Which clinical sign positive in DVT?

Appeared in: NIMHANS Nursing Officer - 2019

Explanation

Homan's sign is the classic clinical sign associated with Deep Vein Thrombosis (DVT).
It is elicited by passively dorsiflexing the patient's foot while their knee is extended.
A positive sign is characterized by pain in the calf muscle during this maneuver, suggesting inflammation or thrombosis of the deep veins.
It is important to note that this sign has low diagnostic value, with both low sensitivity and specificity.
Current best practice relies on objective tests like duplex ultrasonography for DVT diagnosis, and the use of Homan's sign is now discouraged as it is unreliable.

Option B: Kerning's sign is used to assess for meningeal irritation, not DVT.
Option C: Psoas sign is an indicator of irritation to the iliopsoas group of hip flexor muscles, typically seen in appendicitis.
Option D: Romberg's sign (or test) is used to assess neurological function, specifically proprioception (the sense of body position).

Clinical Relevance

Nursing practice connection: Knowing Clinical assessment signs for differential diagnosis, specifically for Deep Vein Thrombosis (DVT) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
While Homan's sign is a classic textbook answer, its unreliability is a critical patient safety point. Nurses must not rule out DVT based on a negative Homan's sign.
A nurse's primary role in suspected DVT is to assess for more reliable signs (unilateral swelling, warmth, redness, pain), notify the healthcare provider promptly, and prepare the patient for definitive diagnostic tests like a duplex ultrasound.
A critical nursing intervention for a patient with suspected or confirmed DVT is to avoid massaging the affected leg, as this could dislodge a thrombus, leading to a life-threatening pulmonary embolism (PE).

How to Approach the Question

First, identify the key condition in the question, which is 'DVT' (Deep Vein Thrombosis).
Next, recall the specific clinical signs associated with various medical conditions that are commonly tested.
Evaluate each option provided. Homan's sign is historically and academically linked to DVT.
Consider the other options to confirm they are incorrect for DVT. Kerning's sign is for meningitis, Psoas sign for appendicitis, and Romberg's sign for balance/proprioception issues.
This process of elimination confirms that Homan's sign is the intended correct answer for this knowledge-based question, even though its clinical use is limited.

Concept Tested & Keywords

Concept Tested: Clinical assessment signs for differential diagnosis, specifically for Deep Vein Thrombosis (DVT).
Stem keywords: clinical sign, positive, DVT
Lead-in keywords: Which

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