Anterior fontanelle tense and bulging. Hair scant.
Sclera white, conjunctiva pink; red reflex present.
External ear canals patent; tympanic membranes pearly gray, with good cone of light.
Nasal mucosa pink.
Oral mucosa moist and pink. Pharynx without exudates.
Trachea midline, neck without thyromegaly
No cervical, axillary, epitrochlear, or inguinal adenopathy
Thorax and lungs
Thorax symmetric with good expansion; no use of accessory muscles of respiration, although patient is crying.
Lungs with transmitted crying sounds. Breath sounds vesicular; no rales, wheezes, or rhonchi.
Good S1, S2; no S3, S4; no murmurs, or extra sounds
Protuberant with active bowel sounds. Umbilicus clean, dry, and intact.
Soft, nontender, nondistended, no masses or hepatosplenomegaly.
Peripheral vascular/ extremities
Capillary refill delayed to 5 seconds. Femoral pulses 2+. No femoral or abdominal bruits.
No inguinal adenopathy. External genitalia without erythema or lesions; no lesions or masses.
Spine intact, no dimpling, no tufts of hair, no skin opening
Difficult to appreciate nuchal rigidity
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