PHYSICAL EXAM: The patient is an elderly man who appears slightly younger than his stated age. Blood pressure is 98/62. Extraocular movements are full. Pupils are equal, round, and reactive to light and accommodation. Sclerae nonicteric. Tympanic membranes are clear. Mouth and pharynx clear. Neck is supple. Thyroid is not prominent. We did not palpate any cervical, supraclavicular, axillary or inguinal lymph nodes. Cardiac examination shows a regular rhythm. Lung fields sound clear. He has a grade 2 systolic murmur. Abdomen soft, nontender, no masses felt. Liver is 2 cm below the right costal margin. Spleen cannot be palpated. Extremities do not show edema or calf tenderness.
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.
