Rearfoot / Ankle · Infection & Wound · Medicine & Peri-op · Advanced
Blistering Legs
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 legs are swollen, blistered and getting worse."
55-year-old male admitted to the hospital for progressive cellulitis of both lower extremities; you are consulted.
History of present illness
Symptoms began 2 weeks ago with hemorrhagic blisters on the dorsum of both feet and the calves. The surrounding redness and blistering have worsened significantly over the past 2 days. Today he seems confused.
- Painful feet, pain out of proportion to the appearance
- Feels feverish and nauseous; labored breathing
- No known trauma, puncture wound or seawater exposure
- Has not received antibiotics before admission
Questions a strong candidate asks at this step
- Onset, initial lesion and speed of progression (hours vs days)
- Portal of entry: trauma, puncture, insect bite, injection drug use, recent surgery, seawater/shellfish exposure
- Pain out of proportion to the exam
- Constitutional symptoms: fever, chills, nausea, vomiting, SOB, confusion
- Recent sore throat/strep infection, NSAID use
- Antibiotics given so far; NPO status; 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.