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

1. Based on this longitudinal view of the anterior hip in a patient with hip pain, which statement is CORRECT?

A) The patient should be referred for MRI to confirm a paralabral cyst and evaluate for labral tear.
B) The patient should be referred for plain radiography to evaluate for femoral neck fracture.
C) The patient has hip synovitis and should be aspirated for synovial fluid analysis and culture and injected with corticosteroids.
D) The patient has a normal hip joint.

2. For an ultrasound examination, how should the patient, ultrasound machine, and examiner be oriented?

A) The examiner is between the patient and the monitor.
B) The examiner is closest to the limb of the patient being scanned while facing toward the monitor.
C) The monitor is between the patient and the examiner.
D) The monitor is on the left of the patient for a left-handed examiner.

3. A practitioner obtains this image of a metacarpophalangeal joint of a patient with periodic joint swelling and warmth. Which of the following is the MOST likely diagnosis?

A) Rheumatoid arthritis
B) Spondylarthritis
C) Osteoarthritis
D) Gouty arthritis

4. A practitioner is counseling a patient with suspected rotator cuff tendinopathy on imaging options. Which of the following is CORRECT regarding diagnostic ultrasound examination?

A) It obviates the need for X-ray examination when cortical margins are normal.
B) It uses sound energy with no adverse effects found in clinical studies.
C) It is the gold standard for preoperative planning for rotator cuff surgery.
D) It provides the same information as an MRI without gadolinium.

5. A 80-year-old man presents with two weeks of wrist swelling and pain. His exam reveals swelling and tenderness over the dorsum of his right wrist as well as synovial swelling of the second and third metacarpophalangeal joints of his left hand. His serum uric acid concentration is 6.0 mg/dL. The longitudinal and transverse images of the dorsal aspect of his right wrist are shown below. What is the MOST likely diagnosis?

A) Rheumatoid arthritis
B) Calcium pyrophosphate arthritis
C) Gout
D) Psoriatic arthritis

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