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American College of Rheumatology RhMSUS Exam Syllabus Topics:

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

1. By comparing gray-scale images from before pharmacologic treatment and after months of treatment, rheumatologists are able to assess patient improvement and response with regard to:

A) Erosions in rheumatoid arthritis.
B) Articular cartilage damage in osteoarthritis.
C) Synovitis in rheumatoid arthritis.
D) Osteophytes in osteoarthritis.

2. 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) A positive Doppler signal is a predictor of future joint damage.
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) Severe (high-grade) synovial hyperemia, but not mild (low-grade) hyperemia, would be an indication to change therapy.

3. A practitioner reviews this long-axis ultrasound image of the medial aspect of the knee. Which of the following is the MOST likely differential diagnosis?

A) Rheumatoid arthritis with erosion formation
B) No sonographic evidence for abnormality
C) Osteoarthritis with bone spur and extrusion of the medial meniscus
D) Topheaceous gout with displacement of the medial collateral ligament

4. A 3-year-old child with juvenile idiopathic arthritis presents for an intra-articular corticosteroid injection of the knee. Using ultrasound guidance, which location should be targeted with a needle?

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

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

Solutions: