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Deep Vein Thrombosis (DVT) OSCE Examination Quiz

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A 46-year-old woman has a painful, swollen left calf after a long-haul flight. Pressing firmly with your thumb over the inner ankle bone and then working up the shin leaves a lasting indentation on the left, up to mid-shin, while the right leg has no swelling. Which interpretation best links this finding to the underlying cause?

A lasting pit confirms lymphatic blockage, because lymphatic failure mainly shifts loose tissue fluid when you press with your thumb. No swelling in the other leg makes a whole-body cause more likely, because heart, kidney and liver causes usually affect only one dependent limb. The extent of the pitting oedema does not matter, because tenderness is the only finding that helps assess suspected DVT. Swelling in both legs would support DVT more strongly, because equal swelling means the deep veins are equally blocked on both sides. Pitting oedema in one leg, extending up the affected shin, supports DVT: blocked deep veins raise venous pressure, pushing fluid out of the capillaries into the tissues.

A A lasting pit confirms lymphatic blockage, because lymphatic failure mainly shifts loose tissue fluid when you press with your thumb.
B No swelling in the other leg makes a whole-body cause more likely, because heart, kidney and liver causes usually affect only one dependent limb.
C The extent of the pitting oedema does not matter, because tenderness is the only finding that helps assess suspected DVT.
D Swelling in both legs would support DVT more strongly, because equal swelling means the deep veins are equally blocked on both sides.
E Pitting oedema in one leg, extending up the affected shin, supports DVT: blocked deep veins raise venous pressure, pushing fluid out of the capillaries into the tissues. ✓

The answer is E: Pitting oedema in one leg, extending up the affected shin, supports DVT: blocked deep veins raise venous pressure, pushing fluid out of the capillaries into the tissues.

Explanation

Why E is correct

See Assessment of Oedema. Option E is correct. Pitting oedema is swelling that leaves a dent after firm pressure, usually over a bony area such as the inner ankle or shin. In a deep vein thrombosis (DVT) a clot blocks the deep vein, so the pressure in the veins behind the clot rises. The raised pressure pushes fluid out of the tiny blood vessels (capillaries) into the tissues, which causes swelling of the affected leg. Because it is a local blockage, the swelling is usually in one leg only, which is the key clue to separate DVT from body-wide causes of oedema. You record how far up the leg the pitting goes. Swelling of the whole leg, pitting oedema, tenderness and more than 3 cm of difference in calf size are all among the findings that suggest DVT. Memory aid: one swollen leg suggests a local block; two swollen legs suggest a whole-body cause.

Pitting oedema: swelling that leaves a dent after firm pressure.
Mechanism: the clot blocks the deep vein, pressure rises behind it and fluid is pushed into the tissues.
Distribution: usually one leg only, which separates DVT from body-wide causes of oedema.
Findings that suggest DVT: whole-leg swelling, pitting oedema, tenderness and more than 3 cm of calf difference.

Why the other options are incorrect

A. A lasting pit confirms lymphatic blockage, because lymphatic failure mainly shifts loose tissue fluid when you press with your thumb.: A lasting pit shows excess fluid but does not tell you the cause. In this woman, swelling and pain in one calf after a flight fit a clot in a deep vein better than lymphatic blockage.
B. No swelling in the other leg makes a whole-body cause more likely, because heart, kidney and liver causes usually affect only one dependent limb.: Heart, kidney and liver causes usually give swelling in both legs, so a normal right leg makes a whole-body cause less likely, not more.
C. The extent of the pitting oedema does not matter, because tenderness is the only finding that helps assess suspected DVT.: The extent of oedema is worth recording, because you work up the leg until the pitting stops. Tenderness is not enough on its own, and other signs such as swelling and a difference in calf size contribute to the assessment.
D. Swelling in both legs would support DVT more strongly, because equal swelling means the deep veins are equally blocked on both sides.: Swelling in both legs usually points to a body-wide cause, such as heart failure, kidney disease or liver disease. A single DVT usually causes swelling in one leg.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
When you inspect both legs in a patient with possible acute deep vein thrombosis, which of these findings most strongly supports the suspicion?
2
You have examined a leg for a suspected deep vein thrombosis (DVT) and found swelling, tenderness and pitting oedema on one side. Which option best completes the examination?

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