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

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

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

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

3. Which is the MAIN pathologic finding shown by this ultrasound picture in a patient with psoriatic arthritis?

A) Proximal interphalangeal synovitis
B) Flexor tenosynovitis
C) Flexor tendon rupture with reparative hyperemia
D) Proximal interphalangeal osteophytes

4. Gray-scale and Doppler ultrasound evaluation examination alone would BEST assist in establishing a diagnosis in which of the following scenarios?

A) Asymptomatic hand and wrist joints with bony deformities present in a 60-year-old female with a positive rheumatoid factor and CCP antibody but normal sedimentation rate and C-reactive protein level
B) Warm, swollen elbow joint in a 70-year-old lymphoma patient with fevers and a history of an abscess of the thoracic spine
C) Knee in a 72-year-old female with unilateral knee pain, no swelling on examination, and medial narrowing of the joint space on knee radiograph
D) Sacroiliac joints in a 35-year-old male with early morning low-back pain and positive HLA B27

5. In this volar transverse image of the carpal tunnel, the arrows represent needles, and the arrowheads represent the needle tips. In planning a carpal tunnel corticosteroid injection with ultrasound guidance, which of the arrows combines the safest path through tissues with the BEST needle visualization?

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

Solutions: