Which of the following signs is positive if a postnatal woman has DVT

Appeared in: MNS 2024

Explanation

Homan's sign is a classic physical assessment finding historically associated with Deep Vein Thrombosis (DVT).
The sign is elicited by forcibly dorsiflexing the patient's foot with the knee extended; pain in the calf muscle indicates a positive sign.
The postnatal period is a significant risk factor for DVT due to the hypercoagulable state of pregnancy, which can persist for up to 6 weeks after delivery.
Although it is a well-known sign, current evidence shows it has low sensitivity and specificity, meaning its absence does not rule out DVT, and its presence can be caused by other conditions.

Option A: Fleischner sign is a radiological finding on a chest X-ray, not a physical examination sign for DVT.
Option B: Romberg's sign is a test of neurological function, specifically proprioception and balance.
Option C: Spalding sign is an obstetrical finding related to the fetus, not the mother.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of Deep Vein Thrombosis (DVT) as background academic context rather than a clinical decision trigger.
Nurses must maintain a high index of suspicion for DVT in all postpartum patients, as pregnancy increases the risk five-fold.
Due to the unreliability of Homan's sign, nurses should focus on more dependable signs and symptoms like unilateral leg swelling, pain, warmth, and redness. Comparing the circumference of both calves is a more objective assessment.
Patient education on DVT prevention is a key nursing role, including encouraging early ambulation after delivery and teaching leg exercises.

How to Approach the Question

First, identify the key terms in the question: 'postnatal woman', 'DVT', and 'sign'. This frames the question as seeking a clinical assessment finding for a blood clot in a new mother.
Next, analyze the options provided. You need to recall or determine the medical context for each sign.
Evaluate 'Homan's sign'. This sign involves calf pain on dorsiflexion of the foot and is classically taught as an indicator for DVT.
Evaluate the other options to confirm they are incorrect. 'Fleischner sign' is radiological (X-ray) and relates to pulmonary embolism. 'Romberg's sign' is neurological (balance). 'Spalding sign' is obstetrical (fetal death).
Conclude that Homan's sign is the only physical assessment sign listed that is directly associated with DVT, even if its diagnostic value is limited.
Select the option corresponding to Homan's sign.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 521-523

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 77-79

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 54-68

Practise the full MNS 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.