A 72-year-old woman presents with acute breathlessness, pleuritic chest pain, and haemoptysis. Her heart rate is 110, oxygen saturations are 91% on air, and she has a swollen left calf. What is your approach?

Tips to guide your answer

- Two-level Wells score for PE: this patient scores highly (clinical signs of DVT +3, PE is the most likely diagnosis +3, tachycardia +1.5 = 7.5 - PE likely)

- If PE likely: proceed to CTPA (not D-dimer)

- If haemodynamically unstable (massive PE): consider urgent reperfusion treatment, including systemic thrombolysis per local protocol, and involve critical care immediately

- Start anticoagulation while awaiting imaging unless contraindicated

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How to approach this Internal Medicine interview question

This quality improvement question is common in Internal Medicine NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "A 72-year-old woman presents with acute breathlessness, pleuritic chest pain, and..." as the anchor for a concise answer with a clear opening, a clinical or professional structure, and a reflective close.

What the panel is testing

A strong quality-improvement answer uses method as well as enthusiasm. Be clear about the problem, baseline measurement, intervention, re-measurement, and how the change was made sustainable. For internal medicine, show safe ward or acute-take judgement. Make escalation, diagnostic uncertainty, prescribing safety, discharge planning, and multidisciplinary working part of the answer where relevant.

Separate audit, QI, research, and clinical governance clearly so the panel can follow your reasoning.
Use a real cycle: baseline, intervention, re-measurement, learning, and sustainability.
Link the project back to patient safety, service reliability, or measurable outcomes.

How to structure your answer

For a quality improvement prompt, aim for a short opening sentence, then two or three evidence-led points, then a final reflection. If you use STAR, keep the result and reflection as strong as the situation. If it is a clinical scenario, say what you would do now, what you would do next, and how you would keep the patient safe while help is coming.

Open by naming the main issue in the question.
Give a structured response rather than a memorised script.
End with escalation, documentation, learning, or follow-up.

Common mistakes to avoid

The weakest answers usually stay too vague, ignore the specific role, or miss the safety issue hidden in the question. Do not use this page to memorise a perfect paragraph. Use it to rehearse the shape of a safe answer, then adapt it to your own experience and the post you are applying for.

Two-level Wells score for PE: this patient scores highly (clinical signs of DVT +3, PE is the most likely diagnosis +3, tachycardia +1.5 = 7.5 - PE likely)
If PE likely: proceed to CTPA (not D-dimer)
If haemodynamically unstable (massive PE): consider urgent reperfusion treatment, including systemic thrombolysis per local protocol, and involve critical care immediately