Forefoot / Midfoot · Infection & Wound · Diabetic Limb & Charcot · Standard
Failing Antibiotics
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
"The tip of my toe has a sore that won't heal, and the antibiotics aren't helping."
49-year-old male with diabetes seen in clinic.
History of present illness
Open ulcer at the apex of the right 2nd toe with a deep, draining, swollen toe that has been getting worse over the past several weeks.
- Ulcer began as a callus/pressure area at the toe tip and broke down
- Treated as an outpatient with an antistaphylococcal penicillin (dicloxacillin); worsened
- Switched to ceftriaxone; still not resolved
- Mild drainage, no fever or chills reported
- Prior left 2nd toe amputation for a similar problem
- Not hospitalized to this point
Questions a strong candidate asks at this step
- Onset, duration, how it started (trauma, shoe, callus), progression
- Drainage, odor, swelling, redness, pain (usually reduced by neuropathy)
- Antibiotics so far: agent, dose, duration, adherence, response
- Fever, chills, nausea, rigors, glucose control trends
- Prior ulcers, prior amputations, prior wound or bone cultures, prior MRSA
- Tetanus status; NPO status if surgery is likely
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.