Physical Exam NORMALS

INTEGUMENT▪ Lesions and rashes are not found. Areas of increased vascularity, ecchymosis, or

bleeding are not seen.▪ Skin is warm, slightly moist, smooth, and finely texture. Skin turgor is elastic.▪ Hair distribution is characteristic for gender and age.▪ Nails are smooth and slightly rounded or flat ( angle of nail base should be

approximately 160 degrees). Nails have a pink cast in light-skinned individuals and a brown cast in dark- skinned individuals.

▪ Mucous membranes are moist and pink.HEAD▪ Skull is normocephalic.▪ Face is symmetric.▪ No signs of alopecia or foreign bodies in the hair are observed on the scalp.▪ Hair is shiny and resilient when traction is applied. It does not come out in clumpsEYES▪ Central vision is 20/20 in both eyes. Visual fields are unrestricted.▪ Eyes appear symmetric with no ptosis, lid lag, or infections or tumors of the eyelids.▪ Eyes move in conjugate fashion.▪ The cover/ uncover test reveals no movement of the either eye.▪ The anterior and posterior chambers, lens, and cornea are transparent. The sclera

and conjunctiva are clear.▪ The lacrimal system is unobstructed, with no enlargement, edema, redness, or

exudate.▪ Pupils are equal, round, and reactive to light and accommodate.▪ Red reflex is symmetrically seen in the center of each cornea.▪ Bilateral well- marginated disks are revealed on funduscopic examination.▪ No signs of arterial narrowing, venous engorgement, atrioventricular nicking,

hemorrhages, or exudate are seen.EARS▪ The Weber’s test result is not referred or lateralized.▪ The Rinne test result is positive (e.g air conduction is greater than bone conduction)▪ Appearance of external ear is normal.▪ Canals are clear without discharge.▪ Tympanic membranes are pearly gray and intact, with visible landmarks.NOSE▪ Nose is symmetrically placed on face.▪ Nasal passages are patent with septum in midline.▪ Mucous membranes are moist and dark pink without perforation or bleeding.▪ Sinuses are nontender.MOUTH▪ No lesions are resent on the lips, gums, tongue, or buccal mucosa.▪ Tongue is pink, moist, well papillate and in midline when at rest and on protrusion.▪ Salivary glands are unobstructed.▪ Pharynx is not injected.

▪ Tonsils are non obstructing.▪ Uvula is in the midline.▪ Palate elevates symmetrically on phonation.▪ Gag reflex is present bilaterally.▪ Teeth are present with no caries.▪ Gums are clear.NECK▪ Neck is symmetric without tenderness or limitation of movement.▪ Trachea is positioned in the midline.▪ Thyroid is not palpable.▪ Bruits are not auscultated.LYMPH NODES▪ Nodes are neither palpable nor tender.FEMALE BREAST▪ Nipples are symmetric with no signs of erosion, discharge, or recent inversion.▪ Breast are symmetric, although they may vary in size.▪ Breast tissue is soft, lobular, and homogenous.MALE BREAST▪ Nipples are symmetric with no erosion or discharge.▪ Masses, discharge, and tenderness are not noted.THORAX, LUNGS▪ Respiratory rate changes between 16-20 bpm.▪ The thorax is symmetric. Costal angle is less than 90 degrees. Transverse diameter is

1:2 to 5:7 (healthy adult is wider from side to side than from front to back). Expansion is 1.2” to 2” (3 to 5cm), symmetric, and free and easy; no bulges or extractions are detected in intercostal spaces.

▪ Diaphragm position and excursion is 1:2’ to 2.4” (3 to 6cm).▪ Fremitus can be felt throughout lung fields, diminishing near the periphery.▪ Percussion is resonant over symmetric areas of the lung to expected lung borders

(5th ICS anteriorly, 7th ICS laterally and T10 posteriorly; dullness is noted between the 3rd and 5th left intercostal spaces.

▪ Adventitious sounds , enhanced voiced sounds, or bronchial breath sounds are not present.

HEART▪ Regular apical pulse rate ranges between 60 to 100 bpm.▪ Thrills, heaves, or abnormal pulsations are not present.▪ Apical impulse is the 5th LICS, at or medial to the midclavicular line (palpated within

one ICS and no more than 0.4” to 0.8” (1-2 cm) wide, 2.8” to 3.5” (7 to 9cm) from the sternal border).

▪ Left cardiac border dullness is percussed 3.5” to 4.7” (9-12cm) from the sternal border.

▪ S1 and S2 are heard in expected locations with expected intensities (S2 split is common in the supine position on inspiration); no extra sounds or murmurs are present.

PERIPHERAL CIRCULATION▪