Forefoot / Midfoot · Diabetic Limb & Charcot · Infection & Wound · Standard
ED Phone Call
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
"My big toe sore is getting bigger and it smells."
The ED calls you about a diabetic foot infection: 58-year-old Hispanic male with a wound on the plantar LEFT hallux.
History of present illness
Ulcer first noticed 2 weeks ago, although he is unsure how long it has been there. He has had previous ulcers, some of which healed after he applied an unknown cream and gauze left over from earlier wounds. He has been doing the same for this wound, but it is getting worse — larger, more surrounding redness and more drainage.
- No pain
- Drainage milky and red-tinged; his wife complains of a bad smell
- Positive fever, chills and nausea; headache
- Denies vomiting, shortness of breath, chest pain, diarrhea or constipation
- Last meal this morning; tetanus status unknown
Questions a strong candidate asks at this step
- Over the phone: vitals, glucose, WBC, whether films were taken and whether there is gas, purulence, crepitus or spreading erythema
- Has the ED started antibiotics or fluids? Blood cultures drawn first?
- Onset, duration, cause (shoe, trauma), prior ulcers and how they were treated
- Drainage, odor, spreading redness
- Constitutional symptoms: fever, chills, nausea, vomiting, SOB, chest pain
- Glucose control and recent readings
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.