RMSK Exam Guide: Registered Musculoskeletal Sonographer Certification Prep
                     APCA
RMSK
ExamName: Registered in Musculoskeletal sonography
Exam Version: 6.0
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Question 1. (Single Select)
During sonography for suspected costochondritis in a 36-year-old, you use a 17-MHz transducer with
compound imaging enabled. Which artifact is most reduced and thus improves your confidence in
differentiating costal cartilage from adjacent structures?
A: Reverberation
B: Mirror artifact
C: Acoustic enhancement
D: Acoustic shadow
E: Side lobe artifact
Answer: A
Explanation:
Compound imaging reduces reverberation by scanning at multiple angles, which is particularly beneficial
when evaluating costal cartilage interfaces.
Question 2. (Single Select)
A patient with deep groin pain and limited hip ROM is found to have a 2.5 cm hypoechoic collection near
the obturator externus tendon. What is the best next step?
A: Start steroids and repeat scan in two weeks
B: Refer for MRI before intervention
C: Ultrasound-guided aspiration under conscious sedation with full Doppler vascular mapping
D: Empirically start antibiotics only
E: Begin immediate physical rehabilitation
Answer: C
Explanation:
Deep collections near neurovascular structures require careful Doppler mapping and sedation to enable
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safe, effective aspiration.
Question 3. (Single Select)
A sonographer is scanning a patient's hip for a suspected ischiofemoral impingement. The transducer is
placed over the space between the ischial tuberosity and the lesser trochanter. The sonographer identifies
the quadratus femoris muscle and notes an adjacent, focal, hypoechoic fluid collection. The dynamic
assessment reveals compression of the muscle during external rotation of the hip. To accurately confirm
the relationship of the fluid collection to the sciatic nerve, the sonographer should:
A: Adjust the depth to $10$ cm to visualize the proximal femoral artery.
B: Trace the sciatic nerve proximally and distally through the entire image plane.
C: Use Power Doppler to assess for vascularity within the nerve.
D: Measure the cross-sectional area of the nerve at the gluteal fold.
Answer: B
Explanation:
Ischiofemoral impingement occurs when the quadratus femoris muscle (which is visualized between the
ischial tuberosity and lesser trochanter) is compressed, leading to pain. The sciatic nerve runs immediately
posterior to the quadratus femoris. A fluid collection in this region could be an inflamed bursa, a cyst, or
potentially nerve sheath fluid/edema. To exclude sciatic nerve entrapment/irritation as a co-existing cause,
the sonographer must trace the sciatic nerve through the image plane to assess its morphology (swelling,
flattening) and relationship to the surrounding structures and fluid collection, a necessary step in advanced
MSK sonography.
Question 4. (Single Select)
A 36-year-old electrician with right-sided numbness and shoulder weakness. US shows an enlarged,
hypoechoic structure in the suprascapular notch, with diminished perineural vascularity on power Doppler.
EMG: supraspinatus/infraspinatus denervation. Most likely?
A: Partial teres minor tear
B: Axillary artery pseudoaneurysm
C: Suprascapular nerve sheath ganglion
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D: Subscapularis bursal cyst
E: Circumflex scapular artery thrombosis
Answer: C
Explanation:
An enlarged, hypoechoic, avascular mass at the suprascapular notch with compatible EMG changes
indicates suprascapular nerve sheath ganglion, implicated in compressive neuropathy.
Question 5. (Single Select)
Imaging the wrist reveals a small hyperechoic structure casting a shadow in the carpal tunnel. Which
artifact is demonstrated, and how does it affect diagnosis?
A: Mirror artifact, duplicating bony outline
B: Posterior enhancement, overestimating soft tissue
C: Reverberation, multiplying structure image
D: Anisotropy, simulating partial tear
E: Posterior acoustic shadowing, obscuring nerve assessment
Answer: E
Explanation:
Posterior acoustic shadowing from dense structures like bone will obscure deeper anatomy, potentially
affecting median nerve evaluation within the tunnel.
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