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

1. Which of the following anatomic structures BEST fits the scope of rheumatologic ultrasound practice?

A) Anterior glenoid labrum
B) Posterior cruciate ligament
C) Posterior patellar cartilage
D) Metacarpal volar plate

2. The best way to facilitate visualization of ultrasound images in an exam room.

A) Dim the exam room lighting to improve the signal-to-noise ratio (This is the best answer)
B) Decrease the amount of gel in between transducer and skin to improve transmission of sound waves
C) Brighten the ambient lighting to improve the signal-to-noise ratio
D) Decrease high-frequency ambient noise to minimize interfering sound waves

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

4. Gray-scale and Doppler ultrasound evaluation examination alone would BEST assist in establishing a diagnosis in which of the following scenarios?

A) Sacroiliac joints in a 35-year-old male with early morning low-back pain and positive HLA B27
B) Warm, swollen elbow joint in a 70-year-old lymphoma patient with fevers and a history of an abscess of the thoracic spine
C) Asymptomatic hand and wrist joints with bony deformities present in a 60-year-old female with a positive rheumatoid factor and CCP antibody but normal sedimentation rate and C-reactive protein level
D) Knee in a 72-year-old female with unilateral knee pain, no swelling on examination, and medial narrowing of the joint space on knee radiograph

5. 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) C
B) D
C) B
D) A

Solutions: