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Ultrasound synovitis — SCE Rheumatology MCQ

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HardMusculoskeletal InvestigationsUltrasound synovitisSCE Rheumatology

A 44-year-old woman has hand pain and 45 minutes of morning stiffness. Examination is equivocal because of obesity and tenderness. RF is negative but anti-CCP is low positive. The clinician wants to determine whether there is true MCP synovitis. What is the most appropriate investigation?

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Correct answer: D — Musculoskeletal ultrasound with power Doppler

The best answer is “Musculoskeletal ultrasound with power Doppler”. Musculoskeletal ultrasound with power Doppler most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“DEXA scan, with clinical reassessment”, “Serum urate alone, within a rheumatology pathway”, “Chest radiograph, after safety review”, “Schirmer test, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: British Society for Rheumatology clinical guidelines: https://academic.oup.com/rheumatology/pages/clinical-guidelines