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

1. A 37-year-old female with a history of rheumatoid arthritis presents for sonographic evaluation. She has been in clinical remission for six months and is considering discontinuation of her biologic agent. Sonography of the right third metacarpophalangeal joint is shown. Which of the following is the MOST accurate description regarding this image?

A) Abnormal hypoechoic extra-articular tissue with Doppler signal
B) Abnormal hyperechoic intra-articular tissue with Doppler signal
C) Abnormal hypoechoic intra-articular tissue with Doppler signal
D) Abnormal hyperechoic extra-articular tissue with Doppler signal

2. 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) Psoriatic arthritis
D) Gout

3. This posterior transverse scan of the shoulder of a 3-year-old boy shows which of the following?

A) Effusion with an erosion of the humeral head
B) Fracture of the humeral head
C) Effusion of the glenohumeral joint
D) Normal shoulder scan

4. A 41-year-old man presents with suspected right carpal tunnel syndrome but normal nerve conduction studies. For which reason will a sonographic study be helpful for further diagnostic evaluation?

A) Ultrasound can identify the underlying etiology of carpal tunnel syndrome.
B) Ultrasound can delineate volar wrist anatomy.
C) Compared to nerve conduction studies, ultrasound is more sensitive for the diagnosis of mild carpal tunnel syndrome.
D) Concurrent use of nerve conduction studies and ultrasonography increases diagnostic sensitivity of mild carpal tunnel syndrome.

5. A 3-year-old child with juvenile idiopathic arthritis presents for an intra-articular corticosteroid injection of the knee. Using ultrasound guidance, which location should be targeted with a needle?

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

Solutions: