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

2. What is the MAXIMUM normal dimension of the structure indicated by the line in this image?

A) 7 mm in adults
B) 7 mm in children less than 5 years old
C) 9 mm in children less than 5 years old
D) 9 mm in adults

3. 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) Psoriatic arthritis
C) Gout
D) Calcium pyrophosphate arthritis

4. A practitioner wants to assess the structure marked with an asterisk (*).

What maneuver should the practitioner instruct the patient to perform of the examined joint?

A) Internal rotation and adduction
B) Neutral position
C) External rotation
D) Lateral abduction

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

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