1. Environment, general appearance
2. Nails, hands, arms, axillae
3. Face, eyes, mouth
4. Neck, thyroid
5. Chest, abdomen
6. Genitalia, legs

Environment

• N/A

General appearance

• Characteristic syndrome appearance.
• See Common Syndrome Exams Reference.
• Stature.
• Weight.
• Ask pt. if any part tender before palpating.

Nails

• See Nails Reference.

Hands

• Oversized hands (acromegaly).
• Heat (hyperthyroid).
• Tremor (hyperthyroid).
• Palmar erythema (hyperthyroid).
• Pigmentation of palmar crease (Addison's, but normal in asians, blacks).
• 3rd, 5th metacarpals shortened (pseudohypoparathryoid).
• Pulse: rate (hyper-, hypothyroid), rhythm, character. See Pulse Reference.

Arms

• Blood pressure for hypertension (Cushing'), hypotension (Addison's).
• Trousseau's sign (hypercalcemia):
  • Occlude brachial artery for 3 min using BP cuff.
  • See if carpal spasm is induced.
• Muscle weakness (hypothyroid, Cushing's).

Axillae

• Acanthosis nigricans (acromegaly).
• Axillary hair loss (hypopituitary).
• Skin tags (acromegaly).

Face

• Syndrome facies.
• Acne, oily skin (Cushing's).
• Hirsutism (panhypopituitary).
• Chin enlargement (acromegaly).

Eyes

• Exophthalmos (hyperthryoid).
• Eye fundus:
  • (DM).
  • (acromegaly).
  • See Fundus Examination.

Mouth

• Buccal pigmentation (Addison's).
• Tongue enlargement (acromegaly).

Neck

• Inspect buffalo hump (Cushing's).
• Palpate supraclavicular fat pads (Cushing's).
• Inspect webbed neck (Turner's).

Thyroid

• Inspect for goiter.
• Dr. palpates pt's thyroid from behind.

Chest

• Pigmented nipple (Addison's).
• Loss, gain of chest hair.
• Male gynecomastia (Cushing's).
• Reduced female breast size (panhypopituitary).

Abdomen

• Pt. lies down, one pillow under head.
• Purple striae (Cushing's).
• Disproportionate abdominal fat (Cushing's).

Genitalia

• Atrophy.
• Virilisation.

Legs

• Peripheral neuropathy (DM).
• Toenails and foot showing same symptoms as Fingernails and Hands.