She appears to be in no acute distress, but her general movement seems slow. Apical rate of 52, regular. Lungs are clear to auscultation and percussion. There is no tenderness. Liver, spleen, and kidneys are nonpalpable.
Femoral pulses are equal.
There is a sound of crepitance on passive range of motion of the patient's right shoulder and both knees. Distal finger joints are enlarged. Cranial Nerves II-XII are intact. Her deep tendon reflexes are all symmetrically slow to respond. Even though she has difficulty getting up from the chair, her Romberg test is negative.