Human Health and Disease MCQ. Test your understanding of Human Health and Disease with these MCQs. Topics include diseases, immunity, AIDS, cancer, and drug abuse. For Class 11-12.
Human Health and Disease MCQ – Mock Online Test
Question 1: Which of the following statements best defines ‘health’ according to the modern concept?
A. Absence of disease
B. A state of complete physical, mental, and social well-being
C. Balance of ‘humors’ in the body
D. Normal body temperature and blood circulation
B. A state of complete physical, mental, and social well-being. Modern definitions of health go beyond just the absence of disease.
Question 2: What did early Greeks like Hippocrates believe about the cause of diseases?
A. Genetic disorders
B. Imbalance of certain ‘humors’ in the body
C. Infections
D. Lifestyle factors
B. Imbalance of certain ‘humors’ in the body. They believed that an imbalance of these ‘humors’ led to different diseases.
Question 3: Whose work disproved the ‘good humor’ hypothesis of health?
A. Hippocrates
B. William Harvey
C. Indian Ayurveda practitioners
D. None of the above
B. William Harvey. His discovery of blood circulation challenged the existing beliefs about the causes of disease.
Question 4: Which of the following is an example of an infectious disease?
A. Diabetes
B. Cancer
C. Pneumonia
D. Heart disease
C. Pneumonia. Infectious diseases are caused by pathogens like bacteria, viruses, etc.
Question 5: Non-infectious diseases are:
A. Caused by pathogens
B. Contagious
C. Not caused by pathogens
D. Always genetic
C. Not caused by pathogens. These diseases can arise from genetic factors, lifestyle choices, or environmental factors.
Question 6: Which of the following is a characteristic of an infectious disease?
A. It cannot be transmitted from one person to another.
B. It is caused by a pathogen.
C. It is always chronic.
D. It is always acute.
B. It is caused by a pathogen. Pathogens like bacteria, viruses, or fungi can cause infectious diseases.
Question 7: Genetic disorders are:
A. Always acquired during life
B. Caused by infections
C. Often inherited from parents
D. Preventable with vaccines
C. Often inherited from parents. These disorders arise from abnormalities in an individual’s genetic makeup.
Question 8: Which of the following lifestyle factors can impact health?
A. Diet
B. Exercise
C. Sleep
D. All of the above
D. All of the above. Diet, exercise, and sleep are crucial components of a healthy lifestyle.
Question 9: Infections can be caused by:
A. Bacteria
B. Viruses
C. Fungi
D. All of the above
D. All of the above. Bacteria, viruses, and fungi are common pathogens that can cause infections.
Question 10: Which bacterium causes typhoid fever?
A. Streptococcus pneumoniae
B. Salmonella typhi
C. Haemophilus influenzae
D. Rhinovirus
B. Salmonella typhi. This bacterium enters the body through contaminated food and water.
Question 11: What test is used to confirm typhoid fever?
A. ELISA test
B. Widal test
C. Blood test
D. Stool test
B. Widal test. This test is commonly used to confirm typhoid fever.
Question 12: Pneumonia primarily affects which part of the respiratory system?
A. Nose
B. Throat
C. Alveoli (air sacs) of the lungs
D. Bronchi
C. Alveoli (air sacs) of the lungs. Pneumonia causes the alveoli to fill with fluid, making breathing difficult.
Question 13: The common cold is caused by which type of pathogen?
A. Bacteria
B. Virus
C. Fungus
D. Protozoa
B. Virus. Rhinoviruses are a common cause of the common cold.
Question 14: Which of the following is NOT a common symptom of the common cold?
A. Fever
B. Sore throat
C. Nasal congestion
D. Chest pain
D. Chest pain. Chest pain is not typically associated with the common cold.
Question 15: How is the common cold typically transmitted?
A. Through contaminated food
B. Through insect bites
C. Through blood transfusions
D. Through respiratory droplets from an infected person
D. Through respiratory droplets from an infected person. These droplets can be inhaled directly or transmitted through contaminated objects.
Question 16: Which of the following diseases is caused by a protozoan?
A. Typhoid
B. Malaria
C. AIDS
D. Ringworm
B. Malaria. Malaria is caused by the protozoan Plasmodium.
Question 17: What is the vector (transmitting agent) for malaria?
A. Housefly
B. Female Anopheles mosquito
C. Aedes mosquito
D. Contaminated food
B. Female Anopheles mosquito. The Plasmodium parasite is transmitted through the bite of an infected female Anopheles mosquito.
Question 18: Amoebiasis is caused by which parasite?
A. Plasmodium
B. Entamoeba histolytica
C. Ascaris
D. Wuchereria
B. Entamoeba histolytica. This protozoan parasite infects the large intestine.
Question 19: Ascariasis is caused by which type of pathogen?
A. Bacterium
B. Virus
C. Helminth (roundworm)
D. Fungus
C. Helminth (roundworm). Ascaris is an intestinal parasite that causes ascariasis.
Question 20: Elephantiasis is caused by which type of pathogen?
A. Bacterium
B. Virus
C. Helminth (filarial worm)
D. Fungus
C. Helminth (filarial worm). Wuchereria is the filarial worm that causes elephantiasis.
Question 21: Which of the following is a common symptom of elephantiasis?
A. Skin lesions
B. Inflammation of the lymphatic vessels
C. High fever
D. Headache
B. Inflammation of the lymphatic vessels. This inflammation often occurs in the lower limbs.
Question 22: Ringworm is caused by which type of pathogen?
A. Bacterium
B. Virus
C. Fungus
D. Protozoa
C. Fungus. Fungi like Microsporum, Trichophyton, and Epidermophyton can cause ringworm.
Question 23: Which of the following is a common symptom of ringworm?
A. Dry, scaly lesions on the skin
B. Inflammation of the lymphatic vessels
C. High fever
D. Headache
A. Dry, scaly lesions on the skin. These lesions are often accompanied by intense itching.
Question 24: Ringworm infections are commonly acquired from:
A. Contaminated food
B. Insect bites
C. Soil or by using contaminated objects
D. Respiratory droplets
C. Soil or by using contaminated objects. Ringworm can be spread through contact with soil or by sharing personal items like towels or combs.
Question 25: What is immunity?
A. The ability of the body to fight disease-causing organisms.
B. The ability of the body to resist all foreign agents.
C. The ability of the body to prevent only viral infections.
D. The ability of the body to only fight bacterial infections.
A. The ability of the body to fight disease-causing organisms. This ability is conferred by the immune system.
Question 26: Which of the following is NOT a type of immunity?
A. Innate immunity
B. Acquired immunity
C. Reactive immunity
D. None of the above
C. Reactive immunity. The main types of immunity are innate and acquired.
Question 27: Which type of immunity is present at birth?
A. Acquired immunity
B. Innate immunity
C. Both A and B
D. Neither A nor B
B. Innate immunity. Innate immunity provides a non-specific defense against pathogens.
Question 28: Which type of immunity is pathogen-specific?
A. Innate immunity
B. Acquired immunity
C. Both A and B
D. Neither A nor B
B. Acquired immunity. Acquired immunity develops after exposure to a specific pathogen.
Question 29: Which type of immunity is characterized by memory?
A. Innate immunity
B. Acquired immunity
C. Both A and B
D. Neither A nor B
B. Acquired immunity. The acquired immune system can “remember” previous encounters with pathogens.
Question 30: Which type of immunity provides a non-specific defense?
A. Innate immunity
B. Acquired immunity
C. Both A and B
D. Neither A nor B
A. Innate immunity. Innate immunity provides a general defense against a wide range of pathogens.
Question 31: Which of the following is NOT a type of barrier in innate immunity?
A. Physical barriers
B. Physiological barriers
C. Cellular barriers
D. Memory barriers
D. Memory barriers. Memory is a characteristic of acquired immunity, not innate immunity.
Question 32: Which of the following is an example of a physical barrier in innate immunity?
A. Skin
B. Tears
C. Saliva
D. Stomach acid
A. Skin. The skin acts as a primary physical barrier to prevent the entry of pathogens.
Question 33: Which cells are involved in the cellular barriers of innate immunity?
A. Leukocytes (WBCs)
B. Red blood cells (RBCs)
C. Platelets
D. None of the above
A. Leukocytes (WBCs). Certain types of leukocytes, like neutrophils and macrophages, can engulf and destroy microbes.
Question 34: Which type of cells are responsible for the production of antibodies?
A. T-lymphocytes
B. B-lymphocytes
C. Both A and B
D. Neither A nor B
B. B-lymphocytes. B-lymphocytes produce antibodies in response to pathogens.
Question 35: What is the other name for antibody-mediated immune response?
A. Cell-mediated immune response
B. Humoral immune response
C. Primary immune response
D. Secondary immune response
B. Humoral immune response. Antibodies are found in the blood, hence the name humoral.
Question 36: Which type of cells mediate cell-mediated immunity (CMI)?
A. T-lymphocytes
B. B-lymphocytes
C. Both A and B
D. Neither A nor B
A. T-lymphocytes. T-lymphocytes are responsible for cell-mediated immunity.
Question 37: Which type of immunity is developed when the body is exposed to antigens?
A. Active immunity
B. Passive immunity
C. Both A and B
D. Neither A nor B
A. Active immunity. Active immunity involves the body producing its own antibodies.
Question 38: Which type of immunity is developed when ready-made antibodies are given to the body?
A. Active immunity
B. Passive immunity
C. Both A and B
D. Neither A nor B
B. Passive immunity. Passive immunity provides immediate but temporary protection.
Question 39: Which of the following is an example of passive immunity?
A. Vaccination
B. Mother’s milk providing antibodies to the infant
C. Getting infected with a disease
D. None of the above
B. Mother’s milk providing antibodies to the infant. Colostrum, the yellowish fluid produced in the initial days of lactation, is rich in antibodies.
Question 40: What is the principle of vaccination based on?
A. The body’s ability to differentiate self and non-self
B. The body’s ability to produce antibodies
C. The body’s ability to remember previous encounters with pathogens
D. None of the above
C. The body’s ability to remember previous encounters with pathogens. Vaccination triggers the production of memory cells that can quickly recognize and respond to future infections.
Question 41: What is injected during vaccination?
A. Antigenic proteins of the pathogen
B. Inactivated or weakened pathogen
C. Both A and B
D. Neither A nor B
C. Both A and B. Vaccines can contain antigenic proteins or weakened pathogens.
Question 42: What is passive immunization?
A. Injecting preformed antibodies or antitoxin
B. Introducing a weakened pathogen into the body
C. Both A and B
D. Neither A nor B
A. Injecting preformed antibodies or antitoxin. This provides immediate protection, such as in the case of tetanus or snakebites.
Question 43: What is an allergy?
A. An exaggerated response of the immune system to certain antigens
B. An under-response of the immune system to antigens
C. A normal response of the immune system to pathogens
D. None of the above
A. An exaggerated response of the immune system to certain antigens. Allergies involve an overreaction of the immune system to harmless substances.
Question 44: What are allergens?
A. Substances that cause allergies
B. Cells that fight allergies
C. Antibodies that cause allergies
D. None of the above
A. Substances that cause allergies. Allergens can include pollen, dust mites, and animal dander.
Question 45: Which type of antibody is associated with allergies?
A. IgA
B. IgM
C. IgE
D. IgG
C. IgE. IgE antibodies play a key role in allergic reactions.
Question 46: What is autoimmunity?
A. When the body attacks its own cells
B. When the body fails to recognize foreign substances
C. When the body overreacts to foreign substances
D. None of the above
A. When the body attacks its own cells. Autoimmune diseases result from the immune system mistakenly targeting the body’s own tissues.
Question 47: Which of the following is an example of an autoimmune disease?
A. Rheumatoid arthritis
B. AIDS
C. Malaria
D. Ringworm
A. Rheumatoid arthritis. In rheumatoid arthritis, the immune system attacks the lining of the joints.
Question 48: What is the basis of self and non-self recognition in the immune system?
A. Genetic makeup
B. Environmental factors
C. Both A and B
D. It is not yet fully understood
D. It is not yet fully understood. The exact mechanisms of self and non-self recognition are still being researched.
Question 49: Which of the following is a primary lymphoid organ?
A. Bone marrow
B. Spleen
C. Lymph nodes
D. Tonsils
A. Bone marrow. Bone marrow is where immature lymphocytes differentiate into antigen-sensitive lymphocytes.
Question 50: Which of the following is a secondary lymphoid organ?
A. Thymus
B. Spleen
C. Bone marrow
D. None of the above
B. Spleen. The spleen is a secondary lymphoid organ where lymphocytes interact with antigens.
Question 51: What does AIDS stand for?
A. Acquired Immuno Deficiency Syndrome
B. Acquired Immuno Deficiency Symptoms
C. Advanced Immuno Deficiency Syndrome
D. Advanced Immuno Deficiency Symptoms
A. Acquired Immuno Deficiency Syndrome. AIDS is a condition that develops due to the deficiency of the immune system.
Question 52: What is the causative agent of AIDS?
A. Bacteria
B. Fungus
C. Human Immunodeficiency Virus (HIV)
D. Protozoa
C. Human Immunodeficiency Virus (HIV). HIV is a retrovirus that attacks the immune system.
Question 53: What type of virus is HIV?
A. Retrovirus
B. Rhinovirus
C. Rotavirus
D. Adenovirus
A. Retrovirus. Retroviruses have RNA as their genetic material.
Question 54: Which of the following is NOT a mode of transmission for HIV?
A. Sexual contact with an infected person
B. Sharing infected needles
C. Mosquito bites
D. Mother to child transmission during pregnancy or childbirth
C. Mosquito bites. HIV is not transmitted through insect bites.
Question 55: Which of the following groups is NOT at high risk of HIV infection?
A. Individuals with multiple sexual partners
B. Intravenous drug users
C. People who eat contaminated food
D. Children born to HIV-positive mothers
C. People who eat contaminated food. HIV is not transmitted through food.
Question 56: Can HIV be transmitted through casual contact like hugging or shaking hands?
A. Yes
B. No
C. Maybe
D. Not sure
B. No. HIV is not transmitted through casual contact.
Question 57: Which enzyme is crucial for HIV replication?
A. Reverse transcriptase
B. DNA polymerase
C. RNA polymerase
D. Ligase
A. Reverse transcriptase. This enzyme helps convert the viral RNA into DNA.
Question 58: What type of cells does HIV primarily infect?
A. Red blood cells
B. Helper T-lymphocytes (TH cells)
C. B-lymphocytes
D. Skin cells
B. Helper T-lymphocytes (TH cells). These cells are vital for the immune response.
Question 59: Where does the integration of viral DNA into the host cell’s DNA take place?
A. Cytoplasm
B. Nucleus
C. Mitochondria
D. Golgi apparatus
B. Nucleus. The viral DNA integrates into the host cell’s DNA in the nucleus.
Question 60: What is the initial symptom of HIV infection?
A. Fever, diarrhea, and weight loss
B. Skin rashes
C. Swollen lymph nodes
D. All of the above
A. Fever, diarrhea, and weight loss. These symptoms are often seen in the early stages of HIV infection.
Question 61: Why do opportunistic infections occur in AIDS patients?
A. Due to a weakened immune system
B. Due to a strong immune system
C. Due to genetic factors
D. Due to lifestyle factors
A. Due to a weakened immune system. The decrease in helper T-lymphocytes makes the body vulnerable to infections.
Question 62: Is there a cure for AIDS?
A. Yes
B. No
C. Maybe in the future
D. Not sure
B. No. Currently, there is no cure for AIDS, but treatments can help manage the disease.
Question 63: What is the commonly used diagnostic test for AIDS?
A. PCR
B. Western blot
C. ELISA
D. Blood smear
C. ELISA. ELISA stands for enzyme-linked immunosorbent assay.
Question 64: What does ELISA detect?
A. HIV RNA
B. HIV DNA
C. Antibodies against HIV
D. White blood cells
C. Antibodies against HIV. ELISA detects the presence of antibodies produced by the body in response to HIV infection.
Question 65: Is ELISA always accurate in detecting HIV?
A. Yes
B. No
C. Maybe
D. Not sure
B. No. ELISA may give false positives or false negatives in some cases.
Question 66: What type of drugs are used to treat AIDS?
A. Anti-retroviral drugs
B. Antibiotics
C. Antifungal drugs
D. Antiviral drugs
A. Anti-retroviral drugs. These drugs help to inhibit the replication of HIV.
Question 67: What is the best option for preventing AIDS?
A. Vaccination
B. Taking antibiotics
C. Prevention
D. None of the above
C. Prevention. As there is no cure for AIDS, prevention is crucial.
Question 68: Which organization in India is primarily involved in AIDS control and prevention?
A. WHO
B. CDC
C. NACO
D. NGO
C. NACO. NACO stands for National AIDS Control Organization.
Question 69: What is cancer?
A. A disease characterized by uncontrolled cell growth
B. A disease caused by bacteria
C. A disease caused by viruses
D. A contagious disease
A. A disease characterized by uncontrolled cell growth. Cancer cells lose the normal regulatory mechanisms that control cell growth and division.
Question 70: What are the agents that can induce cancer called?
A. Carcinogens
B. Pathogens
C. Allergens
D. Toxins
A. Carcinogens. Carcinogens can be physical, chemical, or biological agents.
Question 71: Which of the following is NOT a cause of cancer?
A. Genetic factors
B. Exposure to carcinogens
C. Viral infections
D. Allergies
D. Allergies. Allergies are an immune system response and not directly related to cancer development.
Question 72: What is a benign tumor?
A. A tumor that spreads to other parts of the body
B. A tumor that does not spread to other parts of the body
C. A tumor that always causes death
D. A tumor that is always small in size
B. A tumor that does not spread to other parts of the body. Benign tumors are generally considered non-cancerous.
Question 73: What is a malignant tumor?
A. A tumor that does not spread to other parts of the body
B. A tumor that spreads to other parts of the body
C. A tumor that is always large in size
D. A tumor that is always painful
B. A tumor that spreads to other parts of the body. Malignant tumors are cancerous and can invade surrounding tissues.
Question 74: What is the process of cancer spreading to other parts of the body called?
A. Metastasis
B. Differentiation
C. Proliferation
D. Apoptosis
A. Metastasis. Metastasis is the process by which cancer cells break away from the primary tumor and form new tumors in other parts of the body.
Question 75: Which of the following is a physical carcinogen?
A. X-rays
B. Tobacco smoke
C. Viruses
D. Bacteria
A. X-rays. Physical carcinogens include ionizing radiation like X-rays and UV radiation.
Question 76: Which of the following is a chemical carcinogen?
A. Tobacco smoke
B. UV radiation
C. Viruses
D. Bacteria
A. Tobacco smoke. Chemical carcinogens are found in various substances, including tobacco smoke, industrial chemicals, and certain food additives.
Question 77: Which of the following is a biological carcinogen?
A. Viruses
B. X-rays
C. Tobacco smoke
D. Asbestos
A. Viruses. Biological carcinogens include certain viruses, bacteria, and parasites.
Question 78: What are cancer-causing viruses called?
A. Oncogenic viruses
B. Retroviruses
C. Rhinoviruses
D. Adenoviruses
A. Oncogenic viruses. These viruses have the potential to cause cancer.
Question 79: What are cellular oncogenes (c-onc) or proto-oncogenes?
A. Genes that can cause cancer when activated
B. Genes that suppress cancer
C. Genes that are only found in viruses
D. Genes that are only found in bacteria
A. Genes that can cause cancer when activated. Proto-oncogenes are normal genes that can become oncogenes due to mutations or other factors.
Question 80: Which of the following is an example of an oncogenic virus?
A. Human papillomavirus (HPV)
B. HIV
C. Influenza virus
D. Rhinovirus
A. Human papillomavirus (HPV). HPV is known to cause cervical cancer.
Question 81: What is the process of removing a tissue sample for examination under a microscope called?
A. Biopsy
B. Blood test
C. X-ray
D. CT scan
A. Biopsy. Biopsy involves removing a small tissue sample for examination by a pathologist.
Question 82: Which imaging technique uses X-rays to generate a three-dimensional image of the internal organs?
A. CT scan
B. MRI scan
C. PET scan
D. Ultrasound
A. CT scan. CT scan stands for computed tomography.
Question 83: Which imaging technique uses strong magnetic fields and non-ionizing radiation to detect pathological and physiological changes in the living tissue?
A. MRI scan
B. CT scan
C. PET scan
D. Ultrasound
A. MRI scan. MRI stands for magnetic resonance imaging.
Question 84: Which of the following is NOT a common treatment for cancer?
A. Surgery
B. Radiation therapy
C. Immunotherapy
D. Antibiotics
D. Antibiotics. Antibiotics are used to treat bacterial infections, not cancer.
Question 85: What is the process of using high-energy rays to kill cancer cells called?
A. Radiation therapy
B. Chemotherapy
C. Surgery
D. Immunotherapy
A. Radiation therapy. Radiation therapy uses high-energy rays to target and destroy cancer cells.
Question 86: What is the process of stimulating the body’s immune system to fight cancer called?
A. Immunotherapy
B. Chemotherapy
C. Surgery
D. Radiation therapy
A. Immunotherapy. Immunotherapy aims to boost the body’s natural defenses against cancer.
Question 87: Which of the following is an opioid drug?
A. Heroin
B. Marijuana
C. Cocaine
D. LSD
A. Heroin. Heroin is an opioid drug derived from morphine.
Question 88: Which plant is the source of cannabinoids?
A. Papaver somniferum (Poppy plant)
B. Erythroxylum coca (Coca plant)
C. Cannabis sativa
D. Atropa belladonna
C. Cannabis sativa. Cannabinoids like marijuana and hashish are obtained from this plant.
Question 89: Which of the following is a coca alkaloid?
A. Morphine
B. Cocaine
C. Heroin
D. Nicotine
B. Cocaine. Cocaine is a coca alkaloid that acts as a stimulant.
Question 90: Which of the following is NOT an immediate effect of drug abuse?
A. Euphoria
B. Increased energy
C. Enhanced performance
D. Depression
D. Depression. While depression can be a long-term consequence, the immediate effects of drug abuse are often stimulatory or euphoric.
Question 91: What is the effect of heroin on body functions?
A. Stimulates body functions
B. Slows down body functions
C. No effect on body functions
D. None of the above
B. Slows down body functions. Heroin is a depressant.
Question 92: Which neurotransmitter’s transport is interfered with by cocaine?
A. Serotonin
B. Dopamine
C. Acetylcholine
D. Norepinephrine
B. Dopamine. Cocaine interferes with dopamine transport, leading to its accumulation and stimulatory effects.
Question 93: What is the typical age range for adolescence?
A. 5-10 years
B. 12-18 years
C. 20-25 years
D. 30-35 years
B. 12-18 years. Adolescence is a transitional period between childhood and adulthood.
Question 94: Which of the following is NOT a common reason for drug/alcohol abuse among adolescents?
A. Curiosity
B. Peer pressure
C. Need for adventure and excitement
D. Lack of parental love
D. Lack of parental love. While family dynamics can play a role, the primary reasons for drug abuse among adolescents are often related to curiosity, peer pressure, and the desire for new experiences.
Question 95: How can stress contribute to drug/alcohol abuse in adolescents?
A. It can lead them to seek unhealthy coping mechanisms
B. It can increase their energy levels
C. It can improve their academic performance
D. It can strengthen their relationships with family and friends
A. It can lead them to seek unhealthy coping mechanisms. Adolescents may turn to drugs or alcohol to escape from stress or negative emotions.
Question 96: What is addiction?
A. A physical dependence on a substance
B. A psychological attachment to the effects of a substance
C. Both A and B
D. Neither A nor B
C. Both A and B. Addiction involves both physical and psychological dependence.
Question 97: What is drug tolerance?
A. The ability to handle large amounts of a drug
B. The need for increasing amounts of a drug to achieve the same effect
C. The ability to resist the effects of a drug
D. None of the above
B. The need for increasing amounts of a drug to achieve the same effect. Tolerance develops with repeated drug use, requiring higher doses for the desired effect.
Question 98: What is withdrawal syndrome?
A. A set of characteristic and unpleasant symptoms that occur when drug use is abruptly stopped
B. A set of pleasant symptoms that occur when drug use is continued
C. A set of symptoms that only occur with alcohol withdrawal
D. None of the above
A. A set of characteristic and unpleasant symptoms that occur when drug use is abruptly stopped. Withdrawal symptoms can be physical and psychological.
Question 99: Which of the following is NOT a long-term effect of drug/alcohol abuse?
A. Damage to the nervous system
B. Liver cirrhosis
C. Increased risk of infections like AIDS and Hepatitis B
D. Improved physical health
D. Improved physical health. Drug and alcohol abuse have detrimental effects on physical health.
Question 100: How can drug/alcohol abuse affect an individual’s social life?
A. It can lead to social isolation and strained relationships
B. It can improve relationships with family and friends
C. It can increase social interaction
D. None of the above
A. It can lead to social isolation and strained relationships. Drug and alcohol abuse can lead to social problems, financial difficulties, and relationship breakdowns.
