5.

Cell Recognition Name: ________________________

Immune System
Answer Booklet Class: ________________________

Date: ________________________

Time: 370 minutes

Marks: 297 marks

Comments:

Mark schemes

Q1.
(a) 1. Foreign protein;
Accept glycoprotein / glycolipid / polysaccharide

2. (that) stimulates an immune response / production of antibody;

2

(b) 1. A protein / immunoglobulin specific to an antigen;

2. Produced by B cells

OR

Secreted by plasma cells;

2

(c) 1750(%);
1

(d) 1. Sample 1 / before vaccination no antibody released because patients not yet
encountered vaccine / antigen / virus;
Accept ‘produced’ for ‘released’
 2. (Sample 2 / primary response / after first dose) activation / clonal selection /
expansion of B cells into plasma cells;

3. Plasma cells release antibodies;

4. (Sample 3 / secondary response / after second dose) memory cells produce

more antibodies / produce antibodies more quickly;
4
[9]

Q2.
(a) 1. Outside of virus has antigens / proteins;
2. With complementary shape to receptor / protein in membrane of cells;
3. (Receptor / protein) found only on membrane of nerve cells.
Accept converse argument
3

(b) 1. No more (nerve) cells infected / no more cold sores form;

2. (Because) virus is not replicating.
2

(c) Prevents replication of virus.

1

(d) MicroRNA binds to cell’s mRNA (no mark)

1. (Binds) by specific base pairing;
2. (So) prevents mRNA being read by ribosomes;
3. (So) prevents translation / production of proteins;
4. (Proteins) that cause cell death.
4
[10]

Q3.
(a) 1. Antibody has tertiary structure;
2. Complementary to binding site on protein.
2

(b) 1. Prevents false negative results;

2. (Since) shows antibody A has moved up strip / has not bound to any
Plasmodium protein.
2

(c) 1. Person is infected with Plasmodium / has malaria;

2. Infected with (Plasmodium) vivax;
3. Coloured dye where antibody C present;
4. That only binds to protein from vivax / no reaction with antibody for
falciparum.
Person is infected with P. vivax / Plasmodium vivax = 2
marks (MP1 and MP2)
4
[8]

Q4.
(a) 1. Vaccine contains antigen from pathogen;
2. Macrophage presents antigen on its surface;
3. T cell with complementary receptor protein binds to antigen;
4. T cell stimulates B cell;
 5. (With) complementary antibody on its surface;
6. B cell secretes large amounts of antibody;
7. B cell divides to form clone all secreting / producing same antibody.
5 max

(b) 1. Active involves memory cells, passive does not;

2. Active involves production of antibody by plasma cells / memory cells;
3. Passive involves antibody introduced into body from outside / named
source;
4. Active long term, because antibody produced in response to antigen;
5. Passive short term, because antibody (given) is broken down;
6. Active (can) take time to develop / work, passive fast acting.
5 max
[10]

Q5.
(a) (To diagnose AIDS, need to look for / at)
1. (AIDS-related) symptoms;
2. Number of helper T cells.
Neutral: ‘only detects HIV antibodies’ as given in the
question stem
2

(b) 1. HIV antibody is not present;

Accept HIV antibodies will not bind (to antigen)

2. (So) second antibody / enzyme will not bind / is not present.

2

(c) 1. Children receive (HIV) antibodies from their mothers / maternal

antibodies;
2. (So) solution will always turn blue / will always test positive (before 18
months).
Allow 1 mark for the suggestion that the child does not
produce antibodies yet so test may be negative
2

(d) (Shows that)

1. Only the enzyme / nothing else is causing a colour change;
2. Washing is effective / all unbound antibody is washed away.
2
[8]

Q6.
(a) 1. Rank all STs in ascending order;
2. Find value with same number (of people) above and below.
Accept find middle value
2

(b) Not ethical to fail to treat cancer.

1

(c) Yes since with ipilimumab:

1. Median ST increased by 2.1 months;

2. Percentage of patients showing reduction in tumours increased from
10.3% to 15.2%;
 No because:
3. No standard errors shown / no (Student) t- test / no statistical test carried
out;
4. (So) not able to tell if differences are (statistically) significant / due to
chance (alone);
5. Improvement might only be evident in some patients / no improvement in
some patients;
6. Quality of (extra) time alive not reported;
If answers relate only to ‘Yes’ or ߢNo’, award 2 marks max
4 max

(d) 1. Faulty protein recognised as an antigen / as a ‘foreign’ protein;

2. T cells will bind to faulty protein / to (this) ‘foreign’ protein;
3. (Sensitised) T cells will stimulate clonal selection of B cells;
4. (Resulting in) release of antibodies against faulty protein.
3 max
[10]

Q7.
(a)
Human
Feature Bacterium immunodeficiency
virus (HIV) particle
RNA ✔ ✔
Cell wall ✔
Enzyme
✔ ✔
molecules
Capsid ✔
1 mark for each correct vertical column
2

(b) 1. (Complementary) nucleotides/bases pair

OR
A to T and C to G;
Ignore ‘(DNA polymerase) forms base pairs/nucleotide pairs’
2. DNA polymerase;
3. Nucleotides join together (to form new strand)/phosphodiester bonds form;
Ignore ‘(DNA polymerase) forms base pairs/nucleotide pairs’
If clearly writing rote answer about DNA replication 2 max
e.g. helicase or separating strands
3

(c) 1. DNA double stranded/double helix and mRNA single-stranded;

Contrast requires both parts of the statement
2. DNA (very) long and RNA short;
Accept ‛RNA shorter’ or ‛DNA bigger/longer’
3. Thymine/T in DNA and uracil/U in RNA;
4. Deoxyribose in DNA and ribose in RNA;
R Deoxyribonucleic/ ribonucleic acid
Ignore ref. to histones
Ignore ref. to helix and straight chain alone
5. DNA has base pairing and mRNA doesn’t/ DNA has
hydrogen bonding and mRNA doesn’t;
6. DNA has introns/non-coding sequences and mRNA doesn’t;
Ignore ref to splicing
3 max
 [8]

Q8.
(a) 1. Vaccine/it contains antigen (from HPV);
Term ‛antigen’ may be first mentioned with point 2
2. Displayed on antigen-presenting cells;
Accept named example, e.g. macrophage/phagocyte/B cells
3. Specific helper T cell (detects antigen and) stimulates specific B cell;
Accept ‛helper T cell with receptor on surface’ for ‛specific’
and B cells with receptor/antibody on surface that bind to
antigen for ‛specific’
4. B cell divides/goes through mitosis/forms clone to give plasma cells;
5. B cell/plasma cell produces antibody;
4 max

(b) 1. Two (doses) because got more antibody;

Accept more effective in producing antibody
2. With three doses, second dose/dose at 1 month
doesn’t lead to production of any more antibody (than
the two-dose group)/get same/similar response;
3. Three doses would be more expensive/less popular
with parents/girls (and serves no purpose);
Accept ‘less painful’
2 max

(c) t-test, because comparing two means;

Mark for correct test and explanation correct
Accept ‘comparing the mean’
Reject ‘to show that the results/means are significant’
1

(d) 1. Compare (base sequences of) DNA;

2. Look for mutations/named mutations (that change the
base sequence);
3. Compare (base sequences of) (m)RNA;
1 and 3 accept triplet/codon sequences for comparisons
Ignore references to ‘introns/non-coding DNA’
2 max
[9]

Q9.
(a) 1. Virus can’t bind (to receptor)/ can’t enter cells;
2. So can’t be replicated/ multiply;
Accept can’t reproduce
3. So, doesn’t damage cell(s)/tissues (and cause symptoms);
Accept no toxins released
2 max

(b) 1. Antigen/glycoprotein on Ebola binds to/stimulates (a

specific) B cell;
Accept correct reference to stimulation of B cells by T cells
2. (Binding causes) replication/cloning of B cell;
Accept replication/cloning of plasma cell;
3. Plasma cells/B cells release/produce antibodies;
2 max
 (c) 1. Lots of antibodies (against Ebola) in recovered patient;
2. Transfusion/plasma contains antibodies;
Ignore reference to cells
3. Antibodies (specific so) will bind with (Ebola) antigen;
4. (In recipient) virus destroyed/cannot enter cell;
Antigen destroyed is insufficient
3 max

(d) 1. (High mutation rate leads to) antigens change/antigenic

variability;
Accept (high mutation rate leads to) changes in base
sequence coding for antigen;
2. Vaccine contains specific antigen;
3. Antibodies not complementary to (changed) antigen / won’t
bind to (changed) antigens;
3
[10]

Q10.
(a) 1. Antigen stimulates immune response / activates B/T cells;
2. B/T cells divide OR antibodies produced;
3. Antibodies/T cells attack myelin sheaths;
Ignore references to antigen binding to myelin
3

(b) 1. Fewer cristae/smaller surface area (of cristae);

2. So less electron transport/oxidative phosphorylation;
3. (So) not enough ATP produced
OR
Not enough energy to keep neurones alive;
1. Accept ‘inner membrane’ as ‘cristae’
2. Accept fewer ATP synthase enzymes
2. Accept lower rate of electron transfer/oxidative
phosphorylation
3. Accept less use/stimulation of neurone leads to death of
cell
3. Accept no/less ATP produced/no energy to keep neurones
alive
3. Ignore references to glycolysis/ Krebs cycle
3

(c) (i) (Transmission) electron (microscope) – no mark

Need high resolution (to see structure of mitochondria)

Accept ‘scanning electron microscope’ /TEM/SEM
Accept – optical microscope not high enough resolution
1

(ii) 1. Took photographs/areas at random;

2. Counted total number (of normal) and number of
unusual mitochondria;
3. Divided number of unusual mitochondria by total
number and multiplied by 100;
1. Accept (very) large number of areas/photos/samples
MP 3 = 2 marks (includes MP2)
3
[10]
Q11.
(a) 1. (Releases) toxins;
2. Kills cells / tissues.
2. Accept any reference to cell / tissue damage
Ignore infecting / invading cells
2

(b) 1. Water potential in (bacterial) cells higher (than in honey) / water potential
in honey lower (than in bacterial cells);
Q candidates must express themselves clearly
1. Must be comparative e.g. high WP in cell and low WP in
honey

2. Water leaves bacteria / cells by osmosis;

3. (Loss of water) stops (metabolic) reactions.
3. Needs a reason why lack of water kills the cell
3
[5]

Q12.
(a) Any two from:
1. (Decrease linked to) few(er) cases of whooping cough;
2. (Decrease linked to) risk of / fear of side effects;
3. Insufficient vaccine available / too expensive to produce / distribute.
3. Too expensive unqualified is insufficient for mark
2 max

(b) 1. Vaccination rate increases;

2. Fewer people to spread the disease / whooping cough / more people
immune / fewer susceptible.
2. Neutral − greater herd effect
2. Allow description of immune
Q Reject ‘resistant’.
2

(c) 1. More people are immune / fewer people carry the pathogen;
If neither point 1 or 2 awarded
Herd immunity = 1 mark
Unvaccinated does not mean infected
1. Q Do not accept disease for pathogen

2. So susceptible / unvaccinated people less likely to contact infected

people.
2
[6]

Q13.
(a) Regulator protein.
Accept regulator protein antigen
Reject regulator protein receptor
Ignore regular protein
1

(b) 1. Lipid soluble / hydrophobic

 2. Enters through (phospholipid) bilayer
OR
3. (Protein part of) LDL attaches to receptor
4. Goes through carrier / channel protein.
4. Accept by facilitated diffusion or active transport
4. Reject active transport through channel protein
2

(c) Any two from:

1. (Monoclonal antibody) has a specific tertiary structure / variable region /
is complementary to regulator protein
Do not award MP1 if reference to active site.

2. Binds to / forms complex with (regulator protein)

“It” refers to monoclonal antibody in MP1 and MP2

3. (So regulator protein) would not fit / bind to the receptor / is not
complementary to receptor
3. Reject receptor on LDL
2 max

(d) 1. Injection with salt solution

1. Accept inject placebo in salt solution

2. Otherwise treated the same.

2
[7]

Q14.
(a) (i) 1. (Tumour suppressor) gene inactivated / not able to control / slow down
cell division;
Ignore: references to growth

2. Rate of cell division too fast / out of control.

1 and 2 Accept: mitosis
1 and 2 Reject: meiosis
2

(ii) 1. (Genetic) code degenerate;

Accept: codon for triplet
Accept description of degenerate code, e.g. another triplet
codes for the same amino acid

2. Mutation in intron.
Accept: mutation in non-coding DNA
1 max

(b) 1. Antibody has specific tertiary structure / binding site / variable region;
Do not accept explanations involving undefined antigen

2. Complementary (shape / fit) to receptor protein / GF / binds to receptor

protein / to GF;
Ignore: same shape as receptor protein / GF

3. Prevents GF binding (to receptor).

3
 [6]

Q15.
(a) QWC

1. (Phagocyte engulfs) to form vacuole / vesicle / phagosome;

Accept surrounds bacteria with membrane

2. Lysosome empties contents into vacuole / vesicle / phagosome;

Accept joins / fuses

3. (Releasing) enzymes that digest / hydrolyse bacteria;

Ignore breakdown / destroy / lytic enzymes
3

(b) Two suitable structures;;

Examples,

1. Cell wall;

2. Capsule / slime layer;

3. Circular DNA;
Reject “circular chromosome”

4. Naked DNA / DNA without histones;

5. Flagellum;

6. Plasmid;

7. Pilus;

8. 70s / smaller ribosomes;

9. Mesosome;
2 max
[5]

Q16.
(a) (i) (Whole-cell vaccine),
Accept converse statements for other vaccine
Reject references to the vaccine being alive or the disease
reproducing etc

1. Heat(ing) supposed to kill bacteria;

2. Some might be alive / active / viable;

Accept active pathogens present

3. (If so) bacteria could reproduce;

4. Bacterium makes or contains toxin;

5. Toxin might not be affected / all destroyed by heat;

 6. Bacteria or toxins attacking / killing person’s cells;
3 max

(ii) (Whole-cell vaccine),

Ignore references to more / greater antigens unqualified. It is
the variety of antigens that matters

1. (Contains) many different / greater range of antigens;

2. Each antigen causes its own immune response / production of /

has a specific (type of) antibody;
2

(b) 1. Only patients who had whooping cough have toxin / antibody /
immune response;
Accept converse e.g. those without antibody had another
disease

2. Toxin is an antigen and is (only) produced by this bacterium;

3. Leading to presence of specific antibody / only 4% had this antibody / 13% did
not have antibody;
3

(c) 1. There may not be large rises;

2. Might be the result of wrong diagnosis / reference to difference in figures

/ 13% diagnosed with whooping cough didn’t have it;
Ignore reference to new strains or antigenic variability
2
[10]

Q17.
(a) (i) 1. (Scientists) can't show bias / influence / may have a vested
interest / work for the company developing the vaccine;
Relates to the scientists

2. (Volunteers) can't show psychological / mental effects / ‘placebo

effect’ / expectations;
Relates to the volunteers
Accept: reduces the ‘Hawthorne effect’ / demand
characteristics
Neutral: so they have no idea what they are taking
2

(ii) Any two suitable suggestions, eg

Neutral: refs. to age and health

1. Amount of nicotine in cigarettes;

Neutral: different types of cigarette / different ways /
frequency of smoking

2. Amount inhaled / absorbed / time since last cigarette;

Neutral: absorption by gut / digestion
Accept: absorption by mouth

3. (Different) amounts excreted / metabolism / rate of binding (of

 nicotine) to protein;
Accept: broken down (differently)

4. (Different) blood volumes;

Neutral: different body masses

5. Nicotine from passive smoking / other smokers / other sources;

6. Some volunteers received the vaccine / placebo;

Accept: some volunteers would have / would not have the
antibodies
2 max

(b) (i) 1. Antibodies to nicotine produced / antibodies bind to nicotine;

Q Reject: vaccine contains / produces antibodies
Q Neutral: antibodies digest / kill / fight nicotine

2. (So) nicotine does not bind to protein / does not reach the brain;
Q Reject: any reference to ‘active site’
Neutral: idea that the antibodies bind to the protein

3. (So) cigarettes / smoking does not satisfy addiction / reward

smokers / release (reward) chemicals;
3

(ii) (Agree):

1. People choose to smoke / know the risks;

2. Should spend this money on education / preventing people from

starting to smoke / treating other health problems / vaccines are
expensive;

(Disagree):

3. Unethical not to treat;

4. Less money needed to treat the effects of smoking / cancer /

smokers pay taxes so are entitled to treatment;
3 max

(c) 1. High antibody responders have a high % to stop smoking / are more
likely to stop smoking;
‘People producing a high concentration of antibodies’ is
equivalent to ‘high antibody responders’
Accept: reference to values from the table

2. Only a few may be high antibody responders / no numbers on how many

are high / medium / low antibody responders;
Neutral: not all people are high antibody responders

3. Percentage who stopped smoking is similar for placebo group and low /
medium responders / some / % of placebo group (still) stopped
smoking / placebo has the lowest value / % to stop smoking;
Accept: reference to values from the table

4. Large sample size / double blind so reliable / representative;

 5. Antibody levels peak at / drop after 5 months / boosters may be needed
at / after 5 months;

6. May start smoking again after 5 / 6 months / do not know the percentage
who stopped smoking after 5 / 6 months;

7. Nicotine is not the only factor responsible for making people smoke;
Must mention nicotine
Do not accept: correlation does not mean causation / could
be due to other factors
5 max
[15]

Q18.
(a) (i) Substance that causes an immune response / production of antibodies;
Ignore foreign / non-self
1

(ii) 1. Not lipid soluble;

2. Too large (to diffuse through the membrane);

3. Antigens do not have the complementary shape / cannot bind to

receptor / channel / carrier proteins (in membranes of other
epithelial cells);
2 max

(b) 1. (Vaccine contains) antigen / attenuated / dead pathogen;

1. Reject if in context of injection of vaccine

2. T-cells activate B-cells;

3. B-cells divide / form clone / undergo mitosis;

4. Plasma cells produce antibodies;

5. Memory cells produced meaning more antibodies / antibodies produced

faster in secondary response / on reinfection;
5
[8]

Q19.
(a) 1. Infected by / susceptible to (other) pathogen(s) / named disease caused by a
pathogen (from environment);
Context is where immune system cannot prevent or stop
these events
Allow attack / kill

2. Pathogen(s) reproduce / cause diease (in host);

MPs not given in context of HIV

3. Damage cells / tissues / organs;

4. Release toxins;
3 max

(b) (i) 1. (HIV enters cells) before antibodies can bind to / destroy it;
 Ignore SAFETY comments
1. and 2. Relate to antibodies

2. Antibodies cannot enter cells (to destroy HIV) / stay in blood;

OR

3. (Enters cells) before (secondary) immune response caused /

before memory cells have time to respond;
3. and 4. Relate to virus

4. So no antibodies present (to attack HIV);

OR

5. Vaccine taken up too quickly to cause immune response;

5. and 6. Relate to vaccine

6. So no antibodies / memory cells formed;

2 max

(ii) 1. Antigen (on HIV) changes;

Accept mutates

2. (Specific) antibody / receptor no longer binds to (new) antigen;

Ignore SAFETY comments

OR

3. Many different strains of HIV / many antigens present on HIV;

4. Not possible to make a vaccine for all antigens / vaccine may not
stimulate an antibody for a particular antigen;
2 max

(c) 3 suitable suggestions;;;

QWC ignore reference to HIV cells

E.g.

1. Inactive virus may become active / viral transformation;

2. Attenuated virus might become harmful;

3. Non-pathogenic virus may mutate and harm cells;

4. Genetic information / protein (from HIV) may harm cells;

5. People (may) become / test HIV positive after vaccine used;

Vaccinated people may develop disease from a different
strain to that in the vaccine

6. This may affect their work / life;

May continue high risk activities and develop or pass on HIV
3 max
[10]
Q20.
(a) (Micro)organism that causes disease / harm to body / an immune response;
Accept: named microorganism that causes disease
Allow infection
1

(b) 1. Phagocyte attracted by a substance / recognises (foreign) antigen;

Accept named substance eg chemical / antigen

2. (Pathogen)engulfed / ingested;
Accept: description

3. Enclosed in vacuole / vesicle / phagosome;

4. (Vacuole) fuses / joins with lysosome;

5. Lysosome contains enzymes;

Accept named example of enzyme

6. Pathogen digested / molecules hydrolysed;

Neutral: Destroyed
4 max

(c) 1. Antigens (on pathogen) are a specific shape / have specific tertiary / 3D
structure;
1 / 3 Structure alone is insufficient

2. Antibody fits / binds / is complementary to antigen / antibody-antigen

complex forms;
Reject - active site

OR

3. Antibodies are a specific shape / have specific tertiary / 3D structure;

4. Antigens (on pathogen) fit / bind / are complementary to antibody /

antibody-antigen complex forms;
2
[7]

Q21.
(a) Hydrolysis (reaction);
Accept phonetic spelling
1

(b) 1. Too big / wrong shape;

Wrong charge - neutral
Accept insoluble

2. To fit / bind / pass through (membrane / into cell / through carrier /

channel protein);

3. Carrier / channel protein;

Accept carrier / channel protein not present
3
 (c) Foreign / (act as) antigen / non-self;
Reject foreign cells
1

(d) 1. Dose to be given;

Accept: interaction with other drugs

2. No (serious) side effects;

3. How effective;

4. Cost of drug;
2 max
[7]

Q22.
(a) Has more than one / four polypeptide chains / made up of polypeptide chains;
1

(b) 1. Antibody / variable region has specific amino acid sequence / primary
structure;

2. The shape / tertiary structure of the binding site is complementary to / fits

/ binds with these antigens;
2. Do not accept active site for this point.

3. Forms complex between antigen and antibody;

3
[4]

Q23.
1. Vaccines contain antigens / dead / weakened pathogens / antigens dead /
weakened
pathogens are injected;
Ignore references to T or B cells.

2. Memory cells made;

3. On second exposure memory cells produce antibodies / become active /

recognise pathogens;
3. Idea of memory cells responding.

4. Rapidly produce antibodies / produces more antibodies;

4. Production of antibodies must be qualified for mark.
Underlined ideas essential.

5. Antibodies destroy pathogens;

5. Accept bacteria / viruses etc but not disease
[5]

Q24.
(a) Nitrification;
Accept nitrifying.
Do not accept nitrogen fixing.
1
 (b) 1. Uptake (by roots) involves active transport;
Reject all references to bacteria

2. Requires ATP / aerobic respiration;

2

(c) (i) 1. Not enough time / fast flow washes bacteria away;
“Not enough time for bacteria to convert all the ammonia to
nitrate” gains 2 marks

2. (Not all / less) ammonia converted to nitrate / less nitrification;

2

(ii) 1. Algal bloom / increase in algae blocks light / plants / algae die;

2. Decomposers / saprobionts / bacteria break down dead plant

materials;

3. Bacteria / decomposers / saprobionts use up oxygen in

respiration / increase BOD causing fish to die;
3. Accept alternatives such as microbes / saprophytes.
3
[8]

Q25.
(a) (i) Protein on (surface of) chlamydia;

That initiates an immune response (in mice) / causes antibody

production;
Neutral “foreign protein”
Do not accept glycoprotein.
2. Accept description of initiating immune response.
2

(ii) 1. Antibodies / memory cells against chlamydia (protein / antigen) are

present;

2. Protein on heart (muscle) similar to chlamydia protein / antigen so

T cells / antibodies (attack heart muscle cells);
2. Look for idea that both proteins are similar
2. Detail of what is attacking the heart muscle cells
2

(b) FOR

1. Prevents / reduces heart disease / attacks;

2. Cheaper to vaccinate than treat heart disease;

AGAINST

3. Vaccination costly;

4. Don’t know frequency of chlamydia infection;

5. Research in mice might not be replicated in humans / humans might

have a different protein;
 6. Vaccine could cause heart disease or immune response against heart
(muscle);
2 max for arguments against
Accept other valid answers
3 max
[7]

Q26.
(a) 1. Phagocyte attracted to bacteria by chemicals / recognise antigens on bacteria
as foreign;

2. Engulf / ingest bacteria;

3. Bacteria in vacuole / vesicle;

4. Lysosome fuses with / empties enzymes into vacuole;

5. Bacteria digested / hydrolysed;

1. Accept names chemical e.g. toxin
2. Allow description of engulfing
3. Accept: bacteria in phagosome
5. Neutral: Break down
5. Accept digestive enzymes destroy bacteria
5. Do not accept “destroy bacteria” as it is in question stem
4 max

(b) 1. Microvilli provide a large / increased surface area;

2. Many mitochondria produce ATP / release or provide energy (for active

transport);

3. Carrier proteins for active transport;

4. Channel / carrier proteins for facilitated diffusion;

5. Co-transport of sodium (ions) and glucose or symport / carrier protein for

sodium (ions) and glucose;

6. Membrane-bound enzymes digest disaccharides / produce glucose;

1. Reject villi on epithelial cells
1. Accept brush border
2. Accept large SA:vol ratio
3. Need idea of “lots”
4. Reject: energy produced
5. Accept Na+K+ pump
6. Neutral: Channel proteins
7. Accept named example
6
[10]

Q27.
(a) (i) Antibiotics kill other bacteria / Clostridium is resistant;

Less / no competition so (Clostridium)

 reproduces / replicates / multiplies / increases in number;
Reference to bacteria being ‘immune’ negates first marking
point.
Reference to mitosis negates second marking point.
2

(ii) Immune system less effective / more likely to have other

infections / been in hospital;
Accept: ‘Weak / lower’ immune system’.
1

(b) Attaches to active site (of enzyme);

(Methicillin) is a competitive inhibitor / prevents monomers / substrate
attaching (to enzyme);
‘Competes for active site’ = 2 marks.
Neutral: ‘Prevents monomers joining / attaching to each
other’.
Allow one mark max for answers relating to non-competitive
inhibitor changing active site / preventing substrate
attaching.
Do not penalise Methicillin forms an enzyme / substrate
complex.
2

(c) (i) Have other illness / medical condition / ’weak’ immune system / disease /
infection;
Reject: Due to ‘other factors’, ‘are smokers’, ‘are obese’
unless related to disease or illness.
1

(ii) Increase up to 2006 / 20 (per 100 000) then decreases;

1

(iii) Correct answer in range of 52 – 59.1% = two marks;

Incorrect answer but shows change as between 4.8 – 5.2 / shows

correct subtraction giving this change e.g. 14 – 9 = one mark.
2
[9]

Q28.
(a) Straight lines point to point as not possible to predict intermediate values / values
between points;
1

(b) Increases then levels / falls;

Maximum antibody production 180 units / at dose of 0.25 g per kg;
2

(c) Two marks for correct answer of 57.14 / 57.1;;

One mark for incorrect answer in which candidate clearly divides difference in
antibody production / 60 by 105;
2

(d) Takes into account different masses of mice / allows comparison;

Accept different weights of mice.
Do not accept different size.
1
 (e) Sheep red blood cells have antigens (on their surface);
Antigens are proteins foreign to mice / are non-self;
Stimulate B cells to produce antibodies;
3

(f) Response only observed in mice;

Disease organisms not investigated;
Not all disease caused by pathogens / cured by antibodies;
i.e. not tested on humans
2 max
[11]

Q29.
(a) (i) To show whether immune response occured / because cats are (genetically)
related to cheetahs;
Ignore reference to control.
1

(ii) To show that rejection did not normally occur / skin could (successfully)
be grafted;
1

(b) (i) Rapid rejection between unrelated (domestic) cats / cats are not
genetically similar;
Rapid rejection between (domestic) cat and cheetah / cats and cheetahs
are not genetically similar;
Slow / no rejection in cheetahs / cheetahs are genetically similar;
3

(ii) Sample size small;

Time observed was short;
1 max

(iii) Similar (antigens on all cheetahs);

Accept same / not very different
1

(iv) Protein / antigen production determined by alleles / genes / base

sequence on DNA;
The more similar the proteins the more similar their alleles / genes /
base sequence on DNA / the more they are genetically similar;
2
[9]

Q30.
(a) Girls are not sexually active / not likely to carry HPV / vaccine may not work if
already infected / few girls sexually active (at this age);
Neutral: girls are not sexually mature
Neutral: to provide better protection
Accept: provides immunity before sexually active
Neutral: girls are less likely to have ‘it’ as could mean the
vaccine from the question stem
1

(b) Other (HPV) types have different antigens;

No memory cells for other types / memory cells not activated / antibodies
 cannot attach to antigen / correct antibodies not produced / antibodies are not
complementary;
Accept: refs. to antigenic variability
Accept: B cells for memory cells
Accept: memory cells cannot recognise antigen for ‘not
activated’
Accept: examples of memory cell activation
2

(c) More antigen;

More memory cells;

So more antibodies produced / antibodies produced quicker (if infected);

Accept: ‘many’ / ‘enough’ instead of ‘more’
Neutral: primary / secondary response
Accept: T cells / B cells / plasma cells instead of ‘antibodies’
Reject: the idea that vaccines contain antibodies
Q Reject: antibodies ‘fight’ / ‘antibiotics’
2 max

(d) Cancer takes years to develop / develops later in life;

Takes time for females to become sexually active / females must become
sexually active to obtain data;

Few people / only teenagers vaccinated;

Neutral: will take time to vaccinate 80% of young girls
Accept: do not develop cancer instantly
2 max

(e) (Cervical cancer) can be caused by other types of HPV / other factors /
example given;

OR

(Some) women may have been infected (with HPV) before receiving the
vaccine;

OR

(As a precaution) in case vaccine does not work / a way of monitoring if the
vaccine has worked;
Accept: ‘caused by other types of HPV’ in the context of
mutation
Neutral: to check for abnormal cells / that they are immune to
the virus
1

(f) Virus cannot replicate / is destroyed / is not carried (in vaccinated people);

Non-vaccinated people more likely to contact vaccinated people;

Neutral: ‘do not spread virus’ as in question stem
Must be in context of the individual and not the population as
in question stem
Q Do not allow ‘disease is destroyed’
Neutral: ‘herd effect’ as given in the question stem
 2
[10]

Q31.
(a) (yes):
Many women (with cervical cancer) have HPV 16 (18 &31);

(no):
Few women (with cervical cancer) have HPV 6 / 11;

(HPV infection does not mean causation because):

Could be caused by another factor / example given / may be due to
coincidence;

No control group / did not study HPV in healthy women / did not study all HPV
types / having cancer may increase susceptibility to HPV / does not add up to
100% / not all women with cancer have HPV / individual may have more than
one HPV type;
Neutral: correlation between HPV (16) and cervical cancer
Reject: many women with HPV 16 (18 &31) have cervical
cancer / not all women have cancer
Accept: figures from graph for ‘many’ and ‘few’
Accept: minor errors in reading HPV frequencies from graph
Reject: does not mean HPV vaccine causes cancer;
Neutral: refs. to sample size and factors that should have
been kept constant
3 max

(b) (i) Protein / glycoprotein / glycolipid / polysaccharide;

Causes immune response / antibody production;

Accept: B / T cell production
2

(ii) Memory cells produced / remain / stored (from previous infection);

Neutral: antibodies produced / remain

(When individual) comes into contact with virus / antigen (again);

Neutral: ‘cell’ instead of ‘virus’
Reject: ‘bacteria’ once only

Rapid / secondary / greater response / many or more antibodies

produced;
Accept: B cells / T cells

Destroys virus / antigen before it can cause harm / symptoms / cancer;

Reject: if destroys the virus / antigen in the vaccine before it
can cause harm
Q Do not allow ‘fights HPV’
Q Do not allow ‘memory cells remember’
3 max

(c) HPV destroyed in males / prevents males being carriers of HPV;

Neutral: prevents males catching HPV

Prevents males passing on HPV (to unvaccinated females) / HPV

 may cause (other) cancers in males;
Accept: reference to herd effect protecting the population
2
[10]

Q32.
(a) Virus / fungus / protozoan;
Neutral: named example
1

(b) Produces toxins;

Neutral: infects / colonises / invades cells

Damages cells / tissues / example given e.g. cell lysis;

2

(c) (i) (Antibodies) produced from a single clone of B cells / plasma cells;
Accept: hybridoma cell line instead of B cell / plasma cell
Reject: idea that antibodies are cloned

OR

(Antibodies) produced from the same B cell / plasma cell;

1

(ii) (Specific) primary structure / order of amino acids;

(Specific) tertiary / 3D structure;

(So) Only binds to / fits / complementary to one antigen;

Reject: ‘active site’ for either point 2. or 3. only once
3

(d) (Rapid) treatment of carriers / infected cattle / disease;

Neutral: reference to rapid identification of infected cattle

Can isolate / cull carriers / infected cattle / infected (dairy) products not sold /
consumed / tracked;

Reduces spread of disease / no need to kill / prevents the death of non-

infected animals;
Neutral: ethical arguments
3
[10]

Q33.
(a) Damage / destruction of cells / tissues;
Production of toxins;
2

(b) Contains antigen / proteins / dead / weakened microorganism / pathogen /

virus / bacteria;
Stimulates production of antibodies / plasma cells / memory cells;
Q Do not credit immune response unless qualified.
2

(c) (i) Age;

 Sex;

Ethnicity;

All healthy / not on other medication;

Not previously vaccinated / infected with TB;

Q Do not credit sample size.
Q Allow any suitable reference to health not being affected
for fourth marking point e.g. smoking, ‘depressed immune
system’ etc.
2 max

(ii) Contain the same antigens;

1
[7]

Q34.
(a) Nucleus;
1

(b) Enables organism to remain in area (of food source) / prevent its removal;
Q ‘To attach’ is not sufficient unless qualified
1

(c) (i) Correct answer of 222(%);;

Incorrect answer that clearly identifies difference in number of cases as

5800 –1800 or 5.8 – 1.8;
Correct answer gains two marks
2

(ii) More water-related activities / more ‘organisms’ with increased

temperature;
Q Allow any reference to growth or replication of ‘organisms’.
Do not penalise reference to bacteria.
Q Do not allow increase in water consumption.
1

(d) (i) All have same shape / only binds to Giardia / one type of / specific
antigen;
1

(ii) Has complementary (shape) / due to (specific) tertiary structure / variable

region (of antibody);
Q Binds / fits not sufficient unless qualified;
1

(iii) Enzyme / second antibody would remain / is removed by washing;

Enzyme can react with substrate (when no antigen is present);

2
[9]

Q35.
(a) Phagocytes engulf / ingest pathogens / microorganisms / bacteria / viruses;
 Phagocytes destroy pathogens / microorganisms / bacteria / viruses;

Lung diseases are caused by pathogens / microorganisms / bacteria / viruses;

Q Allow description of process of engulfing
2 max

(b) (i) Alveoli / lungs will not inflate / deflate fully / reduced lung capacity;

Breathing out particularly affected / no longer passive;

2

(ii) Alveolar walls thicken;

Longer diffusion pathway;

Scarred / fibrous tissue;

Reduces surface area (for gaseous exchange);

Q Diffusion is essential for 2nd point and surface area for 4th
point.
4

(c) (i) Cancer develops 20 – 30 years after exposure (to asbestos);

1

(ii) Smoking / air pollution / specified industrial source;

1
[10]
Examiner reports

Q7.
The factual recall question, (a), proved far more challenging than intended. Only 5% of
students obtained both marks and 54% failed to score. There was no particular pattern to
the wrong answers.

Question (b) discriminated very well, with 15% obtaining three marks and 21% scoring
zero. There were good, concise answers that scored three marks for including
complementary base pairing and the role of DNA polymerase in joining nucleotides
together to form the new DNA strand; often in two or three lines.

Many students failed to read the question carefully and did not answer the question as
set. They wrote at length about DNA replication, starting with DNA helicase. These
answers were awarded a maximum of two marks, because the question specifically asked
how the complementary strand of HIV DNA is made. Many students appeared to believe
that DNA actively pulls free nucleotides into place and makes them base pair; some even
wrote about condensation reactions. There were students who confused transcription with
replication and gave accounts of mRNA production.

Some students appeared to focus on ‘HIV’ and ‘replication’ and gave an extended account
of how HIV infects cells, uses reverse transcriptase to make DNA, incorporates its DNA
into host DNA, takes over the cell, is replicated by the host cell, infects new cells and
leads to AIDS. They often went onto an additional page, or wrote their answer under (c)
on the next page, in breach of instructions given on the front of the exam paper. Many of
these students may have found themselves short of time for later questions.

In (c), it was pleasing to find that many students did obey the command word to ‘contrast’
and gave full statements about the differences between DNA and RNA. Many students
knew enough about the structures of DNA and mRNA to give correct contrasting features
and 47% obtained all three marks.

Q8.
Question (a) was a very good discriminator. 19% obtained all four marks, 14% failed to
score and equal percentages obtained one, two or three marks. Many students had the
idea that a vaccine contains antigen and knowledge of antigen-presenting cells was
common. There were also many correct statements about plasma/B cells releasing
antibodies. Fewer students had the idea of a B cell dividing to form plasma cells. Not
many students were able to express clearly the idea of a specific helper T cell or B cell
detecting, or responding to, a specific antigen. Quite a few students got confused between
the roles of T cells and B cells. Some students wrote at length about memory cells and
secondary responses, neither of which was required to answer the question. As in some
other questions, this inclusion of irrelevant material often generated additional pages and
wasted time that could have been spent on other questions.

Most students obtained one mark in (b) for suggesting greater antibody production with
two vaccinations. Almost none went on to make any other suggestion.

In the mathematical requirements section of the specification (pages 62-66), selection and
use of a statistical test is not emboldened and so is required content for both AS level and
full A-level. This is different from the legacy specification and answers to (c) indicated that
most students had not learnt this. Only 6% of students could name the t-test and give the
reason as testing the difference between means. Further guidance about teaching
statistics is provided in the support materials on the AQA website.

The examiners were expecting statements from the specification in answers to (d). In
 ‘Investigating diversity’ (section 3.4.7), genetic diversity is compared (amongst other
ways) by looking at base sequences of DNA and base sequences of mRNA. Very few
students (3%) came up with both of these but some (27%) managed to express one of
them.

Q9.
(a) Most students were able to apply their knowledge to the information in the passage
with 92% gaining 1 mark, usually for stating that the virus would be unable to enter
the cell. There were students who wasted time in restating the question rather than
continuing to explain why disease would not develop. However, over half the
students did go on to explain their answer in terms of the virus not being replicated
or not damaging cells.

(b) Again, in this question many students simply restated the question and the
consequences of an increase in the number of plasma cells and release of antibody
rather than explaining the increase. Most were confident that plasma cells release
antibodies but it was not uncommon to read about antibodies, rather than B cells,
dividing by mitosis. Only the most able students gave the full story to gain 3 marks.

(c) Students often struggled to apply their knowledge in this question. Frequently, it was
unclear whether they were writing about the recovered person or the patient infected
with Ebola and many incorrectly wrote about the secondary immune response.
There were, however, some excellent responses, showing both a good
understanding of the immune response and an ability to use scientific terminology
correctly. Many students lost the opportunity to gain marks by writing about “fighting
off the disease”, “fighting the infection”, rather than referring to antibodies binding to
the viral antigen and destroying the virus.

(d) The idea of antigenic variability was well known but only about half the students
were able to explain why this makes it difficult to develop an effective vaccine. Many
stated incorrectly that the vaccine would contain antibodies. Other common errors
were that the antigen or antibody has an active site and that the antibody would be
unable to bind to the virus rather than to the viral antigen.

Q10.
(a) There were some good answers but there were also a lot of confused answers.
Many started incorrectly, with statements about the injected antigen attacking
myelin. These statements were common amongst the 38% who failed to obtain any
marks. Only 10% wrote about the antigen causing an immune response, leading to
the production of antibody that then attacks myelin. Some good answers scored all
three marks in two lines. There was considerable confusion about what T cells and
B cells do.

(b) This part was a very good discriminator. Most students noted that the unusual
mitochondria had fewer cristae, or a lower surface area (of cristae) for one mark
(23%). Many then went on to associate this with too little ATP production (to keep
the neuron alive) for a second mark (45%). Fewer went on to link loss of cristae to
less electron transfer/oxidative phosphorylation (26%).

(c) (i) The vast majority correctly stated that an electron microscope would be
required but only 43% then gave high resolution as the correct reason. There
were many vague references to magnification and scale and a few suggested
an optical microscope.

(ii) It was pleasing to see that many gave the correct formula to find percentage
and suggested counting normal and unusual mitochondria. This resulted in
34% getting two marks. Only 8% also included a statement that photographs
 would have to be taken at random, or from a large number of different areas.
Those who scored one mark usually just wrote about counting each type of
mitochondrion; others forgot to multiply by 100. Incorrect approaches included
finding percentage cover, centrifugation to isolate each type and
measurements of respiration.

Q11.
(a) Almost 80% of students scored both marks, in a question which tested
straightforward recall. Some described pathogens entering cells and reproducing
without going on to clarify the damage that would have been caused to the cells. A
minority misinterpreted the question and described two ways in which pathogens
were transmitted.

(b) The context of this question proved difficult for many students with fewer than half
the students explaining that water would move out of the bacterial cell by osmosis
because of the water potential gradient. A large number incorrectly wrote about
water being drawn out of the blood and washing away the bacteria and many
argued that water would enter the bacteria causing osmotic lysis. Few students went
on to explain why the loss of water would kill the bacteria

Q12.
(a) Most students successfully used the graph to link the decrease in the percentage of
infants vaccinated to fewer cases of whooping cough, with many correctly noting
figures from the graph. Fewer students gave a second reason: the most common
answer was the fear of side effects with many students linking the vaccine to
potential side effects.

(b) 93% of the students scored one mark usually for correctly interpreting the graph and
stating that the vaccination rate was increasing. Many then went on to discuss herd
immunity in general terms rather than being specific and writing about more people
being immune or fewer being susceptible as a result of the vaccination. Examiners
expected students to use the correct terminology and students who wrote about
‘resistance’ to whooping cough did not gain credit.

(c) Two-thirds of the students scored one mark here, for realising that herd immunity
was involved, but very few explained clearly how it worked. Examiners were looking
for the ideas that there were fewer people in the population in which the pathogen
could survive, because many were immune, having been vaccinated, and secondly
that contact between infected people and unvaccinated people was therefore less
likely. Students confused the terminology with some assuming that all unvaccinated
people were infected. Many incorrectly expressed the idea that infants did not need
to be vaccinated because they had inherited immunity from their parents and a
significant number simply restated the information in the question stem.

Q13.
(a) Over 40% gave the correct response of regulator protein. Students who failed to
score often gave a generic response about what should be in a vaccine, ‘antigen’
being insufficient for this mark. Students should ensure that they relate their answer
to the information given in the question.

(b) Students were expected to have seen from the passage that the LDL would bind to
a receptor on the surface membrane of the liver cell and then use their knowledge of
the structure of the membrane to suggest a suitable route into the cell, for example
through a carrier protein or channel protein. Many students failed to use the
information in the passage and therefore could only gain one mark. A significant
number of students recognised that the LDL would be lipid soluble and could pass
 through the phospholipid bilayer. This alternative was also credited.

(c) This question discriminated well with weaker students struggling to interpret the
information given in the passage. They frequently confused the antibody-antigen
response with enzymes, referring to active sites on the antibody or antigen and the
formation of enzyme-substrate complexes. There was also mention of receptor
"cells" and "antigens on the cell surface membrane of the regulator protein" by
students who clearly had a poor understanding of the molecules. However, the more
able students were able to gain two marks, usually for referring to the antibody
binding to the regulator protein which prevented it from binding to the receptor.

(d) It was clear that many students had learnt a generic answer to this type of question.
Most students knew that the control group would be treated the same as the
experimental group but the generic response of ‘give a placebo’ was insufficient
because the answer needs to be related to the information in the question. The mark
scheme required students to write about injection of saline without the monoclonal
antibody. The second marking point, ‘treated the same’ was sometimes expressed
as ‘given the same diet’, or the ‘same amount of exercise’ or ‘have the same amount
of LDLs’. It is worth noting that the same treatment will include the medical
experience and measurements taken, so identifying a particular control variable,
such as diet, in isolation, was insufficient to gain this mark.

Q14.
(a) (i) The examiners wanted a statement that a mutation could make the gene
inactive and that this would lead to uncontrolled, or very rapid, cell division.
About half of students obtained both marks. Some students did not mention
cell division but just stated that a tumour would grow; apparently taking
‘growth’ to mean cell division. The examiners did not accept these terms as
equivalent. Some students got into long explanations of how a mutation could
lead to a faulty protein and eventually got the first mark point for an inactive
gene. Some of these failed to score because they wrote about mutations
leading to the production of faulty amino acids.

(ii) A large majority of students managed to convey the idea of the genetic code
being degenerate.

(b) Very few students obtained all three marks in this part. This was because they didn’t
address the reference to ‘this antibody’ in the stem. The examiners were looking for
an observation that ‘this antibody’ will have a specific tertiary structure, or binding
site, or variable region. Some of those who did consider this aspect, failed to score
because they referred to a specific ‘active site’. Many students obtained two marks
for suggesting that the antibody binds either to the receptor (protein), or growth
factor, and this prevents growth factor binding to its receptor.

Q15.
(a) It was pleasing to see many good answers to this part that focused on how bacteria
are destroyed by phagocytes. Some students drifted into general accounts of the
immune response and others began by writing at length about how phagocytes find
bacteria. About 30% obtained all three marks. It was common for students to be
vague or wrong about the role of lysosomes. It was not uncommon to see
references to lysosomes fusing with bacteria, rather than with the vacuole containing
the bacteria. The examiners were looking for references to hydrolytic or digestive
enzymes destroying the bacteria, rather than just enzymes breaking down bacteria.

(b) 80% obtained both marks. Those who failed to score usually included features of
eukaryotic cells in their answers.
Q16.
A number of misconceptions about the immune system, immune response and
vaccination were commonly expressed by students in different parts of this question. The
same, or similar, misconceptions have been seen in previous papers and have been
commented upon in the reports.

(a) (i) Many students did not focus on a comparison of a vaccine consisting of whole
cells that had been heat treated with one containing only parts of the bacterial
cell. The former might not have been killed, or might contain toxins, whereas
the latter could not be alive and would not contain toxin. Many students felt
that the introduction of whole cells with their many antigens might overwhelm
the immune system. These students did not seem to appreciate that our
immune systems are exposed to multiple antigens on a daily basis and are not
overwhelmed.

(ii) The examiners were looking for the idea that a whole-cell vaccine would
contain many different antigens and each would lead to the production of an
antibody specific to it. Only about a fifth of students obtained both marks here.
Most students simply wrote that there would be more antigens and thus more
antibodies. This made it impossible for examiners to know whether or not they
understood the ideas of different antigens and different, specific antibodies.

(b) This part produced roughly equal percentages of students obtaining 3, 2, 1 or 0

marks. Many started with the assumption that people with whooping cough would
have no antibody against the toxin; because if they had the antibody, they wouldn’t
get ill. Indeed, many stated that only people who had been vaccinated against
whooping cough could have antibody against the toxin. In essence, they did not
seem to understand that an immune response occurs naturally when someone
becomes infected with a pathogen.

(c) Many appeared to find it difficult to accept that a doctor’s diagnosis might be wrong
and wrote about vaccines not working and the bacterium mutating. About a quarter
of students did spot that the scientists’ work suggests there might not be a real rise
in whooping cough cases and that this might be linked to mis-diagnosis. Another
quarter identified one of these points.

Q17.
Parts (a)(ii), (b)(i), (b)(ii) and (c) proved to be good discriminators.

(a) (i) Nearly all students scored one mark and this was usually for suggesting that
this method prevented the scientists from being biased. Unfortunately, the
second suggestion provided by some also related to the scientists, rather than
the volunteers; for example, ‘they may have a vested interest’. Students who
scored a second mark often referred to reducing the placebo effect or
psychological effects.

(ii) One-third of students scored full marks. The most common mark points
awarded were for suggesting that different types of cigarette contain different
amounts of nicotine, different amounts may be absorbed, different amounts
may be excreted and that the volunteers may have different blood volumes.
Unfortunately, a lack of precision let down some students; for example, ‘they
smoked different cigarettes’ and ‘they had different body masses’.

(b) (i) Just over half of students scored at least two marks. This was usually for
mentioning that nicotine will not bind to the protein, so the smoker will not feel
rewarded. Surprisingly, few students clearly expressed the idea that the
vaccine stimulates the production of antibodies to nicotine, or that these
antibodies bind to nicotine. A common misconception seen in weaker
 responses was that the vaccine contains antibodies to nicotine. Similarly,
some students thought that this vaccine contained a weakened strain of
bacteria. Generally, there were three incorrect approaches to this question,
which were all due to not reading the introduction carefully enough. The first
was that the vaccine causes the release of reward chemicals, meaning that a
person would not need to smoke. The second was that the vaccine stops
smokers from feeling addicted, rather than stopping them from feeling
rewarded. The third was that the antibodies to nicotine bind to the protein in
the brain, instead of to nicotine. Unfortunately, some students had the second
mark disqualified for referring to the protein receptor in the brain as an
enzyme. A minority also thought that the ability of the vaccine to stop people
smoking could be spread within the population to other smokers by herd
immunity.

(ii) Just under half of students scored at least two marks. The most common mark
points awarded were for appreciating that people choose to smoke, the
vaccine would be expensive and less money would be needed to treat the
effects of smoking. Relatively few referred to it being unethical not to treat
smokers, or that money would be better spent in preventing people from
smoking. Students who failed to score often gave vague responses; for
example, ‘if it is free, more people will stop smoking’ and ‘it will prevent people
from dying of cancer’. A minority suggested that the vaccine should not be
used at all, due to the Government losing millions of pounds each year in tax
on cigarettes. Some of the weakest responses did not answer the question
set. These typically contained stock How Science Works phrases such as, ‘it
is only one study’ and ‘we do not know the sample size’.

(c) It was disappointing that only one-fifth of students scored at least three marks.
Again, weaker responses often contained stock How Science Works phrases, which
did not apply specifically to this investigation. The question clearly asked students to
use the data to evaluate the statement made by the journalist. This said, many
students did note that high antibody responders are more likely to stop smoking.
Many also realised that the placebo group and low antibody responders had a
similar percentage of volunteers who stopped smoking. The next most accessible
mark point was that the volunteers may start smoking again after five or six months.
Better responses also noted the peak, or drop, in the concentration of antibodies.
However, some failed to mention when this occurred, or quoted an incorrect time
from the graph. Relatively few students suggested that only a small proportion of the
population may be high antibody responders, or that the large sample size produced
more reliable or representative results. Overall, it was evident that many students
did not analyse the data in the graph and table in enough detail, particularly in
relation to the timing of events.

Q18.
(a) (i) This was done well by many students. Where the mark was not given it was
usually because a student stated that the antigen was foreign but did not go
on to add that it would cause an immune response.

(ii) Difficulties with this question were linked to poor understanding of the ways in
which substances pass through membranes. Weaker answers referred to the
antigens not being ‘allowed’ through, rather than incompatibility between the
shape of the antigen and the shape of trans-membrane protein channels.

(b) Many students scored full marks. Rather than microfold cells being the route by
which vaccines could enter the body, weaker responses included ideas such as the
vaccine being given as treatment for a disease, or people being injected with
microfold cells.
Q19.
The questions in each part of this question related to the short comprehension passage.
Very many students appeared to pay little attention to the contents of the passage and
many did not read the questions carefully enough

(a) This produced some very good answers where students clearly described invasion
by pathogens, their reproduction, invasion of host cells and production of toxins.
They then linked these to death of host cells and tissues. About a third obtained
three marks. Some students concerned themselves with the immune response that
they had been told the people with AIDS did not have; they scored very poorly.

(b) A commonly stated misconception in this question was that vaccines are given after
infection, to treat rather than to prevent.

(i) Nearly forty percent scored one mark, either for the idea of there not being
time for antibodies to destroy HIV, or for there not being time for memory cells
of the immune system to respond. Few gave complete explanations; for
example, following up the antibody point by stating that antibodies do not /
cannot enter cells to follow HIV.

(ii) Students did better in this question and both lines of argument were seen.
The commonest correct answers involved different antigens being produced
and antibody not being able to bind any more. Students’ powers of expression
frequently let them down here.

(c) This question was notable for the use of rote answers; “there might be side effects”,
“it might cost too much”, “it has only been tested on animals”, “it’s not ethical.....”.
The question asks about these types of vaccines, the ones discussed in the
passage, with their various characteristics. A few very good answers were seen,
where students did discuss, for example, the possible perils of an attenuated virus
as a vaccine, when HIV is stated to show a lot of variability. In a ‘real world’ context,
it was interesting to note that almost no students appreciated that one would
become HIV positive if one had been vaccinated. Encouragingly, one of the more
common acceptable observations was that vaccination might encourage unsafe
practices, which could spread HIV if the vaccine did not work.

Q20.
(a) It was clear that many students had learned to define key terms and these students
gave clear and accurate answers. Others were less specific, most commonly stating
that a pathogen was “something” that caused disease. This was insufficient to gain
the mark.

(b) Many students gained all four marks. The main reason for failing to gain marks was
for not specifying the idea of fusion of the lysosome with the phagocytic vesicle.
Some students, however, failed to read the question properly and wrote in more
general terms about B cells and T cells or lymphocytes, ignoring phagocytes.

(c) Poor terminology let down students who clearly understood the concepts. Too
many used active site terminology and were unable to gain the first marking point.
The second marking point tended to be gained more often with the majority of
students correctly referring to antibody and antigen being complementary, fitting and
binding. Those who did not get this mark failed to do so by writing about the
antibodies binding to the pathogens rather than to the antigens.

Q21.
(a) Many students gave the correct answer, hydrolysis. Those who failed to score
usually confused hydrolysis with condensation.
 (b) Many students correctly identified that the peptide was too large or insoluble and
therefore gained one mark. Only the more able students went on to explain that
peptides would therefore not be able to pass through the carrier or channel protein.
There was a significant number of students who wrote about active transport despite
facilitated diffusion being referred to in the question.

(c) This question was generally answered well with most students recognising that the
peptide would be considered “foreign” or “non-self”. Those students who failed to
score often referred to the peptides as cells.

(d) Some students failed to use the information in the passage, which stated that the
drug had already been tested on patients with coeliac disease, and produced
answers referring to trialling on animals or people without the disease. The majority
correctly wrote about side effects, though some gave this answer twice with slightly
different wording. Large numbers of answers gave generic responses here such as
age or gender, without giving any thought to the context of the question.

Q22.
(a) Most students correctly identified the evidence as relating to four polypeptide
chains. Incorrect answers usually centred on the presence of variable regions or of
hydrogen bonds. There was some evidence of the difficulties that students find in
interpreting diagrams with numerous references to two polypeptide chains.

(b) Most students clearly appreciated that an antigen is able to bind to an antibody to
form an antigen-antibody complex. Not all, however, were able to identify the
binding site of the antibody as having a complementary shape to the antigen. Many
of the less able students confused antibodies with enzymes. Use of the term active
site rather than binding site was perhaps understandable, but many went
considerably beyond this in writing of substrates and enzyme-substrate complexes.
There were also many students who failed to maintain the necessary focus and
wrote at length of plasma cells, memory cells and vaccines.

Q23.
The starting point for questions requiring longer responses must be careful determination
of precisely what is required. This question required students to explain how vaccines
protect people against disease but few could resist the temptation to describe in great
detail everything they knew about immunology. This often resulted in the allocated space
being filled with material that, at the very best, could only be regarded as of marginal
relevance. Most students should have been able to access the first three points on the
scheme and indicate that antigens on weakened or dead pathogens stimulated the
production of memory cells. The fact that credit was not always awarded stemmed from
interchangeability of the terms pathogen and disease, and uncertainty over the origin and
nature of memory cells. The second part of the mark scheme referred to the generation of
a secondary immune response. Those students who finally arrived at this concept, often
did no more than offer a few passing thoughts at the very end of the page or on an extra
sheet. As always with questions on this topic, the use of language was often far from
convincing and there were many references to antibodies "fighting" and memory cells
"remembering".

Q24.
(a) Nitrogen-fixing was the commonest wrong answer in this question. The majority of
responses were correct.

(b) This question was answered poorly because students did not think through the
processes that were taking place in the reed bed. There were many incorrect
responses referring to processes in the reeds that result in the formation of nitrates
 from ammonia / nitrite. Some then went on to gain one mark for active transport of
these nitrates into the plant roots. Better students correctly linked the use of ATP
from aerobic respiration in the active transport of nitrates, and wrote clearly and
concisely. There was a surprising amount of confusion between diffusion and active
transport, with active transport being said to be needed to diffuse nitrogen-
containing substances from areas of high to low concentration. The oxygen was also
thought to create a concentration gradient to allow the roots to take up the nitrogen-
containing substances by diffusion.

(c) There were some very clear answers to part (i) from students who understood that
too fast a flow would not allow time for the nitrification to occur, hence the decrease
in concentration of nitrates. There was also not enough time for the saprophytes to
decompose the sewage to release ammonium compounds. Some failed to mention
the ammonia being converted. Other answers suggested that the soil would become
waterlogged, preventing the action of the nitrifying bacteria, or that the reeds would
take up more of the nitrates or that numbers of denitrifying bacteria would increase,
converting the nitrate to nitrogen gas. A number thought that if the flow was too fast,
the reeds would be unable to take up the nitrates, so they would end up in the lake.
The fast flow was also thought to reduce the oxygen concentration in the water, thus
preventing the action of the nitrifying bacteria. There was also confusion with
leaching and eutrophication. There were only very occasional references to the
bacteria being washed away by the fast flow. The fast flow was also said to maintain
a steep diffusion gradient and increase uptake by the plant roots.

In part (ii), it was clear that many students had learnt this topic thoroughly and
included all marking points. Weaker students could not explain the increase in
decomposers breaking down the dead plants and using up the oxygen in the water
in their respiration. The algae were often described as ‘feeding’ on the nitrates. A
common incorrect reason for the death of the fish was a lack of food once the plants
in the lake died. A minority of students had no understanding of the process of
eutrophication and thought that dehydration and osmosis caused the fish to die or
that high nitrate concentrations were toxic to both fish and algae. Increasing
concentrations of carbon dioxide were also thought to be responsible for the death
of the fish.

Q25.
(a) (i) Many candidates gave a generic answer, failing to refer to the passage as
instructed. These candidates often scored only one mark for explaining that an
antigen causes an immune response. Candidates who scored both marks
used the information given to explain that, in this example, the antigen was a
protein on Chlamydia.

(ii) In this question, candidates were more confident in using the information from
the passage and most gained at least a mark for explaining that the proteins
on the Chlamydia cell and the heart were similar. There were candidates who
confused antigens with antibodies and even enzymes but many candidates
gained a second mark, usually by explaining that antibodies would attack the
heart muscle cells. There were a number of excellent answers that showed a
clear understanding of the immune response.

(b) A number of candidates did not go further than the information given in the question,
simply stating that the vaccination would prevent Chlamydia infection. This was not
credited. Candidates who considered the information in the passage wrote about the
possibility of preventing atheroma or, if the human proteins were similar to those in
the mouse, the risk of causing heart disease. There were also creditworthy
references to the cost of a vaccination campaign being higher than alternative
methods of reducing the incidence of Chlamydia. Unfortunately, many limited their
answer to just one factor rather than evaluating the suggestion as instructed.
Q26.
(a) Phagocytosis was well understood by candidates and many gained full marks.
Many, however, wasted time by describing antigen presentation which was not
required. Almost all candidates knew that the bacteria would be engulfed and many
referred to their inclusion in a phagosome or vacuole. Weaker candidates failed to
gain marks through imprecision, e.g., not realising that the lysosomes fuse with the
phagocytic vesicle and just writing about them releasing enzymes or not specifying
what sort of enzymes and then repeating the stem by saying the bacteria were
destroyed without any mention of digestion or hydrolysis.

(b) Many candidates failed to realise that this question was about cell adaptation. There
was a lot of confusion between adaptations of the cell and of the intestine wall
generally, with many answers focusing on factors such as a good blood supply and
maintaining a steep concentration gradient. Such responses were not relevant to
this question. Many candidates had a good understanding of glucose co-transport
and described this in detail, usually gaining two or three marks, even though their
answers were not focused on cell adaptation. Most scored one mark for
understanding a large surface area was involved but many attributed this to villi
rather than to microvilli. Better candidates gained a further two marks for explaining
the cells would have a large number of mitochondria that provide the ATP for active
uptake.

Q27.
(a) (i) This caused little difficulty for most candidates with the vast majority gaining at
least one mark for suggesting that C. difficile is resistant to antibiotics.
Although many candidates realised that the other bacterial species would be
killed, they failed to gain a second mark by not stating that there would be an
increase in the number of C. difficile.

(ii) Most candidates gained this mark by suggesting that the immune system
would be less effective. There were several answers linked to older people
taking lots of antibiotics. These responses were not credited.

(b) Although the majority of candidates obtained at least one of the two marks available,
there was still some confusion, particularly with weaker candidates, about the
precise role of methicillin. Most candidates realised it was a competitive inhibitor but
a significant number referred to it possessing an active site. Approximately forty
percent of candidates provided a clear accurate explanation of competitive inhibition
by methicillin.

(c) (i) The majority of candidates had little difficulty explaining that some of these
patients were already ill and this illness could be the cause of death.

(ii) The vast majority of candidates gained this mark by describing the increase in
the number of deaths up to 2006 followed by a decrease.

(iii) Less than a third of candidates could correctly calculate the percentage
increase in the number of deaths caused by MRSA in Wales from 1996 to
2006. A small percentage of candidates obtained a single mark for reading
figures from the graph but almost sixty percent scored zero.

Q28.
(a) Relatively few candidates appeared to be aware that points on a graph should be
joined with straight lines if it is felt that the position of intermediate points cannot be
predicted reliably. Given that this decision had been made by candidates in drawing
their graphs in stage 2, this was somewhat surprising.
 (b) Although many candidates were able to describe how the curve rose to a maximum
value at 180 units or a dose of 0.25 g per kg, a significant number missed the point
plotted for a zero dose. Other candidates misread the second point as representing
a dose of 0.5 g per kg.

(c) It remains disappointing that so few candidates can calculate percentage increase
or decrease. There were many incorrect answers to this question, frequently from
otherwise sound candidates.

(d) Most candidates appeared to appreciate that calculating the dose per unit mass
allowed differences in mass to be considered and a comparison to be made. Many
responses, however, failed to gain credit because of the vague use of terms such as
“bigger mice” and “size” rather than mass.

(e) It would appear that some candidates had been taught about the immune response
in much greater detail than required by the specification. This additional detail
tended to confuse rather than help the candidates and reduced their marks for this
question. It was relatively uncommon to see three marks awarded for what should
have been a straightforward account. Common errors made by less able candidates
involved the confusion of antibody and antigen or failing to identify the antigens as
being on the surface of the sheep red blood cells.

(f) Most candidates correctly pointed out that this investigation was carried out on mice
and, therefore, the results might not apply to humans but only the better candidates
were able to suggest a second valid reason.

Q29.
(a) Candidates’ knowledge of classification allowed many to make valid statements in
their answers to part (a) about cats and cheetahs being from the same family or
both being feline. Occasional candidates incorrectly referred to cats and cheetahs
belonging to the same species. In part (b), some candidates were able to interpret
the grafting of skin from one part of an animal to another as a test to see whether
rejection would occur in these circumstances. The word ‘reaction’ was not
considered to be synonymous with the specific biological meaning of rejection.

(b) Candidates could have taken one of two approaches in answering part (a). They
could either have concentrated on the speed of rejection or on the closeness of the
genetic relationship between relevant animals. Despite this, this part of the question
was not answered well and responses tended to lack the necessary precision to
gain credit. Most candidates responded to the word reliable in part (b) with a suitable
comment about the size of sample, but there were a few responses that were
correctly worded in terms of the duration of the observation. Although many of the
answers to part (c) were correctly based on the inference that cheetahs must share
similar antigens as skin grafts were tolerated between animals, responses to part (d)
were often poor. There were many confused accounts that failed to reflect the
fundamental idea that proteins such as antigens are coded for by DNA and so any
variation in the amino acid sequence of the protein implied a variation in the DNA
coding. Candidates rarely answered in these simple terms.

Q30.
(a) Two thirds of candidates were aware that the vaccine needed to be given before
girls are sexually active or likely to carry HPV. However, this was often poorly
expressed by weaker candidates e.g. ‘this is when girls reach puberty or are
sexually mature’. Other typical responses attempted to explain why the vaccine was
given in general terms, rather than to this specific age group e.g. ‘to prevent girls
developing cancer later in life’.
 (b) One third of the candidates had the idea that different types of HPV have different
antigens. However, only better candidates wrote about the consequence of this in
terms of memory cells and antibodies. Weaker candidates were let down by poor
expression. Responses such as ‘the immune system does not recognise the virus’,
‘memory cells do not remember the virus’ and ‘antibodies cannot fight the virus’
were seen. A minority of candidates thought that the vaccine contained antibodies.

(c) Nearly half of the candidates had the idea that more memory cells or more
antibodies would be produced. However, only the very best candidates mentioned
both for full credit. Two misconceptions were seen in the responses of weaker
candidates. The first was that each injection of the vaccine was based on a different
strain of HPV and would therefore provide ‘better immunity’. The second involved
safety. They thought that ‘if given all at once, the immune response would be too
strong’. Similarly, many unqualified references to the primary and secondary
responses were seen.

(d) Two thirds of the candidates gained at least one mark for stating that cancer takes
many years to develop or that it takes time for young girls to become sexually active.
Candidates who failed to score often wrote that ‘it takes time to develop immunity’ or
‘it takes many years to obtain data’. Some weaker candidates wrote about immunity
being passed on to offspring or that it would take many years to vaccinate 80% of
12- 13 year olds.

(e) 75% of candidates gained full credit for stating that cancer can be caused by other
factors or that the vaccine may not work. Weaker candidates often repeated
information in the passage and wrote that smear tests are needed to remove
abnormal cells before cancer develops. A minority thought that cancer is infectious
and that smear tests detect the virus.

(f) Only better candidates were aware that people who are vaccinated will destroy the
virus or not act as carriers. Very few of these candidates appreciated that people
who are not vaccinated are therefore more likely to meet people who are
vaccinated. Many candidates simply repeated the stem of the question and stated
that ‘if vaccinated, people cannot spread HPV to others’. Weaker candidates often
referred to the ‘disease’ being destroyed rather than the virus.

Q31.
(a) Only the most able candidates gained full credit on this question. However, most
candidates gained one mark for the idea that cervical cancer could be caused by
other factors. Unfortunately, some candidates misinterpreted the graph and
considered it to show the percentage of women with cervical cancer, rather than the
percentage of women with a specific type of HPV. It was very clear that these
candidates did not realise that all women in the investigation had cervical cancer.
Consequently, this led to responses that were out of context such as that ‘66% of
women with HPV16 have cervical cancer’. Better candidates were able to criticise
the data. They usually referred to the absence of a control group or suggested that
cervical cancer may increase susceptibility to HPV. Weaker candidates often gave
vague answers that were not qualified e.g. ‘it does not prove that HPV causes
cervical cancer’. Similarly, they did not usually refer to specific types of HPV.

(b) (i) Approximately 40% of candidates gained one mark. This was almost always
for stating that an antigen stimulates an immune response. Relatively few
candidates made reference to the chemical nature of antigens.

(ii) Just over a third of candidates scored full marks but 60% scored at least two
marks. A number of candidates were aware that vaccination causes the
production of memory cells or that memory cells remain. However, many
candidates had the idea that memory cells ensure a rapid response to the
 same virus if encountered again. Unfortunately, these points were often poorly
expressed by weaker candidates such as in stating that ‘memory cells
remember the antigen’ or that ‘they fight the germ quicker’.

(c) Most candidates suggested that vaccinating young men would reduce the spread of
HPV to females. However, it was usually only better candidates who explained this
in terms of vaccinated males destroying the virus or not acting as carriers. Weaker
candidates usually expressed this idea poorly e.g. ‘vaccinated males cannot be
infected’. A number of creditworthy references to herd immunity were made,
although it should be noted that this term is not a requirement of this unit. Some
candidates suggested that HPV may cause other cancers in males and this was
also credited. The most common misconception involved vaccinated males passing
on immunity to their children.

Q32.
(a) Over 90% of candidates gained this mark, usually for ‘virus’. Relatively few referred
to ‘fungi’. The few candidates who failed to score usually repeated ‘bacteria’ from
the stem of the question or gave a specific example of a bacterium or virus.

(b) Many candidates gained full marks for this question, although a minority misread the
stem of the question and gave ways in which a pathogen could gain entry into the
body. The most common mark awarded was for the production of toxins.
Unfortunately, some candidates failed to gain the second mark through a lack of
detail e.g. ‘damages the body’ and ‘infects cells’.

(c) (i) This question was poorly answered by most candidates. Only the most able
were aware that monoclonal antibodies were produced by the same B cell or
B cell clone. There was evidence of widespread poor expression and
responses usually fell into one of two discrete camps. Candidates who
focused on the ‘mono’ aspect of ‘monoclonal’ frequently referred to these
antibodies ‘only binding to one antigen’ or ‘being produced from a single
antibody’. Candidates who focused on the ‘clonal’ aspect usually gave
responses that were out of context, such as ‘these antibodies are cloned’ and
‘they are genetically identical antibodies’. Disappointingly, very few candidates
mentioned B cells.

(ii) This question proved to be a good discriminator. The most common mark
awarded was for ‘tertiary structure’. Weaker candidates usually went straight
into an explanation of why monoclonal antibodies are specific in terms of
binding, shape or fit. However, a number of these answers lacked detail
regarding what these antibodies bind to. Relatively few of these candidates
used the term ‘antigen’. In such cases, the terms ‘bacteria’ or ‘pathogen’ were
typically used. A number of candidates also confused antibodies with
enzymes, with references to ‘active sites’ and ‘antibodies being
complementary to the substrate’. There were, however, some highly
impressive answers given by the more able candidates. These usually gained
full marks and often gave more detail than that shown on the mark scheme.

(d) Most candidates gained at least one mark for the idea of reducing the spread of
disease. The more able qualified this by explaining that rapid identification allowed
infected cattle to be isolated and treated. Relatively few wrote about infected dairy
products not being sold. Weaker candidates often gave vague arguments that
related to animal rights and economics. These usually involved less distress being
caused to the animals, not having to transport the animals or money being saved
due to the samples not having to be sent to a laboratory. Such responses were not
credited. Similarly, a minority of candidates incorrectly thought that the monoclonal
antibodies were being used to treat infected cattle, rather than as a diagnostic tool.
Q33.
(a) Most candidates had little difficulty obtaining at least one mark by referring to the
production of toxins by pathogens. However, a significant number of candidates did
not specifically refer to cells or tissues being damaged but instead described how
pathogene enter the body or wrote about damage in general terms.

(b) It was disappointing to find a significant number of candidates describing a vaccine

as ‘a weakened form of a disease’. However, most candidates did refer to the
production of antibodies or memory cells following vaccination. Some candidates did
suggest that a vaccine contains antibodies and provides passive rather than active
immunity.

(c) (i) This question caused little difficulty with the vast majority of candidates able to
provide at least one valid factor, often age or gender. Other common correct
responses related to obtaining healthy volunteers and individuals who had not
been infected with TB or had been previously vaccinated.

(ii) This proved very difficult. Only a small percentage of candidates obtained this
mark by suggesting that the two vaccines have similar antigens. Most
candidates simply stated that the two vaccines were most effective when used
together.

Q34.
(a) Over two thirds of the candidates correctly named the nucleus as the structure
which confirms that G. lamblia is a eukaryotic organism. Ribosome and flagellum
were frequent incorrect responses.

(b) Most candidates gained this mark for stating that the sucker enabled G. lamblia to
remain in the intestines rather than being moved out as substances passed through.
However, some candidates suggested the sucker enabled nutrients to be absorbed
or somehow prevented digestion of the organism.

(c) (i) Approximately one in five candidates obtained both marks for this calculation.
A similar number of candidates did gain one mark for showing some valid
working in attempting the calculation.

(ii) The vast majority of candidates did not obtain this mark as they suggested that
the number of cases would increase in the summer due to an increase in
water consumption. Very few candidates suggested that an increase in
temperature could lead to an increase in the number of G. lamblia in
contaminated water.

(d) (i) Most candidates stated that monoclonal antibodies are the identical with no
reference to their shape or the idea that they are specific to a particular
antigen.

(ii) Many candidates obtained this mark often by referring to the complementary
shapes of the antibody and Giardia antigen. Fewer candidates mentioned the
tertiary structure or the variable region of antibodies. Most incorrect responses
suggested the antibody has an ‘active site’ or the ‘same’ shape as the Giardia
antigen.

(iii) As expected this proved to be a difficult question. Most candidates had

difficulty understanding the flow chart and gave a variety of incorrect
responses. Despite the information provided in the stem of the question many
candidates suggested that the Giardia antigen would remain on the plate and
cause a positive result.
Other misconceptions related to the enzyme reacting with the antigen or with
 the antibodies. Approximately forty percent of candidates obtained one mark
for realising that the second antibody with the attached enzyme would remain
on the plate. Far fewer of these candidates went on to explain that the enzyme
would react with the substrate to provide a yellow colour.

Q35.
(a) Although it was evident that most candidates had a good idea of the role of
phagocytes, poor use of terminology often resulted in marks not being awarded. It
was common to see responses such as phagocytes ‘fighting disease’ or destroying
‘foreign bodies’ or ‘infections’. Nevertheless, approximately a third of candidates
obtained both marking points.

(b) (i) Most candidates obtained one mark for stating that the lungs would not fully
inflate or deflate. However, very few candidates obtained a second mark for
suggesting that breathing out would particularly be affected or that the rate of
diffusion would be reduced. There was some confusion over the meaning of
the term elasticity with many references to ‘lungs contracting and relaxing’.

(ii) This proved to be an effective discriminator. The vast majority of candidates

obtained at least one mark often by referring to the presence of scarred or
fibrous tissue in the lungs. Most candidates then gained a second mark by
linking this to a reduction in the surface area for effective gaseous exchange.
Fewer candidates specifically referred to the thickening of the alveolar walls
but instead mentioned thickening of lung tissue. However, a significant
number of candidates were able to link this thickening to a longer diffusion
pathway.

(c) (i) Most candidates obtained this mark using the information in the passage to
explain that lung cancer develops 20 – 30 years after exposure to asbestosis.
Candidates failing to gain this mark often provided incomplete responses such
ae ‘it takes a long time for cancer to develop’.

(ii) The vast majority of candidates obtained this mark by referring to smoking.