American College of Rheumatology RhMSUS

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

1. 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) 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
C) 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
D) Warm, swollen elbow joint in a 70-year-old lymphoma patient with fevers and a history of an abscess of the thoracic spine

2. A practitioner wants to assess the structure marked with an asterisk (*).

What maneuver should the practitioner instruct the patient to perform of the examined joint?

A) External rotation
B) Internal rotation and adduction
C) Lateral abduction
D) Neutral position

3. In imaging the volar wrist in transverse, this Doppler view helps confirm the presence of which of the following?

A) Flexor tenosynovitis
B) Persistent median artery
C) Median nerve impingement
D) Anomalous radial artery

4. This suprapatellar longitudinal scan in a 3-year-old girl is MOST consistent with which of the following?

A) Chondromalacia of the patella
B) Quadriceps tendinopathy with acoustic shadow
C) Normal anatomy for age
D) An effusion of the suprapatellar recess

5. An 83-year-old female with a medical history of congestive heart failure, critical aortic stenosis, end-stage renal disease, and morbid obesity presents to the office with a complaint of right knee pain for two years. The pain is worse with activity and better with rest. She notes no redness, warmth, or swelling in the joint, with no other joints being painful. A physical examination reveals crepitus in the right knee with medial and lateral joint line tenderness of the left knee. X-rays of the right knee from six months ago are consistent with severe tricompartmental osteoarthritis. Due to morbid obesity, visualization of bony landmarks is not possible and the decision is made to proceed with an ultrasound-guided knee injection with a hyaluronic acid derivative.
Prior to injection, where should the needle tip be visualized?

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

Solutions: