Deep Vein Thrombosis in the ED

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Question 1 of 10

1. Question
Which one of the following statements is true regarding DVT?
- Up to 20% of patients with confirmed DVT will suffer long term symptoms
- Approximately 1% of the population will be affected at some point in their lifetime
- It is more likely in women taking the combined oral contraceptive pill than those who don’t
- It is more common in patients who have had day surgery as opposed to no surgery
- A positive family history is the single greatest risk factor
Question 2 of 10

2. Question
Which one of the following statements is true regarding DVT?
- Homan’s sign is both clinically sensitive and specific for DVT
- Thrombosis is more likely in the proximal veins of the leg
- DVT commonly affects the upper limbs
- DVT presents with pain in the majority of patients
- DVT can be detected in approximately 50% of patients with proven PE
Question 3 of 10

3. Question
Which one of the following correctly describes the components of Virchow’s triad?
- Arterial insufficiency, endothelial damage, disordered anatomy
- Venous stasis, hypercoagulable state, endothelial damage
- Venous valvular incompetence, disordered clotting, hypotension
- Venous stasis, arterial insufficiency, hypercoagulable state
- Endothelial damage, disordered anatomy, hypercoagulable state
Question 4 of 10

4. Question
Which one of the following statements is true regarding Wells criteria risk assessment?
- It can be used instead of radiological investigation
- It is appropriate for use in pregnant patients
- A low score precludes the need for further investigation
- A high score is an indication for D-dimer assay
- There is clinician subjectivity required in applying the Wells criteria to achieve a risk score
Question 5 of 10

5. Question
Which one of the following statements is true regarding the investigation of DVT?
- D-dimer tests have greater specificity than sensitivity
- Venography is ineffective at diagnosing DVT
- Ultrasound of the deep venous system can be performed in the ED
- The combination of a negative D-dimer and a low Wells score is sufficiently sensitive to exclude DVT
- Those patients in whom DVT cannot be excluded require hospital admission
Question 6 of 10

6. Question
Which one of the following statements is true regarding anticoagulation for DVT?
- Anticoagulation is unnecessary whilst waiting for further investigation
- The minimum duration of anticoagulation is 6 months
- Aspirin is an effective treatment
- Rivaroxaban requires bridging therapy with a LMWH until therapeutic anticoagulation is achieved
- Fondaparinux is a suitable alternative to LMWH as bridging therapy for patients started on warfarin.
Question 7 of 10

7. Question
Which one of the following is NOT recognised as a major risk factor for DVT?
- Active cancer
- Pregnancy
- Previous history of DVT
- Family history of DVT
- Recent major surgery
Question 8 of 10

8. Question
A 55-year-old lady presents to the ED with an atraumatic painful left lower leg that has gradually worsened for 3 days. She is normally well but has had a previous DVT during pregnancy. She is a smoker and is taking hormone replacement therapy. There is nothing else of relevance in her history. On examination the left calf is 3cms larger in circumference than the right and she has some tenderness along the deep veins of her left leg.

What is her Wells score?
- +1
- +2
- +3
- +4
- +5
Question 9 of 10

9. Question
The lady in the previous question has a Well’s Score of +3 and is considered to be at high pre-test probability of having a DVT; she goes on to have a Duplex USS which is reported as negative.

Which of the following statements is most appropriate according to NICE Guidance?
- She can be reassured and discharged as the diagnosis is excluded
- She should have a D-dimer assay performed and reassured if this is negative
- because of her high Well’s score, she should have expectant therapy despite her negative USS
- She should have a repeat USS in a week without any interim investigation
- She should be recommended an alternative imaging modality
Question 10 of 10

10. Question
According to NICE Guidance, which one of the following is not a pre-requisite criteria for thrombolytic therapy for DVT?
- The DVT is iliofemoral
- The patient has a good functional status
- The patient has a life expectancy of greater than 1 year
- There is a low risk of bleeding
- Symptoms are less than 7 days duration

Deep Vein Thrombosis in the ED – Post Test

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