Normal Findings on Physical Examination

General Appearance & Vital Signs

• Alert, oriented, no acute distress, well-nourished, well-groomed
• Temperature: 36.5-37.5°C (97.7-99.5°F)
• Heart rate: 60-100 bpm, regular
• Respiratory rate: 12-20 breaths/min, unlabored
• Blood pressure: <120/80 mmHg (normal range roughly 90-120 systolic / 60-80 diastolic)
• SpO2: ≥95% on room air

HEENT (Head, Eyes, Ears, Nose, Throat)

• Head: normocephalic, atraumatic, no masses or tenderness
• Eyes: PERRLA (pupils equal, round, reactive to light and accommodation), EOMI (extraocular movements intact), conjunctivae pink, sclerae anicteric, no nystagmus, red fundal reflex/sharp optic discs on fundoscopy
• Ears: canals clear, tympanic membranes pearly gray with visible light reflex and landmarks, hearing grossly intact
• Nose: patent nares, no discharge or septal deviation, mucosa pink and moist
• Throat/mouth: mucosa moist and pink, no lesions, tonsils not enlarged, uvula midline, dentition intact

Neck

• Supple, full range of motion, no lymphadenopathy, no thyromegaly or nodules, trachea midline, no jugular venous distension (JVP <8 cm at 30-45°), no carotid bruits

Cardiovascular

• Regular rate and rhythm, normal S1 and S2, no murmurs, rubs, or gallops (S3/S4)
• Point of maximal impulse (PMI) at the 5th intercostal space, midclavicular line, non-displaced
• No pericardial friction rub, no distended neck veins, no peripheral edema
• Peripheral pulses (radial, femoral, popliteal, dorsalis pedis, posterior tibial) 2+ and symmetric bilaterally
• Capillary refill <2 seconds

Respiratory

• Chest symmetric, no use of accessory muscles, no retractions
• Vesicular breath sounds throughout, clear to auscultation bilaterally, no wheezes, crackles (rales), rhonchi, or rubs
• Resonant to percussion, symmetric tactile fremitus, no dullness or hyperresonance
• Trachea midline

Abdomen

• Soft, non-tender, non-distended
• Normoactive bowel sounds in all four quadrants (roughly 5-30 sounds/min)
• No hepatosplenomegaly, no masses, no rebound or guarding
• Tympanic to percussion over stomach/bowel, no shifting dullness
• No costovertebral angle tenderness

Extremities / Peripheral Vascular

• No cyanosis, clubbing, or edema
• Full range of motion in all joints, no deformity, warmth, erythema, or effusion
• Symmetric muscle bulk and strength, pulses intact, no varicosities or ulcerations
• Normal skin color, hair distribution, and capillary refill (as noted, physical exam of PAD assesses inspection, palpation, auscultation, and percussion for asymmetry, discoloration, or hair loss - none present in normal exam) - Roberts and Hedges' Clinical Procedures in Emergency Medicine

Neurological

• Alert and oriented x3 (person, place, time)
• Cranial nerves II-XII grossly intact
• Motor strength 5/5 throughout, normal tone, no tremor or fasciculations
• Sensation intact to light touch/pinprick in all dermatomes
• Deep tendon reflexes 2+ and symmetric (biceps, triceps, patellar, Achilles), no clonus
• Normal gait, coordination intact (finger-to-nose, heel-to-shin, Romberg negative)

Skin

• Warm, dry, intact, normal turgor, no rashes, lesions, or jaundice
• No abnormal pigmentation, no palpable lymph nodes

Musculoskeletal

• Normal spinal curvature, no scoliosis/kyphosis
• Full active and passive range of motion in all major joints, no crepitus, swelling, or instability