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DVT rule-out — MRCGP AKT MCQ

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HardInfectious DiseasesDVT rule-outMRCGP AKTUKMLAPARA

A patient with a DVT-likely Wells score has a negative initial proximal leg-vein ultrasound but a positive D-dimer. Interim anticoagulation was started while testing was arranged. What is the next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Stop interim anticoagulation and repeat proximal ultrasound in 6 to 8 days

B is correct. After a negative initial proximal ultrasound with a positive D-dimer, NICE advises stopping interim therapeutic anticoagulation, unless it is required for another indication, and repeating proximal ultrasound in 6 to 8 days. A both continues unconfirmed treatment and delays repeat imaging far beyond the specified interval. C substitutes a non-specific blood test for imaging that can detect propagation. D uses CT venography rather than the specified repeat proximal ultrasound. E both continues interim treatment and substitutes serial D-dimer testing for definitive imaging.

Reference: NICE NG158: venous thromboembolic diseases: https://www.nice.org.uk/guidance/ng158/chapter/Recommendations GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map