaxation have on blood pressure? Plan an experiment that would let you check
out your idea.
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Procedure
The concept map is one method of producing a summary of what you think you know
about a particular subject area, in this case blood pressure. The construction of the map
allows you to think through the ideas covered and clarify your understanding. A map
will often highlight errors or omissions. It can provide a useful tool in learning.
If you have never constructed a concept map you may need to read the
Exam/coursework support before getting started.
Starting with the idea of blood pressure, construct your own concept map.
You might include what blood pressure is, and what it is the result of, then expand out
from these ideas.
If you would like a helping hand use the template below.
is Blood pressure
is the result of
cardiac output
contract
arteriole walls
thus maintaining
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Procedure
Complete the interactive tutorial that accompanies this activity or read the section on
carbohydrates in your textbook and then use what you have learned to complete this
worksheet.
OH OH
2. Label the arrow with the
name of this reaction, and
write in the box the name of
the molecule which is removed.
O
In the box, write the formula
of the molecule that is added
in this reaction. 1. Label the arrow
with the name
of the reaction.
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O O O O
3 On the diagram below, draw in 1,4 glycosidic links. Label one glucose monomer. On
that molecule draw in a hydroxyl group and side group in the correct position.
O O O O O O O O
O O O O O
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6 In the box below, describe how the structure of glycogen is similar to that of starch.
7 Use information from the interactive tutorial and textbook to complete the table below:
Glycogen
In the ICT support there is a data logging sheet on testing for sugars using a colorimeter.
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enzyme
alginate bead
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Safety
The products from the column should not be tasted unless the experiment has been
conducted in a food preparation area with equipment for food use only using food grade
reagents (including food grade enzyme) and observing strict hygiene rules.
Lactase is a relatively safe enzyme, but contact with or inhalation of any enzyme should
be protected against to avoid allergic reaction or sensitisation.
Procedure
1 Mix 2 cm3 lactase with 8 cm3 alginate gel solution. Stir gently with glass rod.
2 Pour 20 cm3 calcium chloride solution into a clean beaker.
3 Clamp a 10 cm3 plastic syringe barrel above the beaker of calcium chloride solution.
Position the syringe close to the top of the beaker.
4 Pour the alginate gel into the syringe, allowing the gel to drip slowly into the calcium
chloride solution. It is best to add about 2 cm3 of gel to the syringe at a time.
5 The gel beads must be left in the calcium chloride solution for 10 minutes to harden,
then strained in a tea strainer, and rinsed with distilled water.
milk
alginate plus
enzyme mixture
immobilised
lactase
syringe gauze
tip
glucose
test strip
calcium chloride
solution
milk dripping
through column
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Procedure
Complete the interactive tutorial that accompanies this activity or read the section on
lipids in your textbook and then use what you have learned to complete this worksheet.
Fats and oils belong to a group of molecules called lipids. Lipids do not dissolve in
water, but do dissolve in non-polar solvents.
OH C
CH2OH O
OH C
CHOH
O
CH2OH
OH C
H2O
O
CH2O C
O
CHO C
O
CH2O C
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Questions
Q1 Label Figure 1 with the following: Name of reaction, number of H2O molecules removed in total, fatty acids,
glycerol, name of product, ester bond.
Q2 In Figure 1, circle and label the atoms removed during the formation of an ester bond between one fatty acid
and glycerol.
Q3 Using the information about joining and splitting sugar units in the section on carbohydrates in the textbook
and Activity 1.15, name the reaction that would split an ester bond to release a fatty acid.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Q5 Draw a simple diagram in the space below to show a monounsaturated fatty acid.
Q6 Referring to the data in Table 1, what effect does an increase in the number of double bonds have on the
melting point of a fatty acid?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Q7 What effect does an increase in the number of carbon atoms have on the melting point?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
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Procedure
Calculating energy requirements
Calculating your basal metabolic rate (BMR)
There are various formulae for calculating basal metabolic rate (BMR). The formula used
here is the HarrisBenedict formula which takes height, mass and age into account.
Calculate your BMR:
Although scientists normally use kilojoules (kJ) as the unit of energy, Calories (kcal) are
very widely used by the food industry for energy content of food. A Calorie is the same
as a kilocalorie. 1 kcal 4.18 kJ.
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Questions
Q1 Suggest how age, gender and body size may all affect BMR.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Q3 When you diet, after a couple of weeks your BMR will slow down as your body attempts to
conserve energy. Use this to explain why exercise may be a more effective way of losing weight than
dieting.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Extension questions
Q4 Assume that an 80 kg person loses 1 kg of body fat for every 7700 kcal that their energy
expenditure is above intake. How long in minutes would they need to run at 6 min per mile in order
to lose 1 kg of body fat?
The smaller an animal, the larger their surface area compared with their volume. A
mouse loses a larger proportion of body heat through its surface than an elephant. A
baby will lose body heat more easily than an adult will.
Q5 Use the information above to suggest how the BMR of a baby per kg of its body mass
compares with that of an adult.
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Calculate your BMI and decide your category of bodyweight using the table below.
BMI Classification of
bodyweight
20 underweight
2024.9 normal
2529.9 overweight
3040 obese
40 severely obese
Questions
Q6 A fully grown adult has a daily energy requirement of approximately 3052 kcal, he has a
daily energy intake of about 3500 kcal. What will be the consequences for his body mass index if
he maintains this energy budget?
Q7 Edgar is 165 cm tall and weighs 70 kg. Work out his body mass index. What advice would
you give him regarding his weight?
Q8 Explain why doctors would advise patients with BMIs above 30 to reduce their weight.
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Antioxidants
Antioxidants are chemicals that help prevent damage within cells by unstable radicals.
Chemical reactions within cells produce radicals. These are atoms or molecules with one
or more unpaired electrons. Radicals are oxidising agents they accept electrons from
other molecules that are oxidised (oxidation is loss of electrons). These reactions cause
damage to DNA, proteins and other molecules in the cell. The damage accumulates over
time and has been linked to the changes that occur with ageing and with diseases such
as coronary heart disease and cancer. Oxidised, low-density lipoproteins are thought to
be more readily taken up by the white blood cells involved in atherosclerosis.
The cell has antioxidant defences against radical damage. For example, oxidised DNA is
repaired by enzymes, and oxidised proteins are destroyed by proteases. Antioxidants in
the diet, such as vitamin C, vitamin E and beta-carotene (used by the body to make
vitamin A), also help prevent the damage caused by radicals in the cell by providing
hydrogen atoms whose electrons pair up with the unpaired electrons in the radicals.
To help reduce radical damage it is recommended that a healthy balanced diet contains
three portions of vegetables and two portions of fruit a day.
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Questions
Q1 a What are radicals?
b How are they formed within cells?
Q2 Will large numbers of radicals in the body increase the risk of developing CHD? Explain your
answer.
Q3 Explain how the Department of Health recommendation that everyone should eat five
portions of fruit and vegetables a day should protect against:
a coronary heart disease
b cancer.
Q4 Check below to find out how frequently you consume foods containing these important
health-promoting vitamins and decide if you are getting enough antioxidants.
How often do you eat these? Never Seldom 12 times 35 times Daily
per week per week
Vitamin C-rich foods:
1 Grapefruits, lemons, oranges
or pineapples
2 Strawberries, kiwi fruits or
honeydew melons
3 Orange, cranberry or tomato juice
4 Green, red or chilli peppers
5 Broccoli, Chinese cabbage
or cauliflower
6 Asparagus, tomatoes or potatoes
Beta-carotene-rich foods:
7 Carrots, sweet potatoes, pumpkins
8 Spinach, spring greens or chard
9 Cantaloupe melons, papayas or
mangoes
10 Nectarines, peaches or apricots.
Vitamin E-rich foods:
11 Wholegrain breads, cereals or
wheat germ
12 Crabs, shrimps or fish
13 Peanuts, almonds or sunflower
seeds
14 Oil, margarine, butter, mayonnaise
or salad dressing
Source: Brown, J.E. (1995) Nutrition Now, St Paul, West Publishing Company
Scoring: Several responses in the last two columns indicate adequate antioxidant vitamin
consumption. If you need to boost your intake, increase the overall amount of fruit,
vegetable and whole grains in your diet. Although nuts, seeds, oils, mayonnaise and
salad dressing all contribute vitamin E, they are high fat and should only be consumed in
moderation.
Q5 These sorts of tests are extremely popular and often found in food and other magazines. How a valid (giving
true results) and b useful do you think they are and why?
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CORE
Student
Caffeine
Plants produce caffeine as an insecticide. Cocoa in South America, coffee in Africa and
tea in Asia have all been used for hundreds of years to produce pick me up drinks
containing caffeine. These days, caffeine is also used as a flavour enhancer in a wide
range of cola and other soft drinks. In addition, it has medicinal uses in aspirin
preparations, and is found in weight-loss drugs and as a stimulant in students exam-time
favourites like Pro-plus and Red Bull.
In humans, caffeine acts as a stimulant drug, causing increased amounts of stimulatory
neurotransmitters to be released. At high levels of consumption caffeine has been linked
to restlessness, insomnia and anxiety, causing raised stress and blood pressure. This can
lead to heart and circulation problems.
Safety
If a stroboscope is used to show the Daphnias heart rate and you know you suffer from
photosensitive epilepsy tell your teacher and take appropriate precautions.
Procedure
Making a hypothesis
What do you think will be the effect of caffeine on the heart rate of water fleas? Write
down your ideas and support your prediction by presenting biological knowledge which
supports the idea. You now have an idea (hypothesis) to test.
Planning
The beating heart of a water flea can be seen through its translucent body, by placing the
flea in a few drops of water in a cavity slide. A cover slip helps stop the water evaporating.
Produce a detailed plan for an experiment that allows you to test your hypothesis about
the effect of caffeine on the heart rate of water fleas.
In your plan, make sure you include the following:
Select suitable apparatus that will give you measurements which will validly test your
hypothesis. Explain why the apparatus is suitable and how the results will let you test
the hypothesis.
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CORE
Activity 1.21 Does caffeine affect heart rate? Student
Include a risk assessment, identifying any risks and explaining any safety precautions
that need to be taken so as to reduce those risks.
Comment on the ethical issues that arise from using living organisms in the experiment
and explain how these will be taken into account in the practical method used.
Identify the dependent and independent variables, and indicate how relevant variables
will be controlled.
Show how you will ensure that reliable and valid results are produced, and describe
what you will do to ensure that measurements are precise, accurate and repeatable.
Identify any potential errors in readings that can be systematic (values differing from
the true value by the same amount) or random (values equally likely to lie above or
below the true value).
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Student
Questions
Identify each of the following statements as true or false to test your knowledge of
heart disease and its risk factors.
Q1 The risk factors for coronary heart disease that you can do something about are: high blood
pressure, high blood cholesterol, smoking, obesity and physical inactivity.
Q2 A stroke is often the first symptom of high blood pressure, and a heart attack is often the
symptom of high blood cholesterol.
Q3 A blood pressure greater than or equal to 160/95 mmHg is generally considered to be high.
Q4 High blood pressure affects the same number of black people as it does white people.
Q5 The best ways to treat and control high blood pressure are to control your weight, exercise,
eat less salt (sodium chloride), restrict your intake of alcohol, and take any high blood pressure
medicine, if prescribed by your doctor.
Q6 A low blood cholesterol is needed to prevent heart attacks in adults.
Q7 The most effective dietary way to lower the level of your blood cholesterol is to eat foods low
in cholesterol.
Q8 Lowering blood cholesterol levels can help many people who have already had a heart attack.
Q9 The only children who need to have their blood cholesterol levels checked are from families at
high risk of heart disease.
Q10 Smoking is a major risk factor for four of the five leading causes of death including heart
attack, stroke, cancer and lung diseases such as emphysema and bronchitis.
Q11 If you have had a heart attack, quitting smoking can reduce your chances of having a
second attack.
Q12 Someone who has smoked for 30 to 40 years will not be able to quit smoking.
Q13 The best way to lose weight is to increase physical activity and eat fewer calories.
Q14 Eating five portions of fruit and vegetables a day will provide antioxidant vitamins that
reduce the risk of coronary heart disease.
Q15 Heart disease is the leading killer of men and women in the UK and in the USA.
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Functional foods
This activity considers the development and trial of functional foods. These are foods
that contain an added ingredient that gives them a health-promoting property in addition
to their usual nutritional value, for example calcium added to orange juice or iron added
to breakfast cereal.
One of the most high profile functional foods is cholesterol-lowering margarine,
welcomed because high blood cholesterol is a known risk factor for coronary heart
disease.
If 2 g a day of plant sterol or stanol was added to the average daily portion of margarine,
there would be a reduction in the risk of heart disease of about 25%, an article in the
British Medical Journal concluded. The normal dietary intake of plant sterols, which are
found mostly in cooking oils and margarine, is 200400 mg a day. The normal intake of
plant stanols is negligible.
Benecol was the first cholesterol-lowering spread, and it contains plant stanols. Unilever
followed with Flora pro-Activ, which was launched in August 2000. The margarine is
enriched with plant sterols. These plant compounds are very similar, both lowering LDL
or bad cholesterol levels by reducing the amount we absorb from our small intestine.
They work by preventing LDL cholesterol entering the bloodstream from the digestive
system and liver.
Table 1 Changes in blood lipids (mmol per l) after use of plant sterol-enriched margarine, or butter, with respect
to control spread.
Source: Hendriks, H.F.J., Weststrate, J.A., Van Vliet, T. and Meijer, G.M. (1999) Spreads enriched with three
different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly
hypercholesterolaemic subjects, European Journal of Clinical Nutrition 53, 319327. Macmillan Publishers Ltd.,
reprinted by permission.
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Questions
Q1 Work out the percentage change relative to the control spread in total cholesterol, LDL
cholesterol, HDL cholesterol and the LDL:HDL cholesterol ratio for each concentration of sterols and
for butter.
Q2 The chosen control spread was Flora. To ensure a fair trial, in what way must it have been
similar to the sterol-enriched margarine?
Q3 Comment on:
a the percentage change in total cholesterol, LDL cholesterol and HDL cholesterol
composition for each of the three sterol-enriched spreads
b the effect of the butter on the total cholesterol, LDL cholesterol and HDL cholesterol
percentage change.
Q4 What effect would the change in the LDL cholesterol as a result of eating the sterol-enriched
spreads be expected to have on the chances of developing coronary heart disease?
Extension questions
Q5 Cholesterol and fat-soluble nutrients including certain vitamins are absorbed along similar
pathways so it was important for scientists to see whether the plant sterols reduced the absorption
of such nutrients. Some lowering of carotenoid absorption was found: the degree depended on the
level of sterol intake. A spread was developed that was enriched with 8% sterols. This provided
1.6 g of sterols per day (with typical usage levels). Suggest three vitamins whose absorption might
be affected by plant sterols.
Q6 Find out what is meant by a double-blind, placebo-controlled study.
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Topic 1 summary
Make sure your notes cover the following points. The points are listed in the order they
appear within the topic. All the points are covered in the textbook but where there is
supporting information within activities this is indicated.
There are suggestions on making notes and on revision in the Exam/coursework support.
You should know the following points:
1 Why many animals have a heart and circulation. (Checkpoint question 1.1)
3 How the structures of blood capillaries, arteries and veins relate to their
functions. (Activity 1.5) (Checkpoint question 1.2)
4 That the cardiac cycle includes diastole, atrial systole and ventricular systole.
(Activity 1.6) (Checkpoint question 1.3)
5 The structure and operation of the mammalian heart in relation to its function.
8 The symptoms of cardiovascular disease, i.e. coronary heart disease (CHD) and
stroke. (Checkpoint question 1.4)
9 The normal electrical activity of the heart, including the roles of the sino-atrial
node (SAN), the atrioventricular node (AVN) and the bundles of His. (Activity
1.8) (Checkpoint question 1.5)
10 How electrocardiograms (ECGs) can aid the diagnosis of CVD and other heart
conditions. (Activity 1.9)
14 Risk factors for cardiovascular disease including age, gender, genetic inheritance,
high blood pressure, diet, smoking and inactivity. (Age and gender Activity
1.11. Genetic inheritance Activity 1.12. Diet Activities 1.18 and 1.19)
(Checkpoint question 1.7)
16 The
1.20)
role of high blood pressure in cardiovascular disease. (Activities 1.7 and
18 make
The structural formulae for a-glucose and maltose and the monomers which
up sucrose and lactose. (Activity 1.15)
24 The possible significance for health of blood cholesterol levels and levels of
high-density lipoproteins and low-density lipoproteins (HDLs and LDLs).
25 practically.
How the effect of caffeine on heart rate in Daphnia can be investigated
(Activity 1.21)
26 How individuals, by changing their diet, taking exercise and not smoking, can
reduce their risk of CHD.
Salters-Nuffield Advanced Biology, Harcourt Education Ltd 2005. University of York Science Education Group.
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