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toenails bilaterally no visible abnormal findingsnoted inspected legs bilaterally for edema noedema noted. Capillary refill tested in all 10 fingersand all ten toes refill time Less Than 3 seconds.Right carotid artery auscultated Bruit present. no bruit to left auscultation of carotid artery Auscultated heart sounds noted as 1 2 and 3especially in the mitral valve area Auscultated breath sounds all sounds present notedadventitious sounds to the lower posterior right andleft Noting fine crackles and rales. Auscultatingabdominal aorta no bruit found. Upon examinationof all abdominal arteries no bruit found. Uponauscultation of bowel sounds in all four quadrantspresent. Upon auscultation of liver and spleen nofriction rubs noted. When palpating the right carotidartery noted thrill + 3, left carotid palpation no thrill,+2. Palpated PMI: displaced laterally brisk andtapping and less than 3 cm. Palpated bilateralbrachial arteries no thrill 2+. Palpation of the left andright radial pulse no thrill, 2+. Palpated left and rightfemoral pulse no thrill +2. Upon palpation of bilateraltibial, dorsalis pedis pulse and popliteal pulse nothrill, 1+ dimished bilateral. Upon light palpation ofall four abdominal quadrants like pressure notenderness reported no masses guarding ordistention. Upon deep palpation of all fourabdominal quadrants no masses are abnormalfindings noted. Location of the liver a palpable 1 cmbelow the right costal margin noted. Palpatedspleen not palpable. Palpated right and left kidneysnot palpable Skin turgor warm dry no tenting noted. Because allfour quadrants of the abdomen no areas of dullnessnoted. On percussion of the spleen no abnormalitiesnoted. Upon percussion of liver span 7cm in themidclavicular line. EKG performed regular sinusrhythm noted no st-elevation or changes.• General Survey: 58 year old male is alert andoriented, with clear speech and in no acute distress• Cardiac: S1, S2, without murmurs or rubs. PMIdisplaced laterally. S3 noted at mitral area. • Peripheral Vascular: Right side carotid bruit. JVP3cm above sternal angle. Right carotid pulse withthrill, 3+. Left carotid pulse without thrill, 2+.Brachial, radial, femoral pulses without thrill, 2+.Popliteal, tibial, and dorsalis pedis pulses withoutthrill, 1+. Cap refill less than 3 seconds - 4 extremities. • Respiratory: Breathing is quiet and unlabored.Breath sounds are clear to auscultation in upperlobes and RML. Fine crackles/rales in posteriorbases of L/R lungs. • Gastrointestinal: Round, soft, non-tender withnormoactive bowel sounds in 4 quadrants; noabdominal bruits. No tenderness to light or deeppalpation. Tympanic throughout. Liver is 7 cm at theMCL and 1 cm below the right costal margin.