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The Patient

  • General Features

    Age, gender, general comfort

  • Vital Signs

    Heart rate, blood pressure, resp rate, temp

  • Conscious State

    Alert, oriented, confused, obtunded

  • Body Habitus

    Weight gain ( ↓ ) / loss ( ↑ ), BMI, shape

  • Mental State

    Anxiety ( ↑ ),mental slowness ( ↓ )

The Hands

  • The Nails

    Onycholysis ( ↑ / ↓ ), peripheral cyanosis ( ↓ )

  • Clubbing

    Increased soft tissue in distal phalanges (Graves)

The Arms

  • Radial Pulse

    Tachycardia ( ↑ ) / bradycardia ( ↓ ), rhythm

  • Pemberton's Sign

    For thoracic outlet obstruction - retrosternal goitre

    Patient lifts arms as high as possible for 1 min, look for facial congestion and cyanosis

  • Biceps / Triceps Reflexes

    Reduced ( ↓ ) / normal / hyper-reflexive ( ↑ )

The Face

  • The Hair

    Alopecia ( ↑ )

  • The Skin

    Pigmentation ( ↑ ), thickening ( ↑ )

  • The Eyes

    Exophthalmos (Graves)

  • The Eyelids

    Lid retraction ( ↑ ), lid lag ( ↑ )

  • The Orbits

    Periorbital oedema ( ↓ ), loss of outer 1/3 of eyebrow ( ↓ )

  • The Mouth

    Swelling of tongue ( ↓ )

The Neck

  • Inspection

    Scars, veins, erythema, swelling, swallow

  • Palpation

    Size, shape, nodules, thrill, fixation, consistency

  • Percussion

    Upper part of manubrium

  • Auscultation

    Over each lobe for bruits

The Chest

  • Auscultate

    Systolic flow murmur ( ↑ ), crackles, pericardial / pleural rub

  • Auscultate Lung Fields

    Stridor, crackles, pleural rub

The Legs

  • Pretibial Myxoedema (Graves)

    Bilateral, firm, elevated dermal nodules

  • Non-Pitting Oedema ( ↓ )

  • Patellar / Ankle Reflexes

    Reduced ( ↓ ) / normal / hyper-reflexive ( ↑ )