For some reason, this seems to be an usually frequent case.
You will probably be asked to examine the hands first, in which case you must carry out a formal hand exam, but make it clear that you are looking for the characteristic skin changes viz sclerodactly, tight skin over the back of the hands (its important o see how far proximally this goes), calcinosis, evidence of Raynauds phenomeneon, loss of finger pulp, nail changes (remember that capillary drop out AND dilatation occurs in diffuse scleroderma) also look for telangiectasia. The functional assessment will be an important here. (In fact, in a colleagues exam in 2001 he was presented with a patient with no fingers all secondary to ischaemia because of scleroderma).
Now proceed to look for other manifestations- hypetension (always do it rather than ask for it), proximal myopathy, dry eyes (secondary Sjorgens), 3 finger test for the mouth, xerostomia (look with a torch), look for telangiectasia, feel the skin over the chest and now carry out a basic respiratory exam looking for fibrosis, alveolar cell carcinoma and effusions.
Now go to the cardiovascular system, looking for pulmonary hypertension, pericarditis, arrthymias secondary to conduction block and CCF. Look and listen for dysphagia – get them to swallow some water. Then look at the legs for vasculitic change and ulceration. Finally ask for a U/A.
The investigations you’ll ask for will primarily depend on your predominant findings but could include ESR, FBC (anaemia), Hypergammaglobulinaemia, ANA, RF, Autoantibodies inc anti-centromere and Anti-SCl70, CXR, lung function tests (DLCO in particular), ECG, hand XR to exclude erosive disease, ECHO and capilloscopy.