Clinical Pharmacology and Therapeutics ST4 Interview Question Bank

The Medibuddy Clinical Pharmacology and Therapeutics ST4 Question Bank includes over 40 scenarios that closely mirror the real interview, each with a model answer written/edited by high-scoring candidates who sat the Clinical Pharmacology and Therapeutics ST4 interview in 2026.

However, knowing a strong answer isn't the same as delivering it well under pressure, which is why we provide:

Study Groups with candidates across the country
Unlimited Live Mocks with real people
Peer Feedback on your mocks from a wide range of candidates

10 years’ experience preparing doctors for interviews

Users of the Medibuddy Clinical Pharmacology and Therapeutics ST4 Revision Platform have secured some of the most competitive training jobs in recent rounds. Ask around, there's a good chance the trainees in the year above you used us too.

Always up to date

Did you know the interviews change every year? That's why we review and update every Question Bank on the platform twice a year, so you know you're always practising with scenarios based on the latest interview structure.

Network and practise real interview scenarios with other candidates

Question Bank

See every scenario, and how to answer it well

Over 40 scenarios covering every part of the interview, which tell you exactly how to respond to each question.

Study Groups

Connect with candidates across the country

Most people only ever practise with one or two friends. Study Groups connect you with candidates right across the country sitting the same Clinical Pharmacology and Therapeutics ST4 interview.

Live MocksBeta

Practise interview technique with different candidates

Arrange or get matched on demand with other candidates and run real scenarios out loud under interview conditions. Those who practise with the widest range of people tend to score the highest.

Peer FeedbackBeta

Reviewed by candidates across the platform

Submit your recorded mocks to candidates across the platform and get honest, varied feedback. Reviewing other people's mocks teaches you just as much.

The question bank, and other candidates to practise with, all in one platform.

What candidates say

Scored well, secured their post

A few of the candidates who prepared with us for the Clinical Pharmacology and Therapeutics ST4 interview.

Verified candidateInterviewed 2026

"The clinical and therapeutics scenarios were pitched exactly right. Having a structure ready meant I could work through a toxicology case calmly under pressure."

Secured first-choice deanery

Verified candidateInterviewed 2026

"Practising the registrar and ethics questions out loud with other candidates was the single most useful thing I did before the day."

Ranked highly

Part 1 • See the questions

The Medibuddy 2027 Clinical Pharmacology and Therapeutics ST4 Question Bank

The interview is a two-station PHST model, scored across several domains, and each part is tightly timed, so you have a limited window to deliver the high-scoring answers you need to do well. That means every point has to land, and knowing how to structure each answer is essential. That's why each of our 40-plus scenarios comes with a model answer, written by candidates who scored highly in the 2026 Clinical Pharmacology and Therapeutics ST4 interview, so you know exactly how to approach every question the interviewers throw your way.

What's inside

What's included in the Clinical Pharmacology and Therapeutics ST4 Question Bank

There's nothing worse than getting to the interview and being handed a scenario you've never seen before. The panel can draw on clinical, registrar, ethical and suitability themes across the two stations, so the safest approach is to revise across all of them. We provide scenarios for every part of the interview, including the common ones and the more unusual cases that have come up before, so you don't get caught out.

Clinical Scenarios

Therapeutics, toxicology and general medical cases where you play the registrar: assess, reason and manage safely, each with a worked answer showing how to structure your response.

Medical Registrar Suitability

Questions on managing the acute unselected take and leading a team, with model answers that show you're ready to work as a medical registrar.

Ethics & Professionalism

Realistic ethical and professional dilemmas, with structured model answers so you can reason through them clearly on the day.

Suitability & Commitment

Your chance to show your motivation for clinical pharmacology and therapeutics and why you're suited to ST4, with example questions and model answers.

Reflecting how CPT is really assessed

Clinical pharmacology turns on safe, evidence-based prescribing and therapeutics, alongside the registrar and professional themes shared across physician training. Communication is assessed throughout, and our model answers are written with all of this in mind.

Try it

Try an example Clinical Pharmacology and Therapeutics ST4 question

A 62-year-old woman with a 20-year history of bipolar affective disorder is brought to A&E by her husband. She has taken lithium carbonate 800mg twice daily for many years. Over the past week he has noticed increasing confusion, a coarse tremor and an unsteady gait.

She started co-amoxiclav five days ago for a dental abscess and has had poor oral intake due to the pain. Observations: blood pressure 100/60, heart rate 92, respiratory rate 18, SpO2 96% on air, temperature 37.2. Her lithium level three months ago was 0.7.

How would you approach this?

Question

How would you assess this patient?

Example answer

This looks like chronic lithium toxicity precipitated by dehydration, needing urgent systematic assessment.

History: the progression of her confusion, tremor and ataxia; her lithium dose, formulation and adherence; and precipitants, especially her reduced oral intake and any NSAIDs, ACE inhibitors or diuretics.
Fluid losses, her renal and thyroid history, a full medicines reconciliation, and the timing of her last dose.
Examination: a neurological exam for GCS, cerebellar signs and a coarse tremor; assessment of hydration and blood pressure; urine output; and signs of thyroid disease.

Question

What is the difference between acute and chronic toxicity, and why does it matter?

Example answer

The distinction is critical because the serum level relates to severity differently, and it drives dialysis decisions.

Acute toxicity: in a lithium-naive patient or a single overdose, the serum level can be very high with mild early neurology, and gastrointestinal symptoms predominate; the dialysis threshold is higher.
Chronic toxicity, as here: lithium has equilibrated into the tissues and CNS, so the serum level underestimates the CNS burden, neurological symptoms predominate even at modest levels, and the dialysis threshold is lower.

In chronic toxicity, clinical severity, not the serum level alone, should guide management.

Question

What investigations would you request?

Example answer

An urgent serum lithium level, repeated every 4 to 6 hours to detect rebound as lithium redistributes from tissues.
U and E and creatinine, as lithium is renally excreted and AKI is both a cause and a complication, plus urine studies for nephrogenic diabetes insipidus.
Thyroid function, as lithium causes hypothyroidism, and FBC, CRP, cultures, glucose, calcium and magnesium.
A 12-lead ECG for lithium-related changes, and CT or MRI of the head if there is focal neurology or diagnostic uncertainty.

Question

Her level returns at 2.4. What are the indications for haemodialysis, and does she meet them?

Example answer

Haemodialysis is highly effective, as lithium is small, not protein-bound and readily dialysable, but the decision should not rest on the level alone.

Per the EXTRIP criteria: a level above 4 in acute toxicity, above 2.5 in chronic toxicity with significant neurotoxicity, any level with reduced consciousness, seizures or dangerous arrhythmia, impaired renal clearance, or deterioration despite fluids.
She has chronic toxicity at 2.4 with significant neurotoxicity and likely AKI from dehydration, so she is at or approaching the threshold and haemodialysis should be strongly considered.

I would discuss urgently with the renal team and the National Poisons Information Service, and expect a rebound level after dialysis, so I would repeat it and be prepared for a second session.

Question

What are the immediate management steps while awaiting nephrology?

Example answer

Stabilise her and remove the precipitants.

Withhold all further lithium and any interacting drugs, and review whether the co-amoxiclav is still needed.
Give IV 0.9% saline to correct dehydration, restore renal perfusion and promote lithium excretion, avoiding forced diuresis, and catheterise to monitor output.
Continuous cardiac monitoring, hourly neurological observations, and repeat lithium and renal function every 4 to 6 hours.
Protect the airway with a low threshold for ITU if her GCS falls, treat seizures with benzodiazepines, and escalate to seniors, nephrology and psychiatry.

Question

After dialysis she recovers. How would you approach monitoring, reintroduction and communication?

Example answer

Monitoring and reintroduction:

Lithium is a trough level taken 12 hours post-dose, with a maintenance range of about 0.4 to 1.0, monitored regularly and more often in illness or dehydration, alongside renal and thyroid function.
Any reintroduction is a multidisciplinary decision with psychiatry, nephrology and the GP, weighing alternatives such as valproate or quetiapine, and if restarted, at a lower dose with close monitoring and clear written guidance.

Communication with her and her husband:

Explain in plain language that the lithium built up to a harmful level, most likely from dehydration during her dental illness, and that this was not her fault.
Cover sick-day rules and avoiding NSAIDs, be honest about the uncertainty around restarting, and, following Montgomery, discuss the material risks of both continuing and stopping so she can decide, documenting and sharing with her GP.

That's one scenario. There are over 40 more.

Actively maintained

How we keep our Question Banks up to date

The Clinical Pharmacology and Therapeutics ST4 interview changes from year to year, and the biggest fear for any candidate is getting to interview day and realising you've revised with a question bank that's totally outdated.

That's why we review and update every Question Bank twice a year, so you know you're revising with scenarios that are likely to come up. We do this in April after the previous year's interviews, and again in the autumn when the new recruitment guidance is published.

For 2027, this process kept the Question Bank aligned with the current two-station PHST format, across the clinical, registrar, ethical and suitability domains, so you always practise with the format the panel is using now.

Updated for 2027 Interviews

Part 2 • Practise them live

The only interview resource where you can practise live with other candidates from across the country

Our Clinical Pharmacology and Therapeutics ST4 Question Bank tells you exactly how to answer real interview scenarios. But how you practise with them will determine how many marks you score. Simply reading answers off a screen won't prepare you for the intense scrutiny you'll face in the interview. And only practising with the same few colleagues or friends limits the amount of feedback you'll get. Medibuddy gives you unique access to Clinical Pharmacology and Therapeutics ST4 candidates across the country, so you can learn from a variety of perspectives and hear a far wider range of feedback than your own circle could ever give you.

Study Groups

When you prepare in isolation, you're relying on your own interpretation of the interview process, which is one of the quickest ways to get found out on the day. Study Groups connect you with other doctors across the country who are also applying to Clinical Pharmacology and Therapeutics ST4, so you can engage and network with people preparing for the same interview as you. Everyone brings different experience from different hospitals and deaneries, meaning you won't ever miss out on the key bits of information that could swing the interview in your favour.

Live MocksBeta

Candidates who don't take part in mocks often struggle to adapt to the pressure of the interview. Your knowledge might be correct, but without convincing delivery the interviewers will score you poorly. The best way to improve your delivery is to take part in as many live mocks as possible, which is why we haven't put a cap on how many you can do. We also know how difficult it can be to organise mocks with other people, so all you have to do is join the waiting room and we'll match you with a different Clinical Pharmacology and Therapeutics ST4 candidate each time. Take turns as both the interviewer and candidate on real Question Bank scenarios, so you can see exactly how other candidates perform in real time, while refining your own interview technique.

Peer FeedbackBeta

Preparing alone means you won't know how you're coming across during the interview. And preparing with the same few candidates means you'll miss opportunities to improve, which is why it's so important to get as many opinions as possible on your performance. With Medibuddy, you can record a mock and submit it for feedback from other candidates on the platform, so you receive a wider range of feedback and refine your answers with each person you practise with. Reviewing other people's mocks is just as valuable, as it shows you how strong candidates handle the same scenarios, which is one of the fastest ways to improve.

The interview

What to expect from the Clinical Pharmacology and Therapeutics ST4 interview

Clinical pharmacology and therapeutics is a small, competitive specialty, recruited through Physician Higher Specialty Training, and strong applicants are often separated by narrow margins at interview.

The interview is a two-station PHST model, with different pairs of interviewers scoring different domains and communication assessed throughout.

Domain