C

8 cm lateral to the midsternal line. Good S-i, S2; no S3 or S4. A II/VI medium-pitched midsystolic murmur at the 2nd right interspace; does not radiate to the neck. No diastolic murmurs.

Breasts. Pendulous, symmetric. No masses; nipples without discharge.

Abdomen. Obese. Well-healed scar, right lower quadrant. Bowel sounds active. No tenderness or masses. Liver span 7 cm in right midclavicular line; edge smooth, palpable 1 cm below right costal margin (RCM). Spleen and kidneys not felt. No costovertebral angle tenderness (CVAT).

Genitalia. External genitalia without lesions. Mild cystocele at introitus on straining. Vaginal mucosa pink. Cervix pink, parous, and without discharge. Uterus anterior, midline, smooth, not enlarged. Adnexa not palpated due to obesity and poor relaxation. No cervical or adnexal tenderness. Pap smear taken. Rectovaginal wall intact.

Rectal. Rectal vault without masses. Stool brown, negative for occult blood.

Extremities. Warm and without edema. Calves supple, nontender.

Peripheral Vascular. Trace edema at both ankles. Moderate varicosities of saphenous veins both lower extremities. No stasis pigmentation or ulcers. Pulses (2 + = brisk, or normal):

Radial

Femoral Popliteal Dorsalis Pedis Posterior Tibial

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