Rearfoot / Ankle · Medicine & Peri-op · Reconstructive · Standard
Day Four
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 heart has been racing since the day after surgery."
29-year-old female, hospital inpatient, post-operative day 4 after an elective foot and ankle reconstruction.
History of present illness
Admitted post-operatively after an elective left rearfoot reconstruction (arthrodesis with multiple screws, splinted non-weight-bearing).
Pain: controlled, ranging 0-6/10
Heart rate: elevated since post-op day 2
Post-op day 4: HR 108, BP 180/94, temperature 36.4 C, WBC 18,000
Symptoms: mild pleuritic chest discomfort and exertional shortness of breath; no hemoptysis, no calf pain or swelling reported
Mobility: minimal since surgery; non-weight-bearing in a splint
Prophylaxis: sequential compression device on the right leg only; no chemoprophylaxis ordered
Questions a strong candidate asks at this step
- Procedure, anesthesia type and duration, tourniquet use
- Pain trend and control; analgesics used
- Chest pain (pleuritic?), shortness of breath, cough, hemoptysis, palpitations, syncope
- Calf pain or swelling, thigh swelling (DVT symptoms)
- Fever, chills, wound drainage, splint tightness
- Mobility since surgery; DVT prophylaxis ordered? Compression devices?
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.