Code Status case · Advanced · Free
Leg pain in a 34-year-old woman
“My calf has been swollen and painful for a couple of days. I thought it would just go away.”
“Two days of right calf pain and swelling. No chest pain or shortness of breath. She's comfortable and her vitals are stable.”
Your challenge
A painful, swollen calf could be a strained muscle, a skin infection, a cyst behind the knee or a blood clot. Maya is comfortable, her vitals are normal, and she thought it would just go away. How likely you think each cause is should decide which test comes first, and a normal result does not always mean what it seems. The harder part comes after you make your plan.
After the case, Attending’s Notes explains the decisions that mattered, backed by 11 sources.
Ready to make the call?
This case is one of the two free cases.
Spoiler: the diagnosis and what this case teaches
Diagnosis
Lower Extremity DVT
Lesson 1
Estimate the Chance of DVT Before Testing
How likely DVT is decides whether to start with D-dimer or ultrasound.
- One swollen calf plus risk factors suggests DVT
- A negative D-dimer can exclude DVT when risk is low
- If DVT risk is low, age-adjust D-dimer after 50
- Order ultrasound first when DVT is likely
Lesson 2
A Negative Leg Ultrasound Can Miss Some Clots
The result applies to the veins actually examined.
- A vein that will not compress suggests a clot
- Proximal DVT carries more PE risk
- Repeat ultrasound if DVT concern stays high
- Leg ultrasound can miss iliac and pelvic clots
Lesson 3
Choose the Anticoagulant
Most DVTs need anticoagulation but the right drug depends on the patient.
- Direct oral anticoagulants suit most patients with DVT
- Apixaban and rivaroxaban can start without heparin
- Pregnancy or severe renal disease can alter treatment
- Check cancer bleeding risks and drug interactions
Lesson 4
Home Treatment Requires Stability and Follow-up
Decide why the clot happened, how long to treat it, and whether home is safe.
- Ongoing clotting risks raise the chance of another clot
- If anticoagulating DVT, treat for at least 3 months
- Most stable patients with low-risk DVT can go home
- Assess new dyspnea or a dusky swollen leg urgently
In the app, every line above opens into the detail behind it: doses, pitfalls and the evidence, with 11 sources linked to the originals.
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All 30 casesMaya is a fictional patient. Code Status is for training only and is not intended for real-world patient care, diagnosis, treatment, or clinical decision-making.