5

3 Fig. 3.1 is a diagram that shows the structure of an antibody molecule.

variable region variable region

constant region

Fig. 3.1

(a) State why the antibody molecule shown in Fig. 3.1 has quaternary structure.

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(b) (i) Use Fig. 3.1 to explain how the structure of the variable region of an antibody molecule is
related to its function.

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(ii) State the role of the constant region of an antibody.

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5: Disease and protections against disease – Topic questions 2 Copyright (c) UCLES 2028
 6

(c) Monoclonal antibodies are used both in diagnosis and in treatment of disease.

(i) Outline how monoclonal antibodies are produced.

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(ii) Suggest the advantages of using monoclonal antibodies in diagnosis of disease.

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[Total: 11]

5: Disease and protections against disease – Topic questions 3 Copyright (c) UCLES 2028
 12

6 Cholera bacteria release the toxin, choleragen, when they are in the intestine.

(a) (i) Name the bacterium that is the pathogen of cholera.

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(ii) Describe the way in which cholera is transmitted from an infected person to an uninfected
person.

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Gangliosides are glycolipids that bind choleragen. These glycolipids are found on many cell
surface membranes.

When choleragen is released from the bacteria in the intestine, it binds to gangliosides on epithelial
cells and enters these cells as shown in Fig. 6.1.

pathogen

choleragen

ganglioside intestinal
epithelial cell

Fig. 6.1 not drawn to scale

5: Disease and protections against disease – Topic questions 4 Copyright (c) UCLES 2028
 13

(b) Suggest how choleragen interacts with gangliosides on intestinal epithelial cells.

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(c) Name the process by which choleragen enters the intestinal epithelial cell as shown in
Fig. 6.1.

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Once inside the cells choleragen is activated. One effect is to increase the movement of chloride
ions through channel proteins out of cells.

(d) Suggest and explain the likely consequences on the intestinal epithelial cells of the loss of
chloride ions through the channel proteins.

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(e) Health authorities recommend that antibiotics, such as tetracycline, are only to be used for
treating people with severe cases of cholera.

Explain why it is recommended that antibiotics should not be given to people with mild cases
of cholera or to protect people from cholera.

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[Total: 11]

5: Disease and protections against disease – Topic questions 5 Copyright (c) UCLES 2028
 7

3 (a) Name the causative organism of tuberculosis (TB).

...............................................................................................................................................[1]

(b) Fig. 3.1 shows the number of deaths from TB and the number of new cases of TB from 1925
to 2010 in Canada.

120

100

number 80
per
100 000 60
population
40

20

0
1925

1930

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010
year
Key
deaths from TB
new cases of TB

Fig. 3.1

The vaccine for TB was introduced in Canada for widespread use from 1948.

Antibiotics, such as streptomycin, were introduced in Canada from 1940.

Use the information in Fig. 3.1 to comment on the effect of the introduction of the vaccine and
antibiotics on the number of new cases and deaths from TB.

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 8

(c) In 2010, Swaziland had one of the highest death rates from TB in the world.

Swaziland also had a high number of new cases of HIV infection in its population in 2010.

People who are infected with HIV are described as HIV+ and people who are not infected
with HIV are described as HIV–.

Table 3.1 shows the number of deaths from TB in Swaziland in 2010.

Table 3.1

number of deaths from TB

HIV status
per 100 000 population
HIV+ 400

HIV– 91

Using the information in Table 3.1, suggest why the number of deaths per 100 000 population
of people who are HIV+ is much higher than that in people who are HIV–.

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[Total: 9]

5: Disease and protections against disease – Topic questions 7 Copyright (c) UCLES 2028
 Mark scheme abbreviations

; separates marking points

/ alternative answers for the same point
A accept (for answers correctly cued by the question, or by extra guidance)
R reject
AW alternative wording (where responses vary more than usual)
underline actual word given must be used by candidate (grammatical variants accepted)
max indicates the maximum number of marks that can be given
ora or reverse argument
mp marking point (with relevant number)
ecf error carried forward
I ignore
AVP alternative valid point

Question Answers Marks

3(a) (antibody has) more than one polypeptide ; A four polypeptides 1

R two / two or more / two types of / many / AW, polypeptides

3(b)(i) allow epitope for antigen max 3

1 (two) antigen-binding, site(s) / region(s) ;
A binds to / AW, antigens
R active site
2 (shape / structure is) complementary to antigen ;
3 idea of specificity / AW ;
4 ref. to, primary structure / sequence of amino acids ;
5 ref. to R-groups / (amino acid) side chains, and interactions with antigen / giving specific shape ;

3(b)(ii) binds to (receptors on), phagocytes / macrophages / neutrophils ; max 1

A other correct named cell of the immune system
AVP ; e.g. gives class of antibody (e.g. IgM, IgG, IgA, IgE)

5: Disease and protections against disease – Topic questions 8 Copyright (c) UCLES 2028
 Question Answers Marks

3(c)(i) 1 antigen, introduced / AW, into, (small) mammal ; A named small mammal max 4
2 B-lymphocytes / B cells / plasma cells / splenocytes / antibody-producing lymphocytes, are taken / are isolated (from
the spleen / lymph nodes) ;
3 (these) cells are fused / AW, with, myeloma / cancer, cells ;
4 hybridoma cells / hybridomas, formed ; R hybridised cells / hybrid cells
5 hybridoma cell, is cloned / AW ;
6 screening / testing, for hybridoma that produces desired antibody ;
7 ref. to scaling up / large-scale production / grow in a fermenter ;
8 AVP ; e.g.
fusion using, fusogen / polyethylene glycol / PEG / electric current (electrofusion) / (Sendai) virus
HAT medium, for, hybridoma growth / inhibiting myeloma growth
humanisation of monoclonal antibody

3(c)(ii) I suggestions for treatment max 2

1 monoclonal antibodies used all have the same specificity ;

R ‘are specific’ unqualified
2 detect only one, antigen / epitope ;
3 can distinguish between different, pathogens / strains of, pathogens ; A types of cancer cells
4 can be, labelled / tagged / marked / AW ; e.g. with fluorescent label
5 monoclonal antibodies can detect location of, tissues expressing antigen / cancer cells / blood clots ; A idea of
locating areas of infection
6 fast(er) (diagnosis) ;
7 can detect antibody levels (e.g. HIV) ;
8 AVP ; e.g. some pathogens cannot be cultured
I ref. to cost

Total: 11

5: Disease and protections against disease – Topic questions 9 Copyright (c) UCLES 2028
 Question Answers Marks

6(a)(i) Vibrio cholerae ; 1

6(a)(ii) faecal-oral route ;; max 2

description of faecal / oral route

infected person
faeces / sewage / stool, contaminating (drinking) water R (human) waste unqualified
or
poor hygiene so transferring, faecal material / sewage, onto utensils / food / AW
or
defaecating / putting sewage, onto vegetable plots ;
or
flies in contact with contaminated faeces landing on food and contaminating / AW

uninfected person
eating contaminated food / using contaminated utensils
or
drinking contaminated water ;

6(b) 1 ganglioside is the receptor for choleragen ; max 2

2 choleragen is complementary to ganglioside ;
3 any interaction between molecules ; e.g. (hydrogen / ionic) bonding

6(c) endocytosis ; A phagocytosis / pinocytosis 1

6(d) 1 loss of water / dehydration ; max 2

2 by osmosis ;
3 (water moves out) down water potential gradient / from high to low water potential / high Ψ to low Ψ ;
4 Loss of cations / positively-charged ions (as well as chloride ions) ;
5 change in potential (difference) / change in charge across membrane ;
6 AVP ; e.g.
disruption of absorption (of products of digestion / vitamins / mineral ions)
disruption of digestion

5: Disease and protections against disease – Topic questions 10 Copyright (c) UCLES 2028
 Question Answers Marks

6(e) 1 rehydration therapy, is effective / can treat cholera / reduces death rate ; max 3
2 any detail ; e.g. solution of glucose and salts
3 antibiotic is a selection pressure / described ;
4 ref. to, antibiotic / tetracycline, resistance ;
5 ref. to, vertical transmission / horizontal transmission, of resistance ;
A described, A transfer for transmission
6 antibiotics will become, ineffective / less effective / AW ;
7 keep antibiotics for use ‘as last resort’ ; AW
8 ref. to cost ;
9 antibiotics kill gut bacteria ;
10 idea that disrupts functions of digestive system ;
11 AVP ; e.g. antibiotics going into the environment / food chain
antibiotics can cause mutation
decreases need to develop new drugs
prevents development of active immunity
idea of transmission between bacterial species
plasmids with resistance genes
Total: 11

5: Disease and protections against disease – Topic questions 11 Copyright (c) UCLES 2028
 Question Answer Marks

3(a) Mycobacterium tuberculosis / Mycobacterium bovis ; correct spelling 1

3(b) 1 deaths decrease to zero / new cases fall to 4 per 100 000, (in 2010) ; max 5
A other values that confirm decrease
(after introduction of antibiotics)
2 deaths relatively constant / approx. 52 per 100 000, until 1943–6 (accept any in range) ; A for a few years
A idea that rate of decrease not improved
3 number of new cases initially stops increasing / plateaus ;
4 (overall) number of new cases increases before decreases ;
5 data to support mp 3 or 4 ; e.g. 88–90 per 100 000 (1940–44)
rises to / drops from, 104 per 100 000 in 1946 ;
(after introduction of vaccination)
6 no change in trend of decrease in deaths / deaths continue to decrease ;
7 decrease from 36–40 per 100 000 (in 1948) ;

8 short plateau / 100 per 100 000 (until 1950), in new cases, then decreases ;

9 antibiotics may not have been in widespread use at first ; ora

10 vaccine, reduces spread / gives (herd) immunity ;
11 ref. to decrease less steep initially as time needed to build up herd immunity ;
12 AVP ; e.g. suggestion why increase in new cases after introduction of antibiotics
suggestion why cases have not decreased to zero
not possible to tell relative effect of vaccine v antibiotic

5: Disease and protections against disease – Topic questions 12 Copyright (c) UCLES 2028
 Question Answer Marks

3(c)(i) some people who are HIV+ will have developed HIV / AIDS ; max 3
HIV / AIDS weakens immune, system / response ; ora

allow ecf for HIV+ people

detail of why immune response weakened ;
people with HIV / AIDS, prone to opportunistic diseases ;
A TB is an opportunistic disease
A more susceptible to, diseases / TB
(Table 3.1 shows that) a greater proportion / AW, people die of TB if they are HIV+ ; AW e.g. greater chance of dying from TB
if HIV+
dormant TB more likely to become the active form in, HIV+ people / people with HIV / AIDS ; AW

AVP ; a high proportion of deaths from HIV / AIDs is due to TB mortality

HIV+ people do not respond well to treatment for life-threatening diseases
inability to pay for treatment for all conditions for HIV+ people

Total: 9

5: Disease and protections against disease – Topic questions 13 Copyright (c) UCLES 2028