Forefoot / Midfoot · Trauma · Medicine & Peri-op · Advanced
Seizure
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 had a seizure."
55-year-old female with epilepsy in the ED; you are paged as the on-call podiatry resident.
History of present illness
Six hours ago at home she lost consciousness and had a seizure. She recalls falling onto her right leg as it buckled outward, with immediate right foot pain.
- Pain 10/10, diffuse midfoot and forefoot, worsening since arrival, not relieved by IV analgesia
- Numbness of the toes developing over the past hours; foot feels cool
- Unable to bear weight
- No head strike reported by family; now alert and oriented ×3
- Missed two doses of her anticonvulsant this week
- No open wounds; last meal 8 hours ago; tetanus up to date
Questions a strong candidate asks at this step
- What was she doing before the seizure? Aura, dizziness, syncope vs. seizure?
- Head strike / LOC duration; orientation (date, place, president)
- Anticonvulsant adherence and levels (e.g. carbamazepine, levetiracetam, phenytoin)
- Foot: onset, location, radiation, what makes it better or worse, ability to bear weight
- Color change, numbness, coldness, pain out of proportion — the 6 Ps
- Other injuries (posterior shoulder dislocation, tongue biting, spine)
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.