RhMSUS Musculoskeletal Ultrasound Certification in Rheumatology Questions and Answers

There must be provisions for the storage and retrieval of examination records of all studies that are documented in the medical chart.

Ultrasound studies must be saved in a DICOM (Digital Imaging and Communications in Medicine) format.

The physician's report on the ultrasound examination must be stored in a physically separate location from the machine.

All images must be part of the electronic or paper patient file.

It uses sound energy with no adverse effects found in clinical studies.

It provides the same information as an MRI without gadolinium.

It obviates the need for X-ray examination when cortical margins are normal.

It is the gold standard for preoperative planning for rotator cuff surgery.

Iliopsoas bursitis in longitudinal view

Hip effusion in longitudinal view

Hip synovitis in longitudinal view

Normal longitudinal view of the hip

Osteophytes and meniscal cyst

Osteophytes and rupture of the medial collateral ligament

Osteophytes and distension and calcification of the medial collateral ligament

Osteophytes, distension of the medial collateral ligament, and meniscal degeneration

Tendon tear

Normal tendon variability

Artifact from transducer placement

Tendinopathy

The ultrasound-guided technique increases the overall success rate in obtaining joint fluid aspirate.

The ultrasound-guided technique results in more pain.

The ultrasound-guided technique takes additional time to perform.

The ultrasound-guided technique leads to more fluid aspiration among novice physicians.

Metacarpophalangeal, palmar longitudinal view

Metacarpophalangeal, dorsal longitudinal view

Proximal interphalangeal, palmar longitudinal view

Proximal interphalangeal, dorsal longitudinal view

Assessment of pain and swelling of unclear etiology at the right temporomandibular joint

Assessment of asymptomatic entheses in a patient with pain at the acromioclavicular joint

Evaluation of shoulder pain in a patient with diabetes most likely related to adhesive capsulitis

Preoperative evaluation of a patient with suspected rotator cuff tear

Dim the exam room lighting to improve the signal-to-noise ratio (This is the best answer)

Brighten the ambient lighting to improve the signal-to-noise ratio

Decrease the amount of gel in between transducer and skin to improve transmission of sound waves

Decrease high-frequency ambient noise to minimize interfering sound waves

Shoulder capsulitis

Polymyositis

Sjögren's syndrome

Eosinophilic fasciitis

A positive Doppler signal is a predictor of future joint damage.

Hyperemia is suggestive of a septic joint and requires further diagnostic testing.

Severe (high-grade) synovial hyperemia, but not mild (low-grade) hyperemia, would be an indication to change therapy.

Low-grade synovial hyperemia is found in most patients in clinical remission from rheumatoid arthritis.

Rheumatoid nodulosis

Extensor tendon tear

Extensor tenosynovitis

Ganglion cyst rupture

A

B

C

D

In gout, using the double contour sign alone as diagnostic confirmation of the disease

In juvenile idiopathic arthritis, to diagnose tenosynovitis in a patient with ankle swelling

In rheumatoid arthritis, to diagnose carpal tunnel syndrome

In fibromyalgia, to confirm the absence of joint and tendon pathology

Complete tear

Intrasubstance tear

Impingement

Enthesopathy

Focus and map

Focus and frequency

Frame average and depths

Frame average and frequency

Infection

Radiation exposure

Poor calibration

Examiner injury

Comet tail

Ring down

Shadowing

Enhancement

Pisiform

Hamate

Triquetrum

Capitate

A slight to-and-fro movement or injection of a small amount of lidocaine may be beneficial in visualizing the needle.

The shortest pathway to the region of interest should be selected with consideration given to adjacent neurovascular structures.

The transducer should be aligned perpendicular to the plane of the needle.

The needle should be visualized only prior to its insertion to the target area.

Option A

Option B

Option C

Option D

Risk of electrical shock

Artifact in the B-Mode image

Increased risk of the spread of infection

No impact on image acquisition

Gouty arthritis

Rheumatoid arthritis

Spondylarthritis

Osteoarthritis

Anterior long- and short-axis views of the biceps tendon

o Anterior view of the subscapularis tendon in external rotation

o Long- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly

o Posterolateral view of the infraspinatus tendon

o Posterior view of the glenohumeral joint recess

o View from cranial at the acromioclavicular joint

Anterior long- and short-axis views of the biceps tendon

o Anterior view of the rotator cuff interval

o Lateral views of the subscapularis tendon

o Lateral long- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly

o Posterior view of the glenohumeral joint recess

o Dynamic lateral long-axis assessment of impingement with abduction of the arm

Anterior long- and short-axis views of the biceps tendon

o Anterior views of the pectoralis tendon insertion

o Anterior view of the coracoid ligament and rotator cuff interval

o Long- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly

o Posterior long- and short-axis views of the infraspinatus tendon insertion

o Axillary long-axis view with arm raised

Anterior long- and short-axis views of the biceps tendon

o Anterior view of the rotator cuff interval

o Long- and short-axis views of the supraspinatus tendon, moving the transducer anteriorly and posteriorly

o Dynamic lateral long-axis assessment of impingement with abduction of the arm

o Posterior transverse view of the suprascapular notch

o View from cranial at the acromioclavicular joint

Sacroiliac joints in a 35-year-old male with early morning low-back pain and positive HLA B27

Warm, swollen elbow joint in a 70-year-old lymphoma patient with fevers and a history of an abscess of the thoracic spine

Asymptomatic hand and wrist joints with bony deformities present in a 60-year-old female with a positive rheumatoid factor and CCP antibody but normal sedimentation rate and C-reactive protein level

Knee in a 72-year-old female with unilateral knee pain, no swelling on examination, and medial narrowing of the joint space on knee radiograph

The tip of an osteophyte

A metacarpal fragment from prior trauma

A foreign body

A normal sesamoid

Sterile probe covers with sterile coupling gel can be employed during intra-articular injections, particularly those that require close proximity between the transducer and the needle tip.

The needle can touch the uncovered probe during the procedure as long as sterile gel is used.

Not using probe covers during ultrasound-guided arthrocentesis has been demonstrated to lead to increased rates of joint infections.

Povidone iodine swab of the injection site has been demonstrated to be insufficient to minimize infection during ultrasound-guided arthrocentesis.