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

DSSSB 14 August 2024

Obstetrics & Gynaecology

Easy

Appeared in: DSSSB 14 August 2024

Explanation

Homan's sign is a classic clinical test used in the assessment for Deep Vein Thrombosis (DVT).
The sign is elicited by forcibly and passively dorsiflexing the patient's foot while their knee is extended.
A positive Homan's sign is indicated by pain in the calf during this maneuver.
It's important to note that this sign is not definitive. It has low sensitivity and specificity, as calf pain can result from other conditions.
Due to its unreliability, it is not used as a sole diagnostic tool but may be part of an initial physical assessment before more definitive tests like Doppler ultrasound are performed.

Option A: Fleischner sign is a radiological finding (a prominent pulmonary artery on X-ray) associated with pulmonary embolism, which can be a complication of DVT, but it is not a direct clinical sign of DVT in the leg.
Option B: Romberg's sign is a neurological test used to assess for sensory ataxia, which is a problem with balance and proprioception (the sense of body position). It has no association with DVT.
Option C: Spalding sign is an obstetric sign indicating intrauterine fetal death. It refers to the overlapping of the fetal skull bones visible on an ultrasound or X-ray, caused by the liquefaction of the brain after death.

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.
Postnatal women are at an increased risk for DVT due to the hypercoagulable state of pregnancy, which can persist for up to 6 weeks postpartum, combined with potential venous stasis from decreased mobility.
While Homan's sign is a well-known term, nurses must rely on a comprehensive assessment, including unilateral leg swelling, warmth, redness, and pain, and advocate for definitive diagnostic tests like Doppler ultrasound, as clinical signs alone are unreliable.
A key patient safety instruction is to never massage a painful, swollen calf, as this could dislodge a clot and cause a life-threatening pulmonary embolism.

How to Approach the Question

First, identify the core clinical condition in the question stem, which is Deep Vein Thrombosis (DVT) in a postnatal woman.
Recall the classic signs and symptoms associated with DVT. These include unilateral leg pain, swelling, warmth, redness, and tenderness.
Evaluate each option to see which sign is specifically used to assess for DVT.
Eliminate Romberg's sign, as it is a neurological test for balance.
Eliminate Spalding sign, as it is an obstetric sign related to fetal death.
Differentiate between Fleischner sign (related to pulmonary embolism, a complication of DVT) and Homan's sign (a direct, though unreliable, test for DVT).

Concept Tested & Keywords

Concept Tested: Clinical signs of Deep Vein Thrombosis (DVT)
Stem keywords: postnatal woman, DVT, sign
Lead-in keywords: Which
Clinical cues: The patient is postnatal, a period with increased risk for DVT due to hypercoagulability and potential immobility.

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