1. 1
   A doctor is investigating cardiovascular disease in a group of patients attending a health clinic. Patients who smoke and eat high-fat diets show higher rates of coronary heart disease than patients who do not. The doctor explains that fatty material has built up inside the coronary arteries of the affected patients, narrowing them and reducing blood flow to the heart muscle.

   (a)

   Which of these risk factors has a proven causal mechanism linking it to cardiovascular disease?

   [1 mark]

   • AEye colour
   • BSmoking
   • CBlood type
   • DHeight

   (b)

   What substance builds up inside the coronary arteries in coronary heart disease?

   [1 mark]

   • AFatty material
   • BBone tissue
   • CMuscle fibre
   • DScar tissue

   (c)

   The doctor prescribes statins to some patients. Explain how statins help to reduce the risk of coronary heart disease.

   [2 marks]

   Total for question 1: 4 marks

2. 2
   A patient attends an oncology clinic after a lump is found during a routine check-up. A biopsy shows that the lump is a tumour. The patient's family history shows a close relative was previously diagnosed with a cancer linked to an inherited faulty gene, although the patient has never smoked and follows a healthy diet.

   (a)

   A biopsy shows that a patient's tumour is contained within a capsule of connective tissue and has not spread to other tissues. What type of tumour is this?

   [1 mark]

   • AMalignant
   • BInfectious
   • CMetastatic
   • DBenign

   (b)

   Which risk factor described in the scenario is a genetic risk factor for cancer, rather than a lifestyle risk factor?

   [1 mark]

   • AFollowing a healthy diet
   • BNever smoking
   • CAn inherited faulty gene linked to cancer
   • DAttending regular check-ups

   (c)

   Describe one difference between a benign tumour and a malignant tumour.

   [2 marks]

   Total for question 2: 4 marks

3. 3
   A national health agency carried out an epidemiological survey comparing the rate of Type 2 diabetes in a group of 10,000 obese adults with the rate in a group of 10,000 adults of healthy body mass. The survey found a strong correlation between obesity and Type 2 diabetes. The agency is now deciding whether to recommend a national public health campaign encouraging weight loss and reduced smoking.

   (a)

   Explain why obesity is considered a risk factor for Type 2 diabetes, and describe why it was important for the researchers to survey a large number of people in each group.

   [3 marks]

   (b)

   The agency is also considering a campaign to reduce smoking rates. Explain how smoking can lead to lung disease and cancer, and describe the human and financial costs of non-communicable disease at a national level.

   [4 marks]

   Total for question 3: 7 marks

4. 4
   A hospital board is reviewing how to allocate its annual health budget. Data submitted to the board shows rising numbers of patients being treated for cardiovascular disease linked to smoking, poor diet and lack of exercise, alongside the ongoing costs of running a national smoking cessation campaign and a shortage of donor hearts available for transplant.

   (a)

   Evaluate the human and financial costs of non-communicable diseases at individual, local, national and global level, using examples of lifestyle risk factors to support your answer.

   [6 marks]

   (b)

   Evaluate the advantages and disadvantages of treating cardiovascular disease using drugs, mechanical devices or transplant, in the context of the hospital board's limited budget.

   [6 marks]

   Total for question 4: 12 marks

End of questions