Review Question - QID 215124

A 45-year-old woman presents to the primary care clinic for 2 months of fatigue. She constantly feels exhausted and has difficulty concentrating at work. She also complains of abdominal pain and has small bowel movements only once per week. She denies fevers, chills, or unintentional weight loss. She has a history of multiple prior kidney stones, which all passed with aggressive hydration. She takes docusate and polyethylene glycol daily. She has never smoked. The patient’s temperature is 98.8°F (37.1°C) and respirations are 16/min. On physical exam, the patient appears comfortable but tired. She has mild, generalized tenderness to palpation of her abdomen without guarding or rebound. Laboratory results are as follows:

Serum:
Calcium: 11.2 mg/dL
Albumin: 3.8 g/dL
Parathyroid hormone (PTH): 120 pg/mL (reference range: 10-65 pg/mL)

Which additional physical exam finding is most likely present given this patient’s underlying disease process?