While this test is the gold standard to make this diagnosis, it is an invasive test and may not be necessary.  Let’s try a less invasive test first.

Correct! The ultrasound reveals increased thickness of the rotator cuff tendons and several areas of increased echogenicity between the tendons likely representing deposits. Below is the  CT:

Great choice! The wrist x-ray reveals several bone cysts in the hand and wrist.

This level will likely be elevated in most ESKD patients and is therefore not that useful of a test here. Try again!

While an MRI might help correctly diagnose this patient, the risk of nephrogenic systemic fibrosis (NSF) as a result of  gadolinium likely outweighs the potential benefit. Try again!

This test is useful in diagnosing carpal tunnel syndrome (CTS), but there are a few other tests that are higher yield here.  Pick again!