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American College of Rheumatology RhMSUS Exam Syllabus Topics:

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

1. For which of the following conditions is the use of diagnostic musculoskeletal ultrasound appropriate?

A) Meniscal tear
B) Osgood-Schlatter disease
C) Tibial stress fracture
D) Anterior cruciate ligament tear

2. Which of the following protocols would be MOST consistent with a complete routine ultrasound examination of the shoulder?

A) Anterior long- and short-axis views of the biceps tendon
oAnterior view of the rotator cuff interval
oLong- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oDynamic lateral long-axis assessment of impingement with abduction of the arm oPosterior transverse view of the suprascapular notch oView from cranial at the acromioclavicular joint
B) Anterior long- and short-axis views of the biceps tendon
oAnterior view of the rotator cuff interval
oLateral views of the subscapularis tendon
oLateral long- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oPosterior view of the glenohumeral joint recess oDynamic lateral long-axis assessment of impingement with abduction of the arm
C) Anterior long- and short-axis views of the biceps tendon
oAnterior view of the subscapularis tendon in external rotation
oLong- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oPosterolateral view of the infraspinatus tendon oPosterior view of the glenohumeral joint recess oView from cranial at the acromioclavicular joint
D) Anterior long- and short-axis views of the biceps tendon
oAnterior views of the pectoralis tendon insertion
oAnterior view of the coracoid ligament and rotator cuff interval
oLong- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oPosterior long- and short-axis views of the infraspinatus tendon insertion oAxillary long-axis view with arm raised

3. What is the appropriate image documentation for an ultrasound study evaluating sonographic synovitis in bilateral hand and wrist joints in a patient with rheumatoid arthritis?

A) Representative sonographic image example of power Doppler and gray-scale synovitis supplemented by a detailed report of each examined joint
B) Images of the sonographic views with the presence of power Doppler synovitis only
C) All appropriate sonographic views of every joint examined
D) Images of the sonographic views with the presence of power Doppler and/or gray-scale synovitis only

4. Proper maintenance of ultrasound equipment between use for each patient is important to prevent which of the following?

A) Poor calibration
B) Examiner injury
C) Radiation exposure
D) Infection

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

Solutions: