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

1. Which of the following is shown in this longitudinal image of the talonavicular-cuneiform joints in a
15-year-old girl?

A) An inflammatory process in the subcutaneous tissues, possibly an infection, extending into the joint spaces
B) The typical appearance of pes equinovarus
C) Irregularities of the respective midfoot bones indicative of damage as well as surrounding areas indicative of synovial hypertrophy and effusions
D) The normal appearance of irregular ossification centers of the respective midfoot bones

2. Which of the following is required in a report documenting an ultrasound-guided procedure?

A) Image labeled with exam date, patient identification, image orientation, and image views of the target area
B) Sections detailing medical indication for procedure, study type (limited versus complete), and overall clinical impressions
C) Image showing needle in the target structure or orthogonal images of the target structure before and after injection
D) Section detailing ultrasonographic observations of any variations from the normal accompanied by measurements

3. What should be adjusted to improve the quality of the image of the tibiotalar joint?

A) Focus and map
B) Frame average and frequency
C) Frame average and depths
D) Focus and frequency

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

5. Which of the following should NOT be evaluated using a musculoskeletal ultrasound?"

A) A femoral neck enchondroma in a patient complaining of hip pain
B) Salivary gland parenchyma in a patient suspected of having Sjogren's syndrome
C) Hand joints for progression of erosive disease in a patient with established rheumatoid arthritis
D) A Morton's neuroma in a patient complaining of foot pain

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