JODHPUR AIIMS SNO-20…: Pain in calf on dorsiflexion of the foot (Homans' sign) may indicate?

JODHPUR AIIMS SNO-2018

Medical & Surgical Nursing

Easy

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Homans' sign, which is pain in the calf upon dorsiflexion of the foot, is a classic clinical finding associated with Deep Vein Thrombosis (DVT).
Thrombophlebitis is the inflammation of a vein due to a blood clot. DVT is a type of thrombophlebitis affecting the deep veins, most commonly in the leg.
The pain is elicited because dorsiflexion stretches the posterior tibial vein and the surrounding calf muscles, causing irritation of the inflamed vein where the thrombus is located.
While its diagnostic reliability is limited, it serves as an important clinical clue prompting further investigation for DVT.

Option B: An aneurysm is a localized, abnormal bulge in the wall of a blood vessel, usually an artery. It does not cause pain specifically on dorsiflexion of the foot.
Option C: Lymphedema is swelling due to lymphatic fluid accumulation. It typically causes chronic, non-pitting, and often painless edema, not acute pain elicited by a specific movement.
Option D: Cellulitis is a bacterial infection of the skin and subcutaneous tissues. It presents with redness, warmth, swelling, and tenderness, but the pain is typically constant and diffuse, not specifically triggered by dorsiflexion of the foot.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical assessment for Deep Vein Thrombosis (DVT) as background academic context rather than a clinical decision trigger.
Recognizing potential signs of DVT, like a positive Homans' sign, is a critical nursing skill because of the risk of pulmonary embolism (PE), a life-threatening complication.
Nurses must know not to massage the affected leg in a patient with suspected DVT, as this can dislodge the clot.
Current practice emphasizes using clinical prediction rules (e.g., Wells score) combined with diagnostic tests like D-dimer and compression ultrasonography over relying on single physical signs like Homans' sign.

How to Approach the Question

First, identify the key term in the question: "Homans' sign".
Recall the definition of Homans' sign: pain in the calf when the foot is dorsiflexed.
Access your knowledge base to remember the primary condition associated with this specific clinical sign.
Evaluate the given options. Thrombophlebitis/DVT is the classic condition indicated by a positive Homans' sign.
Consider the other options (Aneurysm, Lymphedema, Cellulitis) and quickly rule them out by recalling their defining characteristics, which do not match the stimulus described in the question.
Confirm your choice. The link between Homans' sign and thrombophlebitis is a standard piece of knowledge for nursing exams.

Concept Tested & Keywords

Concept Tested: Clinical assessment for Deep Vein Thrombosis (DVT)
Stem keywords: Pain in calf, dorsiflexion, foot, Homans' sign
Lead-in keywords: indicate
Clinical cues: The presence of a specific clinical sign (Homans' sign) points towards a vascular pathology.