WELLS score

Question 1

What is the wells score

Answer 1

risk of developing DVT

Question 2

What are the three categories of questions to ask about a DVT?

Answer 2

history presenting complaint
PMH
SH

Question 3

What is asked about for Hx PC for Wells 6

Answer 3

CLIP PEC
Calf swelling 3cm larger than asymptomatic side
Localised tenderness
Immobilisation of lower limb recently
Paralysis, paresis (weakness)

Pitting oedema on symptomatic leg only
Entire leg swollen
Collateral superficial veins (not varicose which are deep veins)

Question 4

What is asked about for PMH for Wells 3

Answer 4

previous DVT
recently bed ridden for 3+ days or major surgeries in past 3 months required general/ regional anaesthesia
active cancers and treatment for them currently, within past 6 months or palliative

Question 5

What is asked about for SHx for Wells 3

Answer 5

long haul flights
hormone replacement therapy or oral contraceptive pill
smoking

Question 6

What wells score means DVT is likely and DVT is unlikely and what is the investigation for each

Answer 6

0 unlikely
1 moderate risk
2+ likely

0-1 do D-dimer only
2+ do D-dimer and doppler USS

Question 7

What medications can be given for likely DVT in the Wells score 3

Answer 7

LMWH eg dalteparin
anticoagulant eg warfarin with INR between 2-3/ DOAC eg apixiban

Question 8

What is the lifestyle advice and non-pharmalogical advice in regards to the Wells score 4

Answer 8

diet
exercise
smoking cessation
compression stockings

Question 9

Pros and cons of d-dimer

Answer 9

high specificity (for DVT so if negative, can be ruled out)
low sensitivity (not diagnostic if positive)