The 2027 Obstetrics & Gynaecology ST1 Interview Revision Platform: Question Bank, Live Practice and Mocks with Other Candidates

I'd prioritise by clinical risk, using my team. The 18-year-old with severe abdominal pain and tachycardia is likely the sickest, with possible sepsis, a ruptured or torted ovary, an ectopic pregnancy or peritonitis, so she comes first. The post-operative patient found on the floor needs an urgent bedside assessment for bleeding, hypotension or hypoglycaemia, so she's next. The Bartholin's abscess can wait briefly if she's systemically well, but needs monitoring for sepsis. The sliding-scale patient without fluids isn't immediately unstable but must be corrected soon, as a variable-rate insulin infusion needs glucose-containing fluids to avoid hypoglycaemia. A pregnancy test is mandatory in the woman with abdominal pain.

First I'd establish who's available: whether the surgical registrar is in theatre, and where the medical registrar is. Then I'd delegate by urgency and capability. I'd ask the FY1 to attend the post-operative patient immediately for observations, a capillary glucose and a quick assessment, and to call me back. I'd go to the 18-year-old in resus myself because she's the most unstable, and ask the A&E nurses to keep the Bartholin's patient monitored until I can review her. Once the urgent patients are stable, I'd review the abscess and prescribe fluids and monitoring for the sliding-scale patient. Throughout I'd communicate clearly, document my decisions and escalate early.

I'd work through an A-to-E assessment and take a focused history: the onset, character and radiation of the pain, associated symptoms, her last menstrual period, and past medical and surgical history, with an abdominal and, if appropriate, pelvic examination. Investigations: a mandatory urine pregnancy test, a urine dip, bloods including full blood count, U&Es, LFTs, CRP, clotting, group and save and a beta-hCG, and a venous gas with lactate. I'd arrange a pelvic ultrasound as the preferred imaging, with CT if a senior advises. Management: two large-bore cannulas, IV fluids if she's shocked, analgesia, keep her nil by mouth, and escalate urgently to the surgical registrar and gynaecology if I suspect torsion or an ectopic. Early senior decision-making is essential.

If a patient meets sepsis criteria, I'd start the Sepsis 6 within the hour. The three to take are blood cultures, a lactate, and hourly urine output. The three to give are oxygen to keep saturations at or above 94%, broad-spectrum IV antibiotics, and IV fluids, with a 20 to 30ml/kg bolus if she's shocked.

Any post-operative collapse needs prompt assessment. While I finish with the resus patient, I'd have the FY1 take observations, a capillary glucose, a brief neurological check and a look at the surgical site and drains, and I'd attend myself if there are red flags such as hypotension, tachycardia, a drop in haemoglobin, ongoing dizziness or abdominal tenderness. The likely causes are hypotension from bleeding, dehydration or analgesia, hypoglycaemia, a vasovagal episode or infection, so I'd review her medications and fluids, screen for post-operative complications and occult injury, and escalate to a senior if she's deteriorating or I suspect bleeding.

For the Bartholin's abscess: an A-to-E and focused history, then examine for a fluctuant swelling at the four or eight o'clock position and any cellulitis or systemic signs, and swab if there's discharge. If it's mild, oral antibiotics and analgesia; if there's a defined abscess, incision and drainage or a Word catheter under local anaesthetic, following Sepsis 6 if she becomes septic. For the sliding-scale patient: a variable-rate insulin infusion needs concurrent glucose-containing fluids to prevent hypoglycaemia, so I'd prescribe appropriate IV fluids, ensure hourly capillary glucose and electrolyte monitoring, review the fluid-balance chart and hand this over clearly to the nursing staff.