text:  On admission   in general   the patient was in no acute distress   comfortable . Vital signs showed temperature 96.3   pulse 64   blood pressure 170  70   respiratory rate 20   oxygen saturation 98 in room air . Head   eyes   ears   nose and throat examination is normocephalic and atraumatic . Extraocular movements are intact . The pupils are equal   round   and reactive to light and accommodation . Anicteric . Throat is clear . The chest is clear to auscultation bilaterally . Neck was supple with no lymphadenopathy . Cardiovascular shows grade II  VI systolic ejection murmur   regular rate and rhythm . The abdomen is soft   nontender   nondistended   with a small umbilical hernia . Extremities are warm   noncyanotic and nonedematous times four . There is no peripheral edema .