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

1. This image shows the sequence of a guided procedure in a patient with rheumatoid arthritis and a mass of the right shoulder. Although guided aspiration was useful for the fluid examination, surgery was performed for a definitive diagnosis of the acromioclavicular cyst. Which condition is the finding MOST associated with this pathology?

A) Humeral head fracture
B) Chondrocalcinosis
C) Amyloidosis
D) Rotator cuff tear

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

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

3. Based on this longitudinal view of the anterior hip in a patient with hip pain, which statement is CORRECT?

A) The patient has hip synovitis and should be aspirated for synovial fluid analysis and culture and injected with corticosteroids.
B) The patient has a normal hip joint.
C) The patient should be referred for plain radiography to evaluate for femoral neck fracture.
D) The patient should be referred for MRI to confirm a paralabral cyst and evaluate for labral tear.

4. 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) Intrasubstance tear
D) Impingement

5. 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) Psoriatic arthritis
B) Rheumatoid arthritis
C) Gout
D) Calcium pyrophosphate arthritis

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