A 48-year-old woman with a BMI of 34 kg/m² and a history of obstructive sleep apnea presents for pre-anesthetic evaluation before open abdominal hysterectomy. On airway examination, the patient is positioned upright, asked to open her mouth maximally and protrude her tongue. The examiner observes that the soft palate and uvula are visible, but the anterior and posterior tonsillar pillars are obscured by the lateral pharyngeal walls. The patient also has a thyromental distance of 5.5 cm, neck circumference of 42 cm, and limited neck extension due to cervical spondylosis. What is the Mallampati grade, and what is the most appropriate next step in airway management?