Rearfoot / Ankle · Trauma · Medicine & Peri-op · Standard
Overnight Fall
Podiatric surgery residency interview case. Work through it the way you would at an interview: take the history, ask for the exam and imaging, then commit to a diagnosis and plan.
Chief complaint
"I fell last night and my left ankle hurts."
70-year-old male presenting to the emergency department. His daughter is present and translating.
History of present illness
Fell the night before presentation and had immediate left ankle pain, but was able to get around until this morning, when pain and swelling worsened and the family encouraged him to come in.
- Low-energy fall with a twisting (rotational) ankle mechanism
- Initially ambulatory, now unable to bear weight comfortably
- Abrasion over the medial ankle with mild bloody drainage
- No head strike or loss of consciousness; no other injuries
- No numbness or tingling
- No chest pain or syncope with the fall (mechanical, not cardiac); has baseline shortness of breath on exertion
- Last meal about 8 hours before arrival; tetanus status unknown
Questions a strong candidate asks at this step
- Time and mechanism of injury: height, direction of force, foot position (rotation vs axial load)
- Cause of the fall: mechanical vs syncope, dizziness, chest pain, palpitations, hypoglycemia
- Able to walk after the injury? Weight bearing now?
- Head strike, LOC, other injuries
- Open wound or drainage over the ankle? Fracture blisters?
- Numbness, tingling, coldness (6 Ps)
Present the rest of the case
Past history, exam, imaging, assessment, plan and discussion questions, with model answers, are in the interactive trainer. The diagnosis is kept there on purpose so you can practice committing to one.