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

1. 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 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
B) 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
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

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

3. What is the MAIN pathologic finding shown in this ultrasound image?

A) Synovitis
B) Tendon rupture
C) Erosion
D) Osteophytes

4. Proper maintenance of ultrasound equipment between use for each patient is important to prevent which of the following?

A) Examiner injury
B) Poor calibration
C) Infection
D) Radiation exposure

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

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

Solutions: