Revision aid, not clinical advice. This page is educational material written for exam preparation. It is not a substitute for the current guideline or for clinical judgement, and must not be relied on for the care of any individual. Always check up-to-date national guidance and verify independently before acting on anything here.

GP Diplomas
DGM
GP Diplomas

The CGM & DGM

A calm, structured route through the Diploma in Geriatric Medicine (DGM) — the RCP’s two-stage qualification: the CGM written paper, then the DGM clinical OSCE. Here is what the exam involves, and what we have built to revise for it. Everything here is written for the CGM written paper as it is examined now, with the February 2027 sitting in view.

1,000 practice questions14 syllabus modules

This is one of our GP Diplomas — qualifications GPs and other clinicians commonly take alongside their core exams. The DGM sits on its own track: a standalone exam in the medicine of older people, separate from the AKT and MSRA.

What the exam involves

Two exams now: the CGM written paper, then the DGM OSCE

The Royal College of Physicians has split geriatric medicine into two credentials, and it changes what you revise. The Certificate (CGM) is the written knowledge exam and comes first. The Diploma (DGM) is a clinical OSCE you can only sit once you hold the CGM. Both are about the safe, everyday management of older adults — exactly the decisions made every day in general practice, community teams and acute care. The question bank is built for the CGM written exam, and the OSCE module covers the Diploma. Each station is set out with its clock, the RCP’s own marking domains quoted in full, and worked scenarios — including the Comprehensive Geriatric Assessment station, where there is no patient in the room. Supervised clinical practice still matters for a practical assessment; what we add is knowing exactly what each station asks and what it is marked on.

200 questions
The CGM: 200 best-of-five questions in four papers of 50, 90 minutes each, sat online with remote proctoring from wherever you are.
4-station OSCE
The DGM: four live stations, 80 minutes in total, at the RCP assessment centre in Liverpool. RCP fee £642 for the November 2026 diet and £668 for the June and November 2027 diets.
CGM first
You must hold the CGM before applying for the DGM, then have four years to pass it, with a maximum of six attempts. Open to all statutorily regulated healthcare professionals, not doctors only.
RCP · BGS
Awarded by the Royal College of Physicians, developed in collaboration with the British Geriatrics Society.
Next sittings
CGM 24 February 2027, applications 14 December 2026 to 18 January 2027. DGM OSCE 9–11 November 2026 (applications close 14 September 2026); next 1–4 June 2027, applications 30 March–12 April 2027, then 2–5 November 2027, applications 31 August–13 September 2027.

In detail: the CGM exam · the DGM clinical exam · every 2027 date and fee

What you’ll cover

The fourteen areas we map — every one with questions

The RCP’s January 2027 curriculum sets out three domains — gerontology, clinical geriatric practice, and cultural, inequality and environmental themes. We teach it as fourteen practical areas of older-adult medicine, and every one of them now carries questions in the bank alongside its Curriculum topic and Core Lens module; bone health and nutrition have guide chapters too.

01Falls & Syncope
02Frailty & Comprehensive Geriatric Assessment
03Polypharmacy & Prescribing (STOPP/START)
04Dementia
05Delirium
06Continence
07Parkinson’s Disease & Movement Disorders
08Capacity & the Mental Capacity Act
09Advance Care Planning & End of Life
10Acute Presentations in Older Adults
11Bone Health, Osteoporosis & Fragility Fracture
12Nutrition, Sarcopenia, Oral Health & Tissue Viability
13Rehabilitation, Community & Perioperative Care
14Ageing in Context
Your DGM revision toolkit

Everything for the exam, in one place

The same engine that powers our AKT and MSRA revision, focused on the DGM. Our questions are written and reviewed by clinicians and re-audited against current guidance, with corrections logged and dated.

Question Bank · Live

The Question Bank

Original single-best-answer questions across all fourteen syllabus modules — each with a Core Lens summary and an expandable deep dive grounded in BGS, NICE/CKS, STOPP/START and the Mental Capacity Act.

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Revision Guide · Live

The DGM Revision Guide

Twelve high-yield chapters to read alongside the question bank — falls, frailty, prescribing, dementia, delirium and more.

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Clinical exam · Live

The DGM OSCE

The clinical exam station by station — the clock, the RCP’s own marking domains, and worked scenarios for the integrated assessment, the CGA station, and ethics and law.

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Exam Trainer · Live

DGM Interactive Trainer

Recall flashcards, clinical decision drills and the frameworks worth leaning on — active recall across the whole geriatric-medicine syllabus.

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Resources · Live

DGM Core Resources

Straight from the college — the official exam page, syllabus, key guidance and recommended reading.

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Revision & Drills · Live

Revise & drill by module

Work through a module with instant per-question feedback, or run an untimed drill on a single topic to shore up a weak spot before you sit the paper.

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Timed Mock · Live

Timed mock paper

Sit a timed mock under exam conditions — 50 questions in 90 minutes, the exact shape of one CGM knowledge paper — with full feedback and a review of every question at the end.

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Readiness · Live

Per-module dashboard

See your accuracy across the fourteen syllabus modules at a glance, so you always know which area to work on next.

See your progress →
Try before you buy

Try ten DGM questions, free

One question from each of ten DGM modules, with the same explanation members see after every answer: the Core Lens, a Deep Dive and a Founder’s Tip. No sign-up, no timer, nothing saved.

DGM · Acute Presentations in Older AdultsQuestion 1 of 10 · single best answer

Acute presentations: new confusion in a frail older adult

Scenario: An 85-year-old man who is normally independent is brought in by his daughter with a two-day history of new confusion, drowsiness, reduced appetite and two falls. He is afebrile (36.8°C) and has no localising symptoms. His daughter says “he has just gone downhill suddenly.”

Question: What is the most appropriate initial approach?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A: Assess for an acute underlying cause of delirium, including examination and investigations for infection and sepsis.

Core Lens: High-Yield Takeaways

  • New, acute confusion in an older adult is delirium until proven otherwise: a rapid change in cognition and function over hours to days signals an acute medical cause that must be sought and treated, not attributed to ageing or dementia.
  • Atypical presentation is the rule, not the exception: frail older people often present to acute illness with delirium, falls, immobility (“off legs”) or reduced intake rather than classic symptoms — and fever is absent in a large proportion of serious infection.
  • Look for the cause systematically: examine fully and screen for infection/sepsis, dehydration, new drugs, urinary retention, constipation, pain, metabolic disturbance and cardiac or neurological events.
  • Treat the cause, support the patient: manage the underlying illness, use non-drug delirium measures first, and reserve sedating drugs for genuine emergencies.
Click here for Deep Dive

The Fall, the Confusion and the Quiet Sepsis

Comprehensive geriatric thinking starts from a simple safety rule: an acute change in an older person is an acute illness presenting atypically until you have excluded one. Infection, including sepsis, frequently presents without fever or focal symptoms in frailty; the only sign may be new delirium, a cluster of falls or simply “not himself.” Treating that change as ‘just his dementia’ misses time-critical, reversible disease.

Why This Is the Right Move

His two-day history of new confusion, drowsiness, poor intake and falls is acute delirium. The right initial approach is to look for the cause: a full assessment with a delirium tool (such as the 4AT), examination, and investigations directed at infection and sepsis as well as the other common precipitants. Being afebrile does not reassure — it is exactly the trap in older adults. Identify and treat the precipitant, and use supportive, non-pharmacological delirium care.

Why the Other Options Don’t Fit

  • Option B: attributing an acute change to ‘progression of dementia’ is the classic error; dementia progresses over months, not over two days.
  • Option C: antipsychotics do not treat the cause and carry real harms in older people; they are reserved for severe distress or risk after non-drug measures and treatment of the cause.
  • Option D: a routine memory-clinic referral addresses chronic cognitive decline, not an acute, potentially life-threatening deterioration.
  • Option E: diagnosing a UTI from urine appearance and treating blindly is unreliable in older adults and may miss the true cause of his delirium.

“Red Flags” and Key Decision Points

  • Features of sepsis (NICE NG253): tachycardia, tachypnoea, hypotension, low oxygen saturations or a soft/abnormal NEWS — escalate urgently even without fever.
  • Sudden focal neurology: consider stroke and act on the stroke pathway.
  • New medication, opioids or anticholinergic burden: a very common and reversible precipitant of delirium.
  • Acute urinary retention or severe constipation: simple, treatable causes that are easy to miss.

Relevance to General Practice

In the surgery, on a home visit or in the care home, treat ‘sudden decline’ as a red flag: take a collateral history of the baseline and the timeline, examine, check observations (NEWS), and investigate for infection and the other precipitants. Recognising delirium and hunting its cause — rather than labelling it dementia or reflexively treating a ‘UTI’ — is the single highest-yield acute-care skill in older people.

Founder’s Tip

Sudden change is sudden illness. New delirium, new falls or ‘off legs’ in a frail older adult means look for an acute cause — and a normal temperature does not let infection off the hook.

Core Summary: An acute change in cognition or function in a frail older adult is delirium presenting an acute illness; assessment should seek and treat the underlying cause (commonly infection/sepsis, often without fever), per NICE delirium and sepsis guidance and the BGS Silver Book.
DGM · Advance Care Planning & End of LifeQuestion 2 of 10 · single best answer

End of life: planning care for the last days at home

Scenario: A 90-year-old woman with end-stage cancer is recognised to be in the last days of life. She is being cared for at home, which is where she and her family wish her to remain and to die. She is comfortable now but the community team is planning ahead for symptoms that commonly arise.

Question: According to NICE NG31, which is the most appropriate action?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A: Arrange anticipatory (“just-in-case”) medicines for pain, breathlessness, nausea, agitation and respiratory secretions.

Core Lens: High-Yield Takeaways

  • Anticipatory prescribing is core to good home end-of-life care: NICE NG31 recommends prescribing “just-in-case” subcutaneous medicines ahead of need so that pain, breathlessness, nausea/vomiting, agitation and respiratory secretions can be treated promptly at home.
  • Individualise and review: choice and doses are tailored to the person (renal function, frailty, current medicines), with clear instructions for the team and regular review as she changes.
  • Symptoms are titrated, not rationed: opioids and other symptom medicines are given to relieve distress and titrated to effect — not withheld until suffering is severe.
  • Respect the preferred place of care: she and her family want her to die at home, so planning should keep that possible rather than defaulting to admission.
Click here for Deep Dive

Planning Ahead Is the Kindness

Care of the dying adult in the last days of life turns on anticipation. NG31 asks teams to recognise dying, communicate honestly, support hydration and individualised symptom control, and — critically at home — to put anticipatory medicines and a plan in place before a crisis. The predictable symptoms (pain, breathlessness, nausea, agitation, noisy secretions) are far better managed when the drugs and authorisation are already in the house than when a family is waiting for an out-of-hours visit.

Why This Is the Right Move

She is comfortable now, but the right anticipatory step is to ensure subcutaneous ‘just-in-case’ medicines and clear guidance are available so any symptom can be treated immediately at home, supporting her wish to remain there. This is individualised and reviewed, and sits alongside honest communication and attention to comfort, mouth care and hydration as she wishes.

Why the Other Options Don’t Fit

  • Option B: routine intravenous fluids are not recommended for everyone in the last days of life; hydration is individualised and clinically assisted hydration is considered, not given by default.
  • Option C: admitting her contradicts her clearly expressed wish to die at home when good symptom control can be provided there.
  • Option D: withholding opioids until pain is severe is poor and outdated practice; properly titrated opioids relieve symptoms and do not, used correctly, hasten death.
  • Option E: prophylactic broad-spectrum antibiotics have no role here; any antibiotic use at the very end of life is for symptom relief, decided individually.

“Red Flags” and Key Decision Points

  • Uncontrolled symptoms despite anticipatory medicines: seek specialist palliative care advice promptly.
  • Reversible cause of deterioration mistaken for dying: reassess if the picture is atypical or recovery is plausible.
  • Renal impairment or frailty: adjust opioid choice and dose, and watch for accumulation.
  • Carer unable to cope, or change in the patient’s wishes: revisit the place-of-care plan rather than assuming it is fixed.

Relevance to General Practice

For GPs and community teams, dying at home works when the groundwork is laid: recognise dying and document it, hold an honest conversation, prescribe anticipatory subcutaneous medicines with PRN instructions, ensure the ReSPECT/DNACPR and care plan are in the home and shared with out-of-hours and ambulance services, and arrange proactive review. Anticipation is what prevents the avoidable crisis admission.

Founder’s Tip

The kindest prescription in last-days-of-life care is often the one written before it is needed — anticipatory medicines keep symptom relief, and the patient, at home.

Core Summary: NICE NG31 recommends anticipatory (“just-in-case”) prescribing of subcutaneous medicines for pain, breathlessness, nausea, agitation and secretions, individualised and reviewed, to support good symptom control in the preferred place of care.
DGM · Bone Health & Fragility FractureQuestion 3 of 10 · single best answer

Interpreting a T-score against a Z-score

Scenario: A 68-year-old woman has a DXA scan arranged after her mother sustained a hip fracture. The report gives a femoral neck T-score of minus 2.6 and a Z-score of minus 0.4. She has had no fractures, is a lifelong non-smoker and takes no regular medication. Calcium, phosphate, alkaline phosphatase, renal and thyroid function and 25-hydroxyvitamin D are all normal. She asks what the two numbers mean and whether she needs treatment.

Question: How should these two scores be interpreted?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A.

Core Lens: High-Yield Takeaways

  • The T-score compares her with a young adult reference: it counts standard deviations from peak bone mass, and the World Health Organization criteria define osteoporosis as a T-score of minus 2.5 or below.
  • The Z-score compares her with her own age group: it answers a different question, namely whether her bone density is what would be expected for someone of her age and sex.
  • Diagnosis in this population rests on the T-score: in postmenopausal women and in men aged 50 and over, the T-score is the diagnostic measure; the Z-score is used in younger adults and children.
  • A low Z-score is a prompt to look for a cause: a Z-score of around minus 2 or below is described as below the expected range for age and should intensify the search for a secondary cause, but a normal Z-score does not remove the need for basic screening.
Click here for Deep Dive

Two Scores, Two Different Questions

Bone mineral density results are reported in standard deviations rather than absolute units because the absolute values differ between machines and sites. The T-score expresses the result relative to the mean peak bone mass of a young adult reference population, and it is the basis of the World Health Organization diagnostic thresholds: normal at minus 1 or above, osteopenia between minus 1 and minus 2.5, and osteoporosis at minus 2.5 or below. The Z-score expresses the same measurement relative to an age and sex matched reference. Because bone density falls with age in everyone, an older person can have an unremarkable Z-score and a clearly osteoporotic T-score at the same time.

Why This Is the Right Move

The correct reading is that her T-score of minus 2.6 meets the World Health Organization definition of osteoporosis, while her Z-score of minus 0.4 simply tells her that her bone density is close to the average for a woman of 68. Those two statements are not in conflict: her bones are typical for her age and her age carries a level of bone loss that is itself associated with fracture. Management is then decided by her absolute fracture risk rather than by the label, so calculate FRAX including the femoral neck value and treat if she crosses the intervention threshold.

Why the Other Options Don’t Fit

  • Option B: the Z-score does not take precedence in a postmenopausal woman; it describes how she compares with her peers and cannot redefine a diagnosis that is made on the T-score.
  • Option C: an average Z-score cannot exclude osteoporosis, because the whole age group has lost bone; being typical for 68 and having osteoporosis are entirely compatible.
  • Option D: a normal Z-score lowers the probability of a strong secondary driver, but it is the basic screen, already normal here, that establishes that rather than the Z-score; and the screen is what would have identified a vitamin D deficiency needing correction before treatment.
  • Option E: a repeat scan on a different machine is not required and would in fact complicate matters, since bone density results are not directly comparable between different scanners.

“Red Flags” and Key Decision Points

  • A Z-score of around minus 2 or below is below the expected range for age and should prompt a thorough search for secondary causes whatever the T-score.
  • Use the Z-score rather than the T-score in premenopausal women, in men under 50 and in children.
  • Do not treat the DXA number in isolation; a previous fragility fracture can justify treatment irrespective of the T-score.
  • Report and act on the lowest of the femoral neck and lumbar spine values, and be alert to degenerative change falsely raising the lumbar spine result in older patients.

Relevance to General Practice

DXA reports arriving in practice usually state both numbers, and patients frequently latch on to whichever one sounds more reassuring. The explanation worth having ready is that one number compares them with a healthy 30-year-old and the other with people their own age, and that treatment decisions are made on fracture risk rather than on either figure alone. Run FRAX or QFracture with the density value, place the result against the intervention threshold, and explain the plan in those terms rather than in standard deviations.

Founder’s Tip

The T-score asks how she compares with her younger self. The Z-score asks how she compares with her friends. In a postmenopausal woman only the first one makes the diagnosis.

Core Summary: In postmenopausal women and men aged 50 and over, osteoporosis is diagnosed on a T-score of minus 2.5 or below; the Z-score compares with age-matched peers and flags a secondary cause when it is around minus 2 or lower (WHO; NOGG).
DGM · Capacity & Mental Capacity ActQuestion 4 of 10 · single best answer

Capacity: a colleague says dementia means no capacity

Scenario: A 79-year-old woman with moderate, fluctuating dementia needs a decision made about starting a new regular medication. A junior colleague says, “She has dementia, so she can’t consent to anything — we should just decide for her.” You are asked how her capacity should be approached.

Question: Which statement best reflects the Mental Capacity Act 2005?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A: Capacity is decision-specific and time-specific: assess her ability to make this particular decision now, after taking all practicable steps to support her.

Core Lens: High-Yield Takeaways

  • Capacity is decision-specific and time-specific: the Mental Capacity Act 2005 requires assessment of the person’s ability to make this particular decision at this particular time — not a global on/off judgement.
  • Support the decision before concluding she cannot make it: principle 2 requires all practicable steps to help her decide — best timing, plain language, visual aids, treating reversible contributors — before any finding of incapacity.
  • A diagnosis is the start, not the answer: dementia satisfies stage one (an impairment of the mind or brain) but you must still apply the functional test for the specific decision.
  • Capacity can fluctuate and can return: in fluctuating dementia or delirium she may have capacity at some times and not others, so non-urgent decisions can be revisited when she is at her best.
Click here for Deep Dive

Decision-Specific, Time-Specific, Supported

A common and dangerous shortcut is to treat a dementia label as a blanket loss of capacity. The Act forbids this. Capacity is assessed for the decision in front of you: she may be unable to manage complex finances yet perfectly able to decide about a single new tablet, or vice versa. The five principles — presumption of capacity, support to decide, the right to make unwise decisions, best-interests action only if capacity is lacking, and the least-restrictive option — govern every step.

Why This Is the Right Move

The correct approach is to assess her ability to make this specific medication decision now, having first optimised the conditions and supported her to participate. If, despite that, she cannot understand, retain, weigh or communicate the relevant information for this decision, only then does a best-interests process apply — and even then it should involve her as far as possible and be revisited as her state changes.

Why the Other Options Don’t Fit

  • Option B: a diagnosis of dementia does not equate to incapacity; it only establishes stage one of the test.
  • Option C: capacity does not transfer across decisions — lacking it for one does not mean lacking it for all.
  • Option D: capacity can fluctuate and can be regained, so reassessment is often necessary and required.
  • Option E: judging capacity by whether she agrees with you breaches the principle that unwise decisions do not signal incapacity.

“Red Flags” and Key Decision Points

  • Fluctuating presentation: assess at her best time of day and consider whether delirium is reversibly impairing her.
  • Urgent versus non-urgent decision: if the decision can wait, defer until capacity is optimised; if it cannot and she lacks capacity, act in best interests.
  • Registered LPA, deputy or advance decision: check before making best-interests decisions.
  • Repeated ‘she can’t decide anything’ framing from staff or family: a prompt to re-educate and to document a proper decision-specific assessment.

Relevance to General Practice

Teach the team the one-line version: assess capacity for the decision in front of you, at this time, after supporting the person to take part. In primary care this matters for medication changes, investigations, referrals and care arrangements — each is its own decision. Record what you assessed, how you supported her, and the conclusion, and plan reassessment for fluctuating conditions.

Founder’s Tip

“She has dementia so she can’t consent” is the most common capacity error there is. Capacity is always about this decision, at this time, with support given first.

Core Summary: The Mental Capacity Act 2005 makes capacity decision-specific and time-specific: a dementia diagnosis does not remove capacity, all practicable support must be offered first, and capacity can fluctuate and be reassessed.
DGM · DeliriumQuestion 5 of 10 · single best answer

Delirium: preventing delirium in an at-risk inpatient

Scenario: An 86-year-old woman with mild cognitive impairment and poor eyesight is admitted to a community hospital rehabilitation ward after a fractured wrist. She is at high risk of delirium. The ward team asks how best to reduce her chance of developing it during her stay. She is currently oriented and has no acute infection.

Question: According to NICE CG103, which approach is most likely to prevent delirium?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is D: A tailored multicomponent intervention addressing orientation, hydration, mobility, sleep and sensory aids.

Core Lens: High-Yield Takeaways

  • Prevention is multicomponent and non-pharmacological: NICE CG103 recommends a tailored package delivered by a trained team that targets the modifiable clinical factors driving delirium.
  • Address the recognised precipitants: cognitive impairment/disorientation, dehydration and constipation, hypoxia, immobility, infection, multiple medications, pain, poor nutrition, sensory impairment and disrupted sleep.
  • Practical measures matter: reorientation and familiar objects, ensuring glasses and hearing aids are worn, encouraging early mobilisation, good hydration, pain control, and protecting normal sleep-wake cycles.
  • Drugs do not prevent delirium: prophylactic antipsychotics or sedatives are not recommended for prevention and can themselves precipitate or worsen delirium.
Click here for Deep Dive

An Avoidable Complication

Delirium affects a large proportion of older inpatients and is associated with longer stays, higher mortality, new care-home admission and persistent cognitive decline — yet a meaningful share is preventable. The evidence base (exemplified by multicomponent programmes such as HELP) shows that systematically correcting the everyday clinical factors that tip a vulnerable brain into delirium reduces incidence. This is the logic NICE CG103 codifies.

Why This Is the Right Move

This woman has predisposing vulnerability (age, cognitive impairment, sensory impairment) plus a precipitant (fracture, hospital admission). The intervention with the best evidence is a tailored, multicomponent, non-drug package: keep her oriented (clocks, familiar faces, clear communication), ensure she wears her glasses, maintain hydration and bowel function, control her wrist pain with the least deliriogenic analgesia, mobilise her early, review medications for deliriogenic drugs, and protect her sleep. Each element is mundane; together they prevent delirium.

Why the Other Options Don’t Fit

  • Option A: Prophylactic haloperidol is not recommended to prevent delirium and risks extrapyramidal effects and harm, especially if there is unrecognised Lewy body disease.
  • Option B: Benzodiazepines are themselves a precipitant of delirium (except in alcohol withdrawal) and increase falls — exactly the wrong move.
  • Option C: She has no infection; blind antibiotics cause harm (C. difficile, resistance) and prevent nothing.
  • Option E: Immobility is a precipitant of delirium, deconditioning and pressure injury — early mobilisation is protective, not bed rest.

“Red Flags” and Key Decision Points

  • New acute confusion despite prevention: screen with the 4AT and search for the precipitant — treat the cause.
  • Sensory aids missing: a forgotten pair of glasses or a flat hearing-aid battery is a genuine, common precipitant.
  • Constipation and urinary retention: easily overlooked, easily fixed delirium triggers.
  • Deliriogenic drugs: review anticholinergics, opioids and sedatives proactively.

Relevance to General Practice

The same principles apply in care homes, community hospitals and at home: optimise sensory aids, hydration, bowels, pain, sleep and medications in any acutely unwell or recently admitted frail older person. GPs and community teams can prevent delirium by attending to these basics and avoiding the temptation to sedate.

Founder’s Tip

Glasses on, hearing aids in, fluids up, bowels open, moving early, sleeping at night — prevention is a checklist, not a prescription.

Core Summary: NICE CG103 recommends a tailored multicomponent non-pharmacological package targeting modifiable precipitants to prevent delirium in at-risk patients; prophylactic antipsychotics, sedatives, blind antibiotics and bed rest are not appropriate.
DGM · DementiaQuestion 6 of 10 · single best answer

Dementia: driving and the DVLA

Scenario: A 76-year-old man has just been diagnosed with mild Alzheimer’s disease. He still drives locally and feels safe doing so; his examination shows only mild memory impairment and his family have no specific safety concerns yet. He holds an ordinary car (Group 1) licence and asks you what this diagnosis means for his driving.

Question: What is the most appropriate advice to give him about his licence?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A: He has a legal duty to inform the DVLA of the diagnosis, and he may be able to keep driving subject to DVLA assessment.

Core Lens: High-Yield Takeaways

  • The duty to notify sits with the patient: a driver diagnosed with dementia has a legal obligation to inform the DVLA, who will then decide on licensing, often after gathering medical information or arranging assessment.
  • Dementia is not an automatic ban: many people with early dementia and preserved driving ability may continue to hold a Group 1 licence, typically reviewed periodically, while progressive disease eventually ends driving.
  • The clinician advises and documents: your role is to explain the diagnosis, the duty to notify the DVLA and to inform their insurer, and to record that you have done so.
  • Confidentiality has a safety override: if a patient who lacks insight keeps driving against advice and cannot or will not notify the DVLA, GMC guidance permits the doctor to inform the DVLA as a last resort.
Click here for Deep Dive

Dementia and Fitness to Drive

Driving is central to independence, so the conversation must be handled sensitively while taking road safety seriously. The DVLA guidance (Assessing fitness to drive) makes the diagnosis a notifiable condition and bases licensing on the person’s actual functional ability — insight, memory, attention, visuospatial skills and reaction — rather than the label alone.

Why This Is the Right Move

This man has mild disease and feels safe, but the diagnosis still triggers his legal duty to notify the DVLA. The correct advice is therefore to tell him to inform the DVLA and his insurer, to reassure him that this does not automatically mean losing his licence, and to explain that the DVLA may seek further information or an on-road assessment and will review the licence over time. You should document the advice given.

Why the Other Options Don’t Fit

  • Option B: A dementia diagnosis does not automatically and permanently disqualify; early-stage drivers may continue subject to DVLA review, so blanket immediate surrender is wrong.
  • Option C: Waiting for an accident before notifying is unsafe and breaches the legal duty to inform the DVLA of a relevant condition.
  • Option D: The primary duty to notify is the patient’s; the doctor only informs the DVLA directly as a last resort when a patient lacking insight continues to drive against advice, and normally after telling them of that intention.
  • Option E: Having a passenger confers no legal exemption from notification and does not make unsafe driving safe.

“Red Flags” and Key Decision Points

  • Poor insight with continued driving: the highest-risk scenario; escalate and consider the confidentiality override if needed.
  • Getting lost on familiar routes, near-misses, or carer alarm: functional warning signs that should prompt advice to stop pending assessment.
  • Rapidly progressive cognitive decline: revisit driving safety at each review rather than relying on the initial assessment.
  • Group 2 (bus/lorry) licence holders: standards are far stricter and a diagnosis usually ends Group 2 entitlement.

Relevance to General Practice

GPs frequently break the news of a dementia diagnosis and field the driving question. Knowing the simple rule — the patient must notify the DVLA and their insurer, the diagnosis is not an automatic ban, and the doctor advises and documents — keeps both the patient and other road users safe and is medico-legally sound.

Founder’s Tip

The patient notifies the DVLA, not you — your job is to advise clearly, document it, and use the confidentiality override only as a last resort.

Core Summary: A driver newly diagnosed with dementia must notify the DVLA and their insurer; the diagnosis is not an automatic ban, the DVLA decides on licensing, and the doctor advises, documents and may inform the DVLA directly only as a last resort.
DGM · Frailty & Comprehensive Geriatric AssessmentQuestion 7 of 10 · single best answer

Frailty: domains of comprehensive geriatric assessment

Scenario: Your practice is setting up structured reviews for patients on the frailty register. A newly qualified colleague asks what a comprehensive geriatric assessment (CGA) actually involves, having heard it described as the evidence-based model for assessing older people living with frailty.

Question: Which combination of domains best describes a comprehensive geriatric assessment?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A: Medical, functional, psychological and social/environmental domains.

Core Lens: High-Yield Takeaways

  • CGA is multidimensional and interdisciplinary: it assesses the medical, functional (physical), psychological and social/environmental domains, then produces a coordinated problem list, goals and a plan with planned review.
  • It is a process, not a score: a frailty grade such as the Clinical Frailty Scale identifies and grades frailty, but the CGA is the structured response that follows identification.
  • The four domains map to common geriatric needs: medical (diagnoses, medication review, nutrition, continence, pain, senses); functional (mobility, falls, activities of daily living); psychological (mood, cognition); social/environmental (carers, housing, finances, support).
  • CGA improves outcomes: in the hospital setting it increases the likelihood of being alive and living at home at follow-up, and its community adaptations underpin personalised care and support planning in UK general practice.
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The Engine Behind Good Frailty Care

Comprehensive geriatric assessment is the best-evidenced intervention in geriatric medicine. It is defined as a multidimensional, interdisciplinary diagnostic and treatment process that determines the medical, psychological and functional capabilities of a frail older person in order to develop a coordinated, integrated plan for treatment and long-term follow-up. The deliberate breadth is the point: frailty is a multi-system loss of reserve, so a single-disease lens predictably misses the interacting problems — falls, polypharmacy, low mood, weight loss, incontinence — that actually drive dependency and admission.

Why This Is the Right Move

The four domains — medical, functional, psychological and social/environmental — are the standard description used by the British Geriatrics Society and in CGA toolkits. Working through each domain generates a problem list with the patient’s own priorities, which is then turned into a personalised care and support plan, including escalation and future-care preferences. In primary care the model is delivered pragmatically by the GP, practice pharmacist and community therapy and nursing teams rather than always in a hospital clinic.

Why the Other Options Don’t Fit

  • Option B: Listing organ systems is a traditional clerking, not the multidimensional CGA, and omits function, mood, cognition and the social domain.
  • Option C: A repeated frailty score identifies and tracks frailty but is not itself the assessment-and-plan process.
  • Option D: Investigations and a falls score are components that may feed in, but they are not the holistic multi-domain assessment.
  • Option E: Concentrating on one condition is precisely the single-disease approach CGA is designed to replace in people with frailty and multimorbidity.

“Red Flags” and Key Decision Points

  • Identification without action: flagging frailty on a register but not delivering a CGA-based review is the common failure mode.
  • Missing the social domain: carer strain, isolation and self-neglect are easy to overlook yet often decisive.
  • Unexplained weight loss or rapid functional decline found during CGA: investigate as possible acute illness or malignancy rather than recoding the baseline.
  • No agreed plan or review date: a CGA without a documented, shared plan loses most of its value.

Relevance to General Practice

The GP contract makes frailty identification routine; the skill is converting it into a useful multi-domain review. A workable model is to confirm the frailty flag clinically, book a longer or two-stage appointment, involve the practice pharmacist for a structured medication review, use a template covering the four domains plus vaccination and future-care preferences, and close with a written plan and a named review date.

Founder’s Tip

Medical, mind, mobility, milieu: cover all four domains and the frailty syndromes that hunt in packs are far less likely to slip through.

Core Summary: Comprehensive geriatric assessment is a multidimensional, interdisciplinary process spanning medical, functional, psychological and social/environmental domains, culminating in a coordinated, personalised plan with planned review.
DGM · Nutrition, Sarcopenia & Tissue ViabilityQuestion 8 of 10 · single best answer

Grading a sacral pressure ulcer correctly

Scenario: An 86-year-old woman on a rehabilitation ward is found to have a sacral ulcer. The wound bed shows full-thickness skin loss with yellow subcutaneous fat clearly visible across most of the base. There is a small amount of adherent slough at one edge, and the base is visible through it. Bone, tendon, muscle and fascia are neither visible nor palpable. There is about 1 cm of undermining at the lower border. The surrounding skin is intact and blanches normally.

Question: How should this ulcer be classified?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is B.

Core Lens: High-Yield Takeaways

  • Category three is defined by visible fat and nothing deeper: full-thickness skin loss with subcutaneous fat on view, but no exposed or palpable bone, tendon, muscle, fascia, ligament or cartilage, is category three; undermining and tunnelling are common at this depth.
  • A little slough does not make an ulcer unstageable: unstageable applies only when the base is obscured enough that the true depth cannot be judged; here most of the base is visible and can be assessed.
  • Category two is partial thickness: it is a shallow open ulcer with a pink-red bed, or an intact or ruptured serum-filled blister, with no fat visible, no slough and no bruising.
  • The grade drives the response, not the dressing choice alone: categorisation determines documentation, escalation, tissue viability involvement, incident reporting and the intensity of the offloading and nutrition plan.
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Depth Is What the Classification Is Actually Measuring

The international classification used in the United Kingdom describes how deep the tissue loss goes. Category one is non-blanchable erythema of intact skin. Category two is partial-thickness loss exposing dermis. Category three is full-thickness skin loss in which subcutaneous fat may be visible but deeper structures are not. Category four is full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone. Two further descriptors exist for situations where depth cannot be read: unstageable, where slough or eschar obscures the base, and deep tissue injury, where intact or non-intact skin shows persistent deep red, maroon or purple discolouration.

Why This Is the Right Move

This ulcer is category/grade 3. The skin loss is full thickness, subcutaneous fat is clearly visible, and no bone, tendon, muscle or fascia can be seen or felt. The undermining is expected at this depth and does not raise the category by itself; only exposure or direct palpation of deeper structures would do that. The single edge of adherent slough does not make it unstageable, because the depth across the rest of the base can be judged. Recording it accurately with a measurement, a photograph where local policy allows and a documented plan is what allows change over time to be seen.

Why the Other Options Don’t Fit

  • Option A: category two is partial-thickness loss with a shallow pink-red bed or an intact or ruptured blister; visible subcutaneous fat excludes it immediately.
  • Option C: category four requires exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone, and none of those is present here.
  • Option D: unstageable is reserved for ulcers whose base is so obscured by slough or eschar that the depth cannot be determined; most of this base is visible and measurable.
  • Option E: deep tissue injury describes persistent non-blanchable deep red, maroon or purple discolouration of skin that is intact or newly broken, not an open ulcer with a visible fat layer.

“Red Flags” and Key Decision Points

  • Never reverse-grade a healing ulcer: a category three that granulates does not become a category two, it is recorded as a healing category three.
  • Undermining, tunnelling and a foul odour with exposed bone raise the possibility of osteomyelitis and warrant escalation rather than a change of dressing.
  • Deep tissue injury can evolve rapidly to full-thickness loss despite optimal care; document it as such and increase the frequency of review.
  • Damage in darkly pigmented skin may not look red — assess temperature, oedema, induration and reported pain as well as colour.

Relevance to General Practice

Accurate categorisation matters in the community because it determines who else needs to be involved and how quickly. A category three or four ulcer merits tissue viability input, a review of the support surface and nutritional screening, and in most areas triggers reporting arrangements. It also frames the conversation with the family, since a category three sacral ulcer in a frail older adult carries a meaningful risk of not healing and needs realistic goals set from the start.

Founder’s Tip

Grade on what you can see at the base, not on how bad it looks from the doorway. Fat visible and nothing deeper means category three.

Core Summary: Full-thickness skin loss with visible subcutaneous fat and no exposed bone, tendon, muscle or fascia is a category/grade 3 pressure ulcer under NICE CG179 and the international classification.
DGM · Polypharmacy & PrescribingQuestion 9 of 10 · single best answer

Polypharmacy: stopping long-term Z-drugs

Scenario: A 78-year-old woman has taken zopiclone 7.5 mg every night for three years, started after her husband died. She had a minor fall last month and describes feeling groggy most mornings. She asks for help to stop the tablets because she has read they may be linked to falls.

Question: What is the most appropriate management of her zopiclone?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is D: Agree a gradual stepwise dose reduction over weeks to months, with sleep-hygiene support and planned follow-up.

Core Lens: High-Yield Takeaways

  • Long-term Z-drug use is a STOPP target: hypnotics beyond a few weeks deliver little ongoing sleep benefit while roughly doubling the risk of falls, fractures, daytime sedation and cognitive impairment in older people.
  • Taper, never snatch: after three years of nightly use, abrupt cessation risks rebound insomnia, anxiety and, rarely, withdrawal seizures — the safe exit is a gradual, patient-led stepwise reduction.
  • Motivation is the moment: she is asking to stop — deprescribing succeeds far more often when the patient initiates it, so seize the window with a written reduction plan and follow-up.
  • Replace the drug with a strategy, not another drug: sleep hygiene and cognitive behavioural approaches to insomnia are the evidence-based substitutes; swapping to a benzodiazepine or a sedating antihistamine trades one harm for another.
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The Three-Year “Short-Term” Hypnotic

Z-drugs are licensed for short-term use, yet repeat-prescription inertia means many older patients take them for years — often started, as here, around a bereavement. Tolerance to the hypnotic effect develops within weeks, leaving the harms without the benefit: impaired balance and reaction time, morning hangover, memory impairment and dependence. STOPP criteria explicitly flag prolonged hypnotic use in older people, and her fall plus morning grogginess is the classic clinical signature.

Why This Is the Right Move

CKS guidance on benzodiazepine and Z-drug withdrawal recommends a gradual dose reduction negotiated with the patient — for example stepping the dose down every two to four weeks, slowing the taper if withdrawal symptoms emerge — supported by sleep-hygiene advice, management of expectation (some short-term sleep disturbance is normal and settles) and scheduled review. For most patients on a standard nightly dose, reducing the existing drug directly is appropriate; switching to an equivalent dose of diazepam is reserved for those withdrawing from high doses or short-acting benzodiazepines with problematic withdrawal. Bereavement-related distress and mood should be reviewed alongside, since untreated depression undermines the taper.

Why the Other Options Don’t Fit

  • Option A: Abrupt cessation after years of nightly use invites rebound insomnia and withdrawal symptoms and predicts relapse; it is neither kind nor effective.
  • Option B: Temazepam is a benzodiazepine with the same falls, cognition and dependence problems — a sideways swap, not an exit.
  • Option C: Continuing simply renews the harm: tolerance means she gets the falls risk without meaningful hypnotic benefit.
  • Option E: Promethazine is strongly anticholinergic and sedating — in an older faller it adds confusion, dry mouth, urinary retention and next-day impairment.

“Red Flags” and Key Decision Points

  • Screen for the cause of the insomnia: untreated depression, pain, nocturia and sleep apnoea each sabotage withdrawal if missed.
  • High-dose or multiple sedatives: consider specialist or substance-misuse service input and a slower, structured taper.
  • Withdrawal red flags: confusion, perceptual disturbance or seizures during taper need urgent review — slow or pause the reduction.
  • Do not add a new sedative to ease the exit: sedating antihistamines, antipsychotics and alcohol all worsen the falls arithmetic.

Relevance to General Practice

Hypnotic deprescribing is bread-and-butter medication-review work and a recurring AKT theme. The practical formula: identify long-term users on the repeat list, invite a conversation, agree a written stepwise taper with the patient setting the pace, offer sleep-hygiene and CBT-based insomnia resources, and book follow-up. Even partial dose reduction measurably lowers falls risk.

Founder’s Tip

When a patient on a long-term hypnotic asks to stop, that consultation is the intervention — agree the taper there and then, write it down, and book the review before she leaves.

Core Summary: Long-term Z-drug use in an older faller should be ended by a gradual, negotiated stepwise dose reduction with sleep-hygiene support and planned follow-up — never abrupt cessation, continuation, or substitution with another sedating agent.
DGM · Rehabilitation & Perioperative CareQuestion 10 of 10 · single best answer

Handover to community therapy after a long admission

Scenario: An 86-year-old woman is medically fit to leave hospital after a six-week admission with pneumonia complicated by delirium. Before admission she walked to the shops and managed her own home. She now transfers with one person and walks ten metres with a wheeled frame. Inpatient physiotherapy is continuing and she has agreed goals of reaching her own toilet unaided and managing the two front steps. A new care package of two visits a day begins on discharge tomorrow.

Question: What must be in place before she goes home?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is B.

Core Lens: High-Yield Takeaways

  • Rehabilitation does not stop at the hospital door: she has fallen a long way from her baseline and is still improving, so the inpatient programme needs to continue seamlessly as community rehabilitation or reablement.
  • The handover must carry the goals, not just the diagnosis: the community team needs her agreed goals, her current level of transfer and mobility, the equipment supplied and what she was able to do before admission.
  • Intermediate care should start promptly: NICE NG74 expects bed-based intermediate care to start within two days of referral, and the NHS Long Term Plan expects reablement within two days; either way the handover has to be ready before she leaves, because the gains made in hospital are lost quickly if there is a gap.
  • NICE NG27 makes this somebody’s named job: transition out of hospital requires a coordinated plan involving the person and their carers, with medicines, equipment and follow-up arranged before discharge rather than after it.
Click here for Deep Dive

The Gap Between the Ward and the Front Door

A six-week admission with delirium produces substantial deconditioning, and the recovery curve afterwards is neither automatic nor guaranteed. Community rehabilitation and reablement exist to continue the trajectory, and their effect depends heavily on continuity: the same goals, an accurate picture of current function, and prompt commencement. Where the handover fails, the predictable sequence follows — carers who do everything for her because nobody has told them her goal is to walk to the toilet, no therapy for several weeks, progressive loss of what was gained on the ward, a fall or a further admission, and a placement decision made on a level of function that was never her ceiling.

Why This Is the Right Move

A written handover to the community therapy team, setting out her agreed goals, her current transfer and mobility status, her pre-admission baseline and the equipment supplied, is what must be in place. It allows reablement or community rehabilitation to start promptly and to continue the same programme rather than beginning again from a cold assessment. It also tells the care agency what to support rather than what to do for her, which is the difference between a package that rebuilds independence and one that entrenches dependency. The general practice discharge summary is necessary too, but it is a medical document and does not do this job.

Why the Other Options Don’t Fit

  • Option A: a discharge summary tells the practice about diagnoses and medicines; it does not reach the therapy team, does not carry her goals or her current level of function, and does not start any rehabilitation.
  • Option C: a six-week wait with no interim input is precisely the gap in which hospital gains are lost, and NICE NG74 expects intermediate care to start within days of referral rather than weeks.
  • Option D: keeping her in hospital until she is fully independent produces further deconditioning, delirium risk and hospital-acquired infection; much of her remaining recovery will happen faster at home with reablement.
  • Option E: waiting a month for the agency to raise a concern is not a rehabilitation plan and places the responsibility for recognising failure to progress on carers who have not been told what progress would look like.

“Red Flags” and Key Decision Points

  • Reablement and community rehabilitation are short-term and goal-focused; if no goals are transferred, the package silently becomes long-term maintenance care instead.
  • Check that equipment and any home adaptations are in place before discharge, not ordered on the day she leaves.
  • Ask the carer directly whether they can manage what is being planned, rather than assuming a discharge around their availability.
  • Do not make a permanent placement decision from a hospital bed after an acute illness — her function is still moving, and the ceiling is not yet known.

Relevance to General Practice

The practice frequently sees the consequence of a handover that never happened: a patient at home with a care package, no therapy input and a slow slide backwards. Reading the discharge summary for the rehabilitation plan as well as the medicines, and chasing the community therapy referral when there is none, changes the trajectory. It is also worth asking the family what she could do before admission, since the gap between that and her current function defines what reablement is aiming at and how urgently it needs to start.

Founder’s Tip

Send the goals, not just the diagnoses. Carers who know she is working towards her own toilet behave completely differently from carers who have only been told she is frail.

Core Summary: Discharge after a long admission requires a coordinated handover to community therapy carrying the person’s goals, current function and baseline, with intermediate care or reablement starting promptly (NICE NG27; NICE NG74).
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CGM & DGM Question Bank1,000 questions · 14 modules · your progress saves as you go
  • Acute Presentations in Older Adults75%
  • Advance Care Planning & End of Life60%
  • Capacity & Mental Capacity Act40%
  • Continence20%
  • Delirium—
  • Dementia—
  • Falls & Syncope—
  • Frailty & Comprehensive Geriatric Assessment—
  • Parkinson’s Disease & Movement Disorders—
  • Polypharmacy & Prescribing—
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A word from David
Dr David Palethorpe
David’s tip
“Geriatric medicine rewards the unglamorous fundamentals — a structured falls assessment, a STOPP/START medication review, and treating new confusion as an acute illness until proven otherwise. Get comfortable with those and most of the paper feels familiar.”
Dr David Palethorpe, Co-Founder & GP Partner (MBBS, BSc Hons, MRCGP)
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Written by practising UK GPs — Dr Victoria Hammond and Dr David Palethorpe. Education only — always confirm against current guidance. Core Revision is an independent revision resource and is not affiliated with the Royal College of Physicians or the British Geriatrics Society; eligibility, fees, formats and dates are set by the RCP and can change — always check the RCP’s own CGM and DGM pages before you apply.

Quick answers about the CGM and DGM

Checked against the RCP's own pages on 16 October 2026.

When are the next CGM and DGM exams?

The CGM written exam is on Wednesday 24 February 2027, sat online. Applications run from Monday 14 December 2026 to 11am on Monday 18 January 2027. The next DGM clinical exam you can apply for runs from 1 to 4 June 2027 in Liverpool, with applications from 30 March to 12 April 2027.

How much do the CGM and DGM cost?

The CGM fee for 2027 is £350. The DGM clinical exam is £668 in June and November 2027. The RCP requires no course.

What is the difference between the CGM and the DGM?

The CGM is the written knowledge test: 200 best-of-five questions in four papers of 50, each 90 minutes, sat online. The DGM is now the clinical exam alone: four live stations at the RCP in Liverpool. You sit the CGM first, then have four years to pass the DGM.

Who can sit the CGM and DGM?

Any statutorily regulated healthcare professional who is registered, in good standing and without restrictions on practice. The CGM asks for at least two years since qualifying, including four months in a setting with many older people. The DGM needs a CGM pass.

How many attempts do I get at the CGM and DGM?

Six at each. After that, each further attempt needs evidence of extra educational experience signed off by your educational supervisor and training programme director.

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1,000 original questions across all fourteen syllabus modules, each with a Core Lens summary and a deep dive. You also get drills by module, a timed mock paper and a readiness dashboard. Access is £49.99 for 12 months, long enough for both stages. You can try ten questions free first.

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