Physical Examination (Long Format)

👀 Inspection: Neck & Precordium

  • Neck: No jugular vein distention (JVD) or abnormal venous pulsations at 45° angle.
  • Carotid areas free of visible pulsations other than expected carotid upstroke.
  • Precordium/Chest Wall: Symmetric; skin color consistent with ethnicity; no scars, lesions, rashes, or edema.
  • No abnormal heaves, lifts, or visible pulsations over the chest wall.
  • No abnormal chest deformities; sternum and ribs intact.

✋ Palpation: Neck & Precordium

  1. Carotid Arteries: Palpated one at a time; normal amplitude, regular rhythm, no thrills.
  2. Precordial Landmarks Palpated:
    • Aortic (2nd right ICS, RSB)
    • Pulmonic (2nd left ICS, LSB)
    • Erb’s point (3rd left ICS, LSB)
    • Tricuspid (4th–5th left ICS, LSB)
    • Mitral (5th ICS, left MCL, apex)

      • → No abnormal pulsations, thrills, or lifts detected.

  3. PMI (Point of Maximum Impulse): Palpated at 5th ICS, left MCL; normal size (<2 cm), nondisplaced, with gentle amplitude.
  4. No precordial thrills, heaves, or abnormal vibrations noted.

🎧 Auscultation: Heart Sounds

  • Use diaphragm and bell at all 5 precordial points.
  • S1 and S2: present, regular rate and rhythm.
  • S1 best heard at apex; S2 best at base.
  • Carotid pulse palpated to correlate S1 with systole.
  • No extra sounds (S3, S4) present.
  • No murmurs, clicks, rubs, or abnormal heart sounds.

💅 Skin & Nails

  • Skin: Warm, dry, intact; color appropriate for ethnicity.
  • Normal texture, thickness, mobility, and turgor (no tenting).
  • No lesions, scars, masses, or abnormal pigmentation patterns.
  • No edema in extremities. No varicosities. No hair patches. Hair is normal distributed.
  • Nails: Smooth, clean, firmly attached.
  • Nail beds pink, with normal curvature and contour.
  • No clubbing, cyanosis, pitting, or deformities.
  • Capillary refill < 3 seconds bilaterally.