Thrombosis & pulmonary embolism in the Kenntnisprüfung

Which signs suggest deep vein thrombosis?

• Cold, pale legs on both sides with weakened foot pulses and pain on walking
• One-sided swelling, pain, warmth and possibly bluish discoloration of the calf
• Bilateral, symmetrical ankle oedema that subsides overnight with elevation
• One-sided, sharply demarcated redness with a palpable, painful cord directly under the skin

Explanation: DVT (TVT) is typically ONE-SIDED: swelling with a difference in circumference, tension pain, warmth. Cold, pale legs suggest an arterial problem — the distinction is relevant for the exam. A reddened, palpable cord under the skin rather suggests superficial thrombophlebitis.

You suspect a fresh DVT. What is the correct immediate response?

• Stroke the leg out firmly and elevate it, so that the clot loosens and drains away
• Mobilise the patient quickly and let them walk around, so that the muscle pump dissolves the clot
• Inform the doctor, keep the patient lying down, immobilise the leg — do not massage (risk of embolism)
• Immediately put on a compression stocking and inject heparin from the ward stock

Explanation: Until medical clarification: no massage, no compression, avoid strain — the thrombus could detach and cause a pulmonary embolism. The doctor orders diagnostics and therapy; after confirmed DVT under anticoagulation, strict bed rest is usually not necessary.