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American College of Rheumatology Musculoskeletal Ultrasound Certification in Rheumatology Sample Questions:

1. An 81-year-old male with known shoulder osteoarthritis presents to the office for an ultrasound-guided injection of the glenohumeral joint. Prior to injection, where should the needle tip be visualized?

A) D
B) A
C) C
D) B

2. For which of the following clinical scenarios is it appropriate for a practitioner to perform musculoskeletal ultrasound?

A) A patient with psoriasis and posterior heel pain
B) A 50-year-old woman with pain between the third and fourth metatarsals
C) A 40-year-old man with a snapping sensation in his groin with hip flexion and external rotation
D) A patient who has pain and numbness over the lateral calf

3. A practitioner obtains the following ultrasound image of a patient with a positive rheumatoid factor and normal ESR, CRP, and hand X-rays.

Which of the following options would be an evidence-based statement during a discussion of the management plan?

A) A positive Doppler signal is a predictor of future joint damage.
B) Low-grade synovial hyperemia is found in most patients in clinical remission from rheumatoid arthritis.
C) Severe (high-grade) synovial hyperemia, but not mild (low-grade) hyperemia, would be an indication to change therapy.
D) Hyperemia is suggestive of a septic joint and requires further diagnostic testing.

4. The image below shows the injection of the dorsal wrist region in a patient with rheumatoid arthritis. The needle is indicated by the arrows. Considering the ultrasound findings, which of the following is MOST appropriate in completing the injection?

A) Both the radiocarpal and midcarpal recesses should be targeted.
B) The radiocarpal recess should be the primary target.
C) The fourth compartment ten synovium should be targeted.
D) The midcarpal recess should be the primary target.

5. Which is the MAIN pathologic finding shown by this ultrasound picture in a patient with psoriatic arthritis?

A) Proximal interphalangeal osteophytes
B) Proximal interphalangeal synovitis
C) Flexor tenosynovitis
D) Flexor tendon rupture with reparative hyperemia

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