Rearfoot / Ankle · Trauma · Vascular · Advanced
Stair 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 tripped and fell down the stairs."
59-year-old female brought to the ED by EMS.
History of present illness
Tripped and fell down the stairs at home. She was unconscious for about 30 seconds; her husband noted no change in mentation after she awoke and kept her still while calling EMS. He saw no obvious injuries. She received a full trauma work-up on arrival — all assessments were negative except swelling of the LEFT lower leg.
- Now complains of left lower leg and ankle pain and swelling; unable to bear weight
- Pain 8/10, constant
- No headache, neck pain, chest or abdominal pain
- Last meal about 4 hours ago; tetanus up to date
Questions a strong candidate asks at this step
- Mechanism: trip vs syncope (cardiac, hypoglycemia, orthostatic) — why did she fall?
- Loss of consciousness — duration, amnesia, anticoagulants (head CT)
- Primary survey: ABCs; secondary survey for other injuries
- Pain location, ability to bear weight, 6 Ps
- Constitutional symptoms
- NPO status and tetanus status
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.