DVT (Deep Vein Thrombosis) Questions
Common DVT exam questions and answers for doctors, medical students and exams
What is the definition of a proximal DVT?
- A thrombus in the popliteal, superficial femoral, deep femoral, common femoral or external iliac vein.
What is Virchow's Triad?
- Blood stasis, procoagulant tendency, and endothelial injury. Each of these can lead to thrombosis.
Give 4 transient risk factors for DVT?
- Acute infectious or inflammatory illness
What is the Wells score?
The Wells score quantifies the pre-test probability of DVT and guides further investigation:
|Recently bedridden ≥3 days or major surgery in the past 12 weeks||+1|
|Paralysis, paresis or recent plaster immobilization of affected leg||+1|
|Previously documented DVT||+1|
|Calf swelling >3cm more than contralateral leg||+1|
|Swelling of whole leg||+1|
|Localised tenderness along deep venous system||+1|
|Dilated collaterals present (NOT varicose veins)||+1|
|Pitting oedema confined to symptomatic leg||+1|
|An alternative diagnosis is at least as likely||-2|
How does the Wells score guide further investigation?
- If <2, perform a D-dimer test – if negative, DVT is excluded. Consider alternative diagnoses.
- If ≥2, or if the D-dimer is positive, proceed to Doppler and compression ultrasound examination of the venous system.
Is treatment indicated for a below-knee DVT?
- It is not known whether a below-knee DVT confers increased risk of PE; it is certainly a common incidental finding in otherwise well individuals.
- If local symptoms are thought to be due to the DVT, offer treatment. If not, consider repeat scanning in one week to see if the clot has extended proximally.
Which patients with DVT should undergo investigation for an underlying cause?
- Those aged >55yrs with unprovoked DVT, and those with recurrent unprovoked DVT or DVT at an unusual site.
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