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

1. In this image of a knee, what is the MOST obvious abnormality?

A) Chondrocalcinosis
B) Cartilage interface sign
C) Avascular necrosis
D) Asymmetric femoral cartilage thinning

2. A 62-year-old man presents with left shoulder pain. The ultrasound image was taken at the patient's maximum abduction (45 degrees). Which of the following rotator cuff pathologies is BEST evaluated with this shoulder position?

A) Complete tear
B) Enthesopathy
C) Impingement
D) Intrasubstance tear

3. The orthogonal images of a supraspinatus tendon shown here are MOST consistent with which of the following?

A) Tendon tear
B) Artifact from transducer placement
C) Normal tendon variability
D) Tendinopathy

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) Low-grade synovial hyperemia is found in most patients in clinical remission from rheumatoid arthritis.
C) Hyperemia is suggestive of a septic joint and requires further diagnostic testing.
D) A positive Doppler signal is a predictor of future joint damage.

5. A woman with a history of long-standing rheumatoid arthritis presents with persistent, chronic wrist pain and swelling. What do the patient's ultrasound images demonstrate?

A) Extensor tenosynovitis
B) Extensor tendon tear
C) Ganglion cyst rupture
D) Rheumatoid nodulosis

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