CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK

Exam-style questions and sample answers have been written by the authors. In examinations, the way marks are awarded
may be different.

Coursebook answers
Chapter 10
Exam-style questions
The mark schemes, suggested answers and 1 A ; [1]
comments that appear here were written by the 2 C ; [1]
author(s). In examinations, the way marks would
be awarded to answers like these may be different. 3 D ; [1]
4 C ; [1]
Notes about mark schemes 5 a unprotected sexual intercourse ;
A or accept indicates an alternative acceptable
sharing needles (between intravenous drug
answer.
users) / reuse of unsterilised needles ;
R = reject. This indicates a possible answer that
(via) blood transfusion / blood products ;
should be rejected.
(mother to child) across the placenta / at
; The bold semicolon indicates the award of 1 mark.
birth / in breast milk ; [max. 3]
/ This indicates an alternative answer for the same
b doctor’s / hospital, records ;
mark. The alternatives may be separated from the
rest of the answer by commas. tests for HIV status (e.g. at antenatal
( ) Text in brackets is not required for the mark. clinics for pregnant women) ;

Underlining This is used to indicate essential death certificates ;

word(s) that must be used to get the mark.
AW means ‘alternative wording’. It is used to
indicate that a different wording is acceptable
provided the essential meaning is the same, and is
used where students’ responses are likely to vary
more than usual.
AVP means ‘additional valid point’. This means
accept any additional points given by the student
that are not in the mark scheme, provided they
are relevant. But accept only as many additional
points as indicated by the bold semicolons, e.g.
AVP ; ; means award a maximum of 2 extra marks.
ORA means ‘or reverse argument’ and is used
when the same idea could be expressed in the
reverse way. For example: ‘activity increases
between pH2 and pH5 ORA’ means accept
‘activity decreases between pH5 and pH2’.
max. This indicates the maximum number of
marks that can be given.
data recorded by (named), national /
international, organisations (e.g. World
Health Organization) ; [max. 3]
c determine how numbers of people
infected are changing ;
see where medical resources should be
targeted ;
e.g. drugs for treating HIV infection ;

monitor success of HIV/AIDS programmes:
in reducing spread of HIV infection ;
in treating people who are HIV+ so they
do not develop AIDS ;
to see if more education is required ;
to provide support to national / regional
health organisations ;
AVP ; ; [max. 3]

1 Cambridge International AS & A Level Biology © Cambridge University Press 2020

 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK

730 000   a vailability of workers to spray

d i = 0.029
25 500 000 buildings ;
  ratio = 0.029 : 1 ; [1]
  a bility to reach, all / most, of the
ii better health care in North America ; population ;
  better diagnosis, so people who A refs to infrastructure such as
   
are tested as living with HIV start roads / transport
treatment early ;    osquitoes become resistant to
m
  more affluent countries, so insecticides ;
antiretroviral drugs available to (nearly)    eed to be several insecticides so the
n
all people who are living with HIV ; same one is not used in the same
  AVP ; [max. 3] places year after year ;
 [Total: 13]    ets have to be, looked after carefully /
n
kept intact / kept undamaged ;
6 a female Anopheles (mosquito) ;
  Plasmodium becomes resistant to drugs ;
takes a blood meal from an infected person ;
  AVP ; ; [max. 3]
transfers, parasite / pathogen /
Plasmodium, in saliva when takes a blood  [Total: 13]
meal from an uninfected person ; [3] 7 a bacteria pass out in faeces of infected
b decrease in, number / concentration, of person ;
red blood cells ; carried in, water / food, consumed by
less haemoglobin to transport oxygen ; uninfected person ; [2]
increase in risk of anaemia ; b poor sanitation ;

more likely to be, tired / fatigued ; not enough clean drinking water ;

AVP ; [max. 3] poverty ;

lowered immunity / malnutrition / HIV
c i  osquito nets, reduce chances /
m
infection ; [max. 3]
prevent, mosquitoes, feeding on
humans / taking blood meals ; 447
c i × 100 = 1.08 ; [1]
41 421
   osquitoes are killed by insecticides
m ii treatment for cholera involves supply
(on nets / on internal surfaces of of oral rehydration therapy ;
houses) ;
  and provision of safe drinking water ;
  insecticides are long-lasting so, nets do
not need to be renewed often / houses    etter response to emergencies (in
b
do not need to be sprayed often ; some countries) ;
  e ffectiveness of response may depend
  c hildren (under 5) are, most
on number of cases ;
susceptible to malaria / more likely to
die from malaria ;   r ef to very high number of cases in
Haiti ;
   rugs kill, Plasmodium / malarial
d
parasite, when it enters the body ;    ay depend on remoteness of regions
m
affected by cholera ;
  rainy season is when mosquitoes breed ;
   r ways in which, emergency supplies /
o
   osquitoes / Anopheles / vector, breeds
m personnel, can reach affected areas ;
in small pools of water ;
  r ef to high case fatality rates in,
  (therefore) higher risk of transmission ; Nigeria / Somalia ;
AVP ; [max. 4]    se of data to compare case fatality
u
ii provision of, nets / insecticides / drugs, rates in individual country with
is dependent on funding ; global rate ; [max. 3]
  a vailability of, health workers / iii cholera is a serious disease ;
volunteers, to distribute, nets / drugs ;    d
 eath can occur very quickly after
infection ;

2 Cambridge International AS & A Level Biology © Cambridge University Press 2020

 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK
   s preads quickly in population
(especially after a disaster) ;
   deaths are avoidable ;
   if oral rehydration therapy (ORT) is
available immediately ;
   d
 ata is useful to predict, situations
/ places, where cholera may occur ;
WHO can coordinate responses to
outbreaks ; [max. 3]
d i infected person travelled from an area
with an outbreak of cholera ; [1]
ii water supply is not contaminated with
(human), sewage / faeces ;
  piped water / water supply is treated to
kill bacteria ;
  
V. cholera destroyed in sewage
treatment ; [max. 2]
e cholera outbreaks occur after natural
disasters before medical aid can be
provided / AW ;
e.g. during wars / civil unrest, when
medical aid cannot be provided ;
oral rehydration therapy is not started
soon enough ;
death occurs within 24 hours if no
treatment provided ; [max. 2]
 [Total: 17]
8 a i  ycobacterium tuberculosis ;
M
A Mycobacterium bovis [1]
ii infected person, coughs / sneezes /
spits ;
  aerosol / droplets, containing bacteria,
breathed in by uninfected person ; [2]
b i idea that the total populations of
the five countries are different ;
  allows valid comparisons between
the countries ; [2]
ii number of new cases / incidence,
of TB increased from 1990 in all
countries ;
  between 2000 and 2005 numbers
of new cases, reached a maximum /
remained constant ;
  except in Belarus which reached
maximum number before 2000 ;
  number of new cases remained
constant and then decreased ;
3 Cambridge International AS & A Level Biology © Cambridge University Press 2020
  except in Belarus where decrease did
not continue to 2013 ;
  use of figures for numbers of new
cases with year(s) to illustrate any of
the points above ;
  (minimum of two data quotes from
the graph, e.g. two countries for the
same year or one country for two
years) ; [max. 3]
iii t ransmission where there is,
overcrowding / poor housing ;
  high rates of transmission are linked
with poverty ;
   ref to drug-resistant forms of TB ;
   poor ventilation of housing ;
   poor nutrition ;
   poor access to health care ;
  poorly organised treatment for people
with TB ; [max. 5]
 [Total: 13]
9 a i  as antibiotic use increases so does the
percentage of resistant bacteria ;
   a ccurate data quotes for a minimum
of two countries taken from the
scatter graph ;
   e .g. country [4] 13 units and 3%,
country [19] 38 units and 42% ;  [2]
ii either
   a minimum of any two countries with
similar antibiotic use, but different
percentage resistance ;
   or
   a minimum of any two countries with
similar percentage resistance, but
different antibiotic use ;
   and
   a ccurate data quotes for a minimum
of two countries to support ;
   e .g. any two countries with antibiotic
use between 20 and 30 units show
antibiotic resistance between 15%
and 33% ;
   e .g. any two countries with antibiotic
resistance between 10% and 20% have
antibiotic use between 2 and 20 units ;
 [2]
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK

b examples of steps to reduce antibiotic break transmission cycle of resistant

resistance: bacteria / described example ; (e.g. put
doctors should not prescribe antibiotics people infected with antibiotic resistant
for viral infections ; strains in quarantine)

antibiotics should not be used as [max. 5]

preventative medicines ;
antibiotics should only be used (for
treatment) when necessary ;
doctors / hospitals, should use the most
effective antibiotic(s) ;
e.g. carry out antibiotic sensitivity tests (see
Figure 10.17 and ESQ3) / find the minimum
inhibitory concentration (see ESQ10) ;
carry out genetic tests to find resistance
genes in pathogens ;
doctors / health authorities, should ensure
people take the correct dose ;
ensure that people complete the course of
their antibiotic ;
A ensure people follow the instructions
ensure people do not use, ‘left-over’ /
other people’s, antibiotics ;
antibiotics should, only be supplied on
prescription / not be supplied ‘over the
counter’ or for sale on the internet / AW ;
use more than one antibiotic (at the same
time) / use antibiotics in combination ;
A ‘a mixture of antibiotics’
different antibiotics should not be used all
the time ;
[Total: 9]
10 a A 1.5 µg cm–3 ;
B 0.094 µg cm–3 ;
C 0.25 µg cm–3 ; [3]
b ref to ease of reading the E-test strip ;
where edge of, growth / ellipse, intercepts
the test strip ;
gives quantitative results ;
avoids measuring areas of inhibition as
with card discs (Figure 10.17) ;
indicates susceptibility / resistance ;
indicates degree of resistance ;
ensures a suitable dosage of antibiotic is
used ;
AVP ; [max. 4]
c shape of, growth / ellipse, the same as in
the diagram in the question ;
8 μg cm–3 shown in the same relative
position as on E-test strips in the diagram ;
no growth of bacteria shown at
concentrations higher than 8 μg cm–3 ;
ε
D
µg cm−3

i.e. some antibiotics should be rotated

so that they are used for a year and then
replaced by a different antibiotic for a while
some antibiotics should be kept to use as
a ‘last resort’ ;
the same antibiotics should not be used 8
for animals and for humans ;
use of antibiotics in, food production /
(livestock) agriculture, should be
reduced ;
use other antimicrobial drugs ;
develop new, types of antibiotics / drugs ;
[3]
improve, knowledge of antibiotic
resistance among, healthcare professionals d growth only occurs next to E-test strip ;
/ the general population ;
from top of E-test strip down to 6 µg cm–3 ;
improve disease prevention methods with [2]
an example ; (e.g. vaccines / good hygiene
[Total: 12]
in hospitals)

4 Cambridge International AS & A Level Biology © Cambridge University Press 2020