A 78-year-old patient is being examined by a physical therapist in an outpatient setting.  The patient’s primary complaints include bilateral hand arthralgia, generalized muscle weakness, and excessive fatigue.  In addition, the patient reports sensory loss bilaterally in a stocking “gaiter” distribution.  The patient also reports passing several large kidney stones in the last 3 weeks.  Based on this patent’s presentation, which of the following additional signs or symptoms would MOST likely be present?

1. Dry, scaly skin
2. Muscular tetany
3. Respiratory muscle spasms
4. Vertebral compression fractures

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