MD Acumen · MRCGP SCA course · free practice resources
MRCGP SCA course · Station 10
Station 10 · Falls
A 76-year-old has fallen twice in a month, wants his sleeping tablet re-issued and is frightened that any fuss will end with him in a home.
Reviewed and kept current
Video consultation · Older adults · Long-term condition · Prescribing · 12-minute case · 3 min reading · Last editorial review: 11 October 2026 · Next scheduled refresh: 11 April 2027 · Clinical content signed by Course Director, 11 October 2026.
Candidate instructions
Read this as you would outside the room
Read the brief as you would in the examination (RCGP: twelve consultations with simulated patients, each lasting twelve minutes, with 3 minutes' reading at the start of each). There is no reference material. Everything below the brief is folded until the consultation is over.
| Information | |
|---|---|
| Frame | You have 3 minutes to read, then 12 minutes. Video consultation. Everything below this brief is folded away until the consultation is over. |
| Your role | GP partner at a semi-rural practice, holding the morning's video list. |
| Patient | Harold Bickerstaff, 76. |
| Reason for consultation | “Repeat sleeping tablets.” Booked by the patient. Reception note: his daughter rang yesterday, worried that he fell again on Sunday night. |
| Format | Video. He is at home in his sitting room; you can see his face and, if he stands, his gait across the room. You cannot examine him; you may ask what he can do and what he has at home. |
Information available
The records extract, printed as it appears.
| Problem list | Hypertension. Benign prostatic hyperplasia. Osteoarthritis. COPD, mild. Deep vein thrombosis, 2015. Widower, lives alone. |
| Medication | Doxazosin 4 mg at night. Tamsulosin 400 micrograms at night. Bendroflumethiazide 2.5 mg each morning. Amitriptyline 25 mg at night (for “nerve pain”, 2023). Zopiclone 7.5 mg at night (acute issue 2024; now on repeat). Tiotropium inhaler. Allergies: penicillin. |
| Emergency department, 3 weeks ago | Fall at home. Bruised hip. X-ray: no fracture. Discharged. |
| Reception note, yesterday | Daughter rang: worried; father fell again on Sunday getting up in the night. |
| Observations | BP 138/78 sitting, 2 months ago. Weight 68 kg (74 kg a year ago). Bone density: never checked. |
Your task
•
Assess the falls.
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Reach a working diagnosis of why he is falling, with the alternatives you have considered.
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Agree a plan with him, including what happens to his sleeping tablet.
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Address his concerns.
Folded away
For the role player and the observer
Open these after the consultation, or during it if you are observing. The role-player script and every marking section are public (D-76): this is practice material, not an examination.
1 · Role-player script — opening line, story, ICE, hidden facts and triggers (examination findings last)
Candidates: do not open until you have consulted.
Persona and manner
- Harold Bickerstaff, 76, a retired engineer, a widower who lives alone; courteous, precise, understated; you minimise and are keen not to be “a nuisance”. You are terrified of losing your independence: your late wife Margaret went into a care home after a fall and never came out.
- You admit the second fall only if asked directly, and then play it down.
Opening line (verbatim)
- “Good morning. I'm just after my sleeping tablets — they've run out and I sleep dreadfully without them. I gather my daughter's been on the phone; she does fuss.”
The story
- “I sleep badly. Bed at nine, up at two, three and five to pass water. The tablet knocks me out for a few hours.”
- “The hip is still sore from the tumble three weeks ago.”
- If asked directly about Sunday: getting out of bed to go to the toilet, “the room swam” and your legs went; you lay on the floor twenty minutes before getting up using the bed. No injury. You did not tell anyone; your daughter noticed the bruise on your arm.
- If asked about dizziness: dizzy on standing most mornings and after meals, worse since the summer. No chest pain; no palpitations. No blackouts that you know of, though you “may have gone a bit grey”; you are not sure whether you passed out.
- If asked about the tablets: the amitriptyline is for pins and needles in your feet, “I don't think it does much”; the zopiclone every night for 18 months; the doxazosin and tamsulosin both at night “as told”.
- If asked about weight: “I don't cook properly since Margaret died.” Toast and soup. One whisky a night, sometimes two.
- Eyesight: cataracts, “on the list”. A stick outside, not inside. A bungalow; a loose rug in the hall; no grab rails; the bathroom light on a pull cord across the room.
- Mood: lonely; “not depressed, just quiet”; you sleep to pass the time. No thoughts of harming yourself.
Ideas, concerns and expectations
- Idea: “Old age, and not sleeping.”
- Concern: Being put in a home; losing the car; your daughter taking over.
- Expectation: The zopiclone re-issued. No fuss.
Impact
- Home: alone in the bungalow; your daughter lives 40 minutes away and visits weekly; she wants you to have “one of those alarm buttons” and you refuse because “that's the beginning of the end”.
- Driving: you drive to the shops and to the cemetery on Sundays.
- Money: no concern. Work: retired.
Red flags
- Present: Two falls in a month, one with twenty minutes on the floor; dizziness on standing; possible loss of consciousness; five sedating or blood-pressure-lowering drugs in a 68-kg man; 6 kg of weight loss in a year; nocturia three times a night; cataracts; home hazards.
- Absent: No chest pain or palpitations; no fit; no head injury; no new weakness or speech difficulty.
- Absent: No fever; no infection symptoms; no new confusion.
Hidden facts and their triggers
- The second fall and what happened — released only if asked directly whether he has fallen again; the daughter's call is “fussing” until then
- “The room swam”: the dizziness on standing — released only if asked how the fall happened, or about dizziness
- That he may have gone a bit grey and is not sure he stayed conscious — released only if asked about blackouts or whether he remembers hitting the floor
- The weight loss and the toast-and-soup diet — released only if asked about eating, or if the doctor reads the weight from the record
- Margaret's story and the fear of the home — released only if any support, referral or alarm is mentioned, or if asked what worries him
Behaviour
- Minute 1: “She does fuss.”
- Minute 3, only if asked how the fall happened: “The room swam.”
- Minute 7, when any support or referral is mentioned: “That's how it started with Margaret.”
- If the doctor takes a proper falls history, recognises that the tablets are making him dizzy and says so honestly, proposes a medication review as the fixable cause, checks the lying and standing blood pressure, arranges bloods, an ECG and a bone check, refers for strength and balance work, addresses the food and the whisky, and frames all of it as the way to stay at home, involving your daughter with your consent: quiet, then “So the tablets are making me fall?” and “If it keeps me in my own house, I'll do it.” Agree to the alarm “on trial”.
- If the doctor re-issues the zopiclone: “Thank you, doctor.” Go.
- If the doctor says you need to think about whether you can manage alone: close down and ask to leave.
- If the doctor lectures about the whisky: go quiet.
Examination findings, if the candidate states what they would examine and why
- Video: if the candidate asks you to stand and walk across the room: slow, wide-based, you use the furniture. If asked to stand from the chair without using your arms: you cannot. A bruise on the left forearm if asked to show it.
- If the candidate states what they would examine in person and why, give the findings from the nurse's check tomorrow: blood pressure lying 142/80, standing at one minute 108/64 with dizziness; pulse 76 regular; heart sounds normal; alert and oriented; reduced vibration sense at the feet. You have no monitor at home.
2 · Examiner mark sheet — generic SCA scheme plus the key facts for this case
Domain grades — with the key facts that earn a clear pass at this station
| Domain (RCGP wording) · key facts for this case | CF (0) | F (1) | P (2) | CP (3) | Score |
|---|---|---|---|---|---|
1 · Data gathering and diagnosis
| ☐ | ☐ | ☐ | ☐ | /3 |
2 · Clinical management and medical complexity (×1.5)
| ☐ (0) | ☐ (1.5) | ☐ (3) | ☐ (4.5) | /4.5 |
3 · Relating to others
| ☐ | ☐ | ☐ | ☐ | /3 |
| Case total | /10.5 |
Global rating (recorded, not added to the total): ☐ Fail ☐ Bare Fail ☐ Bare Pass ☐ Pass
The domain grades (RCGP descriptors): CP clear pass — above the standard of a newly qualified, independent GP · P pass — sufficiently demonstrated at the standard · F fail — insufficiently demonstrated at the standard · CF clear fail — clearly demonstrated below the standard.
The RCGP grades each domain CF, F, P or CP and weights clinical management and medical complexity against the other two domains; the examination's maximum is 126 over twelve cases, which is 10.5 per case. The RCGP does not publish the mark each grade carries. MD Acumen's training sheet uses CF 0 · F 1 · P 2 · CP 3, with clinical management weighted ×1.5 (0 · 1.5 · 3 · 4.5), so that a case is marked out of 10.5 and a twelve-case circuit out of 126. A P in all three domains is 7.0; MD Acumen treats that line as the training standard for a case. The examination's pass mark is set by borderline regression for each diet and is published in the RCGP's diet summary reports; it is not a fixed fraction of 126.
Weighting rationale, in the RCGP's words: “To reflect the capability coverage within the clinical management and medical complexity domain this is weighted in comparison to the other two domains.”
3 · Expanded station standard — what earns a clear pass, pass, fail and clear fail here
Written to the standard of a newly qualified independent GP; the clear-pass row describes practice above that standard. It is a debriefing aid, not a checklist: the grade is a judgement that the essentials, the italic key facts on the mark sheet, were done well, at the patient's pace and in plain language. MD Acumen training standard; the RCGP does not publish case mark sheets.
| Grade | Data gathering and diagnosis | Clinical management and medical complexity | Relating to others |
|---|---|---|---|
| CP | Reasons aloud in the first three minutes that five sedating or blood-pressure-lowering drugs in a 68-kg man who is up three times a night is the likeliest cause, then confirms it with the falls history, the postural symptoms and what he can show on video. Asks about the blackout and the head. Recognises the weight loss as a separate problem. Asks about the home, the vision and the loneliness briefly. Uses the daughter's call as information, not fuss. | Makes the medication review the plan and explains each change: stop the doxazosin as duplicate alpha-blockade, review the thiazide, withdraw the amitriptyline, taper the zopiclone on a written schedule with a date rather than an ultimatum. Arranges lying and standing blood pressure, bloods, an ECG and a bone-health assessment. Refers for strength and balance and a home assessment. Addresses food and the whisky. Offers the alarm as a trial under his control; sets the review and the safety-net. | Hears “She does fuss” and “That's how it started with Margaret” as the same fear and names it: the plan is how he stays at home. Tells the truth about the sleeping-tablet trade-off and about what the dizziness means. Uses Margaret's story with care, never as leverage. Hands control back: home readings, the taper schedule, the alarm on trial, the daughter involved on his terms. Checks what he will do first, in his own words. |
| P | Describes both falls: circumstances, prodrome, injury, ability to get up, time on the floor. Asks about postural symptoms and syncope. Reviews the full medication list for falls contributors: two alpha-blockers, the thiazide, amitriptyline, zopiclone, alcohol. Asks about nocturia, vision, home hazards, footwear and the walking aid. Notes the weight loss and nutrition, the mood and loneliness. Working diagnosis: multifactorial falls with drug-induced orthostatic hypotension. | Arranges lying and standing blood pressure and examination. Changes the medication: stops doxazosin (duplicate alpha-blockade), reviews the thiazide, withdraws amitriptyline, tapers zopiclone with a written schedule and sleep advice; does not re-issue at full dose. Orders an ECG, bloods and a bone-health assessment. Refers for strength and balance and a home assessment; expedites the cataracts. Addresses nutrition and alcohol. Offers the alarm; involves the daughter with consent. Follow-up at two weeks with a safety-net. | Names the fear of the care home and answers it: the plan is how he stays home. Non-judgemental about the tablets and the whisky. Involves the daughter on his terms. A shared, staged plan; checks what he will do first. |
| F | Treats the consultation as a repeat prescription. Misses the second fall because it was not asked about directly. No medication review, or a review that misses the two alpha-blockers. Does not ask about dizziness on standing or the blackout. Does not read the weight from the record. Does not ask what a fall means to him. | Zopiclone re-issued unchanged, or tapered with no schedule. No orthostatic assessment. The alpha-blocker duplication missed. Amitriptyline continued for a pain it does not help. No ECG, bloods or bone-health plan. No strength and balance referral and no home assessment. The daughter's concern unanswered and the alarm not raised. No safety-net for the next fall, and no review date, so that the next contact is the emergency department. | Raises capacity or care needs without evidence, so that he closes down. Lectures on the whisky. Dismisses the daughter, or sides with her against him. Frames every intervention as needing care rather than staying at home. Uses Margaret's story as a threat. Ends without knowing what he will do. |
| CF | No falls history at all; the second fall never found; the drug list never reviewed; the dizziness never asked about. Or a consultation spent on the daughter's fussing and the sleep with no working diagnosis stated at the end of twelve minutes. | Unsafe: the zopiclone re-issued to a man who has fallen twice in a month on five sedating or hypotensive drugs, with no assessment, no change and no safety-net; or everything stopped at once with no schedule and no review; or an admission or care referral imposed. He leaves with the same risk of the fall that ends his independence. | Patronising, hurried or dismissive; tells him he cannot manage alone; talks about him to his daughter; moralises about the whisky; uses Margaret's story to frighten him; ends with no agreement and no sense of what he will do. No acknowledgement of the fear that drives everything he says, and no attempt to frame any part of the plan as the way he stays in his own house. |
Where candidates lose this station
- Accepting “she does fuss” and never asking directly whether he fell again, so that “the room swam” is never heard (statement D1)
- Re-issuing the zopiclone unchanged, or missing that doxazosin and tamsulosin are two alpha-blockers taken together at night (statement C2)
- Raising whether he can manage alone before the plan is framed as how he stays at home, so that he closes down (statement R2)
What the examiner is listening for in the last four minutes
By 8:00 the working diagnosis should have been stated: multifactorial falls with the tablets as the fixable cause. The examiner is listening for: each drug change explained and the zopiclone taper as a schedule with a date; the lying and standing blood pressure, bloods, ECG and bone check arranged; strength and balance and the home assessment referred; the alarm offered on trial; the daughter involved on his terms; a safety-net that names a blackout, chest pain, a head injury or another fall; and his own words on what he will do first and why it keeps him at home.
4 · RCGP feedback statements — where underperformance was identified — with case-specific examples
The ten statements below are postulated: the feedback an examiner would most likely attach at this station, chosen from the RCGP's standardised list of 26 feedback statements that applies to every SCA case and spans the three marking domains (Data Gathering and Diagnosis; Clinical Management and Medical Complexity; Relating to Others). They are a prediction from the case content, its complexity and the marks that matter, not an examiner's record: any statement on the full list can be attached to any case, and feedback plays no part in the mark. Record the statements that applied in the practice log.
| RCGP feedback statement (postulated top ten) | Underperformance it signals (generic) | Station-specific example |
|---|---|---|
| D1 · Data gathering was insufficient to enable safe assessment of the condition/situation Data gathering and diagnosis · Data gathering and interpretation | History too thin to decide safely: the presenting problem not characterised, the essential negatives not asked. |
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| D2 · Existing information about the case was insufficiently utilised Data gathering and diagnosis · Data gathering and interpretation; Organisation, management and leadership | The records, results or the referral note not read or not used; questions asked that the notes already answer. |
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| D6 · The implications of relevant findings identified during the data gathering were insufficiently recognised or understood Data gathering and diagnosis · Data gathering and interpretation | A finding or result is elicited but its meaning is not recognised or not followed up. |
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| D7 · Differential diagnoses or hypotheses were inadequately generated or tested Data gathering and diagnosis · Making diagnosis/decisions | One diagnosis assumed; alternatives not generated, or generated but not tested with a question. |
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| C2 · The management plan relating to prescribing of medication was inappropriate or not reflective of current practice Clinical management and medical complexity · Clinical management | A drug started, continued or stopped against current guidance, or without the checks it needs. |
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| C3 · The management plan relating to investigations was inappropriate or not reflective of current practice Clinical management and medical complexity · Clinical management | Investigations ordered without purpose, omitted when needed, or not explained. |
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| C5 · The plan relating to the medical management of risk was inadequate or inappropriate Clinical management and medical complexity · Clinical management; Organisation, management and leadership | Clinical risk left unmanaged: no plan for the thing that could go wrong, or the risk not weighed. |
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| R1 · Communication skills, including the non-verbal, responding to cues and/or active listening were insufficiently demonstrated Relating to others · Communication and consultation skills | Cues missed; the patient interrupted; non-verbal signals ignored; questions read like a form. |
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| R2 · The person's agenda, health beliefs and/or preferences were insufficiently explored Relating to others · Communication and consultation skills; Practising holistically, promoting health and safeguarding | What the person thinks is wrong, fears, or wants is not asked, or not used in the plan. |
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| R8 · Teamwork and/or understanding of others' roles was insufficiently recognised or responded to Relating to others · Working with colleagues and in teams | Colleagues' roles not understood; the team not used; the handover not made. |
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The full list of 26 statements, with the generic meaning of each, is on the exam and the mark scheme.
5 · Examiner points of fact and guidelines
Points of fact the examiner should have to hand
Each statement is drawn from the named guideline, in its current version, with the date it was checked. The examiner marks against these facts; the candidate is not expected to quote them.
- Offer a multifactorial falls risk assessment to people aged 65 and over who have had two or more falls in the past year, a fall needing medical attention, or problems with balance or gait; it includes the history of the falls, gait and balance, muscle strength, osteoporosis risk, cognition, vision, cardiovascular examination including postural blood pressure, medication review, continence and home hazards. NICE — NG249 Falls: assessment and prevention in older people and people 50 and over at higher risk, section 1.2, multifactorial falls risk assessment, April 2025, checked 10 Oct 2026
- Offer a structured medication review to older people at risk of falls, with the aim of reducing or stopping medicines that increase the risk, particularly psychotropic drugs and those that lower blood pressure; offer strength and balance training as part of the multifactorial intervention. NICE — NG249 Falls: assessment and prevention in older people and people 50 and over at higher risk, section 1.3, multifactorial interventions, April 2025, checked 10 Oct 2026
- Orthostatic hypotension is a fall in systolic blood pressure of 20 mmHg or more, or diastolic of 10 mmHg or more, within three minutes of standing; measure lying and standing blood pressure in people with postural symptoms or falls; causes include alpha-blockers, diuretics, tricyclic antidepressants and dehydration. NICE — NG249 Falls: assessment and prevention in older people and people 50 and over at higher risk, section 1.2, multifactorial falls risk assessment: cardiovascular examination including lying and standing blood pressure, April 2025, checked 10 Oct 2026
- Zopiclone is licensed for short-term use (up to four weeks); dependence and withdrawal occur with longer use; withdrawal is by gradual dose reduction, for example by a quarter of the dose every two weeks or more slowly, with sleep advice and support, never abruptly after prolonged use. NICE CKS — Insomnia, management: withdrawing hypnotics, current online version, checked 10 Oct 2026
- Medicines associated with dependence or withdrawal symptoms (benzodiazepines, Z-drugs, opioids, gabapentinoids, antidepressants) are reviewed regularly; withdrawal is planned with the person, reduced in steps, with the rate adjusted to symptoms, and never stopped abruptly. NICE — NG215 Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults, section 1.5, withdrawing a medicine, April 2022, checked 10 Oct 2026
- Tricyclic antidepressants and Z-drugs in people aged 65 and over with falls, and the concurrent use of two drugs of the same class (duplication), are among the STOPP criteria for potentially inappropriate prescribing; two alpha-blockers for the same indication is a duplication. O'Mahony D et al. (Age and Ageing) — STOPP/START criteria for potentially inappropriate prescribing in older people: version 3, STOPP section A (duplication) and section K (falls), 2023, checked 10 Oct 2026
- Assess fragility fracture risk in all women aged 65 and over and men aged 75 and over, and in younger people with risk factors, using FRAX or QFracture; a fall with injury, weight loss and low body weight raise the risk; refer for DXA where the calculated risk is at or near the intervention threshold. NICE — CG146 Osteoporosis: assessing the risk of fragility fracture, section 1.1, targeting risk assessment, 2012, last updated February 2017, checked 10 Oct 2026
- Unintentional weight loss of 5% or more in three to six months, or a BMI below 20, identifies malnutrition risk; in an older person living alone, screen with MUST, review the diet, and consider referral to a dietitian and community support for meals. NICE — CG32 Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition, section 1.3, screening for malnutrition, 2006, last updated August 2017, checked 10 Oct 2026
- In a person with hypertension who has symptoms of postural hypotension, or who is aged 80 or over, blood pressure is measured standing as well as sitting; where the systolic pressure falls by 20 mmHg or more on standing, the medication is reviewed, later readings are taken standing and treatment is targeted to the standing pressure, with referral considered if symptoms persist. Alpha-blockers are not first-line antihypertensives and appear only as a step 4 addition; for a new thiazide, indapamide is preferred to bendroflumethiazide. NICE — NG136 Hypertension in adults: diagnosis and management, section 1.2, measuring blood pressure: postural hypotension; choosing antihypertensive drug treatment, NG136, 2019, last updated November 2023, checked 10 Oct 2026
- An approach to care that takes account of multimorbidity is offered to a person who has frailty or falls, takes several regular medicines, or finds daily activities or treatments hard to manage: establish what matters to the person, review every medicine for benefit and harm against the person's own goals using a tool such as STOPP/START, and stop or reduce those of limited benefit. In primary care, frailty is assessed by gait speed (more than five seconds to walk four metres), self-reported health or the PRISMA-7 questionnaire. NICE — NG56 Multimorbidity: clinical assessment and management, section 1.2, identifying people who may benefit; section 1.3, assessing frailty; section 1.6, reviewing medicines, September 2016, checked 10 Oct 2026
- Zopiclone in older people is prescribed at 3.75 mg at night, increased only if necessary to 7.5 mg, for short-term use only; the BNF warns of residual next-day impairment, that the effects are increased by alcohol, and that dependence and withdrawal symptoms follow prolonged use, so the drug is not stopped abruptly after regular use. A 76-year-old on 7.5 mg nightly for 18 months with a nightly whisky is on twice the recommended starting dose for his age. BNF (NICE) — Zopiclone, indications and dose: elderly; cautions and side-effects; dependence and withdrawal, current BNF online, checked 10 Oct 2026
- The Mental Capacity Act 2005 presumes that a person aged 16 or over has capacity unless it is established that they lack it; a person is not treated as unable to decide merely because the decision is unwise, and any act done for a person who lacks capacity must be the least restrictive of their rights and freedom. A 76-year-old who understands the risks and declines an alarm or a care referral is making his own decision; the GP records it and keeps the offer open. GOV.UK (Ministry of Justice) — Mental Capacity Act 2005: Code of Practice, chapter 2, the statutory principles, 2007, checked 10 Oct 2026
- The Older adults Topic Guide expects the GP to assess falls and frailty in a way that preserves independence: to identify polypharmacy and multimorbidity proactively and review medicines for harm, to recognise orthostatic hypotension and the drugs that cause it, to assess nutrition, continence, vision and the home, to work with the multidisciplinary falls and community teams, and to assess capacity and respect the person's own priorities when care or support is proposed. RCGP — GP curriculum: Older adults, Topic Guide: knowledge and skills, Being a GP, 2025 curriculum, checked 10 Oct 2026
Working references for this station
13 statements, 782 words. Every statement is signed by the Course Director before it is published; a station whose facts have changed since signature carries no signature line until it is signed again.
This case's topic and its signed Golden Triangle, for review after the station.
Golden Triangle
Falls in older people: assessment and prevention
Knowledge Amber · Evidence Amber · Real-world Red
Not yet at the Equinox · UK (NHS England) · as of 8 October 2026 · How the triangle works
6 · RCGP curriculum tags for this case
| RCGP curriculum (2025) | This case |
|---|---|
| Topic Guide(s) | Older adults · Continuity and quality of care, safety and prescribing · Musculoskeletal health |
| Core capabilities | Data gathering and interpretation · Clinical management · Medical complexity · Communicating and consulting |
| SCA Clinical Experience Group(s) | Older adults, including frailty and people at the end of life · Long-term condition, including cancer, multi-morbidity, and disability · Prescribing |
| AKT blueprint clinical area | Cardiovascular medicine (broader representation) |
| Case type | long-term condition |
| Modality | video |
7 · My marks and reflection — practice log form
Record your three domain grades, your case total out of 10.5, your global rating, the RCGP feedback statements that applied, and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.
Record my marks and reflection for SCA-10
Revision link for this case: mdacumen.com/sca-station10-falls
Independence & scope. Formative training material from MD Acumen Ltd; not a prediction of exam performance. Not affiliated with, endorsed by, or delivered on behalf of the Royal College of General Practitioners; the marking domains and feedback statements are the RCGP's published ones, and every descriptor on this page is an Acumen training tool calibrated to them. Clinical content reflects UK guidance at the date of editorial review — always check the current guideline. All patients are fictional.
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