Hospital Joining Interview - Doctor / Physician

Moderate to High Difficulty | Clinical & Technical Focus

1. Emergency & Critical Care

1. A 55-year-old man presents with sudden-onset tearing chest pain radiating to the back, BP 180/100 in the right arm and 140/90 in the left. What is your differential and immediate management? (Tests: aortic dissection vs. ACS differentiation, Stanford classification, contraindication of thrombolytics)
2. You are called to a patient in PEA (pulseless electrical activity). Walk me through your approach. (Tests: H's and T's, reversible causes, ACLS protocol)
3. A patient on IV heparin for PE develops new thrombocytopenia (platelets dropped from 180,000 to 60,000 on day 7). What do you do? (Tests: HIT recognition, 4T score, immediate heparin cessation, switching to argatroban/fondaparinux)
4. Describe your management of a patient with septic shock not responding after 30 mL/kg fluid resuscitation. (Tests: vasopressor choice, norepinephrine first-line, steroid use in refractory shock, source control)

2. Pharmacology & Drug Safety

1. A patient with atrial fibrillation and CKD stage 4 needs anticoagulation. How do you choose and dose the agent? (Tests: CrCl thresholds for DOACs, warfarin as alternative, apixaban dose reduction criteria)
2. What are the signs of digoxin toxicity and how do you manage it, including the antidote? (Tests: visual disturbances, arrhythmias, hyperkalemia paradox, digoxin-specific antibody fragments - Digibind)
3. A patient on metformin is scheduled for contrast CT. What is your pre-procedure management and why? (Tests: lactic acidosis risk, hold metformin 48h before/after, eGFR thresholds per current guidelines)
4. You prescribe fluconazole to a patient already on warfarin. How do you manage this interaction? (Tests: CYP2C9 inhibition, enhanced anticoagulation effect, INR monitoring, dose adjustment)

3. Diagnostics & Investigations

1. Interpret this clinical picture: An elderly woman presents with fatigue, constipation, weight gain, bradycardia, and a TSH of 48 mIU/L with free T4 of 0.4 ng/dL. How do you approach treatment, and what is the risk of rapid correction? (Tests: overt hypothyroidism, levothyroxine initiation, starting low in elderly/cardiac patients, risk of precipitating angina/arrhythmia)
2. A patient has a troponin of 0.08 ng/mL (upper limit of normal 0.04) on admission, and it rises to 0.21 at 3 hours. The ECG shows no ST changes. How do you classify and manage this? (Tests: NSTEMI by definition, high-sensitivity troponin delta rule, risk stratification with GRACE/TIMI score, early invasive vs. conservative strategy)
3. What does a wide anion gap metabolic acidosis with an elevated osmol gap tell you, and name the causes? (Tests: MUDPILES mnemonic, osmol gap pointing to toxic alcohol ingestion - methanol/ethylene glycol, management with fomepizole)
4. A chest X-ray shows blunting of the right costophrenic angle. What volume of pleural fluid does this represent, and when do you decide to tap? (Tests: ~200-300 mL threshold for blunting, transudates vs. exudates, Light's criteria, indications for thoracentesis)

4. Clinical Decision-Making & Ethics

1. You disagree with a senior consultant's treatment plan for a patient. How do you handle this professionally? (Tests: respectful escalation, patient advocacy, documentation, chain of command)
2. A patient refuses a blood transfusion on religious grounds despite a hemoglobin of 5.8 g/dL. What do you do? (Tests: autonomy vs. beneficence, informed refusal documentation, alternatives - iron, EPO, cell salvage, palliative approach)
3. How do you approach disclosing a serious medical error (e.g., wrong medication given) to a patient and family? (Tests: open disclosure principles, apology without admission of fault, incident reporting, follow-up plan)

5. High-Yield Clinical Scenarios

1. A 32-year-old pregnant woman at 36 weeks presents with headache, visual changes, BP 160/110, and 3+ proteinuria. What is your diagnosis and management? (Tests: severe preeclampsia criteria, MgSO4 for seizure prophylaxis, antihypertensive targets, timing of delivery)
2. A 70-year-old post-operative patient (day 2 after abdominal surgery) develops fever 38.8°C, tachycardia 108 bpm, and reduced urine output. Walk through your differential systematically. (Tests: "5 W's of post-op fever" - Wind, Water, Wound, Walking, Wonder drugs; DVT, anastomotic leak)
3. How would you diagnose and manage a patient presenting with acute liver failure (jaundice, coagulopathy, encephalopathy)? (Tests: INR-based definition, N-acetylcysteine for paracetamol-induced ALF, early transplant evaluation, managing cerebral edema)

6. Practical & Systems-Based

1. How do you prioritize when you have three patients requiring attention simultaneously - one in mild distress, one with a worsening GCS, and one needing routine discharge paperwork? (Tests: triage thinking, life-threatening first, delegation, communication with nursing staff)
2. What quality improvement or patient safety initiatives have you personally contributed to or would you like to introduce in this hospital? (Tests: systems thinking, awareness of PDSA cycles, incident reporting culture, clinical audits)

Quick Tips for the Interview

• Think out loud - interviewers want to see your reasoning process, not just the final answer.
• Use structured frameworks: ABCDE for emergencies, SBAR for communication, Light's criteria for effusions, etc.
• Cite guidelines where possible (AHA/ACC, WHO, NICE) - it shows you practice evidence-based medicine.
• Acknowledge uncertainty honestly - saying "I would consult a specialist" for a complex case shows appropriate humility.
• Connect clinical decisions to patient safety - hospitals hire doctors who think beyond the individual patient to system-level risk.