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

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

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

2. What should be taken into consideration prior to any procedure?

A) The transducer should be aligned perpendicular to the plane of the needle.
B) The needle should be visualized only prior to its insertion to the target area.
C) A slight to-and-fro movement or injection of a small amount of lidocaine may be beneficial in visualizing the needle.
D) The shortest pathway to the region of interest should be selected with consideration given to adjacent neurovascular structures.

3. Which of the following is the MOST appropriate approach to use when performing an ultrasound-guided aspiration on a Baker's cyst in the posterior knee of a 76-year-old female patient?

A) A posteromedial approach at the level of the mid-gastrocnemius muscle
B) An anteromedial approach at the level of the joint line
C) A posteromedial approach at the level proximal to the joint line
D) A posteromedial approach at the level of the joint line

4. A 30-year-old pregnant woman with rheumatoid arthritis presents with right wrist pain and swelling despite a palpation-guided corticosteroid injection one month ago.

A) Radiocarpal joint
B) Intercarpal joint
C) Extensor tenosynovium
D) Radioulnar joint

5. Which of the following protocols would be MOST consistent with a complete routine ultrasound examination of the shoulder?

A) Anterior long- and short-axis views of the biceps tendon
oAnterior view of the subscapularis tendon in external rotation
oLong- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oPosterolateral view of the infraspinatus tendon oPosterior view of the glenohumeral joint recess oView from cranial at the acromioclavicular joint
B) Anterior long- and short-axis views of the biceps tendon
oAnterior views of the pectoralis tendon insertion
oAnterior view of the coracoid ligament and rotator cuff interval
oLong- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oPosterior long- and short-axis views of the infraspinatus tendon insertion oAxillary long-axis view with arm raised
C) Anterior long- and short-axis views of the biceps tendon
oAnterior view of the rotator cuff interval
oLateral views of the subscapularis tendon
oLateral long- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oPosterior view of the glenohumeral joint recess oDynamic lateral long-axis assessment of impingement with abduction of the arm
D) Anterior long- and short-axis views of the biceps tendon
oAnterior view of the rotator cuff interval
oLong- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly oDynamic lateral long-axis assessment of impingement with abduction of the arm oPosterior transverse view of the suprascapular notch oView from cranial at the acromioclavicular joint

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