Step II Physical examination

1. An evaluation of pubertal development should include current height, weight, and arm span (normal arm span for adults is within 5 cm of height) and an evaluation of the growth chart.

2. Breast development should be assessed by Tanner staging.

3. The genital examination should evaluate clitoral size, pubertal hair development, intactness of the hymen, depth of the vagina, and presence of a cervix, uterus, and ovaries. If the vagina can not be penetrated with a finger, rectal examination may allow evaluation of the internal organs. Pelvic ultrasound is also useful to determine the presence or absence of mullerian structures.

4. The skin should be examined for hirsutism, acne, striae, increased pigmentation, and vitiligo.

5. Classic physical features of Turner syndrome include low hair line, web neck, shield chest, and widely spaced nipples.

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