Fact or Fib ? varicose veins, spider angiomas, deep vein thrombosis
Vol.19, No.08, October 2011

This quiz is just for fun. Some of the clinical statements below are true, and some are just us pulling your leg. See if you can distinguish the facts from the fibs on varicose veins, spider angiomas and deep vein thrombosis.

1. Varicose veins

True / False

Usually occur in people with chronic venous insufficiency.

b) Often run in families.

c) Stasis dermatitis and skin colour changes are extremely common around varicose veins.

d) Trendelenburg’s test, a venous filling test using a thigh tourniquet, is the commonest method of diagnosis.

e) May be treated with vein stripping as only about 10% of blood return in the legs is through the superficial veins.

f) Endovenous laser treatment is nowadays more common than surgery or sclerotherapy.

g) Can develop fragile venous bullae in the skin, which have been known to cause fatality through undetected bleeding at night.


2. Spider angiomas

True / False

Are sometimes referred to as spider telangiectasias or spider nevi.

b) Are commonly seen on the face, neck, trunk and legs.

c) Are common in children.

d) Are associated with high levels of estrogen in the blood, and are more common in women taking oral contraceptives.

e) Do not resolve spontaneously.

f) Momentary pressure in the centre should drain the radiating veins, which will refill upon release.

g) Multiple spider angiomas are often a sign of liver disease.


3. Deep vein thrombosis

True / False

In surgical patients, calf DVT is 5 times more common than proximal DVT.

b) Upper extremity DVT is generally associated with superior vena cava syndrome.

c) About half of patients with DVT have occult pulmonary embolism.

d) Other common complications are chronic venous insufficiency and postphlebitic syndrome.

e) Homans’ sign (ankle dorsiflexion with knee extended) is both sensitive and specific in DVT diagnosis.

f) d-dimer is the gold standard of diagnosis.

g) Contrast venography is the gold standard of diagnosis.


1. Varicose veins: (a) False, most cases are idiopathic and occur in people with no risk factors; (b) True; (c) False, this is surprisingly uncommon; (d) False, this test for retrograde blood flow past incompetent saphenous valves is rarely used today, ultrasound is the most common diagnostic tool; (e) True; (f) False, laser treatment is still comparatively rare and unproven; (g) True, though rare.

2. Spider angiomas: (a) True; (b) False, they aren’t generally seen on the legs, but are common on the arms, and in children, on the hands; (c) True; (d) True; (e) False, they often resolve spontaneously, especially when estrogen levels fall; (f) True; (g) True.

3. In deep vein thrombosis: (a) True; (b) False, superior vena cava syndrome is one possible cause, but most arm DVT follows endothelial injury from catheter, pacemaker, or intravenous drug use; (c) True; (d) True; (e) False, it is neither sensitive nor specific; (f) False, at best normal d-dimer can rule out DVT in low-risk patients; (g) False, venography is the most accurate test, but is too invasive and ultrasound has largely replaced it, being almost as accurate with far fewer risks.


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