Forefoot / Midfoot · Vascular · Diabetic Limb & Charcot · Standard
Nurse's Concern
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
"The visiting nurse told me my toe looks dead."
64-year-old female with morbid obesity, diabetes and CHF, seen in the ED.
History of present illness
Presents to the ED for evaluation of an ulcer and discoloration of the right 3rd toe. She was recently admitted to the hospital for lower-extremity cellulitis, went to a rehab facility, and was discharged home 2 days ago. A visiting nurse who sees her regularly was concerned the toe was necrotic and sent her to the ED.
- Denies pain
- Denies fever, chills, nausea, vomiting or diarrhea
- Denies any trauma to either lower extremity
- Unsure how long the toe has been discolored
Questions a strong candidate asks at this step
- Onset and duration of the discoloration; how it has changed (spreading? drying out?)
- Trauma (including minor repetitive trauma), new shoes, recent procedures
- Pain: rest pain, night pain, claudication — note neuropathy can mask it
- Drainage, odor, spreading redness
- Constitutional symptoms: fever, chills, nausea, vomiting, diarrhea
- Details of the recent cellulitis admission: antibiotics, cultures, vascular work-up
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.