Which of the following is not a typical indication for ultrasound in rheumatology?

a. Search for erosions at MCP 2, 5, and MTP 5 joints in early arthritis. 

b. Detect bone marrow edema of sacro-iliac joints in spondyloarthritis. 

c. Estimate the inflammatory activity in the synovium of a swollen joint. 

d. Distinguish osteoarthritis from rheumatoid arthritis lesions in finger joints. 

e. Distinguish stress fracture from synovitis of MTP joints. 

Which of the following is not a typical indication for ultrasound in rheumatology?

a. Search for erosions at MCP 2, 5, and MTP 5 joints in early arthritis. 

b. Detect bone marrow edema of sacro-iliac joints in spondyloarthritis. 

c. Estimate the inflammatory activity in the synovium of a swollen joint. 

d. Distinguish osteoarthritis from rheumatoid arthritis lesions in finger joints. 

e. Distinguish stress fracture from synovitis of MTP joints. 

2. Which rheumatic disease has no specific ultrasound findings? 

a. Sjogren's Syndrome. 

b. Carpal tunnel syndrome. 

c. Small vessel vasculitis. 

d. Large-vessel giant cell arteritis. 

e. Chondrocalcinosis. 

2. Which rheumatic disease has no specific ultrasound findings? 

a. Sjogren's Syndrome. 

b. Carpal tunnel syndrome. 

c. Small vessel vasculitis. 

d. Large-vessel giant cell arteritis. 

e. Chondrocalcinosis. 

3. Which of the following statements is true? 

a. Medical ultrasound refers to sound frequencies only between 10 and 20 Hz. 

b. Higher ultrasound frequencies lead to better penetration. 

c. The transducer functions as an emitter of sound waves for most of the time. 

d. The loss of energy of ultrasound when traveling through tissue is called "attenuation". 

e. Diagnostic ultrasound implies more heat in the body tissue than therapeutic ultrasound. 

3. Which of the following statements is true? 

a. Medical ultrasound refers to sound frequencies only between 10 and 20 Hx. 

b. Higher ultrasound frequencies lead to better penetration. 

c. The transducer functions as an emitter of sound waves for most of the time. 

d. The loss of energy of ultrasound when traveling through tissue is called "attenuation". 

e. Diagnostic ultrasound implies more heat in the body tissue than therapeutic ultrasound. 

Which of the following statements about ultrasound modes is true? 

a. A-mode is the ideal mode for examining joints. 

b. B-mode stands for "brightness" mode. 

c. M-mode is used for static structures. 

d. 3D mode is essential for musculoskeletal ultrasound. 

e. Doppler mode is useless for vascular imaging. 

Which of the following statements about ultrasound modes is true? 

a. A-mode is the ideal mode for examining joints. 

b. B-mode stands for "brightness" mode. 

c. M-mode is used for static structures. 

d. 3D mode is essential for musculoskeletal ultrasound. 

e. Doppler mode is useless for vascular imaging. 

Which of these frequencies is most adequate for the respective anatomic region? 

a. 1 MHz for ankle. 

b. 2 MHz for elbow. 

c. 10 MHz for wrist. 

d. 100 MHz for MCP

e. 200 MHz for DIP. 

Which of these frequencies is most adequate for the respective anatomic region? 

a. 1 MHz for ankle. 

b. 2 MHz for elbow. 

c. 10 MHz for wrist. 

d. 100 MHz for MCP

e. 200 MHz for DIP. 

Which of the following statements on ultrasound equipment is true? 

a. the preset button serves for raising and lowering the monitor. 

b. the gain adjusts the acoustic power of transmitted signals. 

c. the frequency can be adjusted by the time gain compensation controls. 

d. More foci increase the image frame rate. 

e. decreasing the frequency allows for higher image resolution. 

Which of the following statements on ultrasound equipment is true? 

a. the preset button serves for raising and lowering the monitor. 

b. the gain adjusts the acoustic power of transmitted signals. 

c. the frequency can be adjusted by the time gain compensation controls. 

d. More foci increase the image frame rate. 

e. decreasing the frequency allows for higher image resolution. 

How should the sonographer hold and move the probe? 

a. The sonographer's fingers should not touch the patients's skin. 

b. The monitor should be above the sonographer's eye level. 

c. The sonographer's arm should be elevated while performing the examination. 

D. For performing the heel-toe maneuver, the probe is angled along the transverse axis. 

e. Tilting the probe helps adjust it parallel to an anatomic structure. 

How should the sonographer hold and move the probe? 

a. The sonographer's fingers should not touch the patients's skin. 

b. The monitor should be above the sonographer's eye level. 

c. The sonographer's arm should be elevated while performing the examination. 

D. For performing the heel-toe maneuver, the probe is angled along the transverse axis. 

e. Tilting the probe helps adjust it parallel to an anatomic structure. 

Which echogenicity corresponds correctly to a tissue? 

a. fluid is hyperechoic. 

b. soft tissue is anechoic. 

c. bone is midechoic. 

d. synovitis is hyoechoic. 

e. hyaline cartilage is hyperechoic. 

Which echogenicity corresponds correctly to a tissue? 

a. fluid is hyperechoic. 

b. soft tissue is anechoic. 

c. bone is midechoic. 

d. synovitis is hyoechoic. 

e. hyaline cartilage is hyperechoic. 

Which statement about anisotropy is true? 

a. anisotropy is due to reverberation. 

b. anisotropy is typically found in vessels. 

c. the anatomic structure becomes dark when being parallel to the transducer. 

d. anisotropy may be avoided by rotating the probe. 

e. anisotropy may lead to misdiagnosis of fluid collections. 

Which statement about anisotropy is true? 

a. anisotropy is due to reverberation. 

b. anisotropy is typically found in vessels. 

c. the anatomic structure becomes dark when being parallel to the transducer. 

d. anisotropy may be avoided by rotating the probe. 

e. anisotropy may lead to misdiagnosis of fluid collections. 

Which statement on other artifacts is true? 

a. posterior acoustic enhancement leads to increased echogenicity below a cyst.

b. mirror images only occur in gray scale images. 

c. due to lateral edge shadowing, the lateral areas of an ultrasound image are darker. 

d. the area below the bone is anechoic because of posterior reverberation. 

e. a comet tail usually appears in fluid.  

Which statement on other artifacts is true? 

a. posterior acoustic enhancement leads to increased echogenicity below a cyst.

b. mirror images only occur in gray scale images. 

c. due to lateral edge shadowing, the lateral areas of an ultrasound image are darker. 

d. the area below the bone is anechoic because of posterior reverberation. 

e. a comet tail usually appears in fluid.  

Which is the following just finds the sonographic appearance of synovial hypertrophy?

A. Hypoechoic, compressible, and displacable, exhibits Doppler signal.

B. hypoechoic, noncompressible, and nondisplacablel, exhibits Doppler signal.

C.  Anechoic, noncompressible, and nondisplacable, exhibits Doppler signal.

D.  Hypoechoic, noncompressible, and nondisplacable, does not exhibit Doppler signal.

Which is the following just finds the sonographic appearance of synovial hypertrophy?

A. Hypoechoic, compressible, and displacable, exhibits Doppler signal.

B. hypoechoic, noncompressible, and nondisplacablel, exhibits Doppler signal.

C.  Anechoic, noncompressible, and nondisplacable, exhibits Doppler signal.

D.  Hypoechoic, noncompressible, and nondisplacable, does not exhibit Doppler signal.

What is the assessed US7 score for rheumatoid arthritis?  

A.  Erosions.  

B.  Synovitis.  

C.  Tenosynovitis.  

D.  All of the above.

What is the assessed US7 score for rheumatoid arthritis?  

A.  Erosions.  

B.  Synovitis.  

C.  Tenosynovitis.  

D.  All of the above. 

How many ultrasound views/ images are necessary to confirm the presence of an erosion in rheumatoid arthritis?

a. One.

b. Two.

c. Three. 

d. Four. 

How many ultrasound views/ images are necessary to confirm the presence of an erosion in rheumatoid arthritis?

a. One.

b. Two.

c. Three. 

d. Four. 

Which of the following is the best option to identify osteophytes of the knee?  

A.  Lateral tibiofemoral joint, transverse view.

B.  Medial tibiofemoral joint, longitudinal view.  

C. suprapatellar longitudinal view.  

D.  Posterior  knee transverse view at the popliteal space.

Which of the following is the best option to identify osteophytes of the knee?  

A.  Lateral tibiofemoral joint, transverse view.

B.  Medial tibiofemoral joint, longitudinal view.  

C. suprapatellar longitudinal view.  

D.  Posterior  knee transverse view at the popliteal space.

  Would is the best sonographic description of an osteophyte?  

A.  Hypoechoic area within the bony cortex.

B.  Raised hyperechoic area arising from the bony cortex, without any echogenicity below.  

C.  Compressible anechoic accumulation near the joint space.  

D.  Isoechoic noncompressible tissue.

  Would is the best sonographic description of an osteophyte?  

A.  Hypoechoic area within the bony cortex.

B.  Raised hyperechoic area arising from the bony cortex, without any echogenicity below.  

C.  Compressible anechoic accumulation near the joint space.  

D.  Isoechoic noncompressible tissue.

What is the sonographic finding of the salivary glands most suggestive of Sjogren syndrome?

A.  Parenchymal inhomogeneity

B.  Diffuse hypervascular pattern.  

C.  Distal acoustic enhancement.  

D.  Markedly hyper echo at lines with acoustic shadowing.

What is the sonographic finding of the salivary glands most suggestive of Sjogren syndrome?

A.  Parenchymal inhomogeneity

B.  Diffuse hypervascular pattern.  

C.  Distal acoustic enhancement.  

D.  Markedly hyper echo at lines with acoustic shadowing.

Which of the following is a sonographic feature of acute gout?  

A.  Hyperechoic irregular band over the superficial margin of the articular cartilage.

B. hyperechoic, inhomogeneous material with anechoic rim within the joint.  

C.  Hyperechoic cloudy areas, and spots in thickened synovium.  

D.  Erosions adjacent to inhomogeneous material with anechoic rim.

Which of the following is a sonographic feature of acute gout?  

A.  Hyperechoic irregular band over the superficial margin of the articular cartilage.

B. hyperechoic, inhomogeneous material with anechoic rim C.  Hyperechoic cloudy areas, and spots in thickened synovium.  

D.  Erosions adjacent to inhomogeneous material with anechoic rim.

Which of the following sonographic findings is suggestive of calcium pyrophosphate deposition disease?  

A.  Heterogeneous hypoechoic oval deposition seen in articular recesses.

B.  Thin hyperechoic bands parallel to the surface of the hyaline cartilage.  

C.  Hyperechoic regular band over the superficial margin of the articular cartilage.  

D.  Hyperechoic cloudy areas.

Which of the following sonographic findings is suggestive of calcium pyrophosphate deposition disease?  

A.  Heterogeneous hypoechoic oval deposition seen in articular recesses.

B.  Thin hyperechoic bands parallel to the surface of the hyaline cartilage.  

C.  Hyperechoic regular band over the superficial margin of the articular cartilage.  

D.  Hyperechoic cloudy areas.

What percentage of psoriasis patients without any arthritic complaints can have subclinical sonographic findings of structural changes in the digits?  

A. 40%

B. 55% 

C. 69% 

D. 75%

What percentage of psoriasis patients without any arthritic complaints can have subclinical sonographic findings of structural changes in the digits?  

A. 40%

B. 55% 

C. 69% 

D. 75%

Sonographic feature of tophi at the olecranon bursa?  

A.  Heterogeneity.  

B.  Multiple group nodules.  

C.  Poorly defined contours.  

D.  Hyper echogenicity.

Sonographic feature of tophi at the olecranon bursa?  

A.  Heterogeneity.  

B.  Multiple group nodules.  

C.  Poorly defined contours.  

D.  Hyper echogenicity.

Would is the main difference between power and color Doppler?  

A.  Power Doppler is more sensitive and color Doppler.  

B.  Power Doppler worse with energy and color Doppler worse with the velocity of the moving erythrocyte.  

C.  The Doppler shift only applies to color Doppler.  

D.  Color Doppler is gain dependent but power Doppler is not.

Would is the main difference between power and color Doppler?  

A.  Power Doppler is more sensitive and color Doppler.  

B.  Power Doppler worse with energy and color Doppler worse with the velocity of the moving erythrocyte.  

C.  The Doppler shift only applies to color Doppler.  

D.  Color Doppler is gain dependent but power Doppler is not.

How we would just the Pulse Repetitive Frequency (PRF) when you want to evaluate flow in joint synovitis?  

A. increase the PRF and wall filter to increase sensitivity.  

B.  Increased the PRF but lower the wall filter to increase the sensitivity.  

C.  Decreased PRF and wall filter to increase the sensitivity.  

D.  Decreased PRF but increase the wall filter to increased sensitivity.

How we would just the Pulse Repetitive Frequency (PRF) when you want to evaluate flow in joint synovitis?  

A. increase the PRF and wall filter to increase sensitivity.  

B.  Increased the PRF but lower the wall filter to increase the sensitivity.  

C.  Decreased PRF and wall filter to increase the sensitivity.  

D.  Decreased PRF but increase the wall filter to increased sensitivity.

How do you adjust the Doppler gain when scanning a joint with synovitis?

A.  Increased gain until just below the level of the noise.  

B.  Increase gain just above the level of the noise.  

C.  Decreased gain until only superficial vessels are visible.  

D.  Decreased gain until only flow in the synovium is visible.

How do you adjust the Doppler gain when scanning a joint with synovitis?

A.  Increased gain until just below the level of the noise.  

B.  Increase gain just above the level of the noise.  

C.  Decreased gain until only superficial vessels are visible.  

D.  Decreased gain until only flow in the synovium is visible.

How should you adjust grayscale settings on the ultrasound machine when changing scanning from superficial to deep joints?  You need to:

A. increase the gain.  

B.  Decrease the frequency of the probe.  

C.  Increase the frequency of the probe.  

D.  Increased wall filters.

How should you adjust grayscale settings on the ultrasound machine when changing scanning from superficial to deep joints?  You need to:

A. increase the gain.  

B.  Decrease the frequency of the probe.  

C.  Increase the frequency of the probe.  

D.  Increased wall filters.

What is the optimal method for evaluation of synovitis?  

A.  Scoring the Doppler from 0 to 3.  

B.  Calculating the Doppler packed cells.  

C. Measuring RI using this pectoral Doppler.  

D. No concenus exist on the optimal method to score synovitis.

What is the optimal method for evaluation of synovitis?  

A.  Scoring the Doppler from 0 to 3.  

B.  Calculating the Doppler packed cells.  

C. Measuring RI using this pectoral Doppler.  

D. No concenus exist on the optimal method to score synovitis.

Please select the correct statement.  Evaluating tenosynovitis in rheumatoid arthritis ....?

A.  Has no clinical relevance and should only be evaluated if symptomatic.

B.  Has predictive value for diagnosis and erosive progression.  

C.  Is only relevant when compared to MRI of the same tendon.  

D.  Should be dichotomous as no validated scoring system exists.

Please select the correct statement.  Evaluating tenosynovitis in rheumatoid arthritis ....?

A.  Has no clinical relevance and should only be evaluated if symptomatic.

B.  Has predictive value for diagnosis and erosive progression.  

C.  Is only relevant when compared to MRI of the same tendon.  

D.  Should be dichotomous as no validated scoring system exists.

What is the optimal number of joints to evaluate scoring synovitis for rheumatoid arthritis?  

A. Twenty-eight joints; and gives the best evaluation the patient.

B.  Twelve joints; as a give the best evaluation of the patient.  

C.  One joint; can be used as a target joint.  

D. No consensus exists on the optimal joint count for synovitis.

What is the optimal number of joints to evaluate scoring synovitis for rheumatoid arthritis?  

A. Twenty-eight joints; and gives the best evaluation the patient.

B.  Twelve joints; as a give the best evaluation of the patient.  

C.  One joint; can be used as a target joint.  

D. No consensus exists on the optimal joint count for synovitis.

The optimal technique to assess Doppler activity is: 

A.  Use from pressure for obtaining a good image.  

B.  Be light handed and use rich amount of gel.  

C.  He has little gel as not to disturb the Doppler activity.  

D.  Always use power Doppler.

  The optimal technique to assess Doppler activity is: 

A.  Use from pressure for obtaining a good image.  

B.  Be light handed and use rich amount of gel.  

C.  He has little gel as not to disturb the Doppler activity.  

D.  Always use power Doppler.

The optimal positioning for assessing Doppler activity in joints and tendons is to:

A.  Actively stretch out the joint.  

B.  Always use a pillow and perform a examinations.  

C.  The supine one performing all Doppler examinations.  

D.  Always have a relaxed joint/tendon when performing Doppler examination.

The optimal positioning for assessing Doppler activity in joints and tendons is to:

A.  Actively stretch out the joint.  

B.  Always use a pillow and perform a examinations.  

C.  The supine one performing all Doppler examinations.  

D.  Always have a relaxed joint/tendon when performing Doppler examination.

When doing follow-up examinations of Doppler activity of patients with joint inflammation for treatment response monitoring, it is important to:

A.  Use the same machine in the same Doppler settings.  

B.  Increase the cane to increase the sensitivity.  

C.  Examined the joints in similar or each time.  

D.  Ask the patient to rest for 10 min before the examination.

When doing follow-up examinations of Doppler activity of patients with joint inflammation for treatment response monitoring, it is important to:

A.  Use the same machine in the same Doppler settings.  

B.  Increase the cane to increase the sensitivity.  

C.  Examined the joints in similar or each time.  

D.  Ask the patient to rest for 10 min before the examination.

On a dorsal transverse image of a wrist, the radial ulnar joint synovium can best be identified in which of the following locations:

A.  Deep to the extensor digiti minimi tendon.  

B.  Radial to history is tubercle.

C.  Distal to the radius.  

D.  Distal to the lunate.

  On a dorsal transverse image of a wrist, the radial ulnar joint synovium can best be identified in which of the following locations:

A.  Deep to the extensor digiti minimi tendon.  

B.  Radial to history is tubercle.

C.  Distal to the radius.  

D.  Distal to the lunate.

On ultrasound imaging, De Quervain tendinitis is most commonly manifested by which of the following:

A.  Anechoic, compressible material surrounding the 1st extensor compartment at the distal radius.

B.  Hypoechoic, noncompressible material surrounding the 1st extensor compartment at the distal radius.  

C.  Loss of fibular architecture of the extensor pollicis longus tendon.

D.  Disruption of the cortical margin at the distal radius seen in orthotic in all planes.

On ultrasound imaging, de Quervain tendinitis is most commonly manifested by which of the following:

A.  Anechoic, compressible material surrounding the 1st extensor compartment at the distal radius.

B.  Hypoechoic, noncompressible material surrounding the 1st extensor compartment at the distal radius.  

C.  Loss of fibular architecture of the extensor pollicis longus tendon.

D.  Disruption of the cortical margin at the distal radius seen in orthotic in all planes.

Ulnar imaging of the wrist reveals a 2.5 mm cortical disruption of the ulnar cortical surface and anechoic material surrounding the extensor carpi ulnaris tendon as well as Doppler signal surrounding the extensor carpi ulnaris.  These findings most suggest which of the following:

A.  Osteoarthritis.  

B.  Gout.  

C.  Rheumatoid arthritis.  

D.  Psoriatic arthritis.

Ulnar imaging of the wrist reveals a 2.5 mm cortical disruption of the ulnar cortical surface and anechoic material surrounding the extensor carpi ulnaris tendon as well as Doppler signal surrounding the extensor carpi ulnaris.  These findings most suggest which of the following:

A.  Osteoarthritis.  

B.  Gout.  

C.  Rheumatoid arthritis.  

D.  Psoriatic arthritis.

Which of the following can help distinguish the median nerve from the surrounding tendons?

A.  The nerve is more anisotrophic.  

B.  The nerve has a fine or echotexture.  

C.  The nerve slides more with finger flexion.  

D.  The nerve is surrounded by a bright epineurium.

Which of the following can help distinguish the median nerve from the surrounding tendons?

A.  The nerve is more anisotrophic.  

B.  The nerve has a fine or echotexture.  

C.  The nerve slides more with finger flexion.  

D.  The nerve is surrounded by a bright epineurium.

These orthogonal views of the volar metacarpal -phalangeal joint demonstrate which of the following:

 [image]

A.  Synovial effusion.  

B. Tenosynovial effusion.  

C.  Gouty nodule.  

D.  Ruptured palmar plate.

These orthogonal views of the volar metacarpal -phalangeal joint demonstrate which of the following:

 [image]

A.  Synovial effusion.  

B. Tenosynovial effusion.  

C.  Gouty nodule.  

D.  Ruptured palmar plate. 

  This longitudinal view of the volar wrist demonstrates which of the following:

[image]

A.  Muscle belly surrounding a flexor tendon, impinging the median nerve.  

B.  Tenosynovial effusion impinging the median nerve.  

C.  Median nerve with neuroma.  

D.  Gouty tophus impinging on median nerve.

  This longitudinal view of the volar wrist demonstrates which of the following:

[image]

A.  Muscle belly surrounding a flexor tendon, impinging the median nerve.  

B.  Tenosynovial effusion impinging the median nerve.  

C.  Median nerve with neuroma.  

D.  Gouty tophus impinging on median nerve.

These orthogonal views of the volar metacarpophalangeal joint best demonstrate which of the following:

[image]

[image]

A.  Tenosynovitis.  

B.  Synovitis.  

C.  Phalangeal erosion.  

D.  Metacarpal erosion.

These orthogonal views of the volar metacarpophalangeal joint best demonstrate which of the following:

[image]

[image]

A.  Tenosynovitis.  

B.  Synovitis.  

C.  Phalangeal erosion.  

D.  Metacarpal erosion.

This dorsal longitudinal image of the wrist most clearly demonstrates which of the following pathologies?

[image]

A.  Lunate erosion.  

B.  Radiocarpal synovial hypertrophy.  

C.  Capitate erosion.  

D.  Intracarpal synovial hypertrophy.

This dorsal longitudinal image of the wrist most clearly demonstrates which of the following pathologies?

[image]

A.  Lunate erosion.  

B.  Radiocarpal synovial hypertrophy.  

C.  Capitate erosion.  

D.  Intracarpal synovial hypertrophy.

Which of the following findings on ultrasound is most indicative of a rheumatoid nodule?  

A.  A single nodule with homogeneous echotexture and hypoechoic center.  

B.  A multi lobe nodule with heterogeneous echotexture and surrounding anechoic rim.  

C.  A hypoechoic homogeneous nodule with central Doppler signal.  

D.  An anechoic multi lobed nodule producing acoustic enhancement.

Which of the following findings on ultrasound is most indicative of a rheumatoid nodule?  

A.  A single nodule with homogeneous echotexture and hypoechoic center.  

B.  A multi lobe nodule with heterogeneous echotexture and surrounding anechoic rim.  

C.  A hypoechoic homogeneous nodule with central Doppler signal.  

D.  An anechoic multi lobed nodule producing acoustic enhancement.

Joint effusion or synovitis of the elbow can be detected when the ultrasound scan reveals:

A.  Disruption of the common extensor tendon fibers.  

B.  Displacement of the joint capsule and fat pad.

C.  Loss of the normal bony architecture.

D.  Doppler activity in the brachial artery of the anterior elbow.

Joint effusion or synovitis of the elbow can be detected when the ultrasound scan reveals:

A.  Disruption of the common extensor tendon fibers.  

B.  Displacement of the joint capsule and fat pad.

C.  Loss of the normal bony architecture.

D.  Doppler activity in the brachial artery of the anterior elbow.

The distal aspect of the anterior and radial aspect of the elbow joint capsule forms the:

A.  Radial fossa.  

B.  Olecranon recess.  

C.  Coranoid fossa.  

D.  Annular recess.

The distal aspect of the anterior and radial aspect of the elbow joint capsule forms the:

A.  Radial fossa.  

B.  Olecranon recess.  

C.  Coranoid fossa.  

D.  Annular recess.

Pathology of the distal biceps tendon attachment can be difficult image using ultrasound due to its normally occurring:

A.  Anisotrope.  

B.  Wavy structure.  

C.  Location.  

D.  Doppler activity.

Pathology of the distal biceps tendon attachment can be difficult image using ultrasound due to its normally occurring:

A.  Anisotrope.  

B.  Wavy structure.  

C.  Location.  

D.  Doppler activity.

The lateral collateral ligament can be visualized on ultrasound deep to the:

A.  Coronoid fossa.  

B.  Biceps tendon.  

C.  Olecranon bursa.  

D.  Common extensor tendon.

The lateral collateral ligament can be visualized on ultrasound deep to the:

A.  Coronoid fossa.  

B.  Biceps tendon.  

C.  Olecranon bursa.  

D.  Common extensor tendon.

Synovial thickening or pannus in the elbow joint well most commonly have the following appearance on ultrasound examination:

A.  Hypoechoic.

B.  Anechoic.  

C.  Hyperechoic.  

D.  Isoechoic

Synovial thickening or pannus in the elbow joint well most commonly have the following appearance on ultrasound examination:

A.  Hypoechoic.

B.  Anechoic.  

C.  Hyperechoic.  

D.  Isoechoic

Visualization of the olecranon bursa with ultrasound is best with the elbow and:

A.  Flexion.  

B.  Extension.  

C.  Pronation.  

D.  Motion.

Visualization of the olecranon bursa with ultrasound is best with the elbow and:

A.  Flexion.  

B.  Extension.  

C.  Pronation.  

D.  Motion.

Tendinosis of the common extensor tendon as suggested by all of the following features on ultrasound, except:

A.  Tendon hypoechogenicity.  

B.  Tendon retraction.  

C.  Calcific deposits.  

D.  Epicondylar bone irregularity.

Tendinosis of the common extensor tendon as suggested by all of the following features on ultrasound, except:

A.  Tendon hypoechogenicity.  

B.  Tendon retraction.  

C.  Calcific deposits.  

D.  Epicondylar bone irregularity.

On examination of the common extensor tendon, the following ultrasound findings can be used to distinguish tendinosis from tendinitis:

A.  Tendon fiber disruption.  

B.  Loss of normal fibrillar tendon pattern.  

C.  Increased Doppler activity.  

D.  Adjacent fluid collections.

On examination of the common extensor tendon, the following ultrasound findings can be used to distinguish tendinosis from tendinitis:

A.  Tendon fiber disruption.  

B.  Loss of normal fibrillar tendon pattern.  

C.  Increased Doppler activity.  

D.  Adjacent fluid collections.

The ultrasound finding of one elbow nodule that suggests a diagnosis of rheumatoid nodule is characterized by:

A.  Homogeneous echotexture.  

B.  Indistinct margins.  

C.  Calcium deposition.  

D.  Fluid pockets.

The ultrasound finding of one elbow nodule that suggests a diagnosis of rheumatoid nodule is characterized by:

A.  Homogeneous echotexture.  

B.  Indistinct margins.  

C.  Calcium deposition.  

D.  Fluid pockets.

Ultrasound examination of ulnar nerve entrapment most often shows the following nerve change:

A.  Increase nerve density.  

B.  Doppler activity.  

C. nerve sheath hyper echogenicity.  

D.  Nerve enlargement.

Ultrasound examination of ulnar nerve entrapment most often shows the following nerve change:

A.  Increase nerve density.  

B.  Doppler activity.  

C. nerve sheath hyper echogenicity.  

D.  Nerve enlargement.

The rotator cuff interval as form by which of the following tendons:

A. supraspinatus and infraspinatus.  

B.  Supraspinatus and teres minor.  

C.  Supraspinatus and subscapularis.  

D.  Infraspinatus and subscapularis.

The rotator cuff interval as form by which of the following tendons:

A. supraspinatus and infraspinatus.  

B.  Supraspinatus and teres minor.  

C.  Supraspinatus and subscapularis.  

D.  Infraspinatus and subscapularis.

The following structures retained the long head of the biceps tendon in its position except:

A. Coracohumeral ligament.  

B. Coracoacromial ligament.  

C. Transverse humeral ligament. 

D. Pectoralis major insertion.

The following structures retained the long head of the biceps tendon in its position except:

A. Coracohumeral ligament.  

B. Coracoacromial ligament.  

C. Transverse humeral ligament. 

D. Pectoralis major insertion.

Which is the following does not predispose to long head of biceps tendon subluxation:

A.  Congenitally shallow intertubercular sulcus.  

B.  Coracoid humeral ligament tear.

C.  Medial supraspinatus tear.  

D.  Subscapularis tear.

Which is the following does not predispose to long head of biceps tendon subluxation:

A.  Congenitally shallow intertubercular sulcus.  

B.  Coracohumeral ligament tear.

C.  Medial supraspinatus tear.  

D.  Subscapularis tear.

The best position of the patient for examination of the rotator cuff and coracohumeral ligament is:

A.  Neutral position with palm facing up.  

B.  In internal rotation with palm facing up.  

C.  In external rotation with palm facing up.

D.  In the modified crass position.

The best position of the patient for examination of the rotator cuff and coracohumeral ligament is:

A.  Neutral position with palm facing up.  

B.  In internal rotation with palm facing up.  

C.  In external rotation with palm facing up.

D.  In the modified crass position.

The most common position of the dislocated biceps tendon is:

A.  Above the greater tuberosity.  

B.  Lateral to the greater tuberosity.  

C.  Medial to the lesser tuberosity.  

D.  Invested within the supraspinatus tendon.

The most common position of the dislocated biceps tendon is:

A.  Above the greater tuberosity.  

B.  Lateral to the greater tuberosity.  

C.  Medial to the lesser tuberosity.  

D.  Invested within the supraspinatus tendon.

Ultrasound is most sensitive at detecting fluid at which of the following recesses:

A.  Anterior recess.  

B.  Posterior recess.  

C.  Axillary recess.  

D.  None of the above.

Ultrasound is most sensitive at detecting fluid at which of the following recesses:

A.  Anterior recess.  

B.  Posterior recess.  

C.  Axillary recess.  

D.  None of the above.

Sonography best visualize is the:

A.  Posterior labrum.  

B.  Anterior labrum.  

C.  Superior labrum.  

D.  Inferior labrum.

Sonography best visualize is the:

A.  Posterior labrum.  

B.  Anterior labrum.  

C.  Superior labrum.  

D.  Inferior labrum.

Hill Sachs abnormality occurs one: 

A.  The shoulder dislocate posteriorly.  

B.  The posterior lateral humeral head strikes the anterior-inferior glenoid rim during dislocation.  

C.  The antero humoral head strikes inferior glenoid rim during dislocation.  

D.  The rotator cuff tendons are pulse turn dislocation.

Hill Sachs abnormality occurs one: 

A.  The shoulder dislocate posteriorly.  

B.  The posterior lateral humeral head strikes the anterior-inferior glenoid rim during dislocation.  

C.  The antero humoral head strikes inferior glenoid rim during dislocation.  

D.  The rotator cuff tendons are pulse turn dislocation.

Which is the following is false regarding paralabral cysts: 

A.  The most common location is the anterior labrum.  

B.  Most common location is the superior and posterior labrum.  

C. they can spread to the spinal glenoid notch and suprascapular notch under the myotendinous junction of the infraspinatus and supraspinatus.

D.  Can cause an entrapment neuropathy of the suprascapular nerve.

Which is the following is false regarding paralabral cysts: 

A.  The most common location is the anterior labrum.  

B.  Most common location is the superior and posterior labrum.  

C. they can spread to the spinoglenoid notch and suprascapular notch under the myotendinous junction is of the infraspinatus and supraspinatus.

D.  Can cause an entrapment neuropathy of the suprascapular nerve.

In rheumatoid arthritis shoulders, erosions most commonly occur:

A.  Anteriorly adjacent to the lesser tuberosity.  

B.  Posteriorly.  

C.  Superiorly adjacent to the greater tuberosity.  

D.  Inferiorly.

In rheumatoid arthritis shoulders, erosions most commonly occur:

A.  Anteriorly adjacent to the lesser tuberosity.  

B.  Posteriorly.  

C.  Superiorly adjacent to the greater tuberosity.  

D.  Inferiorly.

Synovitis or effusion in the hip joint are probable when:

A.  The anterior joint capsule measures greater than or equal to 5 mm in thickness and takes on a concave shape.  

B.  The anterior joint capsule measures greater than or equal to 5 mm in thickness or there is asymmetric distention of the joint capsule of greater than or equal to 1 mm compared to the opposite hip.  

C.  The anterior joint capsule measures greater than or equal to 7 mm in thickness or there is asymmetric distention of the joint capsule of greater than or equal to 1 mm compared to the opposite hip.  

D.  The anterior joint capsule measures greater than or equal to 9 mm in thickness and takes on a cart backs shape.

 Synovitis or effusion in the hip joint are probable when:

A.  The anterior joint capsule measures greater than or equal to 5 mm in thickness and takes on a concave shape.  

B.  The anterior joint capsule measures greater than or equal to 5 mm in thickness or there is asymmetric distention of the joint capsule of greater than or equal to 1 mm compared to the opposite hip.  

C.  The anterior joint capsule measures greater than or equal to 7 mm in thickness or there is asymmetric distention of the joint capsule of greater than or equal to 1 mm compared to the opposite hip.  

D.  The anterior joint capsule measures greater than or equal to 9 mm in thickness and takes on a cart backs shape.

Which is the following structures is not seen on the anterior longitudinal view of the hip?  

A.  Acetabulum.  

B.  Labrum.  

C.  Iliopsoas tendon.  

D.  Tensor fascia lata.

Which is the following structures is not seen on the anterior longitudinal view of the hip?  

A.  Acetabulum.  

B.  Labrum.  

C.  Iliopsoas tendon.  

D.  Tensor fascia lata.

Positive color power doppler ultrasound is a common finding in inflammatory arthritis of the hip joint.

A.  True.  

B.  False.

Positive color power doppler ultrasound is a common finding in inflammatory arthritis of the hip joint.

A.  True.  

B.  False.

In patients with rheumatoid arthritis, synovial thickening in the hip joint has been shown to improve with disease modifying treatment.  

A.  True.  

B.  False.

In patients with rheumatoid arthritis, synovial thickening in the hip joint has been shown to improve with disease modifying treatment.  

A.  True.  

B.  False.

Which had the following findings could be missed on lateral longitudinal views of the hip with the patient placed in the lateral decubitus position?  

A.  Subgluteus maximus bursitis.  

B.  Gluteus medius tendinopathy.  

C.  Gluteus minimus tendinopathy.  

D.  Iliotibial band tendinopathy.

Which had the following findings could be missed on lateral longitudinal views of the hip with the patient placed in the lateral decubitus position?  

A.  Subgluteus maximus bursitis.  

B.  Gluteus medius tendinopathy.  

C.  Gluteus minimus tendinopathy.  

D.  Iliotibial band tendinopathy.

The gluteus medius tendon inserts on the:

A.  Anterior facet of the greater trochanter.  

B.  Lateral facet of the greater trochanter.  

C.  Superiorioposterior facet of the greater trochanter.  

D.  B and C.

The gluteus medius tendon inserts on the:

A.  Anterior facet of the greater trochanter.  

B.  Lateral facet of the greater trochanter.  

C.  Superiorioposterior facet of the greater trochanter.  

D.  B and C.

Which of the following tendons is most prone to anisotropy, due to its oblique course relative to the surface of the skin?

A.  Gluteus medius tendon.  

B.  Iliopsoas tendon.  

C.  Gluteus  minimus tendon.  

D.  Iliotibial band.

Which of the following tendons is most prone to anisotropy, due to its oblique course relative to the surface of the skin?

A.  Gluteus medius tendon.  

B.  Iliopsoas tendon.  

C.  Gluteus  minimus tendon.  

D.  Iliotibial band.

The needle path during ultrasound-guided hip joint injection using a long axis approach to the femoral neck from distal to proximal includes all the following except:

A.  Rectus femoris.  

B.  Tensor fascia lata.  

C.  Iliopsoas.  

D.  Anterior hip joint capsule.

The needle path during ultrasound-guided hip joint injection using a long axis approach to the femoral neck from distal to proximal includes all the following except:

A.  Rectus femoris.  

B.  Tensor fascia lata.  

C.  Iliopsoas.  

D.  Anterior hip joint capsule.

The following structures exhibit anisotropy except: 

A.  Anterior hip joint capsule.  

B.  Gluteus medius tendon.  

C.  Iliopsoas tendon.  

D.  Femoral head cartilage.

The following structures exhibit anisotropy except: 

A.  Anterior hip joint capsule.  

B.  Gluteus medius tendon.  

C.  Iliopsoas tendon.  

D.  Femoral head cartilage.

Which is the following ultrasound findings constitute part of the scoring system and the 2012 EULAR / American College of Rheumatology provisional classification criteria for polymyalgia rheumatica.

A.  Unilateral hip effusion or trochanteric bursitis, in addition to unilateral glenohumeral joint effusion, subacromial bursitis, and biceps tenosynovitis.  

B.  Hip effusion alone.  

C.  Trochanteric bursitis alone.  

D.  Bilateral hip effusion or trochanteric bursitis.

Which is the following ultrasound findings constitute part of the scoring system and the 2012 EULAR/ACR provisional classification criteria for polymyalgia rheumatica.

A.  Unilateral hip effusion or trochanteric bursitis, in addition to unilateral glenohumeral joint effusion, subacromial bursitis, and biceps tenosynovitis.  

B.  Hip effusion alone.  

C.  Trochanteric bursitis alone.  

D.  Bilateral hip effusion or trochanteric bursitis.

To increase sensitivity for the detection of effusions at the knee, suprapatellar imaging should be performed with the joint. . .  

A.  Full extension.  

B. 30° of flexion.  

C. 90° of flexion.  

D.  Maximal flexion possible for the patient.

To increase sensitivity for the detection of effusions at the knee, suprapatellar imaging should be performed with the joint. . .  

A.  Full extension.  

B. 30° of flexion.  

C. 90° of flexion.  

D.  Maximal flexion possible for the patient.

Monosodium urate crystals can be distinguished from calcium pyrophosphate crystals using ultrasound imaging because:

A.  Monosodium urate crystals layer within cartilage and calcium pyrophosphate crystals where on top of cartilage.  

B.  Monosodium urate crystals layer on top of cartilage and calcium pyrophosphate crystals where within cartilage.

C.  The cannot, both crystals may have the same appearance on ultrasound.  

D.  Only monosodium urate crystals can reliably be seen on ultrasound imaging; CPPD crystals cannot.

Monosodium urate crystals can be distinguished from calcium pyrophosphate crystals using ultrasound imaging because:

A.  Monosodium urate crystals layer within cartilage and calcium pyrophosphate crystals where on top of cartilage.  

B.  Monosodium urate crystals layer on top of cartilage and calcium pyrophosphate crystals where within cartilage.

C.  The cannot, both crystals may have the same appearance on ultrasound.  

D.  Only monosodium urate crystals can reliably be seen on ultrasound imaging; CPPD crystals cannot.

Ultrasound guidance for any aspiration may not be indicated if:

A.  Prior palpation guided aspiration attempts have failed.  

B.  The patient is morbidly obese.  

C.  There is uncomplicated anatomy and prior palpation guided temp seven successful.  

D.  Aspiration is to be performed posteriorly for a popliteal  cyst.

Ultrasound guidance for any aspiration may not be indicated if:

A.  Prior palpation guided aspiration attempts have failed.  

B.  The patient is morbidly obese.  

C.  There is uncomplicated anatomy and prior palpation guided temp seven successful.  

D.  Aspiration is to be performed posteriorly for a popliteal  cyst.

The essential landmarks on the posterior transverse scan of the knee to evaluate for popliteal cyst include:

A.  Semi tendinosis.  

B.  Popliteal vessels.  

C.  Posterior collateral ligament.  

D.  Medial head of gastrocnemius.

The essential landmarks on the posterior transverse scan of the knee to evaluate for popliteal cyst include:

A.  Semi tendinosis.  

B.  Popliteal vessels.  

C.  Posterior collateral ligament.  

D.  Medial head of gastrocnemius.

The OMERACT   Definition of synovial hypertrophy is:

A.  Abnormal hypoechoic intra-articular tissue that is nondisplacable and poorly compressible, and may exhibit Doppler signal.

B.  Abnormal  hyperechoic intra-articular tissue that is nondisplacable and poorly compressible, and may exhibit Doppler signal.

C.  Abnormal hypoechoic intra-articular tissue that is nondisplacable and highly compressible, and may exhibit Doppler signal.  

D. abnormal hyper echo, intra-articular tissue that is nondisplacablel and highly compressible, and may exhibit Doppler signal.

The OMERACT   Definition of synovial hypertrophy is:

A.  Abnormal hypoechoic intra-articular tissue that is nondisplacable and poorly compressible, and may exhibit Doppler signal.

B.  Abnormal  hyperechoic intra-articular tissue that is nondisplacable and poorly compressible, and may exhibit Doppler signal.

C.  Abnormal hypoechoic intra-articular tissue that is nondisplacable and highly compressible, and may exhibit Doppler signal.  

D. abnormal hyper echo, intra-articular tissue that is nondisplacablel and highly compressible, and may exhibit Doppler signal.

The articular cartilage of the knee is best characterize on the?  

A.  Suprapatellar longitudinal.  

B.  Posterior transverse

C.  Suprapatellar transverse maximal flexion.  

D.  Medial longitudinal.

The articular cartilage of the knee is best characterize on the?  

A.  Suprapatellar longitudinal.  

B.  Posterior transverse

C.  Suprapatellar transverse maximal flexion.  

D.  Medial longitudinal.

The absence of Doppler signal indicates lack of synovial inflammation.  

A.  True.  

B.  False.

The absence of Doppler signal indicates lack of synovial inflammation.  

A.  True.  

B.  False.

Effusion at the knee is most readily detected in the:

A.  Suprapatellar pouch.  

B.  Lateral or medial parapatellar regions.  

C.  Either A or B.  

D.  None of the above.

  Effusion at the knee is most readily detected in the:

A.  Suprapatellar pouch.  

B.  Lateral or medial parapatellar regions.  

C.  Either A or B.  

D.  None of the above.

Ultrasound assessment is a reliable method to monitor treatment response in several inflammatory diseases.  

A.  True.  

B.  False.

Ultrasound assessment is a reliable method to monitor treatment response in several inflammatory diseases.  

A.  True.  

B.  False.

Which is the following normal structures in the knee are anisotropic?

A.  Patella tendon.  

B.  Medial meniscus.  

C.  Articular cartilage.  

D.  Tibia.

E.  A&B.  

F.  None of the above.

Which is the following normal structures in the knee are anisotropic?

A.  Patella tendon.  

B.  Medial meniscus.  

C.  Articular cartilage.  

D.  Tibia.

E.  A&B.  

F.  None of the above.

Which is the following ultrasound findings are most specific for rheumatoid arthritis?  

A.  Retrocalcaneal bursitis.  

B.  MTP 2 synovial thickening with increased color power Doppler signal.

C.  MTP synovial fluid over 1 mm on dorsal longitudinal view.  

D.  Subtalar joint effusion seen on lateral view.  

E.  MCP 5 erosion less than 2.5 mm in diameter.

Which is the following ultrasound findings are most specific for rheumatoid arthritis?  

A.  Retrocalcaneal bursitis.  

B.  MTP 2 synovial thickening with increased color power Doppler signal.

C.  MTP synovial fluid over 1 mm on dorsal longitudinal view.  

D.  Subtalar joint effusion seen on lateral view.  

E.  MCP 5 erosion less than 2.5 mm in diameter.

The double contour sign:

A.  When clearly demonstrated, is specific for urate deposition.  

B.  Most often represents urate deposition on the cartilage surface.  

C.  Is tapered at each end.  

D.  Remains stationary in the joints flexed and extended.  

E.  Results from reverberation.

The double contour sign:

A.  When clearly demonstrated, is specific for urate deposition.  

B.  Most often represents urate deposition on the cartilage surface.  

C.  Is tapered at each end.  

D.  Remains stationary in the joints flexed and extended.  

E.  Results from reverberation.

The normal plantar fascia thickness is generally up to: 

A. 1 to 2 mm.  

B. 2 to 3 mm.  

C. 3 to 4 mm.  

D. 4 to 5 mm.  

E. 5 to 6 mm.

The normal plantar fascia thickness is generally up to: 

A. 1 to 2 mm.  

B. 2 to 3 mm.  

C. 3 to 4 mm.  

D. 4 to 5 mm.  

E. 5 to 6 mm.

Musculoskeletal ultrasound Achilles tendon abnormalities are marked by:

A.  Tenosynovial color power Doppler signal.  

B.  Intratendonus inflammation reflected in colored power Doppler signal.  

C.  Narrowing of the tendon diameter.  

D.  Drosion where the Achilles inserts into the calcaneus.  

E.   Loss of fibrillar pattern.

Musculoskeletal ultrasound Achilles tendon abnormalities are marked by:

A.  Tenosynovial color power Doppler signal.  

B.  Intratendonus inflammation reflected in colored power Doppler signal.  

C.  Narrowing of the tendon diameter.  

D.  Erosion where the Achilles inserts into the calcaneus.  

E.  Loss of fibrillar pattern.

The following ultrasound finding of the tibialis posterior tendon is abnormal, he even if found without other findings:

A.  2 mm of synovial fluid at the medial malleolus.  

B.  Tenosynovial thickening of 2 mm.  

see.  Increased color power Doppler signal and super malleolar aspect.  

D.  Expansion of the tendon near the navicular insertion.  

E.  Enlargement twice the size of the flexor digitorum longus tendon.

The following ultrasound finding of the tibialis posterior tendon is abnormal, he even if found without other findings:

A.  2 mm of synovial fluid at the medial malleolus.  

B.  Tenosynovial thickening of 2 mm.  

see.  Increased color power Doppler signal and super malleolar aspect.  

D.  Expansion of the tendon near the navicular insertion.  

E.  Enlargement twice the size of the flexor digitorum longus tendon.

The extensor tendons as seen on the dorsal transverse view of the ankle:

A.  Are less commonly pathologic as compared to the flexors.  

B.  Normal have a small amount of tenosynovial fluid in the distal aspect.  

C.  Are superficial to the proximal retinaculum and deep to the distal retinaculum.  

D. Are deep to the proximal retinaculum and superficial to the distal retinaculum.  

E.  Normally have a paratenon attached to the proximal retinaculum.

  The extensor tendons as seen on the dorsal transverse view of the ankle:

A.  Are less commonly pathologic as compared to the flexors.  

B.  Normal have a small amount of tenosynovial fluid in the distal aspect.  

C.  Are superficial to the proximal retinaculum and deep to the distal retinaculum.  

D. Are deep to the proximal retinaculum and superficial to the distal retinaculum.  

E.  Normally have a paratenon attached to the proximal retinaculum.

The best way to determine if hypoechoic signal and a joint space is synovial fluid is all

A.  Teller power Doppler signal evaluation.  

B.  But for acoustic shadowing.  

C.  Measure bone to capsule distance.  

D.  Bellotment with the transducer.  

E.  Recheck this signal abnormalities on power.

The best way to determine if hypoechoic signal and a joint space is synovial fluid is all

A.  Teller power Doppler signal evaluation.  

B.  But for acoustic shadowing.  

C.  Measure bone to capsule distance.  

D.  Bellotment with the transducer.  

E.  Recheck this signal abnormalities on power.

At what portion of the Achilles is paratenonitis most conspicuous?

A.  Anterior.  

B.  Posterior.  

C.  Lateral.  

D.  Distal.  

E.  Central.

At what portion of the Achilles is paratenonitis most conspicuous?

A.  Anterior.  

B.  Posterior.  

C.  Lateral.  

D.  Distal.  

E.  Central.

The retro-achilles bursa:

A.  May not be visible by ultrasound in normal people.  

B.  Is most often egg shaped as visualized by ultrasound.  

C.  Normally is 2 mm in maximum dimension.  

D.  Lies superficial to the Achilles the proximal calcaneus.  

E.  May communicate with subtalar joint and up to 20% of normal people.

The retro-achilles bursa:

A.  May not be visible by ultrasound in normal people.  

B.  Is most often egg shaped as visualized by ultrasound.  

C.  Normally is 2 mm in maximum dimension.  

D.  Lies superficial to the Achilles the proximal calcaneus.  

E.  May communicate with subtalar joint and up to 20% of normal people.

You placed the probe on the dorsal longitudinal view of a swollen ankle and immediately see a normal appearing tibiotalar joint.  The next most important maneuver to perform would be:

A.  Change probe to the anterior transverse view.  

B.  Turn on color Doppler signal using a stand off view.  

C.  Ballottement with the probe. 

D.  Look for subcutaneous edema in overlying tissue.  

E.  Move the probe laterally and medially.

You placed the probe on the dorsal longitudinal view of a swollen ankle and immediately see a normal appearing tibiotalar joint.  The next most important maneuver to perform would be:

A.  Change probe to the anterior transverse view.  

B.  Turn on color Doppler signal using a stand off view.  

C.  Ballottement with the probe. .  

D.  Look for subcutaneous edema in overlying tissue.  

E.  Move the probe laterally and medially.

In this longitudinal scan along the distal femur of 83-year-old girl with juvenile idiopathic arthritis, the arrows are pointing to a hypoechoic area with hyperechoic signals.  This represents:

[image]

A.  A joint effusion in the knee joint with hyperechoic signals.  

B.  Osteochondritis of cartilage of the femur.  

C.  Hyaline cartilage in the femur epiphysis with normal cartilage signals likely representing vascular channels.  

D.  Chronic damage to the cartilage from juvenile arthritis.

   In this longitudinal scan along the distal femur of 83-year-old girl with juvenile idiopathic arthritis, the arrows are pointing to a hypoechoic area with hyperechoic signals.  This represents:

[image]

A.  A joint effusion in the knee joint with hyperechoic signals.  

B.  Osteochondritis of cartilage of the femur.  

C.  Hyaline cartilage in the femur epiphysis with normal cartilage signals likely representing vascular channels.  

D.  Chronic damage to the cartilage from juvenile arthritis.

This longitudinal scan along the humeral radial joint in a 9-year-old girl shows: 

[image]

A.  A hypoechoic area representing either fusion extending from the radial fossa up to the radial head.  

B.  An effusion in the coronoid fossa and hyaline cartilage in the epiphysis of humerus and radius.  

C. a normal humeral radial joint with incomplete ossification of the hyaline cartilage.  

D. A subluxation of the humeral joint.

This longitudinal scan along the humeral radial joint in a 9-year-old girl shows: 

[image]

A.  A hypoechoic area representing either fusion extending from the radial fossa up to the radial head.  

B.  An effusion in the coronoid fossa and hyaline cartilage in the epiphysis of humerus and radius.  

C. a normal humeral radial joint with incomplete ossification of the hyaline cartilage.  

D. A subluxation of the humeral joint.

This suprapatellar longitudinal scan a 3-year-old girl shows: 

[image]

A.  An effusion of the suprapatellar recess.  

B.  The cartilage of the developing patella but no fluid in the suprapatellar recess.  

C.  Quadriceps tendinopathy.  

D.  None of the above.

This suprapatellar longitudinal scan a 3-year-old girl shows: 

[image]

A.  An effusion of the suprapatellar recess.  

B.  The cartilage of the developing patella but no fluid in the suprapatellar recess.  

C.  Quadriceps tendinopathy.  

D.  None of the above.

This longitudinal scan of the hip shows:

[image]

A.  Thickening of the joint capsule of the hip with a double contour sign.  

B. The two layers of the joint capsule of the hip.  

C.  A fracture of the femoral head.  

D.  None of the above.

This longitudinal scan of the hip shows:

[image]

A.  Thickening of the joint capsule of the hip with a double contour sign.  

B. The two layers of the joint capsule of the hip.  

C.  A fracture of the femoral head.  

D.  None of the above.

Which of the following statements is correct with regard ultrasound findings of the hip joint?  

A.  In transient synovitis, fluid accumulates between the anterior and posterior layer of the joint capsule without thickening of the capsule self.  

B.  The demonstration of synovial thickening without Doppler signal is suggestive of transient synovitis.  

C. a hypo echogenic distension of the intra-articular space is suggestive of septic arthritis ( high cell count with and a intra-articular fluid).

D.  Changes of the morphology of the femoral head and advanced hurts disease can be seen on radiographs but not ultrasonography which can only demonstrate soft tissue abnormalities involving joint space.

Which of the following statements is correct with regard ultrasound findings of the hip joint?  

A.  In transient synovitis, fluid accumulates between the anterior and posterior layer of the joint capsule without thickening of the capsule self.  

B.  The demonstration of synovial thickening without Doppler signal is suggestive of transient synovitis.  

C. a hypo echogenic distension of the intra-articular space is suggestive of septic arthritis ( high cell count with and a intra-articular fluid).

D.  Changes of the morphology of the femoral head and advanced hurts disease can be seen on radiographs but not ultrasonography which can only demonstrate soft tissue abnormalities involving joint space.

For temporal mandibular joint ultrasound, which statement is cracked?  

A.  Diagnostic ultrasound of the temporomandibular joint is not possible for technical reasons.  

B. musculoskeletal ultrasound cannot reliably demonstrate synovitis of the temporomandibular joint.  

C.  MRI and ultrasonography are equally sensitive for demonstration of synovitis in the temporomandibular joint.  

D.  Synovitis  in the TMJ  can be reliably demonstrated but the disc physician cannot be fully assessed.

For temporal mandibular joint ultrasound, which statement is cracked?  

A.  Diagnostic ultrasound of the temporomandibular joint is not possible for technical reasons.  

B. musculoskeletal ultrasound cannot reliably demonstrate synovitis of the temporomandibular joint.  

C.  MRI and ultrasonography are equally sensitive for demonstration of synovitis in the temporomandibular joint.  

D.  Synovitis  in the TMJ  can be reliably demonstrated but the disc physician cannot be fully assessed.

When examining clinically swollen ankles and children suffering from juvenile idiopathic arthritis with ultrasonography, the ultrasound exam will typically demonstrate the following: 

A. children with polyarticular disease or more likely to have complex involvement including synovitis as well as tenosynovitis that does with oligoarticular J IA.  

B.  More than 50% of children with oligoarticular Jia a have tibiotalar joint synovitis.  

C.  The highest percentage of any pathology and oligo GI a is lateral tenosynovitis.  

D.  1/3 to 1/2 of children have tenosynovitis only.

When examining clinically swollen ankles and children suffering from juvenile idiopathic arthritis with ultrasonography, the ultrasound exam will typically demonstrate the following: 

A. children with polyarticular disease or more likely to have complex involvement including synovitis as well as tenosynovitis that does with oligoarticular J IA.  

B.  More than 50% of children with oligoarticular Jia a have tibiotalar joint synovitis.  

C.  The highest percentage of any pathology and oligo GI a is lateral tenosynovitis.  

D.  1/3 to 1/2 of children have tenosynovitis only.

The longitudinal midline scan of the wrists with power Doppler in a 10-year-old boy shows: 

[image]

A.  Synovitis of the radiocarpal joint with a pathologic Doppler signal at the site of an early erosion of the lunate bone.  

B.  A feeding vessel entering the lunate bone.

C.  A pathologic shunt between extra and intrarticular joint space.  

D.  None of the above.

The longitudinal midline scan of the wrists with power Doppler in a 10-year-old boy shows: 

[image]

A.  Synovitis of the radiocarpal joint with a pathologic Doppler signal at the site of an early erosion of the lunate bone.  

B.  A feeding vessel entering the lunate bone.

C.  A pathologic shunt between extra and intrarticular joint space.  

D.  None of the above.

This longitudinal scan of the posterior calcaneus and Achilles tendon demonstrates:

[image]

A.  Normal appearance of the calcaneus and four old child.  

B.  Erosive disease in the posterior calcaneus.  

C.  Normal appearance of the calcaneus a 10-year-old child.  

D.  Advanced Achilles tendinopathy.

This longitudinal scan of the posterior calcaneus and Achilles tendon demonstrates:

[image]

A.  Normal appearance of the calcaneus in a four old child.  

B.  Erosive disease in the posterior calcaneus.  

C.  Normal appearance of the calcaneus in a 10-year-old child.  

D.  Advanced Achilles tendinopathy.

Which is the following statements with regards to erosions in the small joints of the fingers is true:

A.  Erosions in the MCP joints cannot be shown with ultrasonography.  

B.  In children, erosions of the small finger joints can be expected anymore epiphyseal location than an adults.  

C.  Erosions of the MCP joints in children cannot be visualize due to the cartilage in the epiphyseal areas.  

D.  Erosions only occur in a mature skeleton full ossification.

Which is the following statements with regards to erosions in the small joints of the fingers is true:

A.  Erosions in the MCP joints cannot be shown with ultrasonography.  

B.  In children, erosions of the small finger joints can be expected in a more epiphyseal location than an adults.  

C.  Erosions of the MCP joints in children cannot be visualize due to the cartilage in the epiphyseal areas.  

D.  Erosions only occur in a mature skeleton full ossification.

The procedure needle tip and shaft is best visualized:

A.  In-plane with the probe at 45° to the ultrasound.  

B.  Out of plane with a probe at 45° to the ultrasound.

C.  In-plane with the probe and at right angles to the ultrasound beam.  

D.  In-plane with the probe and at a steep angle to the ultrasound beam.  

  The procedure needle tip and shaft is best visualized:

A.  In-plane with the probe at 45° to the ultrasound.  

B.  Out of plane with a probe at 45° to the ultrasound.

C.  In-plane with the probe and at right angles to the ultrasound beam.  

D.  In-plane with the probe and at a steep angle to the ultrasound beam.  

What safety measures can be undertaken to prevent infections in the puncture site during ultrasound-guided procedures?  

A.  Make certain the ultrasound gel covers the puncture site.  

B.  Use a longer needle a truck versus the gel before penetrate the skin.

C.  Use a longer needle to keep the puncture site away from the gel.

D   Use a condom on the probe and then traversing ultrasound gel with a needle.

What safety measures can be undertaken to prevent infections in the puncture site during ultrasound-guided procedures?  

A.  Make certain the ultrasound gel covers the puncture site.  

B.  Use a longer needle a truck versus the gel before penetrate the skin.

C.  Use a longer needle to keep the puncture site away from the gel.

D   Use a condom on the probe and then traversing ultrasound gel with a needle.

In hip joint injections, the procedure needle should be directed into the:

A.  Acetabula femoral joint.  

B.  The greater trochanter.  

C.  Acetabular labrum.  

D.  Synovial recess of the femoral neck.

In hip joint injections, the procedure needle should be directed into the:

A.  Acetabula femoral joint.  

B.  The greater trochanter.  

C.  Acetabular labrum.  

D.  Synovial recess of the femoral neck.

The needle out of plane of the ultrasound beam appears as: 

A.  A brightly reflective circle, crescent, or rim.  

B.  Completely and visible.  

C.  A long reflective shaft.  

D.  A series of reflective ghosts.

  The needle out of plane of the ultrasound beam appears as: 

A.  A brightly reflective circle, crescent, or rim.  

B.  Completely and visible.  

C.  A long reflective shaft.  

D.  A series of reflective ghosts.

Ultrasound-guided procedures compared to anatomic landmark procedure guidance are not: 

A.  More accurate.  

B.  More painful.  

C.  More costly per procedure.  

D.  As safe.

Ultrasound-guided procedures compared to anatomic landmark procdure guidance are not: 

A.  More accurate.  

B.  More painful.  

C.  More costly per procedure.  

D.  As safe.

In an abnormal shoulder with rotator cuff pathology/ tears, if you injected medication into the subacromial bursa, where also may also see injected date?  

A.  Bicipital tendon sheath.  

B.  Glenohumeral joint.  

C.  Medications his only in the subacromial bursa.  

D.  Supraspinatus tendon.

In an abnormal shoulder with rotator cuff pathology/ tears, if you injected medication into the subacromial bursa, where also may also see injected date?  

A.  Bicipital tendon sheath.  

B.  Glenohumeral joint.  

C.  Medications his only in the subacromial bursa.  

D.  Supraspinatus tendon.

Which ultrasound guided needle approach method is not recommended for carpal tunnel injections?  

A.  Probe in transverse view of the median nerve needle in plane under approach.  

B.  Probe transverse view of the median nerve needle in plan radial approach.

C.  Probe in the transverse view of the median nerve needle out of plane approach.  

D.  Problem longitudinal view of the median nerve needle in planned approach.

Which ultrasound guided needle approach method is not recommended for carpal tunnel injections?  

A.  Probe in transverse view of the median nerve needle in plane ulnar approach.  

B.  Probe transverse view of the median nerve needle in plan radial approach.

C.  Probe in the transverse view of the median nerve needle out of plane approach.  

D.  Problem longitudinal view of the median nerve needle in planned approach.

For aspiration procedures, the most reasonable indication to use ultrasound guidance is to:

A.  Enhanced standard anatomic palpation guided approaches to joint aspiration.  

B.  Visualization of the nasal in normal anatomic structures redness.  

C.  Make aspiration less painful.  

D.  Confirm fluid to be aspirated and direct the needle into the fluid in a previously failed anatomic palpation guided aspiration.

For aspiration procedures, the most reasonable indication to use ultrasound guidance is to:

A.  Enhanced standard anatomic palpation guided approaches to joint aspiration.  

B.  Visualization of the nasal in normal anatomic structures redness.  

C.  Make aspiration less painful.  

D.  Confirm fluid to be aspirated and direct the needle into the fluid in a previously failed anatomic palpation guided aspiration.

The flexible procedure needle on a syringe is angled away from the intended for target, the best technique to redirected is:

A.  Forcefully point this range in the direction of the target.

B.  Forcefully point the syringe in the direction of an angled needle.

C.  Pulse back in slight a point the syringe in the direction of the target.  

D.  Pulled back slightly point the syringe in the direction of the angled needle.

The flexible procedure needle on a syringe is angled away from the intended for target, the best technique to redirected is:

A.  Forcefully point this range in the direction of the target.

B.  Forcefully point the syringe in the direction of an angled needle.

C.  Pulse back in slight a point the syringe in the direction of the target.  

D.  Pulled back slightly point the syringe in the direction of the angled needle.

In ultrasound-guided needle procedures, bubbles in the fluid in the syringe are:

A.  Useful as ultrasound contrast to see with the needle tip is.

B.  A danger source of infection.  

C.  Indicate contamination of the lidocaine or corticosteroid.  

D.  Should be expelled before procedure because injected bubbles interfere with ultrasound imaging. 

In ultrasound-guided needle procedures, bubbles in the fluid in the syringe are:

A.  Useful as ultrasound contrast to see with the needle tip is.

B.  A danger source of infection.  

C.  Indicate contamination of the lidocaine or corticosteroid.  

D.  Should be expelled before procedure because injected bubbles interfere with ultrasound imaging. 

What is the intima-to-media complex (IMC) thickness?  

A.  The distance between the upper and lower borders of the color flow.  

B.  The distance between the outer and inner hyperechoic lines on the vessel wall.

C.  The distance between the outer anechoic and inner hyperechoic lines on the vessel wall.  

D.  None of the above.

What is the intima-to-media complex (IMC) thickness?  

A.  The distance between the upper and lower borders of the color flow.  

B.  The distance between the outer and inner  hyperechoic lines on the vessel wall.

C.  The distance between the outer anechoic and in her hyperechoic lines on the vessel wall.  

D.  None of the above.

Why should one steer the window in color Doppler ultrasound examination?  

A.  Get more stable images well moving the transducer.  

B.  To get sufficient collar failing according to the Doppler Swift acquisition.  

C.  To visualize the whole length of the artery.  

D.  No need to steroid window.

Why should one steer the window in color Doppler ultrasound examination?  

A.  Get more stable images well moving the transducer.  

B.  To get sufficient collar failing according to the Doppler Swift acquisition.  

C.  To visualize the whole length of the artery.  

D.  No need to steroid window.

Which diseases can present with halo sign in the temporal arteries?  

A.  Giant cell arteritis.  

B.  Other medium vessel vasculitides.  

C.  Infections.  

D.  All the above.

  Which diseases can present with halo sign in the temporal arteries?  

A.  Giant cell arteritis.  

B.  Other medium vessel vasculitides.  

C.  Infections.  

D.  All the above.

How to avoid a false halo in a patient with thick hair?  

A.  Apply heart pressure with transducer.  

B.  She of the hair.  

C.  Use copious amounts of gel.  

D.  Apply gentle pressure with the transducer.  

E.  C and D.

  How to avoid a false halo in a patient with thick hair?  

A.  Apply heart pressure with transducer.  

B.  She of the hair.  

C.  Use copious amounts of gel.  

D.  Apply gentle pressure with the transducer.  

E.  C and D.

Which is the appropriate frequency and PRF adjustment of the color Doppler in order to examine the cranial arteries?  

A. 10 MHz for the frequency and 2 MHz for the PRF.  

B. 3.5 MHz for the frequency and 2 MHz for the PRF.  

C.  As well as possible for the frequency and PRF.  

D.  13 MHz and 5 MHz.

Which is the appropriate frequency and PRF adjustment of the color Doppler in order to examine the cranial arteries?  

A. 10 MHz for the frequency and 2 MHz for the PRF.  

B. 3.5 MHz for the frequency and 2 MHz for the PRF.  

C.  As well as possible for the frequency and PRF.  

D.  13 MHz and 5 MHz.

Why is it important use high end ultrasound equipment visualized temporal artery?  

A.  Because you are able to visualize the whole temporal artery with excellent resolution and assess inflammation.  

B.  Because it is easier to perform ultrasound with high quality equiptment.  

C.  Because the power doppler is performing excellent in high end equipment.  

D.  A&B.

Why is it important use high end ultrasound equipment visualized temporal artery?  

A.  Because you are able to visualize the whole temporal artery with excellent resolution and assess inflammation.  

B.  Because it is easier to perform ultrasound with high quality equiptment.  

C.  Because the power doppler is performing excellent in high end equipment.  

D.  A&B.

How often are the blood vessels and lower extremities affected in giant cell arteritis on ultrasound evaluation?  

A.  Never.  

B.  20%.  

C.  50%. 

D.  90%.

How often are the blood vessels and lower extremities affected in giant cell arteritis on ultrasound evaluation?  

A.  Never.  

B.  20%.  

C.  50%. 

D.  90%.

Which are the supra-aortic arteries that are routinely evaluated in GCA patients?  

A.  None, we do not need to perform ultrasound of large vessels in GCA, the disease affects only cranial arteries.  

B.  Carotid, axillary, subclavian arteries.  

C.  Vertebral arteries, cervical cephalic trunk, and mastic artery.  

D.  Carotid arteries.

  Which are the super aortic arteries that are routinely evaluated in GCA patients?  

 Which are the supra-aortic arteries that are routinely evaluated in GCA patients?  

A.  None, we do not need to perform ultrasound of large vessels in GCA, the disease affects only cranial arteries.  

B.  Carotid, axillary, subclavian arteries.  

C.  Vertebral arteries, cervical cephalic trunk, and mastic artery.  

D.  Carotid arteries.

A.  None, we do not need to perform ultrasound of large vessels in GCA, the disease affects only cranial arteries.  

B.  Carotid, axillary, subclavian arteries.  

C.  Vertebral arteries, cervical cephalic trunk, and mastic artery.  

D.  Carotid arteries.

Which is the difference between color and power Doppler?  

A.  Only the color.  

B.  No difference -we can use both equally in the examination blood vessels.  

C.  Color doppler measures the velocity well power doppler measures the energy.  

D. power doppler is more sensitive in color doppler in visualize in the interval wall inflammation.

Which is the difference between color and power Doppler?  

A.  Only the color.  

B.  No difference -we can use both equally in the examination blood vessels.  

C.  Color doppler measures the velocity well power doppler measures the energy.  

D. power doppler is more sensitive in color doppler in visualize in the interval wall inflammation.

What is the sensitivity of color Doppler of temporal artery and large vessels in giant cell arteritis diagnostics according to recent studies?  

A. 20%.  

B. 55%.  

C. 80%.  

D. 100%.

What is the sensitivity of color Doppler of temporal artery and large vessels in giant cell arteritis diagnostics according to recent studies?  

A. 20%.  

B. 55%.  

C. 80%.  

D. 100%.

The best adjustment to increase ultrasound penetration to deeper structures is:

A.  Decrease frequency.  

B.  Increased gain.  

C.  Decreased grayscale.  

D.  Increased power.  

The best adjustment to increase ultrasound penetration to deeper structures is:

A.  Decrease frequency.  

B.  Increased gain.  

C.  Decreased grayscale.  

D.  Increased power.  

Which tissue type demonstrates the most anisotropy?

A.  Nerve.  

B.  Tendon.  

C.  Muscle.  

D.  Synovium.

Which tissue type demonstrates the most anisotropy?

A.  Nerve.  

B.  Tendon.  

C.  Muscle.  

D.  Synovium.

Power doppler ultrasound of and MCP joint appears negative.  To minimize the chance that this images false negative, the Doppler region of interest folic should be:

A.  Sized as large as possible within the window.  

B.  Position to exclude superficial vessels.  

C.  Imaged with firm probe/ skin contact. 

D.  Adjusted by gain to include artifact.

Power Doppler ultrasound of and MCP joint appears negative.  To minimize the chance that this images false negative, the Doppler region of interest folic should be:

A.  Sized as large as possible within the window.  

B.  Position to exclude superficial vessels.  

C.  Imaged with firm probe/ skin contact. 

D.  Adjusted by gain to include artifact.

Which is the following structures is responsible for stabilizing the proximal interphalangeal joint, presenting hyperextension injuries?  

A.  Volar plate.  

B.  Flexor tendon.  

C.  Collateral ligament.  

D.  Extensor central slip.

Which is the following structures is responsible for stabilizing the proximal interphalangeal joint, presenting hyperextension injuries?  

A.  Volar plate.  

B.  Flexor tendon.  

C.  Collateral ligament.  

D.  Extensor central slip.

Which of the following structures distinctly delineates extensor compartment 3 which contains the abductor pollicis longus from extensor compartment 2 which contains extensor carpi radialis brevis and longus?  

A.  Lister's tubercle.  

B.  Scapholunate ligament.  

C.  Radial artery.  

D.  Triangular fibrocartilage compartment.

Which of the following structures distinctly delineates extensor compartment 3 which contains the abductor pollicis longus from extensor compartment 2 which contains extensor carpi radialis brevis and longus?

A.  Lister's tubercle.  

B.  Scapholunate ligament.  

C.  Radial artery.  

D.  Triangular fibrocartilage compartment.

Erosions due to rheumatoid arthritis in the MCP joints can be detected by ultrasound.  Which MCP joints are best evaluated by the ultrasound as compared to utilizing plain x-rays?  

A.  MCP 2 and MCP 5.  

B.  MCP 3 and MCP 4.  

C.  MCP 2 and MCP 4.  

D.  MCP 3 and MCP 5.

Erosions due to rheumatoid arthritis in the MCP joints can be detected by ultrasound.  Which MCP joints are best evaluated by the ultrasound as compared to utilizing plain x-rays?  

A.  MCP 2 and MCP 5.  

B.  MCP 3 and MCP 4.  

C.  MCP 2 and MCP 4.  

D.  MCP 3 and MCP 5.

Chronic tendinosis of the common extensor tendon of the elbow is typically seen with certain features on ultrasound.  

Which is the following is a feature of chronic tendinosis?  

A.  Tendon thinning.  

B.  Homogeneous echotexture.  

C.  Hypoechoic tendon rim.  

D.  Calcifications.

Chronic tendinosis of the common extensor tendon of the elbow is typically seen with certain features on ultrasound.  

Which is the following is a feature of chronic tendinosis?  

A.  Tendon thinning.  

B.  Homogeneous echotexture.  

C.  Hypoechoic tendon rim.  

D.  Calcifications.

The ulnar nerve can be found on ultrasound by placing a probe between the bony prominences of the olecranon process and the. . .

A.  Radial tuberosity.  

B.  Medial epicondyle.  

C.  Lateral epicondyle.  

D.  Ulnar styloid.

The ulnar nerve can be found on ultrasound by placing a probe between the bony prominences of the olecranon process and the. . .

A.  Radial tuberosity.  

B.  Medial epicondyle.  

C.  Lateral epicondyle.  

D.  Ulnar styloid.

The best way to position the patient to look for joint effusion the posterior elbow joint is:

A.  Flexion.  

B.  Extension.  

C.  Pronation.  

D.  Supination.

The best way to position the patient to look for joint effusion the posterior elbow joint is:

A.  Flexion.  

B.  Extension.  

C.  Pronation.  

D.  Supination.

The rotator cuff interval as form by which the following tendons?  

A.  Supraspinatus and Infraspinatus.  

B.  Supraspinatus and Teres minor.  

C.  Supraspinatus and Subscapularis.  

D.  Infraspinatus and Subscapularis.

The rotator cuff interval as form by which the following tendons?  

A.  The supraspinatus and infraspinatus.  

B.  Supraspinatus and teres minor.  

C.  Supraspinatus and subscapularis.  

D.  Infraspinatus and subscapularis.

Ultrasound of the rotator cuff: 

A. Has a sensitivity and specificity greater than 0.9

B. Is less sensitive in patients with rheumatoid arthritis. 

C. Is less useful than MRI in identifying muscle atrophy. 

D. Also identifies labral tears. 

Ultrasound of the rotator cuff: 

A. Has a sensitivity and specificity greater than 0.9

B. Is less sensitive in patients with rheumatoid arthritis. 

C. Is less useful than MRI in identifying muscle atrophy. 

D. Also identifies labral tears. 

Accuracy of needle placement in the shoulder is: 

A. 64% accurate in a study of 6 surgeons for the posterior joint. 

B. Highly correlated with physician confidence. 

C. 45-75% accurate in a study of 6 surgeons for the posterior joint. 

D. Improved to 92% for all approaches to the joint if ultrasound is added. 

Accuracy of needle placement in the shoulder is: 

A. 64% accurate in a study of 6 surgeons for the posterior joint. 

B. Highly correlated with physician confidence. 

C. 45-75% accurate in a study of 6 surgeons for the posterior joint. 

D. Improved to 92% for all approaches to the joint if ultrasound is added. 

This longitudinal scan in grey scale and power doppler of the wrist in an 11-year-old boy with JIA along the midline is showing: 

[image]

A. Normal appearing joint with partly ossified bones without evidence of synovitis. 

B. Anechoic areas representing fluid in the radiocarpal as well as the midcarpal and carpometacarpal joint. 

C. Doppler signals indicative of synovitis in the area of the capitate bone. 

D. A delay in ossification as shown by incompletely ossified bones. 

This longitudinal scan in grey scale and power doppler of the wrist in an 11-year-old boy with JIA along the midline is showing: 

 [image]

A. Normal appearing joint with partly ossified bones without evidence of synovitis. 

B. Anechoic areas representing fluid in the radiocarpal as well as the midcarpal and carpometacarpal joint. 

C. Doppler signals indicative of synovitis in the area of the capitate bone. 

D. A delay in ossification as shown by incompletely ossified bones. 

This longintudinal scan along the humeroulnar joint in a nine year old girl shows: 

[image] 

A. Hypoechoid area representing an effusion extending from the coronoid fossa up to the coronoid process. 

B. An effusion in the coronoid fossa and hyaline cartilage in the epiphysis of humerus and ulna. 

C. A normal humeroulnar joint with incomplete ossification of the hyaline cartilage. 

D. A subluxation of the humeroulnar joint. 

This longintudinal scan along the humeroulnar joint in a nine year old girl shows: 

[image] 

A. Hypoechoid area representing an effusion extending from the coronoid fossa up to the coronoid process. 

B. An effusion in the coronoid fossa and hyaline cartilage in the epiphysis of humerus and ulna. 

C. A normal humeroulnar joint with incomplete ossification of the hyaline cartilage. 

D. A subluxation of the humeroulnar joint. 

This grey scale and Power doppler longitudinal image of an eleven year old boy with Juvenile Idiopathic Arthritis taken in midline at the wrist are showing: 

[image]

A. Normal appearing radiocarpal, midcarpal, and carpometacarpal joints with physiologic Doppler signals. 

B. Mild distention of the radiocarpal joint recess with intrasynovial doppler signals suggestive of synovitis. 

C. Mild distention of the midcarpal joint recess with intrasynovial doppler isgnals suggestive of synovitis. 

D. Irregular wrist bones suggestive of chronic changes secondary to synovitis. 

This grey scale and Power doppler longitudinal image of an eleven year old boy with Juvenile Idiopathic Arthritis taken in midline at the wrist are showing: 

[image]

A. Normal appearing radiocarpal, midcarpal, and carpometacarpal joints with physiologic Doppler signals. 

B. Mild distention of the radiocarpal joint recess with intrasynovial doppler signals suggestive of synovitis. 

C. Mild distention of the midcarpal joint recess with intrasynovial doppler isgnals suggestive of synovitis. 

D. Irregular wrist bones suggestive of chronic changes secondary to synovitis. 

Which position is recommended for scanning the anterior hip? 

A. Hip 15 degrees internally rotated, knees and ankles touching. 

B. Hips 15 degrees externally rotated knees and ankles touching. 

C. Hips in natural position, knees and ankles touching. 

D. Hips abducted, knees flexed, ankles touching.

Which position is recommended for scanning the anterior hip? 

A. Hip 15 degrees internally rotated, knees and ankles touching. 

B. Hips 15 degrees externally rotated knees and ankles touching. 

C. Hips in natural position, knees and ankles touching. 

D. Hips abducted, knees flexed, ankles touching.

Which best describes the normal joint capsule over the femoral neck? 

A. Convex

B. The width is within 5 mm of the contralateral side. 

C. Concave. 

D. More than 7mm wide. 

Which best describes the normal joint capsule over the femoral neck? 

A. Convex

B. The width is within 5 mm of the contralateral side. 

C. Concave. 

D. More than 7mm wide. 

When performing an ultrasound guided hip joint injection, where should the needle target be? 

A. femoral-acetabular joint. 

B. Iliopsoas bursa. 

C. Trochanteric bursa. 

D. Capsule at the femoral head-neck junction. 

When performing an ultrasound guided hip joint injection, where should the needle target be? 

A. femoral-acetabular joint. 

B. Iliopsoas bursa. 

C. Trochanteric bursa. 

D. Capsule at the femoral head-neck junction. 

When examining the knee, what is the ideal position for obtaining maximal doppler signal and grey scale abnormalities in the recesses and joint space?

A. Extended

B. Extended with quad contraction. 

C. 30 degrees flexion. 

D. 90 degrees flexion. 

When examining the knee, what is the ideal position for obtaining maximal doppler signal and grey scale abnormalities in the recesses and joint space?

A. Extended

B. Extended with quad contraction. 

C. 30 degrees flexion. 

D. 90 degrees flexion. 

During examination of the entheses, what problem can arise when there is tension on tissue? 

A. obscured gray scale findings of enthesitis. 

B. Obscured Doppler findings of enthesitis. 

C. Enthesial tears more difficult to evaluate. 

D. Obscured bursitis. 

During examination of the entheses, what problem can arise when there is tension on tissue? 

A. obscured gray scale findings of enthesitis. 

B. Obscured Doppler findings of enthesitis. 

C. Enthesial tears more difficult to evaluate. 

D. Obscured bursitis. 

When looking for pes anserine bursitis, what structure should be followed to its insertion? 

A. Patellar ligament. 

B. Lateral collateral Ligament. 

C. Medial collateral ligament. 

D. Popliteus tendon. 

When looking for pes anserine bursitis, what structure should be followed to its insertion? 

A. Patellar ligament. 

B. Lateral collateral Ligament. 

C. Medial collateral ligament. 

D. Popliteus tendon. 

Which of the following are important elements to define 76881, complete joint ultrasound? 

A. AP, lateral, oblique views. 

B. Dorsal, Ventral, Medial and lateral views of a joint. 

C. A specific joint examination that includes the muscles, tendons, joint, other soft tissue structures an any identifiable abnormality. 

D. A specific joint examination that includes the muscles, tendons, joint, bone, and other soft tissues structures. 

Which of the following are important elements to define 76881, complete joint ultrasound? 

A. AP, lateral, oblique views. 

B. Dorsal, Ventral, Medial and lateral views of a joint. 

C. A specific joint examination that includes the muscles, tendons, joint, other soft tissue structures an any identifiable abnormality. 

D. A specific joint examination that includes the muscles, tendons, joint, bone, and other soft tissues structures. 

What special limitation is usually applied to the use of 76881 and 76882?

A. you cannot ever use M05.79 RA with RF of multiple sites as an indicationfor a diagnostic US. 

B. More than one complete US per joint per 12 month period is considered medically necessary. 

C. You cannot order a 76970 US F/U after 76881 or 76882. 

D. More than four extremity US in 12 mo Complete or limited will be considered not medically necessary. 

What special limitation is usually applied to the use of 76881 and 76882?

A. you cannot ever use M05.79 RA with RF of multiple sites as an indicationfor a diagnostic US. 

B. More than one complete US per joint per 12 month period is considered medically necessary. 

C. You cannot order a 76970 US F/U after 76881 or 76882. 

D. More than four extremity US in 12 mo Complete or limited will be considered not medically necessary. 

Which joint is defined in the list of bundled codes for US guided arthrocentesis? 

A. AC joint. 

B. SC joint. 

C. SI Joint. 

D. Lumbar facet joint. 

Which joint is defined in the list of bundled codes for US guided arthrocentesis? 

A. AC joint. 

B. SC joint. 

C. SI Joint. 

D. Lumbar facet joint. 

Sonographic detection of bony erosion in rheumatoid arthritis has the highest yeild if it includes which of the following areas? 

A. femoral head. 

B. MCP 5

C. Distal ulna. 

D. MTP 5

Sonographic detection of bony erosion in rheumatoid arthritis has the highest yeild if it includes which of the following areas? 

A. femoral head. 

B. MCP 5

C. Distal ulna. 

D. MTP 5

Which of the following sonographic features of gout is part of the eular/acr classification criteria for gout? 

A. tophus within tendon body. 

B. tophus within joint. 

C. double contour sign. 

D. bony erosion with marginal overhang. 

Which of the following sonographic features of gout is part of the eular/acr classification criteria for gout? 

A. tophus within tendon body. 

B. tophus within joint. 

C. double contour sign. 

D. bony erosion with marginal overhang. 

Which of the following is the most normal range for plantar fascia origin thickness? 

A. one to two mm

B. two to four mm. 

C. four to six mm. 

D. six to eight mm. 

Which of the following is the most normal range for plantar fascia origin thickness? 

A. one to two mm

B. two to four mm. 

C. four to six mm. 

D. six to eight mm. 

Which of the following statements regarding needle imaging is true? 

A. A needle placed in a shallow orientation reflects sound the same as a needle in a steep oritentation. 

B. A needle placed "in plane" is more difficult to visualize than "out of plane" 

C. Some ultrasound machines have programming to enhance needle visualization. 

D. Probe Choice has no effect on imaging a superficial versus a deep tissue target. 

Which of the following statements regarding needle imaging is true? 

A. A needle placed in a shallow orientation reflects sound the same as a needle in a steep oritentation. 

B. A needle placed "in plane" is more difficult to visualize than "out of plane" 

C. Some ultrasound machines have programming to enhance needle visualization. 

D. Probe Choice has no effect on imaging a superficial versus a deep tissue target. 

Which statement regarding the approach to a target is true? 

A. Direct in plane visualization creates the potential to see the needle from entry to placement. 

B. direct out of plane visualization creates the potential to see the needle from entry to placement. 

C. Indirect localization does not improve with imaging of the target in orthogonal planes. 

D. Color power doppler use cannot create an additional signal during needle placement to help trace the needle track. 

Which statement regarding the approach to a target is true? 

A. Direct in plane visualization creates the potential to see the needle from entry to placement. 

B. direct out of plane visualization creates the potential to see the needle from entry to placement. 

C. Indirect localization does not improve with imaging of the target in orthogonal planes. 

D. Color power doppler use cannot create an additional signal during needle placement to help trace the needle track. 

Which statement regarding potential benefits of ultrasound-guided arthrocentesis is true. 

A. USG has no effect on needle placement. 

B. USG has no effect on procedural pain. 

C. USG increases synovial fluid volume removed during aspiration. 

D. US Guidence increases trauma to joint space during arthrocentesis. 

Which statement regarding potential benefits of ultrasound-guided arthrocentesis is true. 

A. USG has no effect on needle placement. 

B. USG has no effect on procedural pain. 

C. USG increases synovial fluid volume removed during aspiration. 

D. US Guidence increases trauma to joint space during arthrocentesis. 

In this longitudinal scan along the distal femur of a three year old girl with juvenile idiopathic arthritis the arrows are pointing to a hypoechoic area with hyperechoic signals. This represents: 

[image]

A. Joint effusion in the knee joint with hyperechoic signals. 

B. Osteochontrosis of the cartilage of the femur. 

C. Hyaline cartilage in the femur epiphysis with normal cartilage signals likely representing vascular channels. 

D. Chronic dmaage to the cartilage from the juvenile arthritis. 

In this longitudinal scan along the distal femur of a three year old girl with juvenile idiopathic arthritis the arrows are pointing to a hypoechoic area with hyperechoic signals. This represents: 

[image]

A. Joint effusion in the knee joint with hyperechoic signals. 

B. Osteochontrosis of the cartilage of the femur. 

C. Hyaline cartilage in the femur epiphysis with normal cartilage signals likely representing vascular channels. 

D. Chronic dmaage to the cartilage from the juvenile arthritis. 

This grey scale image is showing a knee joint effusion with a hypoechoic structure with slightly hyperechoic borders indicated by the arrows inside the effusion. This structure represents:

[image] 

A. Normal irregular outline of the knee joint effusion. 

B. An area of synovial hypertrophyl

C. Fat from the prefemoral fatpad herniating into the effusion. 

D. The typical appearance of pigmented villonodular synovitis. 

This grey scale image is showing a knee joint effusion with a hypoechoic structure with slightly hyperechoic borders indicated by the arrows inside the effusion. This structure represents: 

[image]

A. Normal irregular outline of the knee joint effusion. 

B. An area of synovial hypertrophyl

C. Fat from the prefemoral fatpad herniating into the effusion. 

D. The typical appearance of pigmented villonodular synovitis. 

When examining clinically swollen ankles in children suffering from JIA with ultrasonography, the ultrasound exam will typically demonstrate the following: 

A. Children with polyarticular disease are more likely to have complex involvement including synovitis as well as tenosynovitis than those with oligoarticular JIA. 

B. More than 50% of children with oligoarticular JIA had tibiotalar joint synovitis. 

C. The highest percentage of any pathology in oligo JIA was lateral tenosynovitis. 

D. 1/3 to 1/2 of the children had tenosynovitis only. 

When examining clinically swollen ankles in children suffering from JIA with ultrasonography, the ultrasound exam will typically demonstrate the following: 

A. Children with polyarticular disease are more likely to have complex involvement including synovitis as well as tenosynovitis than those with oligoarticular JIA. 

B. More than 50% of children with oligoarticular JIA had tibiotalar joint synovitis. 

C. The highest percentage of any pathology in oligo JIA was lateral tenosynovitis. 

D. 1/3 to 1/2 of the children had tenosynovitis only. 

A 40 year old, obese but otherwise healthy woman with joint pain for the past 2 years and tender MCPs has these orthoganal views of an MCP joint. 

Which of the following would be the most appropriate treatment recommendations? 

A. Duloxetine. 

B. Naproxen. 

C. Hydroxychloroquine. 

D. Methotrexate

E. Colchicine. 

A 40 year old, obese but otherwise healthy woman with joint pain for the past 2 years and tender MCPs has these orthoganal views of an MCP joint. 

[image]

Which of the following would be the most appropriate treatment recommendations? 

A. Duloxetine. 

B. Naproxen. 

C. Hydroxychloroquine. 

D. Methotrexate

E. Colchicine. 

A 40 year old, obese but otherwise healthy woman with joint pain for the past 2 years and tender MCPs has these orthoganal views of an MCP joint. 

[image]

Which of the following would be the most appropriate treatment recommendations? 

A. Duloxetine. 

B. Naproxen. 

C. Hydroxychloroquine. 

D. Methotrexate

E. Colchicine.  

The best description of the orthogonal views of the anterior shoulder obtained in the crass position is: 

[image]

A. Full thickness tear of the supraspinatus tendon. 

B. Partial thickness tear of the supraspinatus tendon. 

Normal supraspinatus with subacromial bursitis. 

D. Normal supraspinatus tendon with normal subacromial bursae. 

E. Intrasubstance tear of the supraspinatus tendon. 

The best description of the orthogonal views of the anterior shoulder obtained in the crass position is: 

[image]

A. Full thickness tear of the supraspinatus tendon. 

B. Partial thickness tear of the supraspinatus tendon. 

Normal supraspinatus with subacromial bursitis. 

D. Normal supraspinatus tendon with normal subacromial bursae. 

E. Intrasubstance tear of the supraspinatus tendon. 

A patient with acute wrist pain is evaluated with ultrasound by one of you colleagues who shows you these ortogonal views of the radiocarpal joint and asks you if you think there is fluid that can be aspirated. After chiding him for not noincluding the intercarpal joint, not getting "compression" views, and not getting doppler views you tell him "the radiocarpal abnormal appearance is ..."

[image]

A. Likely due to anisotropy so arthrocentesis will be unlikely to yield fluid for analysiss. 

B. Likely due to synovial thickening so arthrocentesis will be unlikely to yeild fluid for analysis. 

C. Likely due to effusion so arthrocentesis is likely to result in more than 4 ml of fluid. 

D. Likely due to effusion so arthrocentesis is likely to result in less than 1 ml of fluid. 

E. Likely due to shadowing from overlying calcium so you cannot tell whether an arthocentesis will yield fluid. 

A patient with acute wrist pain is evaluated with ultrasound by one of you colleagues who shows you these ortogonal views of the radiocarpal joint and asks you if you think there is fluid that can be aspirated. After chiding him for not noincluding the intercarpal joint, not getting "compression" views, and not getting doppler views you tell him "the radiocarpal abnormal appearance is ..."

[image]

A. Likely due to anisotropy so arthrocentesis will be unlikely to yield fluid for analysiss. 

B. Likely due to synovial thickening so arthrocentesis will be unlikely to yeild fluid for analysis. 

C. Likely due to effusion so arthrocentesis is likely to result in more than 4 ml of fluid. 

D. Likely due to effusion so arthrocentesis is likely to result in less than 1 ml of fluid. 

E. Likely due to shadowing from overlying calcium so you cannot tell whether an arthocentesis will yield fluid. 

This is a posterior longitudinal view of the Achilles tendon at the calcaneus. The asterisk is located in: 

[image]

A. Kager's fat pad. 

B. Hoffa's Fat pad. 

C. Jimmy's fat pad. 

D. The retrocalcaneal bursa

This is a posterior longitudinal view of the Achilles tendon at the calcaneus. The asterisk is located in: 

[image]

A. Kager's fat pad. 

B. Hoffa's Fat pad. 

C. Jimmy's fat pad. 

D. The retrocalcaneal bursa

What statement best fits with the orthogonal images of the achilles tendon? 

[image]

A. This tendon was found in a 60 year old patient with metabolic syndrome and no tenderness over the Achilles. 

B. This tendon was found in an asymptomatic, healthy 20 year old ultrasound model. 

C. This tendon was found in a 25 year old man with ankylosing spondylitis and Achilles pain. 

D. This tendon was found in a 75 year old man with gout and achilles pain. 

E. This tendon was found in a 40 year old, asymptomstic basketball player after achilles tendon repair surgery 1 year ago. 

What statement best fits with the orthogonal images of the achilles tendon? 

[image]

A. This tendon was found in a 60 year old patient with metabolic syndrome and no tenderness over the Achilles. 

B. This tendon was found in an asymptomatic, healthy 20 year old ultrasound model. 

C. This tendon was found in a 25 year old man with ankylosing spondylitis and Achilles pain. 

D. This tendon was found in a 75 year old man with gout and achilles pain. 

E. This tendon was found in a 40 year old, asymptomstic basketball player after achilles tendon repair surgery 1 year ago. 

These orthogonal views of the ankle came from which area: 

[image]

A. Anterior. 

B. Medial. 

C. Posterior. 

D. Lateral. 

E. Plantar. 

These orthogonal views of the ankle came from which area: 

[image]

A. Anterior. 

B. Medial. 

C. Posterior. 

D. Lateral. 

E. Plantar. 

This is a longitudinal (sagittal) view of the infrapatellar region. At the right is the orthogonal (transverse) view. Choose the best term for the finding deicted here: 

[image]

A. Soft tissue edema. 

B. Distal extention of the knee effusion. 

C. Torn infrapatellar tendon. 

D. Superficial infrapatellar bursitis. 

E. Deep infrapatellar bursitis. 

This is a longitudinal (sagittal) view of the infrapatellar region. At the right is the orthogonal (transverse) view. Choose the best term for the finding deicted here: 

[image]

A. Soft tissue edema. 

B. Distal extention of the knee effusion. 

C. Torn infrapatellar tendon. 

D. Superficial infrapatellar bursitis. 

E. Deep infrapatellar bursitis. 

These orthogonal views of the popliteal space are most likely to have come from which of the following clinical scenarios: 

[image]

[image]

A. 40 year old woman with pain in the back of her knee. 

B. 60 year old man with medial joint line tenderness and a large knee effusion. 

C. 65 year old woman who developed sudden pain and redness going down her leg after a 2 week episode of knee pain. 

D. 30 year old man with rheumatoid arthritis and ankle swelling. 

E. 20 year old healthy ultrasound model. 

These orthogonal views of the popliteal space are most likely to have come from which of the following clinical scenarios: 

[image]

[image]

A. 40 year old woman with pain in the back of her knee. 

B. 60 year old man with medial joint line tenderness and a large knee effusion. 

C. 65 year old woman who developed sudden pain and redness going down her leg after a 2 week episode of knee pain. 

D. 30 year old man with rheumatoid arthritis and ankle swelling. 

E. 20 year old healthy ultrasound model. 

Based soley on these two longitudinal images of the medial knee, the most likely diagnosis is: 

[image]

A. Chondrocalcinosis

B. Paramedian meniscal cyst. 

C. Osteoarthritis. 

D. Erosive rheumatoid arthritis. 

E. Normal Knee. 

Based soley on these two longitudinal images of the medial knee, the most likely diagnosis is: 

[image]

A. Chondrocalcinosis

B. Paramedian meniscal cyst. 

C. Osteoarthritis. 

D. Erosive rheumatoid arthritis. 

E. Normal Knee. 

This longitudinal and transverse scan of the right knee joint at the joint line. What is structure #1. 

[image]

A. Torn medial collateral ligament. 

B. The lateral meniscus with CPPD crystals in it. 

C. A synovial cyst. 

D. A calcified geniculate artery. 

This longitudinal and transverse scan of the right knee joint at the joint line. What is structure #1. 

[image]

A. Torn medial collateral ligament. 

B. The lateral meniscus with CPPD crystals in it. 

C. A synovial cyst. 

D. A calcified geniculate artery. 

Anterior longitudinal and transverse scans of the shoulder are shown below. What is your sonographic impression of these scans? 

[image]

A. Biceps tenosynovitis. 

B. Subdeltoid bursitis and effusion. 

C. Deltoid muscle tear. 

D. Biceps tendon calcification. 

E. Biceps tendon tear. 

Anterior longitudinal and transverse scans of the shoulder are shown below. What is your sonographic impression of these scans? 

[image]

A. Biceps tenosynovitis. 

B. Subdeltoid bursitis and effusion. 

C. Deltoid muscle tear. 

D. Biceps tendon calcification. 

E. Biceps tendon tear. 

These orthogonal views of the shoulder in Crass position show a bursal effusion and: 

[image]

A. A partial supraspinatus tear. 

B. A full thickness supraspinatus tear. 

C. A partial infraspinatus tear. 

D. A full thickness infraspinatus tear. 

E. Intact rotator cuff tendons. 

These orthogonal views of the shoulder in Crass position show a bursal effusion and: 

[image]

A. A partial supraspinatus tear. 

B. A full thickness supraspinatus tear. 

C. A partial infraspinatus tear. 

D. A full thickness infraspinatus tear. 

E. Intact rotator cuff tendons. 

The doppler signal shown in the image is likely due to: 

[image][image]

A. Artifact. 

B. Biceps tendon rupture. 

C. Biceps tenosynovitis and normal biceps. 

D. Biceps tenosynovitis and tendonitis. 

E. Subacromial bursitis. 

The doppler signal shown in the image is likely due to: 

[image][image]

A. Artifact. 

B. Biceps tendon rupture. 

C. Biceps tenosynovitis normal biceps. 

D. Biceps tenosynovitis and tendonitis. 

E. Subacromial bursitis. 

40 year old man with acute onset shoulder pain. Orthogonal anterior scans of the shoulder in maximal internal rotation are shown. Is there anything in these scans which can explain his pain? 

[image]

A. Supraspinatus tendon tear. 

B. Deltoid muscle tear. 

C. Subdeltoid bursa effusion. 

D. Calcific tendinitis. 

40 year old man with acute onset shoulder pain. Orthogonal anterior scans of the shoulder in maximal internal rotation are shown. Is there anything in these scans which can explain his pain? 

[image]

A. Supraspinatus tendon tear. 

B. Deltoid muscle tear. 

C. Subdeltoid bursa effusion. 

D. Calcific tendinitis. 

Which of the shown short axis views most likely depicts the head of the humerus? 

[image]

[image]

These images of the lateral elbow are most consistent with: 

[image]

A. Acute on chronic enthesitis. 

B. Acute enthesitis. 

C. Chronic enthesitis. 

D. Acute synovitis. 

These images of the lateral elbow are most consistent with: 

[image]

A. Acute on chronic enthesitis. 

B. Acute enthesitis. 

C. Chronic enthesitis. 

D. Acute synovitis. 

Anterior longitudinal and transverse scans of shoulder were obtained in neutral postion and are shown below. What abnormality do you see in these images? 

[image]

A. Subdeltoid bursa effusion. 

B. Effusion in biceps tendon sheath. 

C. Apparent abnormality is normal deltoid muscle. 

D. Biceps tendon tear. 

E. Humeral fracture. 

Anterior longitudinal and transverse scans of shoulder were obtained in neutral postion and are shown below. What abnormality do you see in these images? 

[image]

A. Subdeltoid bursa effusion. 

B. Effusion in biceps tendon sheath. 

C. Apparent abnormality is normal deltoid muscle. 

D. Biceps tendon tear. 

E. Humeral fracture. 

The orthogonal dorsal images of the proximal interphalangeal joint pictured, most likely came from a patient with: 

[image]

[image]

A. Gout. 

B. Rheumatoid Arthritis. 

C. Osteoarthritis. 

D. Ganglion Cyst. 

The orthogonal dorsal images of the proximal interphalangeal joint pictured, most likely came from a patient with: 

[image]

[image]

A. Gout. 

B. Rheumatoid Arthritis. 

C. Osteoarthritis. 

D. Ganglion Cyst.