Take a few moments to look at the patient’s face, level of distress, use of accessory muscles of respiration, any abnormal pulsations in the chest and neck, and whether they look unwell. Make a mental note to exclude other conditions, particularly features that suggest endocrine disorders such as hypo- or hyper- thyroidism, Acromegaly, or other conditions with cardiovascular complications such as Marfans, Turners or Downs syndromes. What is the patient’s habitus? Are they obese? Does the patient appear cachectic, (an emaciated state that denotes serious illness, including severe cardiac failure, malignancy, or malnutrition). Rarely, a spot diagnosis may be made even at this early stage of proceedings, but this should not detract the examiner from completing an exam that will establish potential complications of the diagnosis.