Walk into your Stroke Medicine ST4 interview already knowing how you will answer

“Tell us about a closed-loop audit you have led that moved a SSNAP key indicator — describe the standard, your denominator, the intervention, the re-audit and the measurable change — and then explain why stroke medicine specifically and what in your portfolio supports that commitment.”

“Give us a one-minute summary of your experience leading the acute unselected medical take, then describe a complex discharge from a hyperacute stroke unit you co-ordinated and what you learned about MDT leadership from it.”

“Talk us through a piece of teaching you designed for the hyperacute stroke team — your needs assessment, delivery, feedback and the change you measured — and link it to your longer-term academic plan in stroke medicine.”

“A 72-year-old man arrives in your hyperacute stroke unit 2 hours 40 minutes after a witnessed onset of right hemiplegia and global aphasia. NIHSS 18. CT shows no haemorrhage; CTA shows a left M1 occlusion; ASPECTS 8. BP 192/108, INR 1.1, on apixaban with last dose 'yesterday morning'. Walk me through your decision on IV thrombolysis and mechanical thrombectomy, your BP target, and how you would co-ordinate transfer to the neuroscience centre.”

“A 34-year-old breastfeeding mother presents 26 hours after wake-up onset of right-sided weakness and dysphasia. MRI DWI–FLAIR mismatch is positive; ASPECTS 9; CTA shows a left M2 occlusion. She is reluctant to be 'cut off' from her 6-week-old. Discuss your decision on extended-window thrombolysis and thrombectomy, your consent conversation, and how you would handle the breastfeeding question.”

“A 58-year-old woman is admitted with sudden-onset severe occipital headache and reduced GCS. CT shows a 28 ml left thalamic intracerebral haemorrhage with intraventricular extension. She is on warfarin (INR 3.4) for AF and BP is 196/112. Talk me through your immediate medical management, anticoagulation reversal, BP target and when you would escalate to neurosurgery.”

“A 71-year-old man is 36 hours post-large right MCA infarct (NIHSS 19, midline shift on repeat CT) and has dropped his GCS to 11. The family ask if 'everything is being done'. Walk me through the indications for decompressive hemicraniectomy, how you would discuss prognosis and quality of life with the family, and when you would shift to a palliative pathway.”

“A 28-year-old woman presents with a week of progressive headache, blurred vision and a new left-sided focal seizure. CT venogram shows superior sagittal sinus thrombosis. She is 3 weeks postpartum and breastfeeding. Talk me through your acute management, anticoagulation choice, monitoring for deterioration, and when you would escalate for endovascular treatment.”