Well's score

Question 1

What does Wells’ score measure?

Answer 1

Probability of developing a DVT

Question 2

What HPC factors can contribute to wells score?

Answer 2

Paralysis, paresis or recent immobilisation of leg = 1 point.
Localised tenderness along the deep venous system = 1 point.
Entire leg swollen = 1 point.
Calf swelling >3cm compared to other leg (measured 10cm below the tibial tuberosity) = 1 point.
Pitting oedema, confined to symptomatic leg = 1 point.
Collateral superficial veins present = 1 point.

Question 3

What PMH can contribute to wells score?

Answer 3

Bedridden recently >3 days or major surgery within 12 weeks = 1 point.
Active cancer (treatment or palliation within 6 months) = 1 point.
Previous DVT = 1 point.

Question 4

What SHx can contribute to wells score?

Answer 4

Long haul flights
HRT /OCP
Smoking

Question 5

What other factors contribute to Wells score?

Answer 5

Alternative Dx to DVT as or more likely

Question 6

(HPC) What do the following score?
a)Paralysis, paresis or
recent immobilisation
of leg
b) Localised tenderness
along the deep venous
system
c) Entire leg swollen
d) Calf swelling >3cm
compared to other leg
(measured 10cm below
the tibial tuberosity)
e) Pitting oedema,
confined to
symptomatic leg
f) Collateral superficial
veins present

Answer 6

a) 1 point
b) 1 point
c) 1 point
d) 1 point
e) 1 point
f) 1 point

Question 7

(PMH) What do the following score?
a) Bedridden recently >3
days or major surgery
within 12 weeks
b) Active cancer
(treatment or palliation
within 6 months)
c) Previous DVT

Answer 7

a) 1 point
b) 1 point
c) 1 point

Question 8

What does a score of 0 mean?

Answer 8

DVT unlikely
5% prevalence

Question 9

What does a score of 1-2 mean?

Answer 9

DVT moderate risk
17% prevalence

Question 10

What does a score of ≥3 mean?

Answer 10

DVT likely
17–53% prevalence

Question 11

What lifestyle advice can we give?

Answer 11

Diet
Exercise
Smoking cessation

Question 12

What investigations are done for the following?
a) DVT unlikely
b) DVT likely

Answer 12

a) D dimer
b) D dimer and USS

Question 13

What are D-dimers good for?

Answer 13

negative exclusion?

Question 14

Is the sensitivity and specificity of D dimer?

Answer 14

High specificity
Low sensitivity

Question 15

What does the results of a D-dimer mean?

Answer 15

-ve = can be ruled out.
+ve = it isn’t diagnostic.

Good if they have a low clinical probability score.

Question 16

When is a USS doppler of veins created?

Answer 16

Only if high risk

Question 17

What is gold standard for diagnosing a PE?

Answer 17

CTPA