Forefoot / Midfoot · Infection & Wound · Diabetic Limb & Charcot · Advanced
Neglected Nail
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 foot is painful and draining."
54-year-old woman seen in the emergency department.
History of present illness
Presents with a painful, draining right foot.
- Stepped on a nail about 4 weeks ago and never sought treatment
- Pain has worsened, with increasing drainage and a foul odor
- Fevers and joint stiffness (see ROS)
- Tetanus status, last meal and glucose control: not given (ask)
Questions a strong candidate asks at this step
- Onset, mechanism (what penetrated, shoe or barefoot, where, how deep) and time course
- Pain character, drainage, odor, spreading redness or swelling
- Fevers, chills, nausea, vomiting, confusion (sepsis screen)
- Treatments tried: antibiotics, soaks, prior care
- Home glucose readings and diabetic control
- Tetanus status and NPO status (possible emergency surgery)
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.