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A physical therapist evaluates a patient who presents with leg swelling and discomfort. The patient has a history of recent surgery and prolonged immobility. Based on the Wells Criteria for deep vein thrombosis, which of the following would be the MOST relevant factor in assessing the patient's risk for deep vein thrombosis?

1. Body mass index greater than 28
2. Previous history of deep vein thrombosis 10 years ago
3. Previous history of prostate cancer 5 years ago
4. Current diagnosis of cellulitis

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist evaluates a patient who presents with leg swelling and discomfort. The patient has a history of recent surgery and prolonged immobility. Based on the Wells Criteria for deep vein thrombosis, which of the following would be the MOST relevant factor in assessing the patient's risk for deep vein thrombosis?

1. Body mass index greater than 28
2. Previous history of deep vein thrombosis 10 years ago
3. Previous history of prostate cancer 5 years ago
4. Current diagnosis of cellulitis

The Wells Criteria is an instrument used for patients with a suspected lower extremity deep vein thrombosis (DVT). The instrument categorizes patients as low, moderate or high risk based on various clinical criteria. The level of risk assists therapists in determining if the patient should be referred for further diagnostic testing.

Let’s explore each of the options:
Option 1 - Body mass index (BMI) greater than 28
While BMI itself is not directly listed in the Wells Criteria for DVT, obesity is an important risk factor in general for clot formation. Clinicians should still consider it when assessing a patient's overall risk. However, obesity is typically classified as a BMI of 30 or greater. A BMI of 28 would be classified as “overweight.”

Option 2 - Previous history of DVT 10 years ago
Previous history of a DVT is one of the risk factors that is considered as part of the Wells Criteria. The fact that this patient had a DVT several years ago does not change its relevance as a risk factor.

Option 3 - Previous history of prostate cancer 5 years ago
Previous history of cancer is not a risk factor that is considered as part of the Wells Criteria. However, having active cancer (defined as receiving treatment for cancer in the previous six months or currently receiving palliative treatment) would be considered a relevant risk factor.

Option 4 - Current diagnosis of cellulitis
A current diagnosis of cellulitis is not a factor that increases the likelihood of a DVT using the Wells Criteria. 

In fact, alternative diagnoses that could more likely explain the patient’s symptoms, such as cellulitis, a calf strain or normal post-operative swelling, would serve to reduce the likelihood of a DVT when using Wells Criteria.

The correct answer is Option 2

Let’s explore the all student data:
5% of students selected Option 1, Body mass index (BMI) greater than 28
60% of students selected Option 2, Previous history of DVT 10 years ago - the correct response
20% of students selected Option 3, Previous history of prostate cancer 5 years ago
10% of students selected Option 4, Current diagnosis of cellulitis

System Classification
This question is a Cardiovascular and Pulmonary Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out page 412 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!