American Board of Internal Medicine (ABIM) Certification Practice Exam

According to the Well's score, which symptom scores a point for DVT assessment?

1. Calf swelling ≥3cm

2. History of hypertension

3. Leg cramps

4. Fever

The correct answer is: Calf swelling ≥3cm

The Wells score is a clinical prediction tool used to assess the risk of deep vein thrombosis (DVT) in patients based on various clinical criteria. Each criterion carries a specific point value that contributes to the overall score, helping clinicians decide on the likelihood of DVT in a patient. In the case of calf swelling, a difference of 3 cm or more when measuring the affected leg against the other leg is indeed a key component of the Wells score and is considered a strong indicator of DVT. This measure reflects objective swelling that could be due to thrombus formation preventing proper venous drainage and leading to local edema. Other options, such as a history of hypertension or leg cramps, do not directly indicate the presence of DVT and are not scored in the Wells criteria. Fever, while it may be associated with other conditions, is also not a symptom estimated in the context of DVT risk assessment using the Wells score. Therefore, calf swelling of at least 3 cm is a clinically relevant sign that contributes to evaluating the possibility of deep vein thrombosis effectively.