Physical exam: Temperature 37° heart rate 76 and regular respiratory rate 14 unlabored blood pressure 144/78; Oriented alert moderately overweight white female in no distress
HEENT, Skin and neck : PERRL fundi clear without vascular changes, Pharynx pink clear, skin without rashes or bruising, No thyromegaly, adenopathy and carotid bruits
Lungs Cardiac: lungs clear to auscultation and percussion; S1/S2 without murmur rub or gallop
Abdomen: abdomen soft round nontender no organomegaly; Hemoccult negative
Neurologic: gate slow stiff, cranial nerves II-XII grossly intact what are the pertinent positives and negatives in her physical examination, strength five over five in bilateral upper and lower extremities
Musculoskeletal: Full ROM at shoulders and elbow, Hands have decreased range of motion, Heberdan and Bouchard nodules present in bilateral hand examination, back has decreased flexion and extension, moderate scoliosis, Right shoulder slightly lower than left, no kyphosis or lordosis, knees enlarged with decreased flexion/extension and crepitation present bilaterally, right greater than left; No joint heat, tenderness or erythema present.
What is your differential dx and why?
What tests if any would you like to get?