Question 1

Why do you want to work in respiratory medicine?

Accepted Answer

I think it was the first patient I put on NIV who settled it for me. I was a junior on a medical take in winter, and a man in his seventies with COPD came in drowsy and acidotic. He'd had nebulisers, steroids and controlled oxygen, and an hour later his gas hadn't really moved. My registrar talked me through the decision: was NIV appropriate, what was his ceiling of care, what did he want? We started it on the respiratory unit, and I came back two hours later to find him awake, talking and asking for a cup of tea. I'd never seen physiology turn round that quickly in front of me. What kept me interested afterwards was everything around that moment. The same patient needed a proper conversation about what he'd want next time, a pulmonary rehab referral, help to stop smoking and a plan with the COPD nurses so he could stay at home. Respiratory medicine gives you that whole arc. You can be doing a chest drain in the morning, sitting in a lung cancer clinic breaking difficult news in the afternoon and reviewing a sleep study the next day. I'm also drawn to how much of the work is about people who often feel overlooked. A lot of our patients live in deprived areas, many smoke, and some feel judged before they've said a word. I like being the doctor who explains their inhaler properly and actually listens to how breathless they are at home. I know it's a hard specialty. Winter pressures are relentless, and you look after a lot of patients at the end of life. That hasn't put me…

Question 2

Which of the NHS values matters most to you as a respiratory doctor, and how have you shown it?

Accepted Answer

The six NHS values are working together for patients, respect and dignity, commitment to quality of care, compassion, improving lives and everyone counts. They all matter, but the one I think about most in respiratory medicine is everyone counts. The reason is that many of our patients have conditions closely linked to smoking, deprivation, damp housing or the jobs they did, and it's easy for that to colour how they're treated. I looked after a woman in her fifties who'd been admitted with her fourth COPD exacerbation in a year. On the board round someone called her a frequent flyer, and I could see how that label had shaped her care. Nobody had checked her inhaler technique in months, she'd never been offered pulmonary rehab, and she was still smoking twenty a day without any treatment for her tobacco dependence. I took the time to sit with her. It turned out she couldn't coordinate her metered dose inhaler at all, she was sleeping in a cold, damp flat, and she'd stopped going to the GP because she felt told off every time. I switched her to a device she could actually use, referred her to our inpatient tobacco dependence team, asked the COPD specialist nurses to see her before discharge and made a pulmonary rehab referral. I also wrote a clear discharge summary so her GP practice knew what had changed. She did come back that winter, but she stayed out of hospital longer, and when I saw her in clinic she said it was the first time someone had explained things without…

Question 3

You need to tell a patient that their CT and biopsy results show lung cancer. How would you approach that conversation?

Accepted Answer

I'd start well before I walked into the room. I'd make sure I had all the results, that the case had been through the lung cancer MDT so I knew the likely stage and the treatment options being considered, and that a lung cancer clinical nurse specialist could join me. I'd book a quiet room, hand my bleep to a colleague and check whether the patient wanted someone with them. If they needed an interpreter, I'd arrange a professional one rather than relying on family. In the room I'd introduce everyone and start by asking what they understood so far and how they'd been feeling since the scan. Often people already suspect something serious, and their answer tells me where to begin. I'd give a warning shot, something like, 'I'm afraid the results aren't what we'd hoped for,' and then pause. Then I'd say it clearly: 'The biopsy has shown that this is a lung cancer.' I wouldn't hide behind words like 'shadow' or 'lesion', because those leave people confused. After that I'd mostly be quiet. People react in very different ways. Some cry, some go silent, some immediately ask whether they're going to die. I'd follow their lead and answer honestly, without giving a precise timeframe I can't stand behind. I'd explain in plain language what the MDT has recommended and what happens next, whether that's further staging, a PET scan or a surgical or oncology appointment. Before they leave, I'd check what they've taken in, because very little sticks after news like this. I'd make sure they…

Question 4

A 24-year-old woman is admitted with acute asthma. She can't complete sentences, her peak flow is very low and her saturations are 91% on air. Talk us through your management.

Accepted Answer

Saturations of 91% on air in asthma put her in the life-threatening category straight away, so I'd treat this as an emergency. I'd go to the bedside, call for help, and ask the nurse to put out a call to my registrar and alert critical care early, because these patients can tire quickly. I'd assess her using ABCDE while treatment starts. I'd give oxygen to keep her saturations in the target range of 94 to 98%, start back-to-back oxygen-driven nebulised salbutamol with ipratropium, and give steroids promptly, either oral prednisolone if she can swallow or IV hydrocortisone if she can't. I'd get IV access, bloods and an arterial blood gas. I'd be looking closely at the gas, because a normal or raised carbon dioxide in someone this breathless means she's tiring, and that's a sign of a near-fatal attack. I'd listen for a silent chest, look for exhaustion, confusion or hypotension, and get a chest X-ray to look for a pneumothorax or consolidation, without letting it delay treatment. If she isn't improving after the first nebulisers, I'd discuss IV magnesium sulfate with my senior and make sure critical care had come to see her. I wouldn't start aminophylline or anything else unfamiliar without senior advice. I'd be cautious about sedation of any kind. Once she's stabilised, I'd want to understand why this happened. Was she on preventer therapy, was she taking it, had she had previous ITU admissions, and is there anything like a recent infection or a trigger at work? Before…

Question 5

A patient with known COPD arrives from the ambulance on 15 litres of oxygen through a non-rebreathe mask. They're drowsy. What would you do?

Accepted Answer

My first thought would be that this patient may be developing hypercapnic respiratory failure, possibly made worse by too much oxygen. But I wouldn't just whip the mask off. Stopping oxygen suddenly in someone who's hypoxic can be dangerous, so I'd step it down in a controlled way. I'd assess them using ABCDE, check their airway and conscious level, and take an arterial blood gas as soon as possible. While I'm doing that, I'd switch to a Venturi mask, usually 28% to start, and aim for target saturations of 88 to 92%, which is what the BTS emergency oxygen guidance recommends for people at risk of hypercapnic failure, unless the gas or the history tells me otherwise. I'd look for an oxygen alert card or a previous gas in their notes, because some patients have a personalised target. Then I'd treat the exacerbation itself: nebulised bronchodilators driven by air rather than oxygen, with supplemental oxygen through nasal cannulae if needed, oral steroids, and antibiotics if there are signs of infection. I'd get a chest X-ray to look for pneumothorax or pneumonia. If the gas shows a respiratory acidosis, I'd discuss NIV with my registrar or the respiratory team straight away, and before starting I'd want a clear plan for what we'd do if NIV fails. If the patient is very drowsy and protecting their airway poorly, I'd call critical care and my senior immediately. Finally, I'd make sure the oxygen is prescribed properly on the chart with the target range written down, and that the…

Question 6

You're reviewing a patient with severe COPD on home oxygen. They live alone, still smoke, and you notice burn marks on their clothes and nasal cannulae. They say they're fine and want to go home. What would you do?

Accepted Answer

The burn marks worry me a lot. Smoking near oxygen can cause serious burns and house fires, which put neighbours and firefighters at risk too. But my starting point would be that this is an adult who's entitled to make choices, including ones I wouldn't make, so I'd want to understand the situation properly rather than jump to a decision. I'd start with a calm, non-judgemental conversation. I'd ask how they're managing at home, whether they smoke while the oxygen is running, and whether they've had any near misses. I'd explain the risk clearly and check that they understand it. If I had any reason to doubt their capacity to make decisions about their oxygen and their discharge, I'd assess it formally under the Mental Capacity Act, decision by decision, and document it. Capacity is presumed, and an unwise decision doesn't mean someone lacks it. Assuming they have capacity, I'd work with them on reducing the risk rather than lecturing. I'd offer treatment for tobacco dependence through our inpatient team, including nicotine replacement. I'd involve the home oxygen service, because they'll want to do a risk assessment, and the outcome might mean changes to the oxygen prescription. With the patient's consent, I'd arrange a home fire safety visit from the local fire and rescue service, which can include fire-retardant bedding and smoke alarms. I'd also think about self-neglect, which is recognised under the Care Act. If they're struggling to look after themselves, I'd involve…

Question 7

A patient with a COPD exacerbation still has a pH of 7.28 and a raised carbon dioxide after an hour of optimal medical treatment. How do you decide whether to start NIV?

Accepted Answer

A persistent respiratory acidosis after an hour of optimal medical treatment is exactly the situation where acute NIV can make a real difference, so I'd be moving quickly. But before the mask goes on, I'd want three things clear. First, I'd check the treatment really has been optimal: controlled oxygen to target saturations, nebulised bronchodilators, steroids and antibiotics if indicated. I'd look at the chest X-ray for a pneumothorax, which would need a drain before NIV, and for other causes of the acidosis. Second, I'd agree the ceiling of care. With my registrar or consultant, and ideally with the patient, I'd decide whether they'd be for intubation if NIV failed, or whether NIV is the ceiling. That depends on their baseline function, previous admissions, other illnesses and, most importantly, what they want. If they're too drowsy to discuss it, I'd talk to their family about what the patient would have wanted, while making clear the decision is a medical one made in the patient's best interests. I'd record the plan clearly, including resuscitation status. Third, I'd make sure NIV happens in the right place, which is usually the respiratory support unit or a ward with staff trained in NIV and the right nurse-to-patient ratio, not a general ward bay where nobody can watch closely. Once it's started, I'd prescribe the settings on a dedicated NIV chart, check mask fit and synchrony myself, and repeat the gas at around one to two hours. If the pH and carbon dioxide are…

Question 8

How do you keep your respiratory knowledge up to date, and where do you see your career in the next few years?

Accepted Answer

I try to keep it structured, because otherwise the busy weeks win. I keep an eye on new and updated BTS and NICE guidance, and I'm a member of the British Thoracic Society, so I see the summer and winter meeting content. I also learn a lot from our own departmental meetings. Radiology and ILD MDT meetings have probably taught me more about reading a CT chest than any textbook. I keep a portfolio, and I reflect on cases that challenged me, not just the ones that went well. After a difficult NIV case last winter I wrote a reflection, read the acute NIV guidance again and asked our respiratory physiotherapist to go through mask fitting with me. That's the kind of learning that changes what I do on the next shift. Procedurally, I'm logging my pleural work, including thoracic ultrasound, aspirations and Seldinger drains, and I'd like to build towards independent competence with proper supervision. I'm also interested in sleep and ventilation and would value time in that service if the rota allows. In terms of where I'm going, my aim over the next few years is to build the experience and evidence I need to apply for entry onto the Specialist Register through the portfolio pathway, so I'm gathering evidence against the respiratory curriculum as I go. I've also started preparing for the Specialty Certificate Examination. I want to be a doctor this department can rely on: confident on the acute take, safe with procedures, good at teaching juniors and comfortable in clinic. I…

Respiratory Medicine Interview Questions & Answers

About this NHS interview question bank

Free NHS interview questions and model answers

Question 1: Why do you want to work in respiratory medicine?

Question 2: Which of the NHS values matters most to you as a respiratory doctor, and how have you shown it?

Question 3: You need to tell a patient that their CT and biopsy results show lung cancer. How would you approach that conversation?

Question 4: A 24-year-old woman is admitted with acute asthma. She can't complete sentences, her peak flow is very low and her saturations are 91% on air. Talk us through your management.

Question 5: A patient with known COPD arrives from the ambulance on 15 litres of oxygen through a non-rebreathe mask. They're drowsy. What would you do?

Question 6: You're reviewing a patient with severe COPD on home oxygen. They live alone, still smoke, and you notice burn marks on their clothes and nasal cannulae. They say they're fine and want to go home. What would you do?

Question 7: A patient with a COPD exacerbation still has a pH of 7.28 and a raised carbon dioxide after an hour of optimal medical treatment. How do you decide whether to start NIV?

Question 8: How do you keep your respiratory knowledge up to date, and where do you see your career in the next few years?

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