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OB First Trimester Written Comp

Student Name: Shelby Rhoda Date Submitted: 10/4/16


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:
Age: 32
Sex: Female
Ethnicity: African American
Symptoms: vaginal bleeding, abdomen pain mainly on right side, nausea, vomiting
History: ovarian cysts

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:
Hematocrit: 35.2 (low) this can indicate that the patient is losing blood in some way
HCG Quantitative: 125,798 (normal) this correlates with the patients pregnancy
Positive HCG Qualitative this verifies that the patient is pregnant
LMP: unknown due to irregular bleeding
EDD: 05/12/17

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:
Previous exams:
Ultrasound of the gallbladder to evaluate for the right sided abdomen pain. The results of
this exam was within normal limits.

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OB First Trimester 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 symptoms of bleeding and a low HCT this leads me to expect a possible
hemorrhage. The abdomen pain and history of ovarian cysts leads me to expect to possible
see a possible ovarian cyst causing pain on the right side.

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 identified the patient by checking the patients wrist band with her name, date of
birth, and MRN number. I also asked the patient to state her birthday so that I could check
that I had the right test selected on the machine for the exam. I explained to the patient that
I was going to begin the ultrasound by taking images transabdominally. I also explained that
if I could not see everything well enough transabdominally that I would have to perform a
transvaginal exam to get a better look at the uterus and ovaries and their contents. I set the
patient up by having her lay flat and legs stretched on with her pants lowered to her hips. I
then explained that my gel was warm and also gave her a towel to tuck into her pants to
prevent getting gel on them while I was scanning. For the transvaginal exam, I had the
patient empty her bladder and undress from the waist down. I placed a wedge under the
patient to elevate her hips for optimal scanning.

Grade for
Section 3

During the Exam: Sonographic findings of structures, pathologies,


measurements, and instrumentation
Section 4:
Identify the sonographic features of the maternal/fetal structures to include: uterus sagittal
midline, gestational sac transverse mid, and fetal pole crown rump length (CRL)
Answer:
Uterus Sagittal Midline: the uterus was homogeneous medium shades of gray with a
gestational sac and contents in the upper portion of the uterus.
Gestational Sac Trv Mid: the sac was located within the upper portion of the uterus as an
anechoic structure with a hyperechoic ring all the way around it with a hypoechoic area seen
lateral to the sac and the fetal pole, yolk sac and amnion was visualized within the sac.

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OB First Trimester Written Comp

Fetal Pole CRL: the fetal pole was seen as an echogenic structure with a crown rump length
of 1.25 cm correlating with a gestational age of 7 weeks and 3 days.

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:
Heart Rate: 141.6 bpm
CRL: 1.25 cm = 7 weeks 3 days
Yolk Sac: 0.24 cm
Right Ovary: 3.9 x 2.2 x 2.3 cm
Left Ovary: 3.1 x 1.4 x 1.7 cm
Uterus: 10.2 x 6.4 x 8.4 cm
All measurements are normal.

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:
Hypoechoic area noted inferior and lateral to gestational sac measuring 3.4 x 0.8 x 2.9 cm
with no internal vascularity representing a subchorionic hemorrhage.
A complex cyst on the right ovary measuring 2.8 x 2.1 x 2.3 cm with ring of fire vascularity
and a mild amount of free fluid adjacent to it in the right adnexa representing a possible
corpus luteal cyst.

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:
Preset: OB 1st trimester was used because this preset correlates with the exam being
performed.
Transducer: C1-5 curvilinear probe used for the transabdominal imaging and the 1C5-9 probe

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OB First Trimester Written Comp

used for the transvaginal imaging


Frequency: 4.7 MHz used for the transabdominal and 4.2 MHz used for the transvaginal
imaging, both to penetrate to visualize the uterus as a whole and all of its contents as well
as provide a big enough field of view.

For your fetal heart and chest documenting heart rate with M-mode, identify depth and focal
zone(s) used and why they were correct.
Answer:
Depth of 3 cm on a zoomed image of the heart to best interpret the M-Mode reading and no
focal zones are seen due to the zoomed image. This is correct because the image needs to
be zoomed onto the fetal heart to receive an accurate heart rate by the M-Mode tracing.

For your gestational sac sagittal mid, identify depth and focal zone(s) used and why they
were correct.
Answer:
Depth of 8 cm to visualize the gestational sac in its entirety and also evaluate the
surrounding area.
Focal zones placed at 4 cm to focus the sound beams just posterior to the gestational sac.

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 reported to the sonographer that I saw a hypoechoic area adjacent to the gestational sac
possibly representing a subchorionic hemorrhage. I also mentioned the complex cystic area
seen on the right ovary that could be the remnant of a corpus luteal cyst.

Grade for
Section 8

Section 9:
What was the physicians interpretation of the exam?
Answer:
A single living intrauterine pregnancy with estimated gestational age of 7 weeks 3 days.
Subchorionic hemorrhage super and inferior to gestational sac. The physician also confirmed
the presence of a corpus luteal cyst on the right ovary.

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OB First Trimester Written Comp

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)
Answer:
I agree with the physician because the information reported correlates correctly with the
findings of the ultrasound.

Grade for
Section 10

Clinical Site: BMH Memphis


Sonographer with credentials Courtney Caccamisi, RDMS(AB)(OB/GYN),
and specialties: RVT(VT)
Patient MRN: 1C11932253
Exam order on request: US OB Transvaginal
Performance date of final scan 9/26/16
comp:
Is this a second attempt written No
comp?

Points Description
5 No errors were identified
4 One error was identified
3 Errors identified In less than the of the components required
2 Errors identified In up to s of the components required
1 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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