What is the positive sign that can be seen in deep vein thrombosis?

Appeared in: RRB Nsg. Superintendent-20 July 2019 (Shift-3rd)

Explanation

Homan's sign is a classic physical assessment finding associated with Deep Vein Thrombosis (DVT).
The sign is elicited by passive, abrupt dorsiflexion of the patient's foot with the knee extended.
Pain in the calf or popliteal region upon this maneuver constitutes a positive Homan's sign.
It is caused by the stretching of the posterior tibial nerve, which is irritated by the inflamed, thrombosed vein.
However, it is important to note that this sign is considered unreliable, with low sensitivity and specificity, and is not recommended for routine assessment in modern practice.

Option B: Jacquemier's sign is related to pregnancy, not DVT. It is the bluish discoloration of the vaginal mucosa due to increased blood flow.
Option C: Kernig's sign is a test for meningeal irritation, a hallmark of meningitis, not DVT.
Option D: Hegar's sign is a probable sign of pregnancy, not DVT. It refers to the softening of the lower uterine segment.

Visual 1: Diagram - Illustration showing the procedure for eliciting Homan's sign, with arrows indicating the dorsiflexion of the foot and the location of potential pain in the calf.
Visual 2: Diagram - Illustration of Kernig's sign, showing the patient supine with hip and knee flexed, and the painful resistance upon attempting to extend the knee.
Visual 3: Table - A comparative table of presumptive, probable, and positive signs of pregnancy, listing Jacquemier's and Hegar's signs under the appropriate categories.

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 the signs and symptoms of DVT is a critical nursing skill, as it is a potentially life-threatening condition that can lead to pulmonary embolism.
Nurses must understand that Homan's sign is an unreliable indicator and should perform a comprehensive lower extremity assessment, looking for unilateral edema (especially a difference in calf circumference), erythema, warmth, and tenderness.
Definitive diagnosis of DVT requires imaging studies, most commonly a venous Doppler ultrasound. A nurse's prompt reporting of suspicion is key to timely diagnosis and treatment.

How to Approach the Question

First, identify the key concept in the question stem: 'deep vein thrombosis' (DVT).
The question asks for a 'positive sign' associated with this condition.
Review the options provided and recall the clinical signs associated with each term.
Homan's sign is classically taught as a sign for DVT.
Jacquemier's and Hegar's signs are related to pregnancy.
Kernig's sign is related to meningitis.

Concept Tested & Keywords

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Practise the full RRB Nsg. Superintendent-20 July 2019 (Shift-3rd)

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