A 55-year-old woman with known COPD presents to the acute medical unit with worsening breathlessness, productive cough, and wheeze over three days. Her oxygen saturations are 86% on air. She is using accessory muscles. How do you manage this?
- Controlled oxygen therapy: target saturations 88 - 92% in known COPD (risk of CO2 retention)
- Use a Venturi mask to deliver precise FiO2 (start at 24 - 28%)
- Nebulised bronchodilators: salbutamol 5 mg + ipratropium 500 mcg, driven by air (not oxygen) - or use oxygen-driven nebs for a maximum of 6 minutes
- Systemic corticosteroids: prednisolone 30 mg orally for 5 days (or IV hydrocortisone if unable to swallow)
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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 55-year-old woman with known COPD presents to the acute medical unit with worsening..." 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.
- Controlled oxygen therapy: target saturations 88 - 92% in known COPD (risk of CO2 retention)
- Use a Venturi mask to deliver precise FiO2 (start at 24 - 28%)
- Nebulised bronchodilators: salbutamol 5 mg + ipratropium 500 mcg, driven by air (not oxygen) - or use oxygen-driven nebs for a maximum of 6 minutes