PHYSICAL EXAM:  MSE:  The patient presents as usual with ponytail pulled back behind her head to the mid level of her back, dark and large-framed glasses, minimal amount of make-up, quiet, not always talkative, but when she talks, her speech is goal directed without evidence of thought disorder. Good syntax and grammar. Sensorium and cognition grossly intact. Insight and judgment are partial and decreased in regard to her continuing to do things that cause her negative consequences with the legal system. No abnormal involuntary muscle movements, tics or mannerisms are noted. The patient states she is not currently hearing any voices or having any thoughts of wanting to hurt herself or others. Insight and judgment are still somewhat decreased and only partial.

PHYSICAL EXAM:
VITAL SIGNS: Normal. The patient states pain 5/10.
GENERAL: A very nice elderly woman who is very thin.
MUSCULOSKELETAL: Fair muscle tone with very thin muscles.
BACK: Examination of the back shows no midline tenderness. There is obviously some mild kyphosis. She is tender in the upper gluteal area on the left but not over the sciatic notch. She has negative straight leg raising, but it is very painful for her to move about as she does have some muscle spasm in the lumbar paraspinal, on the left. Distally, she has normal sensory down the leg, and her circulation is good with normal capillary refill.
ABDOMEN: Benign. No organomegaly or mass. No pulsatile masses or bruits.
LUNGS: Revealed rather distant sounds. No rales.
HEART: Distant heart tones. No murmur.

PHYSICAL EXAM:
VITAL SIGNS: Weight 210 pounds. Height 5 feet and 4 inches. BP 122/90 left arm, 126/90 right arm; pulse 76 and regular; respirations 18 and unlabored.
HEENT: Normocephalic, atraumatic. PERRL, EOMI, no lid lag, no exophthalmos, no xanthelasma, conjunctivae pink, no scleral icterus. Ears and nose externally normal. Pharynx normal.
NECK: No JVD. No carotid bruit, no thyromegaly, no adenopathy. Surgical scar present in the neck.
CHEST: Lungs clear. Breath sounds normal bilaterally.
HEART: PMI in the 5th intercostal space, no lift or thrill. S1 and S2 normal. No gallop, murmur or rub.
ABDOMEN: Flat, soft, nontender. Normal bowel sounds. No bruit. No palpable aortic aneurysm, mass or organomegaly. Moderately obese.
EXTREMITIES: Full range of motion. No cyanosis, clubbing, or edema.
MUSCULOSKELETAL: No gross joint deformity or swelling.
NEURO: Alert and oriented x 3. Cranial nerves intact. Balance, gait and coordination normal. Normal affect.
SKIN: No significant skin lesions or rashes.
PSYCHIATRIC: Mentation normal.

PHYSICAL EXAMINATION:

VITAL SIGNS: Temperature 97.6 orally, pulse 94, respirations 18, blood pressure 96/64, O2 sat 98% on room air.
GENERAL:  She is sitting on the examination table in no acute distress. She is alert and interactive and answers questions appropriately. She does not appear to be in any discomfort.
HEENT:  Pupils are equal, round, and reactive to light. Sclerae are white. Conjunctivae are pink. Extraocular eye movements are intact and nonpainful. Mucous membranes are moist and pink.
NECK:  Supple without jugular venous distention or lymphadenopathy.
LUNGS:  Lungs are clear to auscultation bilaterally. There are no wheezes, rales or rhonchi, and she has good air entry throughout.
HEART:  Regular rate and rhythm with normal S1 and S2. There were no murmurs, rubs or gallops.
ABDOMEN:  Soft, nontender, nondistended. There is no rebound or guarding.
MUSCULOSKELETAL:  Full range of motion in all joints. There are no peripheral extremity clubbing, cyanosis or edema.
SKIN:  No rashes and is warm and dry with capillary refill time of 2 seconds.
NEUROLOGIC:  Alert and oriented x 3. She has a normal strength, gait, and balance.
BREASTS:  Reveals a left breast that has a palpable nodule and cord in the left upper outer quadrant at approximately 3 o’clock consistent with unexpressed milk. The remainder of the breast is soft. In the left upper outer quadrant, there is overlying erythema and tenderness to palpation. There is no fluctuance indicative of abscess. There is no bloody discharge expressible from her nipple. The overlying erythema is also warm to the touch but not indurated.

PHYSICAL EXAM:
VITAL SIGNS:  Blood pressure 124/78, pulse 110, respirations 20, temperature 96, O2 saturation is 100% on room air.
GENERAL: Well-developed, well-nourished Caucasian male in no acute distress.
HEENT: Sclerae are slightly icteric. Extraocular motions intact. Pupils are equal, round and reactive to light. Mucous membranes are moist. Oropharynx is clear.
NECK:  Supple without lymphadenopathy or JVD.
RESPIRATORY:  Breath sounds are clear and equal. No rales, rhonchi or wheezes.
CARDIOVASCULAR: Tachycardic, regular rhythm with good distant pulses.
ABDOMEN:  Soft, distended with mild caput medusae and an easily reducible umbilical hernia.
EXTREMITIES:  He has 5/5 strength throughout.
SKIN:  Warm and dry.
NEUROLOGIC:  Awake, alert and oriented. No focal deficits.
PSYCHIATRIC:  Affect is appropriate.

PHYSICAL EXAMINATION: On admission, the infant was vigorous, pink, and well appearing. Anterior fontanelle was open and flat. Normocephalic and atraumatic. Positive red reflex in the eyes. Ears were normally set. No cleft lip. No cleft palate. There were no masses in the neck. The chest was symmetrical and clear to auscultation bilaterally. There were no murmurs, rubs or gallop in the heart. Abdomen was soft, nontender, nondistended. No masses and normal female genitalia with no hip clicks. On the back, there were no hair tufts or dimples.

PHYSICAL EXAMINATION:

VITAL SIGNS:  Blood pressure 134/58, pulse 76, respirations 16, temperature 97.8.
GENERAL:  Well-nourished, well-developed male in no acute distress.
HEENT:  Head is normocephalic and atraumatic. Pupils are equal, round and reactive to light.
NECK:  Full range of motion with no meningeal signs.
ABDOMEN:  Soft, nontender. No masses or organomegaly.
EXTREMITIES:  Examination of his left knee shows that there is no joint swelling. The patella is medial and nonballotable. He does have some tenderness with patella ballottement. There is no femoral tendon pain and the patella does track medially. No tenderness medially or laterally. No tenderness posteriorly. No posterior fossa mass. Ligamentous testing shows instability with anterior and posterior drawer as well as varus and valgus stress testing; it is stable. The grind test is that there is no pain with axial loading. There is no erythema or edema noted here. The patient was observed ambulating without difficulty here in the emergency department. Remainder of extremity exam is atraumatic without any joint pain, redness or swelling.
SKIN: Warm and dry. No noted skin rashes or lesions.

PHYSICAL EXAMINATION:

VITAL SIGNS:  Blood pressure 126/86, pulse 78, respirations 20, temperature 97.8, O2 saturation of 96% on room air.
GENERAL:  The patient is an obese male who does not appear in any acute distress and is alert and oriented x3.
HEENT:  Pupils are equal, round and reactive to light and accommodation. Extraocular movements are intact. The patient has moist mucous membranes.
NECK:  Supple with no lymphadenopathy and full range of motion. The patient does note pain in his right shoulder when he turns his head to the left.
LUNGS:  The patient’s lungs are clear to auscultation bilaterally with no wheezes, rales or rhonchi appreciated.
HEART:  Regular rate and rhythm with no murmurs, rubs or gallops appreciated.
ABDOMEN:  Obese, soft, nontender with positive bowel sounds.
NEUROLOGIC:  Cranial nerves II-XII are grossly intact. The patient has 5/5 strength throughout, including his right upper extremity. The patient has normal sensation.
MUSCULOSKELETAL:  The patient has tenderness to palpation in multiple areas in his right shoulder area, both medially and laterally. The patient notes pain to even the lightest of palpation. The patient also notes pain with movement of his right shoulder, particularly abduction and movement posteriorly. The patient notes radiation of this pain to his right neck. The patient’s extremities are warm with no clubbing, cyanosis or edema and 2+ pulses is all four extremities.

PHYSICAL EXAM:

GENERAL:  Well-developed, well-nourished black female in no acute distress.
VITAL SIGNS:  T 98.6, R 18, P 64, BP 158/82, pulse ox on room air is 92%.
HEENT:  EOMI. Conjunctivae are clear. Oropharynx is clear. Mucous membranes are moist.
NECK:  Supple. No JVD or asymmetry.
HEART:  Regular rate and rhythm, 2+ distal pulses.
LUNGS:  Clear to auscultation and equal bilaterally without any retraction or crackle.
ABDOMEN:  Positive bowel sounds. Soft, nontender, nondistended. No mass, rebound, rigidity or guarding.
EXTREMITIES:  Negative cyanosis, clubbing or edema.
SKIN:  Warm and dry. No rash or nodules noted.
PSYCHIATRY:  Appropriate mood, affect and judgment.
NEUROLOGIC:  GCS 15. Cranial nerves II through XII are intact. Motor 5+/5+, equal bilaterally including deltoids, biceps, triceps, wrist extensors, wrist flexors, interossei, thumb extensors and thumb opposition. Normal finger-to-nose. Normal range of motion. 2+ pulses x4. Brisk capillary refill x4. With Phalen’s, there is no reproducible symptoms but Tinel’s causes slight worsening of the tingling in her left fourth digit, but she states that she has had carpal tunnel before and this feels different. We are unable to reproduce her symptoms when pushing on her ulnar groove; although, she states that she does lean on her left elbow quite a bit and has been laying in bed quite a bit, laying on her left elbow watching TV. Her toes are well perfused. There is no rash or trauma. No signs of any circulatory compromise or infection.

PHYSICAL EXAMINATION: General: This thinly built, middle-aged Hispanic male is alert, in no acute distress. Vital Signs: Blood pressure 122/72, pulse 80, respirations 18, and temperature 98.2. HEENT: Head normocephalic. Pupils are reactive. Fundi not visualized. Throat is clear. Ears and Nose: No inflammation. Nasal mucosa injected. Neck: No lymphadenopathy. Trachea midline. No bruits. Chest: Reveals equal movements with decreased excursions. Percussion note resonant throughout. Occasional wheezes are scattered bilaterally. No crackles on either side. Expirations are prolonged. Heart: Heart sounds are regular. S1 and S2 heard. No S3, gallop or murmur. Abdomen: Soft, protuberant without mass. No organomegaly. The bowel sounds are active. Extremities: Varicosities. No edema. Reflexes are brisk. There are no gross motor deficits. Neurologic: Cranial nerves grossly intact. Rectal: Exam is deferred. Skin: No lesions are observed.

PHYSICAL EXAMINATION: GENERAL: This averagely built, middle-aged Hispanic female is alert, in no acute distress. Mild pallor. No cyanosis or icterus. No lymphadenopathy or peripheral edema. Skin turgor was good. VITAL SIGNS: Blood pressure is 112/62, pulse 94, respirations 24, and temperature 98. HEENT: Head normocephalic. Pupils are reactive. Nasal mucosa edematous. Throat is mildly injected. Ears, mild cerumen. Fundi are not visualized. Neck: Supple. No lymphadenopathy. Trachea midline. No bruits or thyroid enlargement. Chest: Reveals equal movements with a scar of surgery in the left breast area with a draining wound in the nipple area. No axillary lymphadenopathy. Chest also revealed decreased breath sounds at the bases with occasional wheezes in the upper lung fields. No definite crackles. Heart: The heart sounds are regular. S1 and S2. Heard no murmur. Abdomen: Soft, protuberant. Scars of surgery are noted. No organomegaly or tenderness. Bowel sounds active. Extremities: No edema. Mild varicosities. No calf tenderness. Homans sign is negative. Reflexes are brisk. There are no gross motor deficits. Neurologic: Cranial nerves grossly intact. Rectal: Exam is deferred.

PHYSICAL EXAMINATION:  GENERAL:  Well-developed, well-nourished white male in no acute distress. VITAL SIGNS:  T 98, R 18, P 84, blood pressure 168/128. Without any intervention, supine pressure was 148/96, pulse of 84, standing 155/104, pulse of 90. Repeat blood pressure upon resting here 130/94. HEENT:  EOMI. Conjunctivae are clear. Oropharynx is clear. Mucous membranes are moist. NECK:  Supple. No JVD or asymmetry. Funduscopic exam shows sharp disks. No nicking or hemorrhages. He did have a nosebleed from the left naris recently, but his nares are bilaterally clear without any signs of active bleeding or other abnormality. HEART: Regular rate and rhythm. 2+ distal pulses. LUNGS:  Clear to auscultation and equal bilaterally without any retraction or crackle. ABDOMEN:  Positive bowel sounds. Soft, nontender, nondistended. No mass, rebound, rigidity or guarding. EXTREMITIES:  Negative cyanosis, clubbing or edema. SKIN:  Warm and dry. No rash or nodules noted. PSYCHIATRY:  Appropriate mood, affect and judgment. NEUROLOGIC:  Awake and alert, oriented. Cranial nerves II through XII grossly intact. Moves all four extremities. Glasgow coma scale 15. Motor 5+/5+ equal bilaterally. Negative drift. Light touch intact. Normal finger-to-nose. No Kernig or Brudzinski. Dix-Hallpike maneuver caused him to feel “nauseous” but not necessarily dizzy.

PHYSICAL EXAM:  GENERAL:  Examination revealed a white male who is awake and alert. VITAL SIGNS:  Temperature 97.2, pulse 78, respirations 18, blood pressure 146/86. HEENT:  Pupils are equal and reactive. Conjunctivae are clear. There is some mild to moderate edema, swelling of the right facial maxillary region with tenderness. No significant erythema, warmth. Oropharynx examination revealed poor dental hygiene with sensitivity in the right upper canine and right premolar area. No gingival drainage. No trismus. Airway is intact. No stridor. NECK:  Supple, no meningismus. HEART:  Regular rate and rhythm. LUNGS:  Sounds clear. EXTREMITIES:  Show no joint swelling. Full range of motion actively. NEUROLOGIC:  The patient is awake, alert and oriented x3, no focal deficit.

PHYSICAL EXAMINATION:

VITAL SIGNS: Blood pressure 158/84, temperature 96.8, pulse 96, respirations 20. Pulse ox is 97% on room air.
GENERAL: This is a (XX)-year-old white male who appears to be in some discomfort though is alert and oriented x3.
HEENT:  Head is normocephalic, atraumatic.
NECK:  Supple though he is slightly tender to palpation throughout the posterior aspect of the neck.
CARDIAC:  Regular rate and rhythm.
LUNGS:  Clear to auscultation bilaterally.
BACK:  The patient is tender to palpation in the thoracic midline and paraspinal muscles bilaterally. No other back tenderness throughout.
EXTREMITIES:  The patient ambulates without difficulty. Reflexes are +2 bilaterally. Strength is 5/5 bilaterally. Distal pulses palpable. Sensation is intact throughout.

PHYSICAL EXAMINATION:
VITAL SIGNS:  Blood pressure 118/74, pulse 74, respiratory rate 18, temperature 97.2.
GENERAL:  This is a well-appearing, African-American gentleman in no acute distress.
HEENT:  The pupils are equal, round and reactive to light. The extraocular muscles are intact. TMs are clear bilaterally. No erythema or effusion. Nares are patent bilaterally. The oral mucosa is pink and moist. No oral lesions. No posterior pharynx erythema or exudate. Uvula is midline. No swelling or asymmetry. He has some mild frontal sinus and maxillary sinus tenderness to palpation bilaterally. He does have obvious rhinorrhea with some swelling of his turbinates. There is no obvious colored mucus in his nasal passages.
NECK:  Supple, without lymphadenopathy or JVD.
LUNGS:  Clear to auscultation bilaterally. No wheezes, rales or rhonchi.
HEART:  Regular rate and rhythm. No murmurs, rubs or gallops.
ABDOMEN: Soft, nontender, nondistended with good bowel sounds. No organomegaly. No masses palpated.
MUSCULOSKELETAL: The patient moves all four extremities in all directions. No cyanosis, no clubbing, no edema.
SKIN:  Warm and dry, without any rashes or lesions.
NEUROLOGIC:  The patient is awake, alert and oriented x3. Cranial nerves II through XII are checked and intact. The motor is 5/5 in the bilateral upper and lower extremities. Sensation is grossly intact to light touch. Reflexes – biceps, triceps, patellar and Achilles tendons are 2+.
PSYCHIATRIC:  The patient had normal affect, normal insight, normal judgment.

PHYSICAL EXAM:
VITAL SIGNS: Blood pressure 128/88, pulse 58, respirations 16, temperature 96.8, satting 98% on room air.
GENERAL: The patient is a well-appearing female in no acute pain or distress. HEENT:  Atraumatic, normocephalic. Extraocular movements are intact. There is no pallor or icterus. Mucous membranes are moist.
NECK: Supple. There is no JVD.
LUNGS: Clear to auscultation bilaterally.
HEART: Regular rate and rhythm. No murmur, gallop or rub.
ABDOMEN: Soft, nontender, nondistended.
PELVIC: Normal external genitalia. The patient has some white discharge on exam, but there is an amount of blood in the vault making the exam somewhat difficult. No cervicitis is noted. No cervical motion tenderness, fundal tenderness or adnexal tenderness.
EXTREMITIES: No clubbing, cyanosis or edema x4.
NEUROLOGIC:  Grossly intact.
PSYCHIATRIC:  Affect is appropriate.

PHYSICAL EXAMINATION:  VITAL SIGNS:  Blood pressure 124/74. Pulse 68. Respirations 20. Temperature 98.8. Pulse ox is 99% on room air. GENERAL:  The patient is alert and oriented x3 and in no apparent distress. HEENT:  Normocephalic, atraumatic. Extraocular muscles are intact. Pupils are equal, round and reactive bilaterally. Mucous membranes are moist. NECK: Supple. No C, T or L-spine tenderness. HEART: Regular rate and rhythm with no murmurs, rubs or gallops. LUNGS: Clear to auscultation bilaterally. No wheezes, rhonchi or rales. CHEST: The chest has no tenderness to palpation over the rib cage. ABDOMEN: Soft and nontender. Bowel sounds are present. No rebound or guarding. No peritoneal signs. EXTREMITIES: Without clubbing, cyanosis or edema. The patient has 2+ pulses in all distal extremities. NEUROLOGIC:  Intact and nonfocal. Gait is normal. Strength is 5/5 in all extremities. Sensation is intact. No dysdiadochokinesia or dysmetria. Cranial nerves II through XII are intact.

PHYSICAL EXAM:
VITAL SIGNS: Blood pressure 142/100, pulse 68, respirations 18, temperature 97.8, O2 sat 96% on room air.
GENERAL:  This is a well-developed, well-nourished, pleasant (XX)-year-old Caucasian male in no apparent distress. He is awake, alert and oriented x4. He is appropriate throughout the exam.
HEENT: Pupils are equal, round and reactive to light. Extraocular motions are intact. Sclerae white. Conjunctivae are pink. TMs clear bilaterally. Oral mucosa is moist and pink with no visible lesions.
NECK:  Supple. No lymphadenopathy, no JVD, no carotid bruit.
HEART:  Regular rate and rhythm. No murmurs, rubs or gallops.
LUNGS:  Clear to auscultation bilaterally.
ABDOMEN:  Soft, nontender, nondistended with positive bowel sounds.
EXTREMITIES:  Without cyanosis, clubbing, edema. Pulses 3/4 throughout.
NEUROLOGIC:  Cranial nerves II-XII grossly intact. Strength is 5/5 throughout. Sensation is intact and symmetric. Gait is normal. Romberg is negative. Cerebellar function tests are appropriate and symmetric. He is able to ambulate on his toes. He is able to ambulate on his heels. He has no saddle anesthesia. Straight leg raise reproduces his pain on the right side. Straight leg raise on his left leg does not reproduce the pain.

PHYSICAL EXAMINATION:
VITAL SIGNS: Height 5 feet 6 inches, weight 150 pounds, blood pressure 146/84, pulse 90, respirations 20, and temperature 98.2.
GENERAL: This is a very pleasant middle-aged female, in no acute distress. She is alert and oriented x3, speaking in complete sentences without difficulty.
HEENT: Full head of hair. Pupils are equal, round, and reactive. Sclerae nonicteric. Oropharynx clear.
NECK: Supple.
LYMPHATICS: No cervical, axillary or inguinal lymphadenopathy.
LUNGS: Clear to auscultation bilaterally.
HEART: Regular rate and rhythm without murmur.
ABDOMEN: Positive bowel sounds, soft, nontender, nondistended. No organomegaly.
EXTREMITIES: No cyanosis, clubbing or edema.

PHYSICAL EXAM:
VITAL SIGNS: Weight 176 pounds, stable. Blood pressure 122/78, pulse 78, respirations 20, and temperature 98.8.
GENERAL: Alert and oriented x3, pleasant female, in no acute distress, speaking in complete sentences without difficulty.
HEENT: Hair is short, regrowing. Pupils are equal, round, and reactive to light. Sclerae nonicteric. Oropharynx clear.
NECK: Supple.
LYMPHATICS: No cervical, axillary or inguinal lymphadenopathy.
LUNGS: Clear bilaterally to auscultation.
HEART: Regular rate and rhythm without murmur.
ABDOMEN: Soft, nontender, and nondistended. Bowel sounds active x4 quadrants. No organomegaly. Right lower quadrant reddened area is marked with what appears to be decreasing erythema and healing wound. Area is nonindurated, nondraining, nontender. The patient does have less than 0.5 cm area to the left of the umbilicus, again appears to be healing.
EXTREMITIES: No clubbing, cyanosis or edema. Left lower shin biopsy site healing with a small scabbed area. No induration or drainage.
NEUROLOGIC: Grossly nonfocal.

PHYSICAL EXAMINATION:
GENERAL: This is a well-developed, well-nourished Hispanic male, not in acute distress. Alert, awake, and oriented x4.
VITAL SIGNS: Noted.
HEENT: AT/NC. PERRLA. EOMI.
NECK: No JVD. No bruit. No thyromegaly.
LUNGS: Clear to auscultation bilateral.
HEART: S1, S2 heard. No murmurs, rubs or gallops.
ABDOMEN: Soft. Surgical incision healing well. Mild tenderness to palpation. Good bowel sounds.
EXTREMITIES: No clubbing, cyanosis or edema.
NEUROLOGIC: Exam is nonfocal.

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 148/86, pulse 78, respirations 18, and temperature 98. Weight 162; this is up 5 pounds from last visit.
GENERAL: This is an alert and oriented x3, pleasant and cooperative (XX)-year-old female who appears in no acute distress. She maintains good eye contact. She is appropriate, cooperative, and conversive throughout the examination.
HEENT: Normocephalic with equal hair distribution. Oropharynx is pink and moist without any erythema, lesions or exudate. Oral mucosa is pink and moist without erythema, lesions or bleeding.
NECK: Supple with full range of motion. No lymphadenopathy.
LUNGS: Lungs have inspiratory and expiratory wheezes with some coarse rhonchi bilaterally throughout. Regular respiratory rate.
HEART: S1 and S2. Regular rate and rhythm without murmur. Bilateral trace lower extremity edema.
ABDOMEN: Obese and soft without any masses or tenderness; however, abdominal examination is difficult due to the fact that she is not able to lay on the table with her back pain from her nephrostomy tubes.
GENITOURINARY: The patient does have two nephrostomy tubes in place on the right and left flank with dressings that are intact and without copious drainage. Tubes appear to be draining some clear yellow urine.

PHYSICAL EXAM:
VITAL SIGNS: Height 5 feet 4 inches, weight 306 pounds, blood pressure 132/82, heart rate 82, afebrile.
HEENT: Oral examination negative. Pupils are equal, round, and reactive to light and accommodation.
LYMPHATIC: No adenopathy in neck, axillae or groins.
LUNGS: Clear.
HEART: Regular rate and rhythm.
ABDOMEN: Soft and nontender. No masses.
EXTREMITIES: No leg edema.
NEUROLOGIC: Exam nonfocal.
SKIN: No skin rashes.

PHYSICAL EXAMINATION:
VITAL SIGNS: Weight 220, blood pressure 118/66, pulse 94 and regular, temperature 96.8, and height 5 feet 10 inches.
GENERAL: Alert and oriented x3, in no acute distress.
HEENT: Face symmetric. Extraocular movements are intact. Hard of hearing. Sclerae nonicteric. Mouth clear. Throat: Uvula and tongue are central.
NECK: Supple. No lymphadenopathy or mass in the neck or supraclavicular fossa. No JVD. Trachea is central.
LUNGS: Clear to auscultation and percussion.
BACK AND SPINE: No spinous or CVA tenderness.
HEART: Regular rhythm and rate. No gallops.
ABDOMEN: Soft, no hepatosplenomegaly. No masses. Inguinal lymph nodes not enlarged.
EXTREMITIES: No swelling of the lower extremities. No tenderness of the calves. No petechiae.
SKIN: No skin rash.
NEUROLOGIC: Gait is normal and with the help of a walker. The walker was added to his armamentarium after the last admission, and a week prior to that admission, he was able to walk freely and worked in his garden with no problems.

PHYSICAL EXAMINATION:
HEENT: Head is atraumatic and normocephalic. Eyes are clear. Ears are clear. Mouth and throat are clear.
NECK: Nontender.
CHEST: Nontender.
LUNGS: Clear.
HEART: Regular rate and rhythm without murmur.
PERIPHERAL VASCULAR SYSTEM: No bruits, no thrills. No pulsatile abdominal mass, no abdominal bruits. Strong femoral pulses.
ABDOMEN: Soft. Tender in the right side. No guarding, rigidity or rebound. There is fullness in the right side of his abdomen. No organomegaly. No hernias. Nondistended.
GROIN: No hernia. No inguinal or femoral adenopathy.
EXTREMITIES: No edema.
BACK: Nontender.
NEUROLOGIC: No focal deficits.
RECTAL: On examination of the perineum, no evidence of fissure, fistula or perianal dermatitis. Digital rectal examination reveals normal sphincter tone, nontender exam. No mass or lesions. Prostate surgically absent. Proctoscopy to 15 cm is normal.

PHYSICAL EXAMINATION:
GENERAL: The patient is alert and oriented x3.
VITAL SIGNS: Weight 210, blood pressure 130/74, temperature 97.8, pulse 80, respiratory rate 18, and O2 saturation 96% on room air.
HEENT: Hair is full. Head is nontraumatic. Oropharynx is clear.
NECK: Supple without adenopathy.
HEART: Regular.
LUNGS: Clear but diminished in the entire right side throughout. No wheezes or crackles.
ABDOMEN: Soft and nontender. There is some faint bowel sounds throughout the abdomen.
EXTREMITIES: There is no extremity edema. She is seated in a wheelchair.
NEUROLOGIC: Speech is clear. Gait is guarded.

PHYSICAL EXAMINATION:
GENERAL APPEARANCE: The patient is a [x]-year-old well-developed, well-nourished male/female in no acute distress.
VITAL SIGNS: Blood pressure [x] mmHg, pulse rate [x] beats per minute, respirations [x] breaths per minute, temperature [x] degrees Celsius/Fahrenheit, and O2 saturation [x]% on room air/on [x] liters nasal cannula.
HEENT: Normocephalic and atraumatic. No scleral icterus. Pupils are equal, round, and reactive to light and accommodation. No conjunctival injection is noted. Oropharynx is clear. Mouth revealed good dentition, no lesions. Tympanic membranes are clear.
NECK: Supple. Trachea is midline. No evidence of thyroid enlargement. No lymphadenopathy or tenderness.
CHEST: Symmetric. Nontender to palpation.
LUNGS: Breath sounds are equal and clear bilaterally. No wheezes, rhonchi, or rales.
HEART: Regular rate and rhythm with normal S1 and S2. No murmurs, gallops, or rubs.
BREASTS: Symmetrical. No skin or nipple retractions. No nipple discharges or masses.
ABDOMEN: Soft, flat, and benign. No mass, tenderness, guarding, or rebound. No organomegaly or hernia. Bowel sounds are present. No CVA tenderness or flank mass.
GENITOURINARY: [Male]. The phallus is circumcised. There are no penile plaques or genital skin lesions. The glans is normal. The meatus is orthotopic, patent, and clear. The testicles are descended bilaterally without masses or tenderness. The epididymis and cords are normal. The perineum is normal.
GENITOURINARY: [Female]. External genitalia normal. Vagina and cervix without lesions or masses. Uterus is normal. Adnexa negative for masses or tenderness. Urethral meatus is normal. Perineum and anus are normal.
RECTAL: [Male]. Normal sphincter tone. No masses. Prostate is smooth and nontender and without nodules or fluctuance.
RECTAL: [Female]. Normal sphincter tone. No masses or tenderness.
EXTREMITIES: No cyanosis, clubbing, or edema.
NEUROLOGIC: No focal sensory or motor deficits are noted. Gait is normal. Cranial nerves II through XII are intact. Deep tendon reflexes are intact.
PSYCHIATRIC: The patient is awake, alert, and oriented x3. Recent and remote memory is intact. Appropriate mood and affect.
SKIN: Warm, dry, and well perfused. Good turgor. No lesions, nodules or rashes are noted. No onychomycosis.
LYMPHATICS: No cervical, axillary, or groin adenopathy is noted.

PE Sample 1

Physical Exam Format 2: Subheadings in ALL CAPS and transcribed in paragraph format.

PHYSICAL EXAM: GENERAL APPEARANCE: The patient is a well-developed, well-nourished female/male in no acute distress. VITAL SIGNS: Blood pressure [x] mmHg, pulse rate [x] beats per minute, respirations [x] breaths per minute, temperature [x] degrees Celsius/Fahrenheit, and O2 saturation [x]% on room air/on [x] liters nasal cannula. HEENT: Ears: There is no evidence of any external masses or lesions noted. Eyes: Extraocular muscles are intact. Pupils are round and reactive to light. Conjunctivae are pink and moist. Sclerae are white and nonicteric. Nose: Nasal mucosa is pink and moist. Septum is midline. Mouth: Oral mucosa is pink and moist. Dentition is good. NECK: Supple. Trachea is midline. There is no jugular venous distention noted. There are no carotid bruits noted. There are no palpable masses. LUNGS: Clear to auscultation bilaterally. There are no crackles, wheezes or rhonchi noted. There is no crepitus on palpation. HEART: Regular rate and rhythm, S1/S2. No murmurs are noted. There are no lifts, heaves or thrills noted on palpation. ABDOMEN: Soft and nontender. There are good bowel sounds. There is no rebound or guarding. There is no evidence of hernia. LYMPHATICS: There is no inguinal, axillary, supraclavicular or cervical adenopathy noted. SKIN: There are no rashes, lesions or ulcers noted. Warm and dry with good turgor. MUSCULOSKELETAL: Gait is coordinated and smooth. There is no clubbing, cyanosis or edema. NEUROLOGIC: Cranial nerves II through XII are grossly intact. Sensation to light touch and pain is intact bilaterally. PSYCHIATRIC: The patient is alert and oriented to person, place and time. There is no apparent mood disorder.

PE Sample 2

Physical Exam Format 3: Subheadings in Initial Caps and transcribed in paragraph format.

PHYSICAL EXAMINATION: General Appearance: This is a well-developed, well-nourished Hispanic female in no distress. Vital Signs: T: [x] degrees. P: [x] beats per minute. R: [x] breaths per minute. BP: [x] mmHg. HEENT: Normocephalic. Face: No lesions. Eyes: Conjunctiva pink. Sclera are anicteric. PERRLA. EOMs are full. Ears: The right and left ear canals are clear. Both tympanic membranes are intact. Nose: No external or internal nasal deformities. Nasal septum is midline. Mouth: The lips are within normal limits. The dentition is good. Tongue is midline with no lesions. The oral cavity is clear. Pharynx: Tonsils are normal size and clear. No exudates. Neck: Supple. No masses. No lymphadenopathy. Thyroid: No thyromegaly or masses. Chest: Clear to auscultation and percussion. Heart: Regular sinus rhythm. No gallops or murmurs. Abdomen: Soft, nontender. Normoactive bowel sounds. No organomegaly or masses. Extremities: No cyanosis, edema or deformities. Neurologic: Grossly intact. Skin: No lesions.

PHYSICAL EXAMINATION:  External examination showed the pupils to be round and to react equally to light. The eyes were straight in all fields of gaze. The conjunctiva of each eye was not remarkable in appearance. The cornea and the anterior segment of each eye were clear. In the right eye, there was a posterior chamber IOL in good position. The left eye showed significant cortical and nuclear lens opacities. Examination of the fundi showed the retina in each eye to be flat in all areas with the exception of some wrinkling in the macular region of the right eye. The disks and major vessels were normal. A posterior vitreous detachment also could be seen with a microscope. An OCT was performed. The left eye showed a normal fovea, but in the right, there was a membrane over the surface of the retina.

PHYSICAL EXAMINATION:  On examination, the patient’s uncorrected vision is 20/50 with pinhole improvement to 20/25 in both eyes. Anterior segment examination is unremarkable. Intraocular pressures are 20 mmHg in each eye. Fundus examination, right eye, reveals the retina to be without any retinal tears. There is a retinal hole inferotemporally. There is slight vitreous traction present on the edges of the hole. There are no pigmented cells in the vitreous cavity. Fundus examination, left eye, reveals the retina to be without any tears or holes. There are no pigmented cells in the vitreous cavity.

PE Sample 1

PHYSICAL EXAMINATION:  The patient’s best corrected vision in the right eye is 20/40. Slit lamp revealed nuclear sclerotic cataract, right eye, and a hypermature cataract in the left eye. Tonometry was 17 in the right eye and 19 in the left eye. Funduscopic evaluation of the right eye was unremarkable. The left eye, unable to see the fundus. B scan performed and grossly unremarkable.

PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 97.6, pulse 58, respirations 20, BP 154/84, pulse oximetry 99% on room air.
GENERAL: A well-developed, well-nourished, nontoxic, ambulatory, (XX)-year-old male.
CHEST: Examination of the chest reveals equal bilateral breath sounds. Clear to auscultation with normal chest wall excursion.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rub or gallop.
ABDOMEN: Benign.
BACK: Deferred.
RECTAL: Deferred.
GENITALIA: Deferred.
EXTREMITIES: Full range of motion of all extremities with pain noted to the right knee only with terminal flexion and extension. Varus and valgus stressing of the knee reveals no medial or lateral collateral ligament laxity. Lachman, McMurray and Apley tests are negative as well. The patient is ambulatory with a stable but somewhat antalgic gait, otherwise exhibits strong distal pedal pulses. Brisk capillary refill in all digits of the right foot.
NEUROLOGIC: Exam reveals no gross motor sensory deficits. The patient is alert, cooperative, and exhibits intact distal sensation in all digits of the right foot.
INTEGUMENTARY: Without diaphoresis, rash or lesions. Skin is warm and dry to touch. Normal tone and turgor.

PE Sample 2

PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 97.6, pulse 90, respirations 18, blood pressure 128/78, and pulse ox 98% on room air.
GENERAL: The patient is alert and oriented x4.
LUNGS: Clear to auscultation.
HEART: Regular rate and rhythm. S1, S2. No murmurs.
EXTREMITIES: Examination of his left wrist shows a granulated eschar but no surrounding erythema or edema or tenderness. Full range of motion of elbow, wrist and fingers. No presence of lymph nodes, epitrochlear or axillary. Examination of his right knee shows a warm but not hot knee. There is no erythema. He has generalized edema around the knee joint. Ballottement difficult to assess. He has patellar tenderness. Range of motion is 0-30 degrees and then pain is elicited. Negative McMurray and anterior/posterior drawer, tenderness over the tibial tendon. Distally full range of motion of other joints. Neurovascularly intact. Also, hip has full range of motion with no complaints of pain. No lymphadenopathy palpated.

PE Sample 3

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 198/134, pulse 96, respirations 18, temperature 98.2, and O2 saturation 98% on room air.
GENERAL: This is a well-developed, slightly obese (XX)-year-old male who is alert and oriented x3 and appears to be in no acute distress. The patient is cooperative, communicates well, and is ambulatory.
SKIN: Warm and dry to touch.
HEENT: Normocephalic, atraumatic. Pupils equal, round, reactive to light and accommodation. Extraocular movements are intact bilaterally. Conjunctivae are pink without discharge. Sclerae are nonicteric. TMs appear clear. Buccal mucosa is pink and moist. Pharynx is without erythema or exudate.
NECK: Supple without lymphadenopathy. Trachea is midline. No JVD or bruits noted.
LUNGS: Clear to auscultation bilaterally. No wheezing, rales or rhonchi noted.
HEART: Regular rate and rhythm. No murmurs, rubs or gallops noted.
ABDOMEN: Soft, nondistended and nontender to palpation in all four quadrants. There is no rebound or guarding noted. There are no masses noted either. Bowel sounds present in all four quadrants.
EXTREMITIES: Distal pulses 2+ bilaterally. The patient has full range of motion of all extremities. Sensation is intact to light touch. Upon further examination of the patient’s right upper extremity, he has 2+ radial and ulnar pulses. The patient has some swelling noted extending from the first dorsal compartment of the wrist distally to the MCP of his thumb. The patient upon examination has intact sensation to both right and left upper extremities. When the patient is instructed on how to perform the Finkelstein test, the patient does have pain elicited on the right dorsolateral wrist with ulnar deviation. The patient has no pain elicited on the left upper extremity. The patient has no pain with palpation over the snuffbox or fifth metacarpal. The patient has no pain with palpation in the wrist. The patient has intact sensation to two-point discrimination and light touch. The patient has 5/5 strength of that extremity. The patient has brisk capillary refill.
NEUROLOGIC: Cranial nerves II-XII are intact. DTRs are 2+ bilaterally of both upper and lower extremities. Muscle strength 5/5 of all extremities. No focal deficits noted.

PE Sample 4

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 108/72, pulse 74, respiratory rate 20, temperature 98.6 degrees, and pulse oximetry 98% on room air.
GENERAL: The patient is alert and oriented x3, in no acute distress. The patient is nontoxic, jovial, laughing and joking.
HEENT: Pupils are equal, round and reactive to light. Extraocular movements intact. Oropharynx clear. Mucous membranes moist.
NECK: Supple, nontender to palpation, no lymphadenopathy, no masses, no JVD, no carotid bruits, no meningismus. Negative Kernig and Brudzinski signs.
CHEST: Clear to auscultation bilaterally.
CARDIAC: Regular rate and rhythm. No murmurs, rubs, or gallops.
ABDOMEN: Bowel sounds are present. The belly is soft, nontender, nondistended. No masses, no hernias, no rebound, no guarding.
BACK: No CVAT. No spinous process tenderness. Straight leg raise is negative bilaterally. No evidence of trauma.
GENITOURINARY: The patient has a Foley catheter in place with a small amount of grossly bloody urine within it.
EXTREMITIES: Distal pulses 2+ bilaterally. No clubbing, cyanosis or edema. Calves are symmetric in color, temperature, and size. No evidence of trauma.
SKIN: No rash, no petechiae, no purpura, no jaundice.
PSYCH: Normal mood, normal affect.
NEUROLOGIC: Alert and oriented x3. Normal mental status. Cranial nerves II through XII intact. Strength 5/5 bilaterally throughout. Station and gait within normal limits.

Infant PE Sample 5

PHYSICAL EXAM:  The patient is a pleasant (XX)-year-old male weighing 204 pounds.  The patient has positive cervical orthopedic tests, including a positive right and left Jackson compression test that was relieved with cervical distraction.  Shoulder depression test was negative.  Soto-Hall test was negative.  Palpation demonstrated mild bilateral suboccipital and midline upper cervical tenderness with mild bilateral suboccipital spasm.  There was mild to moderate left lumbar and midline lumbosacral as well as left lumbosacral tenderness and mild left lumbar and lumbosacral paravertebral spasm. Neurological examination revealed all upper and lower extremity DTRs, including triceps, biceps, brachioradialis, patellar, and Achilles to be +2/5, normal. Sensory examination performed with a Wartenberg pinwheel was normal and equal in both the upper and lower extremities. Gross muscle strength was normal at +5/5 in the upper and lower extremities bilaterally. Lumbar range of motion with pain in flexion, right and left rotation, and right and left lateral flexion. Right and left Kemp sign was positive for dorsolumbar pain. Right sacroiliac joint was restricted on the modified Thomas test. There was a positive left Nachlas and a negative right Nachlas. Derifield was positive.  There was negative bilateral Yeoman and Ely tests. Bilateral Patrick/fabere test was negative. The leg lowering test was positive actively; it was negative passively. Right SLR was positive at 60 degrees for posterior leg and lower back pain with a positive Bragard.  Left SLR and Bragard were negative.

PHYSICAL EXAMINATION:  The patient has good muscle bulk in her lower extremities. The calf circumference of the left leg, 10 cm below the tibial tubercles, is 36.5 cm and on the right is 37.0 cm. There is no obvious atrophy. Her motor strength appears to be full in the lower extremities, though she seems to have pain in the left lower extremity, and she has obvious, very significant crepitus in the left knee without effusion. Light touch is grossly maintained in the lower extremities. Reflexes are 3+ knee jerks, 2+ ankle jerks. There is three beats of ankle clonus bilaterally. Plantar stimulation results in withdrawal phenomenon. Her upper extremity reflexes are additionally 2-3+ but symmetric.

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 136/76, pulse 80, respirations 18, temperature 98.8, and pulse ox on room air 99%.
GENERAL: A well-developed, moderately obese Hispanic female in no acute distress. She is alert and oriented x3, well appearing.
HEENT: Normocephalic, atraumatic. Pupils are equal, round and reactive to light. Extraocular muscles intact. Mucous membranes pink and moist with no evidence of anemia. Ears are clear with no erythema, bulging retraction of the TMs bilaterally. Oropharynx exhibits no tonsillar swelling, erythema or exudate.
NECK: Supple without lymphadenopathy. No JVD or thyromegaly.
CHEST: Respirations easy and unlabored. She does have significant reproducible tenderness with palpation to the chest wall muscles. This is also reproduced when she sits forward.
LUNGS: Clear to auscultation bilaterally without wheezes, rales, rhonchi.
HEART: Regular rate and rhythm without murmur, rub or gallop.
ABDOMEN: Soft, nondistended, nontender. Bowel sounds normoactive in all four quadrants. There are no masses or hepatosplenomegaly appreciated.
EXTREMITIES: No cyanosis, edema or clubbing. There are no cords appreciated or calf tenderness.
SKIN: Warm, dry, and intact.
NEUROLOGIC: Cranial nerves II-XII are tested and intact. She has good finger-nose-finger, rapid hand movement, and heel-to-shin movement. She has full 5/5 strength with resisted movement in all muscle groups of the upper and lower extremities. There are no focal neurologic deficits.

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 144/80, pulse 78, respirations 18, temperature 97.8, and pulse ox on room air is 100%
GENERAL: This is a well-developed, well-nourished Hispanic female in no acute distress. She is alert and oriented x3.
HEENT: Normocephalic, atraumatic. Pupils are equal, round, and reactive to light. Extraocular muscles are intact. Mucous membranes are pink and moist. Nostrils are clear. The patient has macerated abraded skin under the right nostril and extending to the nasolabial fold. There is no erythema or induration, no evidence of preseptal cellulitis. There is no purulent drainage appreciated. No vesicles.
NECK: Supple without lymphadenopathy.
LUNGS: Exhibit diffuse end-expiratory wheezes without focal rales or rhonchi.
HEART: Regular rate and rhythm without murmur, rub or gallop.
CHEST: Respirations easy and unlabored.
EXTREMITIES: No cyanosis, edema or clubbing.
SKIN: Warm, dry and intact.

PHYSICAL EXAMINATION:
GENERAL: The patient is alert and unresponsive, in no acute distress.
VITAL SIGNS: Temperature 100.4, respiratory rate 24, heart rate 80, and blood pressure 166/52.
HEENT: Pupils are equal and reactive to light. No discharge from nose or ear.
NECK: There is scar in the neck suspicious for previous tracheostomy. No masses were noted.
LUNGS: Rhonchi bilaterally, more on the left side.
HEART: Regular rate and rhythm. No murmurs.
ABDOMEN: Distended and soft. Bowel sounds are hypoactive. PEG tube in place.
EXTREMITIES: Contracted and deformed. No edema.
NEUROLOGIC: The patient was unresponsive.

PE Sample 1

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 124/92, pulse 82 and regular.
GENERAL: The patient appears well developed, well nourished, in no acute distress. Alert and oriented x3.
HEENT: No scleral icterus or conjunctival pallor. Extraocular movements intact. Pupils equal, round, and reactive to light. Throat clear, no lesions or exudate.
NECK: Supple. No palpable lymphadenopathy, mass, jugular venous distention.
LUNGS: Clear to auscultation and percussion.
HEART: Regular rate and rhythm. Positive S1, S2. No appreciable murmurs or gallops.
ABDOMEN: Mild lower tenderness, but no guarding, rebound, or palpable organomegaly or masses.
RECTAL: Hard stool in the rectum with no significant external hemorrhoids, fissures. The anal sphincter tone is normal, and there is no obvious stricture or palpable masses or tenderness.
BACK: No costovertebral angle or spinal tenderness.
EXTREMITIES: No cyanosis, clubbing or edema.
NEUROLOGIC: Cranial nerves II-XII, motor, sensory grossly intact.
MUSCULOSKELETAL: No gross joint deformity.
SKIN: No rashes, hives or stigmata of chronic liver disease appreciated.

PHYSICAL EXAMINATION:  On examination, she is able to toe walk and heel walk.  She stands with a slight list to the left.  She has tenderness in the mid to lower lumbar area, both sacroiliac joints, and sciatic notches.  She can forward bend 70 degrees with a moderate list to the left.  Backward bend to 10 degrees.  Lower motor exam reveals about 50% weakness of the left foot dorsiflexors, normal plantar flexion, about 30% weakness of the left quadriceps and hamstrings.  Sensory exam is normal.  Reflexes at the knees are 2+/2+, at the ankles 1+/1+.  She can straight leg raise to 80 degrees on the right but only 45 degrees on the left.  Her thigh circumference is 1 inch smaller on the left.  Her calf circumference is equal on both sides.  Her left ankle exam reveals some fullness over the anterior and lateral aspects of the joint with tenderness over the anterior joint line and anterolateral ligaments.  There is some limitation of motion.  The patient can plantarflex 40 degrees on the right, only 30 degrees on the left, dorsiflex 15 degrees on the right, 3 degrees on the left.  Inversion is 30 degrees on the right, 25 degrees on the left, and eversion is 25 degrees on the right, 0 degrees on the left.  She has a positive anterior drawer sign on the left and a 2+ positive talar tilt.

PHYSICAL EXAMINATION: Neurologic examination at this time finds the patient to be cheerful and cooperative. He is fully alert and oriented and able to render his history in precise and detailed fashion. Speech and language are unimpaired. Optic disks flat. Extraocular movements are full without nystagmus. Pupils are equal, round, and normally reactive to light and accommodation. Eye closure, facial expression, tongue, palate, sternocleidomastoid, and trapezius function normally. Deep tendon reflexes 1+ throughout. Babinski signs are absent. Motor power testing fails to disclose any atrophy, wasting, or fasciculation. Strength is normal in all groups. Tone is normal throughout. Sensory testing finds an intact symmetric perception to pin, touch, and temperature. There is no extinction to double simultaneous tactile stimulation. Position sense is intact. Cerebellar testing finds finger-to-nose done normally. Neck is supple. The patient was not ambulated.

PHYSICAL EXAMINATION:  The examination reveals that the patient is an attractive woman.  Examination of the periorbital area reveals upper lid dermatochalasia with mild brow asymmetry between the left and right brows.  Examination of the lower lids reveals puffiness in the appearance of her lower lids and creases within the lower lids that are accentuated by smiling.  In addition, when she smiles, on the left, there is an isolated herniated fat pad, which is seen more prominently on the left side than the right.  This would be the middle fat pad.  Globe pressure does show herniation of all three fat pads.  There is a mild tear trough deformity present.  The patient has presence of some crow’s feet at rest and also pretarsal creases present.  The patient has mild glabellar creases at rest and three horizontal deep frontalis creases that do not completely eliminate with skin distraction.  The cranial nerve VII appears intact bilaterally.  The skin is thick, and the lower lid skin also seemed to be somewhat thick and edematous.

PE Sample 2

PHYSICAL EXAMINATION:
GENERAL: The patient is awake, alert, oriented, in no acute respiratory distress.
VITAL SIGNS: T-max was 98.6, respirations 20, and blood pressure 110/68.
HEENT: Pupils reactive to light and accommodation. Conjunctivae and sclerae clear. No jaundice. No conjunctivitis.
LUNGS: Clear to auscultation.
HEART: S1 and S2 within normal limits. No gallops, rubs, or murmurs. No heaves, thrills, or lifts.
ABDOMEN: Soft and nontender. No masses.
EXTREMITIES: Lower extremities are within normal limits. No cords. No swelling. The right hand revealed marked swelling on the dorsum of the hand between the first and second metacarpal area. No open wounds. No significant erythema. There was minimal tenderness on palpation. There was also some edema with no streaking over the palmar aspect of the right hand at the first and second metacarpal areas. No open wounds were noted.

PHYSICAL EXAMINATION:  The patient has a dorsal hump deformity. The take-off of her nose at the glabella is relatively superiorly located. There is a dorsal hump deformity that appears to be composed of a combination of bone and cartilage. Intranasal examination revealed a slight septal deviation to the right, although, patent airways bilaterally. There is no evidence of septal perforation. Her nasolabial angle is approximately 90 degrees. The patient has localized adiposity of the bilateral outer thighs with associated mild cellulite. There is also a small dog-ear on the right lateral abdominoplasty scar.

PHYSICAL EXAMINATION:  On physical examination, he is afebrile, nontoxic, well appearing, in no apparent distress. HEENT: Pupils are equal and reactive to light and accommodation. Extraocular muscles are intact. Oropharynx is clear without exudates. Neck is supple without lymphadenopathy. Heart: Regular rate and rhythm. No murmurs, gallops, or rubs. Lungs: Clear to auscultation bilaterally. No wheezing, rhonchi, or rales. Abdomen: Soft, nondistended, nontender. Bowel sounds are present. Extremities: No clubbing, cyanosis, or edema. Skin: No rash or other skin lesions. Neurologic: Grossly nonfocal.

PHYSICAL EXAMINATION:

GENERAL: A well-developed and well-nourished (XX)-year-old Hispanic male resting comfortably in bed at this time, in no acute distress.
VITAL SIGNS: Blood pressure 178/96, pulse 72 and regular, respirations 14 and unlabored, and temperature afebrile.
HEENT: Normocephalic and atraumatic. Conjunctivae are pink. Sclerae anicteric. Pupils are equal, reactive to light and accommodation. Extraocular movements are intact. Ears, nose, and throat are clear. Mucous membranes of the oropharynx were slightly dry.
NECK: Supple without adenopathy or thyromegaly. There were bilateral carotid bruits.
CHEST: Symmetrical. There is a well-healed sternotomy scar.
LUNGS: Grossly clear to percussion and auscultation.
HEART: Normal sinus rate. S1, S2, and S4 are present without thrills, murmurs, or extra sounds.
ABDOMEN: Soft, obese, and +2 bowels sounds present without evidence of organomegaly, mass, rebound, or guarding. Negative for CVA tenderness.
EXTREMITIES: Intact without cyanosis or clubbing, but there was trace lower extremity edema. Peripheral pulses of lower extremities were diminished. There was a burn scar present on the right lower extremity.
NEUROLOGIC: Major motor function appeared to be intact. Detailed sensory exam of the lower extremities was not performed. Cognitive function appeared to be adequate; however, detailed exam was not performed. Ambulation and gait were not tested at this time.

PE Sample 3

PHYSICAL EXAMINATION: GENERAL: The patient is currently lying in bed, comfortable, in no apparent distress. He appears younger than his stated age. He answers all questions promptly and accurately. He is accompanied by his wife and he looks well nourished. HEENT: Head is normocephalic. Pupils are equal and reactive to light and accommodation. NECK: Supple. No JVD or lymphadenopathy is appreciated. CHEST: Symmetrical. Bilateral good air entry. HEART: Regular rate and rhythm. No murmurs, rubs or gallops appreciated. ABDOMEN: Flat, positive bowel sounds, slightly distended but not tender to palpation. No masses. No hernias or any other abnormalities noted. EXTREMITIES: 2+ pulses throughout. Full range of motion. No cyanosis or edema is appreciated. NEUROLOGIC: The patient is alert, awake and oriented with no neurological deficits appreciated.

PHYSICAL EXAMINATION:  The examination reveals that the patient has fair features. Facial freckles are noted. Examination of the face reveals the patient has some volume loss and gravitational changes associated with aging. At the periocular area, a tear trough is noted with some protruding lower lid bags. The tear trough extends around the complete lower portion of the inferior orbital rim. The patient has some separation between the middle and medial fat pads in the cheek with a mild nasolabial fold. The patient’s perioral area has many signs of facial aging, including perioral lip line’s loss of lip volume and deep marionette creases with a jowl. The jowl does not completely disturb the mandibular line but rests against the labiomental fold. The patient has a longer lip on the left side than the right with a small asymmetry also in lip height. The patient’s seventh nerve is equal and symmetrical. She has a strong DAO.

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 108/66, temperature 98.8, pulse 108, respirations 20, 100% on room air.
GENERAL: The patient is a (XX)-year-old who is awake, alert, pleasant, holding some ice on the left side of her face. She is in no obvious distress.
HEENT: She does have some soft tissue swelling around the left orbital rim and tenderness to palpation throughout this area, a little tenderness across the zygomatic arch on the left hand side, but there is no crepitation or instability noted. Her pupils are equal and reactive. Extraocular muscles are completely intact. There is no obvious injury to the eye itself. Her TMs show no hemotympanum. She also had some abrasions in her upper lip but nothing which would require any repair.
NECK: C-spine is nontender to palpation, axial loading and range of motion. She does have some minimal erythema to the left anterior neck.
HEART: Regular rate without murmur, rub or gallop.
LUNGS: Equal breath sounds bilaterally with no wheezing, rales or rhonchi. There is no chest wall tenderness or instability.
ABDOMEN: No external sign of injury. Bowel sounds are present. Abdomen is soft, nontender, no rebound, no guarding, no rigidity. There are no palpable masses. There is no flank pain on exam.
EXTREMITIES: Strong peripheral pulses. There is no clubbing, no cyanosis and no edema.
SKIN: No rash.

PHYSICAL EXAMINATION:
GENERAL: The patient is a well-developed female with Down syndrome.
VITAL SIGNS: Temperature 98.6 degrees, pulse 102, respirations 18, and blood pressure 116/78.
HEENT: Examination of the head and neck still shows slight left facial weakness. Pupils are equal and reactive to light and accommodation.
NECK: Supple to palpation.
LUNGS: Diminished breath sounds.
HEART: Heart sounds S1 and S2 are present with regular rate and rhythm.
ABDOMEN: Normoactive bowel sounds. Soft and nontender. No organomegaly is palpated.
EXTREMITIES: Examination of the extremities shows normal tone in the right upper and lower extremities with decreased tone in the left upper and lower extremities. Peripheral pulses are intact. Homans sign is absent. The patient still has clonus in her left ankle but was able to demonstrate some active extension of her right. There is no significant tenderness on the left leg on palpation.

PHYSICAL EXAMINATION:  Vital signs were stable, afebrile. He has tenderness over the right cervical region upon palpation. There was a 2 cm indurated, raised, and well-circumscribed swelling in the right submandibular gland region. The right submandibular gland duct was noted to be absent of any salivary flow. No purulent discharge was observed, however.

PHYSICAL EXAMINATION:  The patient is lying in bed, sleepy but arousable. Vitals: Temperature 98.4, heart rate 108, blood pressure 78/54, T-max 104.2. HEENT: Atraumatic and normocephalic. Pupils are equal. No conjunctival hemorrhage. No sinus tenderness. No oral lesion. Neck is supple. No lymphadenopathy. Chest: Bilateral rales, posterior half. Heart: S1, S2 audible. No murmurs or rubs. Abdomen: Soft. Bowel sounds audible. There is mild tenderness in the right upper quadrant. No guarding or rigidity. Extremities: No edema, clubbing, or cyanosis. Few pigmentary lesions in the lower and upper extremity.

PHYSICAL EXAMINATION:  At this time demonstrates an alert and oriented female in no acute distress. She denies any complaints and wants to go home. Her blood pressure is 120/68, heart rate is 72 and regular, and she is afebrile. HEENT: Anicteric sclerae. Jugular venous pressures are elevated, but no carotid bruits are noted. She has clear lung fields. Chest: Healed, stable sternotomy incision. Heart: S1 normal. A2/P2 normal. There is a harsh 2 to 3/6 systolic murmur with peaks in late systole and obscures the second heart sound with a single component. There is a third heart sound noted. There is 1/6 diastolic murmur suggestive of aortic insufficiency. Abdominal exam is negative. Extremities are free of cyanosis and clubbing. There is an ankle edema and an ecchymotic area over the left ankle.

PE Sample 1

PHYSICAL EXAMINATION:  Blood pressure is 144/74, pulse 86, and respirations 18. The patient is afebrile at 96.8. The patient is a (XX)-year-old Caucasian female looking much older than stated age. Alert and oriented. Skin is warm and dry, pink and nonicteric. Sclerae nonicteric. Oral mucosa is pink and moist. No lesions noted. Neck: No lymphadenopathy or thyromegaly. Chest: Clear, bilaterally expanded. Respirations are even and unlabored. Heart: S1 and S2. No rubs, murmurs, or gallop. Abdomen: Soft, very tender from right lower quadrant up and across upper abdomen. Bowel sounds are present throughout. Unable to assess organomegaly secondary to patient’s discomfort. The patient moves all extremities well and equal.

PHYSICAL EXAMINATION:  The patient is alert, oriented, pleasant. He has an NG tube in place, which is draining scant fluid, which has a tinge of red. His head is without evidence of trauma. No balding pattern is noted. His sclerae are clear. Conjunctivae pink. Pupils react to light and accommodation. Extraocular muscles are intact. Neck is without lymphadenopathy or thyromegaly. Tongue is in the midline. Articulation is clear. There is no glossitis or angular stomatitis. Heart has regular rate and rhythm without murmur, rub, or click. Lungs are clear without rales, rhonchi, or wheezing. The abdomen is soft. There is moderate tenderness to moderate palpation in the right and left lower quadrant. There is no guarding or rebound. There is no rigidity. There is no ecchymosis of the periumbilical area or flanks. There is no organomegaly. The spleen is not enlarged to percussion or palpation nor his liver. Extremities are without cyanosis, clubbing, or edema.

PHYSICAL EXAMINATION:  Initial blood pressure 152/84, temperature 99.6, and pulse 94. The patient is awake, alert, and in no apparent distress. No extremity swelling. Normal peripheral pulses. Gait not tested. Normal strength in the upper and lower extremities. Normal tone without any atrophy. Reflexes are 2+ and symmetric. No clonus. Normal orientation, concentration, memory, language, and fund of knowledge. Cranial nerves II through XII are intact. Vision is grossly normal. Extraocular muscles intact. Normal facial sensation and normal facial strength. Palate elevates in the midline. Normal shoulder shrug. Tongue does not deviate. No dysmetria with finger-to-nose. Negative Romberg. Normal coordination.

PHYSICAL EXAMINATION:  On examination, the patient is frail and looks very wasted, but she is oriented x3. Her blood pressure is 92/72 and the JVP is not elevated. Trachea is midline. Thyroid is not enlarged. Heart rate now is 92, normal sinus rhythm. She was in atrial fibrillation. She has a harsh pansystolic murmur heard over the left parasternal area, and she also has 3/6 mitral regurgitation murmur. She has a soft murmur across the aortic valve. Cardiomegaly was noted clinically. Lungs demonstrate decreased breath sounds at the bases. The skin is very thin, flaky, and dry. Abdominal examination is negative. No masses.

PHYSICAL EXAMINATION:  Blood pressure is 110/62, pulse 68, and temperature 97.6. Elderly frail female, lying in the bed. On cranial nerve testing, she has severe visual acuity problems, but her extraocular movements appeared intact. Her face shows left nasolabial fold flattening. Tongue and palate are midline. Corneal reflexes are symmetric. On motor testing, she has a left hemiparesis, power is 3/5 and right-sided power is 4+/5. Coordination reveals no dysmetria on the right. Deep tendon reflexes are 3+ on the left and 2+ on the right. Gait is deferred.

PHYSICAL EXAMINATION:  Blood pressure is currently 82/52 with a pulse of 84 and T-max of 98.6. The patient states that her blood pressure usually runs in the 80s systolic. Head normocephalic. No masses or tenderness. Pupils symmetric. Sclerae with positive icterus. Mouth with dry mucous membranes. Normal tongue. Neck: No JVD. No thyromegaly. Lungs: Diminished breath sounds, particularly on the right, otherwise symmetric excursions. Cardiac: Normal S1 and S2. No murmurs, gallops, or rubs. Abdomen: Grossly distended with positive succussion splash. Extremities: Actually show no clubbing, cyanosis, or edema. Skin: Icteric. No ulceration seen. No petechiae or purpura are present. Neurologic: The patient is alert and oriented x3 with a nonfocal neurological exam. Left upper extremity contains a PICC line.

PE Sample 2

PHYSICAL EXAMINATION:  The patient is sitting on the chair, a very conversant and good historian. Blood pressure is 112/82, heart rate is 88, and respiratory rate is 14. She is afebrile. Skin has normal color with no areas of ischemia, blue toes, or infarctions or embolization. HEENT: There is a little puffiness of the face. Neck is supple without JVD. Lungs are clear. Heart has a regular rhythm. Abdomen is negative for masses, megalies, or bruits. Extremities show 1+ bilateral edema.

PHYSICAL EXAMINATION:  Alert and oriented, in no acute distress, lying comfortably in bed. She is afebrile. Pulse 76, respirations 18, blood pressure 100/62, O2 saturation 100% on room air. HEENT: No pallor, icterus or oropharyngeal lesions. NECK: No JVD. No bruits. Normal carotid upstrokes bilaterally. CHEST: Clear. CARDIAC: Regular rate and rhythm. Normal S1, S2. No S3 or S4. No murmurs. ABDOMEN: No mass, bruit or organomegaly. EXTREMITIES: No clubbing, cyanosis or edema. Pulses 2+ bilaterally.

PHYSICAL EXAMINATION:  Alert, elderly woman, in no apparent distress, who is afebrile with a blood pressure of 110/66 and pulse of 66 and regular. There is a faint right carotid bruit. Heart exam reveals bradycardia, normal S1 and S2 heart sounds. The patient is oriented to person and day of the week only. She thinks it is 1986. She cannot name the president or vice president. She cannot name her medications or treating physicians. She has no knowledge of current events. She has limited insight into herself and overall situation. Speech is characterized by short phrases with ability to follow some two-step commands. Naming of objects is normal. There is impaired ability to perform all calculations, except the most simple additions. Pupils are equal and reactive to light. Extraocular movements are full without nystagmus. Visual field testing is full to finger count. Fascial movements are symmetric. Motor exam demonstrates 5/5 strength throughout all four limbs. The patient deferred on standing at this time. Deep tendon reflexes are 2+ throughout the upper limbs, 1+ at the knees and ankles. Plantars are flexor.

PHYSICAL EXAMINATION:  Temperature 96.8, blood pressure 98/64, heart rate 90, respirations 20. This is a Hispanic female who appears to be in no acute distress. She is alert, awake, and oriented x3. Heart: She has a regular rate and rhythm. Lungs: Clear to auscultation. Abdomen: At the site of the G-tube, there is a Foley present. J-tube noted. She has mild erythema and slight drainage around the J-tube. She is on TPN feedings right now. Abdomen: Otherwise soft, obese, nontender, and nondistended. No rebound or guarding. Extremities: She has left leg edema, mostly 3+, with erythema. Rectal: Deferred.

PHYSICAL EXAMINATION:  Afebrile. Blood pressure 118/66, heart rate is 52, respirations 16. The patient looks older than his stated age, in no acute distress. HEENT: Normocephalic, atraumatic. Neck: Supple. No jugular venous distention or carotid bruits. Lungs: Clear. Respirations are unlabored. Heart: Regular rate and rhythm. S1 and S2. No frank extra heart sounds or murmurs. Abdomen: Soft and nontender. Bowel sounds present. Extremities: No peripheral edema. Neurologic: Alert, oriented, grossly nonfocal.

PHYSICAL EXAMINATION:  VITAL SIGNS: P is 148/78, heart rate is 92, and respirations 22. HEENT: Carotid pulses were 2+ with normal upstroke without bruit. Right carotid artery endarterectomy scar is noted. LUNGS: Diminished breath sounds diffusely without audible wheezes or rhonchi. HEART: Tones are decreased. There is a regular rhythm. No audible gallop or murmur appreciated. PMI is not palpable. ABDOMEN: Markedly obese. There is no palpable tenderness. Femoral pulses were 1+, no audible bruit. EXTREMITIES: Dorsalis pedis pulses 2+ on the right, weak on the left. Posterior tibial pulses are not palpable bilaterally. There is no pedal edema at this time.

PHYSICAL EXAMINATION:

VITAL SIGNS: Pulse 78, blood pressure 114/52, respiratory rate is 22, and temperature afebrile.
GENERAL: The patient is a pleasant Hispanic female in no apparent distress, except for slight tachypnea.
HEENT: Pupils are equal and round. Mucosa and conjunctivae are pink.
NECK: No increased JVD.
CHEST: Bibasilar rales.
CARDIAC: PMI is not palpable. S1 and S2 are normal. Grade 2/6 holosystolic murmur at apex.
ABDOMEN: Soft. Nontender. No hepatosplenomegaly.
EXTREMITIES: No clubbing, cyanosis, 2+ pedal edema. Denies dorsalis pedis pulses.
PSYCHIATRIC: Oriented x3.

PE Sample 1

PHYSICAL EXAMINATION:  Examination of the head reveals a laceration in the occipital region, sutures in place. Examination of the eardrums reveals no hemotympanum, reveals them to be intact bilaterally. No raccoon eyes or Battle sign. The patient does have infraorbital ecchymosis on the right eye. No ocular involvement. The patient does have tenderness in the right TMJ as well. Was unable to completely open mouth secondary to pain. None of his teeth are loose on examination. The patient does have abrasion on the bridge of the nose as well as the right side of the nose with some soft tissue swelling as well. No septal hematoma noted within. The patient is alert and oriented x3. The patient has normal remote memory, but short-term memory surrounding the event is not present. Neurologically, cranial nerves II through XII are grossly intact. DTRs are 2/4 in the upper and lower extremities.

PHYSICAL EXAMINATION:  The patient is well built, well nourished, not in any distress. He is 5 feet 8 inches tall, 230 pounds. Vital signs are within normal limits. Head and neck examination was normal. Cranial nerves are intact. Cardiovascular exam was within normal limits. Lungs are clear on auscultation. Abdomen is obese. In the lumbosacral area, there is diffuse tenderness in the right gluteal area medially. No definite tenderness or tender point or trigger point identified. Gait is normal. The patient can stand on toes and heels. Motor and sensory exam was not significant. Deep tendon reflexes are symmetrical and equal. Straight leg raise test was negative. Patrick’s negative bilaterally. Lumbar spine flexion is limited to 40-45 degrees. Extension is 15 degrees with some pain. Right and left bend was within normal limits.

PHYSICAL EXAMINATION:  The patient is alert and oriented x3 and in slight distress secondary to pain. Head: Normocephalic and atraumatic. Eyes: Pupils equal, round, and reactive to light and accommodation. Extraocular muscles intact. Sclerae, conjunctivae, and fundi are clear bilaterally. Ears: There is cerumen present in both canals. Nose and Throat: Pink, moist, and clear. Cervical Spine: There is no tissue texture change, spasm, or tenderness noted. Range of motion, neurologic, and vascular status intact. Lumbosacral Spine: There is moderate ecchymosis and tenderness from the mid sacral region to the coccyx extending to the left sacroiliac region. Forward bending is approximately 80 degrees. Heel and toe walk intact. Motor 5/5. Deep tendon reflexes 2/4. Straight leg raise causes low back pain at approximately 10 degrees of hip flexion bilaterally. Figure-of-four causes low back pain bilaterally. Neurologic: Cranial nerves II through XII, sensory and cerebellar function intact. Motor in the upper and lower extremities 5/5. Deep tendon reflexes are 2/4. Romberg negative.

Infant PE Sample

PHYSICAL EXAMINATION:  On physical exam, the patient appears his stated age and has mesomorphic body habitus, appears in no acute distress. Head, neck, and upper extremities are grossly normal and symmetric. As we travel down his lower back, there is some bilateral pain. In lumbosacral area, there are tight muscles bilaterally, some tenderness over the spinous processes. SI joint exam is essentially negative. Reflexes are intact bilaterally. There is positive straight leg raise on the right at only 20 degrees, negative on the left. Patrick maneuver is equivocal.

PHYSICAL EXAMINATION:  He appears about his stated age. He is in no acute distress. He is moderately overweight. HEENT: Grossly normal. Neck grossly normal. Upper extremities are symmetrical. No evidence of muscle wasting or asymmetry. Thoracic spine is nontender. As we move to the lumbar area, there is some tightness, especially along the right side of the lumbar area. It does not reproduce the patient’s pain, however, and his predominant complaint is not actual back pain. He is not particularly tender over the spinous process line, the facet joint line, or in the area of the SI joints. Positive straight leg raise on the right at only 10 to 20 degrees, negative on the left. He appears to have intact sensation and good strength on both legs. He tolerates Patrick maneuvers well without reproducing his pain and flexion, extension, and rotational movements of the back are tolerated reasonably well. The patient does walk with a significant limp, however.

PE Sample 2

PHYSICAL EXAMINATION:  The patient appears to be a pleasant woman, communicates very well, moves around in bed. She is grabbing on her right lumbar area due to pain. On palpation, there is discomfort there. Further examination of the back revealed no acute deformity or tenderness over the lumbosacral junction or over the sciatic notch. Straight leg raising indicates slight bit of hamstring spasm when leg is raised beyond 60 degrees. Hip, knee, and ankle motions are fine. No motor or sensory deficits identified. The deep tendon reflexes are difficult to elicit, including the knees and over the ankles.

PHYSICAL EXAMINATION:  On exam, the patient is a very pleasant gentleman in no acute distress. He is about 5 feet 6 inches and weighs 210 pounds. His gait is nonantalgic. His tandem walk is normal. HEENT: Normocephalic and atraumatic. Pupils equal and reactive to light and accommodation. Extraocular movements are intact. Oropharynx is clear. Neck is supple. No adenopathy. Chest is clear to auscultation. S1 and S2 without gallops or murmur. Abdomen is obese and nontender. A left-sided transverse incision is noted. Incisional hernia is present. It does not appear to be strangulated or incarcerated. Spine exam demonstrated tenderness in the lumbosacral junction, posterior-superior iliac spine. Tenderness was increased on bilateral facet-loading maneuver. Flexion is complete, but this is met with symptom provocation. The patient experienced pulling on Lasegue maneuver. Straight leg raise is negative for radicular pain. Extremities show no clubbing or cyanosis. Peripheral joint range of motion reduced. Neurological evaluation is noted for diminished deep tendon reflexes. The rest of the neurologic exam is normal.