Forefoot / Midfoot · Infection & Wound · Trauma · Core
Barefoot Roofer
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 drove a nail through my toe."
36-year-old male roofer seen in the ED.
History of present illness
Presents to the ED with a piece of nail through his right 3rd toe. He was working barefoot when he accidentally drove the nail through his foot at work.
- Injury about 1 hour ago; nail still in place
- Pain localized to the 3rd toe
- No numbness or tingling
- Last tetanus booster was more than 5 years ago (completed primary series as a child)
- Last meal 3 hours ago
Questions a strong candidate asks at this step
- Time of injury; object (type, clean vs rusty/contaminated); still in place?
- Barefoot vs through a shoe (Pseudomonas risk with rubber-soled shoes)
- Depth; did it hit bone or a joint?
- Tetanus immunization status and number of primary doses
- Numbness, weakness, coldness
- NPO 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.