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

1. A practitioner obtains this image of a metacarpophalangeal joint of a patient with periodic joint swelling and warmth. Which of the following is the MOST likely diagnosis?

A) Gouty arthritis
B) Osteoarthritis
C) Rheumatoid arthritis
D) Spondylarthritis

2. An 83-year-old female with a medical history of congestive heart failure, critical aortic stenosis, end-stage renal disease, and morbid obesity presents to the office with a complaint of right knee pain for two years. The pain is worse with activity and better with rest. She notes no redness, warmth, or swelling in the joint, with no other joints being painful. A physical examination reveals crepitus in the right knee with medial and lateral joint line tenderness of the left knee. X-rays of the right knee from six months ago are consistent with severe tricompartmental osteoarthritis. Due to morbid obesity, visualization of bony landmarks is not possible and the decision is made to proceed with an ultrasound-guided knee injection with a hyaluronic acid derivative.
Prior to injection, where should the needle tip be visualized?

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

3. Which condition is the ultrasound examination of this nodular structure MOST suggestive of?

A) Subcutaneous abscess
B) Gouty tophus
C) Ganglion cyst
D) Rheumatoid nodule

4. At approximately how many degrees of flexion is the MOST sensitive resting position of the knee for imaging fluid in the suprapatellar recess?

A) 30
B) 15
C) 0
D) 45

5. Which of the following images is MOST consistent with crystal-induced arthropathy?

A) Option B
B) Option D
C) Option A
D) Option C

Solutions: