Case 36: Diagnostic Testing

Case 36 Index

Take a look at this patient’s most recent labs.
Basic labs

Basic Lab Ref

Choose the highest yield tests below (more than one choice may be correct)!
Bone biopsy
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.
Shoulder ultrasound & CT
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:
Wrist x-ray
Great choice! The wrist x-ray reveals several bone cysts in the hand and wrist.
Serum beta-2 microglobulin level
This level will likely be elevated in most ESKD patients and is therefore not that useful of a test here. Try again!
Shoulder MRI with gadolinium
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!
Nerve conduction study
This test is useful in diagnosing carpal tunnel syndrome (CTS), but there are a few other tests that are higher yield here.  Pick again!

Click here to close out this case!

Case 36 Index
Case 36 Introduction
Case 36 Physical Exam