Venous Thrombosis: The Daily PANCE Blueprint

Home Venous Thrombosis: The Daily PANCE Blueprint

Venous Thrombosis: The Daily PANCE Blueprint

A 71-year-old male smoker with prostate cancer presents to your clinic complaining of unilateral leg swelling and pain. Vital signs are unremarkable. On a physical exam, the entire leg is swollen with localized tenderness along the venous system. Which of the following is the next best step?

A. Order a d-dimer
B. Order a duplex ultrasound
C. Admit to the hospital immediately
D. Reassurance and follow-up in 6 months
E. Order a CT angiogram

Answer and topic summary

The answer is B. Order a duplex ultrasound

This patient needs an ultrasound because he has a high pre-test probability for thrombosis. Ordering a d-dimer, in this case, would be inappropriate. Lots of things (e.g., cancer, trauma, etc) can elevate d-dimer.

Well’s Score helps us determine a patient’s risk for DVT based on these criteria: active cancer, surgery or bedridden, calf swelling, collateral veins presence, entire leg swollen, localized tenderness along deep venous system, pitting edema, previous DVT, recent immobilization, & alternative diagnosis more likely.

The main idea: d-dimer should be ordered in low-risk patients, and a venous duplex US should be ordered for high-risk patients.

View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Vascular Disease ⇒ Venous thrombosis

Also covered as part of the General Surgery PAEA EOR topic list

Sign up for the ENTIRE Blueprint Daily Email Series (1000 daily questions. . . and counting! 😀)

Sign Up
X

Have you tried the NEW Smarty PANCE QBANK? It's FREE with EVERY membership purchase 😀!

Meet the new QBank! 👈
X