Forefoot / Midfoot · Trauma · Medicine & Peri-op · Standard
Desk Kick
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 toe is bleeding." (history from nursing-home staff; patient is demented)
60-year-old female brought to the ED from a nursing home.
History of present illness
Kicked a desk about 2 hours ago, then had bleeding from the left big toe.
- Demented; increasingly aggressive, currently sedated with lorazepam (Ativan)
- Cefazolin (Ancef) already given in the ED
- Mechanism: low-energy blunt/crush of the toe against a hard edge
- Tetanus status: not documented (obtain from the facility record)
- Last oral intake: not documented (needs to be established for anesthesia)
Questions a strong candidate asks at this step
- Mechanism, time since injury (hours to OR matters), where it happened, environment (indoor, clean vs. dirty/outdoor)
- Source of history: patient is demented — ask staff / power of attorney
- Bleeding amount, deformity, ability to move the toe
- Tetanus immunization status
- Last oral intake (NPO status) and time of any sedative given
- Antibiotics already given (what, when) and analgesia
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.