Question & Scenario Bank
200 structured scenarios across the four ST4 stations. Each has a framework, ideal-answer key points and a consultant-style model answer — tucked behind an accordion so you can attempt before peeking.
Why do you want to pursue this medical specialty at ST4 level?
Tell me about a quality improvement project you have led.
A junior colleague is repeatedly leaving the ward early without finishing handover. How do you handle this?
What is clinical governance and how do you contribute to it as a registrar?
A 78-year-old with metastatic cancer refuses a blood transfusion that you believe is life-saving. What do you do?
You suspect a consultant colleague has been drinking on call. What is your duty?
What is your current Personal Development Plan?
What is a weakness you are actively working on?
During a busy shift, how do you find opportunities to learn?
A senior colleague tells you 'we don't Datix things like that here'. How do you respond?
Why do you want to pursue this specialty at ST4 — and what have you done to evidence that commitment?
You are the medical registrar on a night shift where two of the four SHOs are absent and no locum has been found. How do you manage the shift, and what do you do afterwards?
A 76-year-old woman has a new temporal headache, jaw claudication and an episode of transient visual loss today. CRP 92. How do you manage her?
A 64-year-old man with rheumatoid arthritis on etanercept and methotrexate has a hot, swollen knee and rigors. How do you manage him?
A 26-year-old woman with lupus has new leg swelling, frothy urine and a creatinine that has doubled. How do you manage her?
A 49-year-old woman with early diffuse systemic sclerosis has a severe headache, BP 212/120 and a rising creatinine. How do you manage her?
Why rheumatology, and what have you done that evidences that commitment?
Your department must switch 400 patients from originator adalimumab to a biosimilar within six months. How would you lead it?
A woman with lupus nephritis on mycophenolate tells you she has stopped contraception to try for a baby and refuses to change her medication. How do you approach this?