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Fetal Spine and Extremities Written Comp

Student Name: Kristen Cherry

Date Submitted: 02/09/2015

Directions:

Students are required to complete each area based on the scan comp completed to
receive maximum points.
There are 10 sections; each section is worth a maximum of 5 points. Answers
provided must relate to specific information requested. Additional information
including non-applicable information will result in point deduction

Before the exam: Patient Interview, Chart Review, Possible Pathology, Patient Set
Up, and Preparation
Section 1:
Identify the patients age, sex, ethnicity, current symptoms and pertinent history relevant to
the exam.
Answer:
The patient was a 24 year old Caucasian female. The patient was experiencing no
symptoms, and was having a routine anatomy scan. She was a gravida two, para one. Her
current pregnancy had a gestational age of 19w2d. She had a history of diabetes and
anemia.
Identify the patients labs relevant to the exam (as high, low, or normal) and explain what
the patients lab values indicate.
If the patient had no labs, identify the labs relevant to the exam (with normal values) and
explain what deviations in these lab values indicate.
Answer:
The patient had a positive qualitative hCG-urine pregnancy test. This value is either
positive or negative and indicates if the patient is pregnant or not. She also had a positive
quantitative hCG-blood pregnancy test. This value is either positive or negative, and
indicates the same thing. The patient had not had the AFP blood test, or a Triple or Quad
Screen done at this time. High AFP levels indicate open neural tube defects, and low levels
indicate Downs Syndrome. The Triple and Quad Screen exams are used to detect
chromosome abnormalities.
Identify the patients previous exams and results relevant to the exam.
If the patient had no previous exams, identify one other imaging modality that could be used
to evaluate your patients symptoms. Explain why this modality would be used in
conjunction with sonography.
Answer:
The patient had a previous exam performed on 11/13/2014 for a first trimester
confirmation. The crown rump length revealed a gestational age of 8w4d, which was earlier
than the patients previously stated LMP. She had given a LMP of 8/25/2014. The ultrasound
revealed a single IUP with a normal fetal heart rate of 175 BMP. A yolk sac was visualized as
well as a corpus luteum on the right ovary measuring 1.5 cm. Both of these findings were
within normal limits. Her uterus and ovaries measured normal. No masses or abnormalities
were visualized in either adnexa.

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Fetal Spine and Extremities Written Comp


Grade for
Section 1
Section 2:
Based on the patients clinical history, labs, and previous exams and results, what did you
expect to find during this exam and why?
Answer:
Based on the patients clinical history, labs, and previous exams and results, I expected
to find a single fetus in a variable position within the uterus. I expected that the fetus would
be growing correctly and according to the estimated due date. I also expected that all parts
of the extremities and spinal column would be able to be individually evaluated, and would
appear within normal limitsall connections between each section of the upper extremities,
(humerus, rad/ulns, metacarpals and digits), and the lower extremities (femurs, tib/fibs,
metatarsals, digits), and the correct number and alignment of each section of spine (c spine
7, t spine12, l spine5, s spine5, coccyx). I also expected for the shape of the long
bones to appear normally, since the patient had no family history or previous history of
genetic diseases or chromosome abnormalities.
Grade for
Section 2
Section 3:
Describe how you identified the patient and educated the patient on the exam being
performed.
Identify the patient set up, and exam preparation.
Answer:
I obtained the patients chart and checked her name and date of birth. I went to the
waiting room and called the patients name. When she made it to the door, I introduced
myself and asked her to follow me back to the ultrasound room. Once in the room I asked
her to verbally verify her name and date of birth. I then matched this information to the
information on the patient chart and to the information that was on the machine worklist. I
told the patient that I am a senior student sonographer, and that if it was alright with her, Id
be performing her exam. I told her that the exam would probably take about 45 minutes,
because it was a full anatomy scan. I told her that we would be evaluating all of the babys
anatomy, including head and facial structures, abdominal organs, heart, extremities, and
spine, as well as examine the placenta and the cervix. I said that the sonographer would
review my images and possibly scan after me. I said that once we were both finished, we
would get a report over to her doctor who would come talk to her once she was moved to a
room.
The patient was supine in the exam chair, with her head not quite all the way back as to
prevent her from getting dizzy or short of breath. The exam paper on the table had been
changed after the previous patient had left the exam room. The transducer had also been
cleaned with the correct disinfectant wipes after the previous patient was scanned. A sheet
was tucked into the front of the patients pants to prevent gel from getting on her clothes.
Grade for
Section 3

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Fetal Spine and Extremities Written Comp


During the Exam: Sonographic findings of structures, pathologies,
measurements, and instrumentation
Section 4:
Identify the sonographic features of the fetal structures to include: sagittal CSP, transverse
TSP, and sagittal LSP.
Answer:
SAG C SP

5 cervical vertebrae that were properly aligned with one another

Hyperechoic with posterior shadowing

Full shape of each vertebrae (no flattening)

TX T SP

Three vertebral points at the level of the heart, indicating thoracic vertebrae

Hyperechoic with posterior shadowing

Hyperechoic ribs visualized on each side of the vertebrae encasing the thoracic cavity

SAG LS SP

5 lumbar and 5 sacral vertebrae that were properly aligned with one another, and the
coccyx bringing the vertebral column down to a point

Hyperechoic with posterior shadowing


Grade for
Section 4

Section 5:
Identify all protocol measurements obtained and identify if the measurement is normal or
abnormal. If abnormal, what is indicated?
Answer:
No measurements were required for this exam.
Grade for
Section 5
Section 6:
Identify the pathology documented during the exam, including location, size, vascularity,
and sonographic features.
If no pathology is seen, identify a common pathology seen with this exam and how you
would need to modify your protocol to document this pathology.
Answer:
There were no pathologies visualized during this exam. A common pathology that may be
seen when examining the spine and extremities is clinodactyly. This is a curvature of a digit,
usually the fifth, towards the adjacent fourth digit. It often occurs along with other
abnormalities in many genetic syndromes, such as Trisomy 21.

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Fetal Spine and Extremities Written Comp


If this pathology was seen while scanning the patient, protocol changes would need to be
made. Clear delineation of the curved digit would need to be demonstrated in the images so
that the doctor could say for sure it was clinodactyly. Also, other areas of the fetus would
need to be evaluated more in depth to ensure no corresponding abnormalities are present.
Grade for
Section 6
Section 7:
Identify the ultrasound preset, transducer, and frequency utilized to provide diagnostic
images and why the specific instrumentation was correct.
Answer:
PresetObstetric 2/3 routine

This is correct, because this preset has optimal resolution for good visualization of
small structures, such as vertebrae, digits, and the boundaries at the end of long
bones. It allows a very thorough check for fetal pathologies.

TransducerC-1-5

This is correct, because it allows for good penetration when looking at fetal structures
deep within the mothers abdomen. It also has a wide field of view. This allows for
large portions of the baby to be visualized and included in each image if needed.

Frequency3 MHz

This is correct, because it is the best choice for penetration and resolution working
together. It is a lower frequency which allows for penetration through the mothers
abdomen, and different structures of the baby, while maintaining good resolution for
borders and small pathologies.

For your fetal upper extremity longitudinal right ulna/radius image, identify depth and focal
zone(s) used and why they were correct.
Answer:
Depth10 cm

This is correct, because it includes the entire portion of the upper extremity in the
image, making sure to include all borders of the skin lines.

Focal Zone6 cm

This is correct, because the best resolution is at the level of the ulna and radius,
ensuring that both bones are completely visualized to rule out abnormalities like
possible chromosome issues.

For your transverse LS-SP, identify depth and focal zone(s) used and why they were correct.
Answer:
Depth12 cm

This is correct, because it goes just a couple of centimeters beyond the inferior part
of the fetus to show the full length of the L/S spine. This allows visualization of any
spinal abnormalities, which are common in this area.

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Fetal Spine and Extremities Written Comp


Focal Zone6 cm

This is correct, because it ensures that the best resolution in the image is focused on
the spine. This is very beneficial when examining the tiny vertebrae for anomalies
such as hemivertebrae.
Grade for
Section 7

Exam Findings: Students Preliminary Report and Physicians Interpretation


Section 8:
What did you report to the sonographer and/or physician regarding the exam and describe
your interaction.
Answer:
I told the sonographer that the spine and all extremities appeared normal at the end of
the exam. I said that I could demonstrate a clear connection between all sections of the
upper and lower extremities on both the left and the right. I said that all the long bones
appeared straight and had no curvature or fractures present. I told her that in sagittal, the
spine had the correct curvature and that I could clearly demonstrate it coming to a closed
point at the coccyx. I also told her that the vertebrae all appeared to have a normal
thickness and shows no signs of platyspondaly. I said that all of them aligned correctly, and
that there was the correct number in each section of the spinec spine 5, t spine 12, l spine
5, s spine 5, and coccyx. I also told her that the skin line was clearly visualized and no
defects were seen here either.
Grade for
Section 8
Section 9:
What was the physicians interpretation of the exam?
Answer:
At MOGA, the sonographers report is the final report. The physician trusts the
sonographers to be detailed in every aspect of the exam that was evaluated, and use their
report to discuss the findings with the patients. So, from the sonographers report, the
doctor reported to the patient that everything appeared normal. The baby was growing at an
appropriate rate for the dates, and heart tones, and all other anatomy appeared normal.
Grade for
Section 9
Section 10:
Do you agree or disagree with the physicians interpretation of the exam and why or why
not? (This must be supported by current literature)

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Fetal Spine and Extremities Written Comp


Answer:
I agree with the interpretation of the exam, because it was the findings that the
sonographer and I reported together. We found that all long bones appeared to be growing
correctly with no curvatures or fractures. All connections in the upper and lower extremities
were demonstrated on both the right and left side of the fetus. We were able to clearly
evaluate all of the sections of spine. Each section had the correct number and alignment of
vertebrae, and no pathophysiological curvature was visualized. The skin line was also clearly
visualized to evaluate for pathologies such as open or closed spinal defects.
Grade for
Section 10
Clinical Site:
Sonographer with credentials
and specialties:

Memphis OB/GYN East


Ruby Morgan
RDMS (AB), (OBGYN)
RVT (VT)

Patient MRN:
Exam order on request:
Performance date of final scan
comp:
Is this a second attempt written
comp?

34911
Fetal Anatomy Survey
1/22/2015
No

Points

Description

No errors were identified

One error was identified

Errors identified In less than the of the components required

Errors identified In up to s of the components required

Immediate action required

errors identified in more than s of the components required

evidence of an unsafe event (unsafe events may result in


failure of the competency)

required image not included

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