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

1. The second finger was examined. Which of the following is shown in the image below?

A) Metacarpophalangeal, palmar longitudinal view
B) Proximal interphalangeal, dorsal longitudinal view
C) Metacarpophalangeal, dorsal longitudinal view
D) Proximal interphalangeal, palmar longitudinal view

2. Ultrasound is the MOST appropriate tool to evaluate which of these structures for pathology?

A) Achilles tendon insertion site in a patient with spondyloarthropathy, assessing for enthesopathy
B) Sacroiliac joint in a patient with positive HLA B27 and inflammatory-type lower back pain, assessing for joint space narrowing
C) Temporomandibular joint in a patient with juvenile idiopathic arthritis, assessing for erosions
D) Cartilage loss quantification in a patient with osteoarthritis

3. What is the position of the arm MOST likely used to obtain this B-Mode image of the shoulder?

A) External rotation
B) Crass
C) Modified Crass
D) Neer impingement

4. A 38-year-old woman with recent history of right shoulder subacromial impingement presents for a two-week follow-up after an anatomically guided subacromial/subdeltoid corticosteroid injection. She reports some initial, but only short-lived, improvement of her right shoulder pain and discomfort with arm elevation.
Her right shoulder X-rays are normal. What would be the MOST appropriate next intervention?

A) Referral to occupational therapy for shoulder rehabilitation exercise
B) Ultrasound-guided corticosteroid injection of the glenohumeral joint
C) Ultrasound-guided corticosteroid injection of the right shoulder subacromial/subdeltoid bursa
D) Anatomically guided corticosteroid reinjection of the right shoulder subacromial/subdeltoid bursa

5. Which of the following structures for injection has the BEST evidence for the superiority of ultrasound guidance over palpation alone?

A) Trochanteric bursa
B) Flexor digitorum tendon at the A1 pulley
C) Glenohumeral joint
D) Subacromial bursa

Solutions: