Physical examination may be suggestive of thyroid dysfunction, congenital heart defects, inflammatory bowel disease, characteristic skeletal deformities and body habitus/skin manifestations.

• Patient may show signs of poor growth velocity and malnutrition indicative of failure to thrive.
• Patients may be hyperactive.
• The presence of short stature, a webbed neck, pigmented nevi, puffiness of the hands and feet, a cubitus valgus deformity, genu valgum on physical examination are highly suggestive of Turner syndrome.

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• High-grade / low-grade fever
• Hypothermia / hyperthermia may be present
• Tachycardia with regular pulse or irregularly irregular pulse – Hyperthyroidism
• Bradycardia with regular pulse or irregularly irregular pulse – Hypothyroidism
• Tachypnea – Secondary to Acute pulmonary edema from ischemic heart disease
• Hypertension in the upper extremities with hypotension in the lower extremities, decreased post ductal oxygen saturation in the lower extremities, absent lower extremity pulses – Coarctation of aorta
• Widened pulse pressure + water hammer pulse – Aortic Regurgitation secondary to aortic dissection

• Lymphedema of hands and feet
• Toe nail cellulitis
• Vitiligo
• Alopecia
• Nail hypoplasia
• Psoriasis – silver scaled erythrematous plaques present on extensor surfaces
• Pigmented melanocytic nevi – avoid rubbing against clothes.
• Hyperconvex nails
• Oslers nodes, Jane way lesions]] – Infective Endocarditis

Ear

• Weber test may be abnormal- Conductive hearing loss or sensorineural hearing loss
• Rinne test may be positive – Conductive hearing loss or sensorineural hearing loss
• External ear canal deformities may be noted.

Eye

1. Prominent epicanthal folds
2. Bilateral epicanthus
3. Strabismus
4. Ptosis
5. Cataract
6. Nystagmus
7. Roth spots – secondary to infective endocarditis

• Pterygium colli
• Low posterior hair line
• Loose skin on the nape of newborns
• Jugular venous distension – Rule out Eisenmengirsation secondary to congenital heart defects, pressure may be transmitted to the internal jugular vein.
• Hepatojugular reflux – There is an increased risk of ischemic heart disease and cardiomyopathy secondary to this may cause Right sided heart failure.

• Pulmonary examination of patients with Turner syndrome is usually normal.
• Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally (rule out)

• Patient has a wide shield shaped chest with inverted nipples.
• S3 (rule out)
• S4 (rule out)
• Gallops (rule out)
• A pansystolic murmur heard over the tricuspid area – Ventricular Septal defect
• Early blowing diastolic murmur head over the left upper sternal border – Aortic regurgitation secondary to aortic dissection
• Systolic ejection click followed by a crescendo decrescendo murmur (early P2 and delayed A2) – Early onset aortic stenosis secondary to a bicuspid aortic valve
• Fever + Petechiae + Heart murmur – Infective Endocarditis

• Look for signs of inflammatory bowel disease such as fistulas, skin tags and oral aphtous ulcers

• Kyphosis
• Scoliosis

• Chronic estrogen deficiency may lead to signs of atrophic vaginitis
• Rudimentary uterus
• Palpable mass secondary to dysgerminoma or gonadoblastoma

• Neuromuscular examination of patients with Turner syndrome is usually normal.

• Shortened limbs
• Shortened 4th metacarpal
• Cubitus valgus deformity
• Madelung deformity
• Cyanosis – Secondary to structural heart defects
• Pitting edema of the upper/lower extremities – Hypothyroidism
• Muscle atrophy

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