Return to Scenario ListShow Learning Points most relevant to Phase 1:

Deep vein thrombosis

Clinical Discipline(s)/Organ System(s)
General Practice, Haematology, Clinical Pharmacology, Ethics, Radiology
Progress Test Topic(s)
Blood and lymph
While on your GP placement you see a 45 year old NZ European woman who has just returned from holiday in London. She has noticed that her left leg has become swollen and painful. This has never happened to her before but her sister has had a 'clot in the leg' in the past. During the consultation, the GP remembers that she started the patient's 15 year old daughter on the combined oral contraceptive pill a few weeks ago, without her mother's knowledge.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of venous system
   - Mechanisms that promote venous blood flow in the lower limbs
   - Virchow's triad
   - Mechanisms controlling haemostasis: platelets and coagulation factors. Laboratory assessment of these including effects of anticoagulants and antiplatelet agents
   - Factor deficiencies, genetic diseases and conditions that create a procoagulant environment
   - Pharmacology of warfarin, heparin and low-molecular weight heparin, dabigatran, rivaroxaban
Clinical and Communication Skills 
   - History from a patient with a swollen limb; assess risk factors for a deep vein thrombosis
   - Perform and record an examination of a swollen limb; use dermatological terminology to describe skin changes and recognise neurovascular compromise
   - Indications for venous duplex ultrasound of the lower limb and thrombophilia screen
   - Interpret D-dimer result
   - Differential diagnosis of swollen limb
   - Calculate Wells score for deep vein thrombosis
   - Management of deep vein thrombosis, pulmonary embolus and haemorrhage while anticoagulated
   - Complications of deep vein thrombosis
   - Perioperative management of anticoagulation
   - Role of thrombosis service and pharmacist for patients on anticoagulants
   - Pharmacological and non-pharmacological preventions of deep vein thrombosis and pulmonary embolism
   - Warfarin counselling
   - Strategies to prevent post-thrombotic complications
   - Management of patient on warfarin with international normalised ratio (INR) greater than therapeutic range
Personal and Professional Skills 
   - Ethics regarding treatment in minors
   - Ethics involved with care of family/whānau members
Hauora Māori 
   - Ability to cater for differential health literacy needs of Māori patients and whānau particularly in regard to warfarin treatment
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand when presenting with deep vein thrombosis (such as underlying cancer)
   - Consideration of access to cultural/spiritual support for patient and whānau including advice on rongoa and interactions with warfarin
Population Health 
   - Epidemiology of deep vein thrombosis: risk factors, associated conditions, prevention and awareness
Conditions to be considered relating to this scenario
deep vein thrombosis, cellulitis, ruptured Baker's cyst, peripheral vascular disease, Achilles tendonitis, venous stasis dermatitis
Less common but 'important not to miss'
polycythaemia vera, heart failure, antiphospholipid syndrome, antithrombin defiency, factor V Leiden, protein C/S deficiency, dysfibrinogenaemia, necrotizing fasciitis, pulmonary embolism
lymphoedema, thrombophlebitis, stress fracture