Obj Examination

Itchy rash in the upper thorax, diffuse bruises on the legs, pale skin, 

HR: 120 bpm SpO2: 98% BP: 106/69 mmHg

Monolateral enlarged cervical lymph nodes, hepatosplenomegaly.

Soft systolic ejection murmur  at the left upper sternal border due to known ASD (Levine II). Regular Rythm and no additional pathological sounds.

Harsh breath with rhonchi during expiration.