Cardiac: The point of maximum intensity intercostal space in the midclavicular line. Grade II/VI soft systolic murmur head best at toward the left sternal border but not toward splits normally. Bones, Muscles, and Joints: bral angle tnederness. of the cardiac impulse is in the fifth Cardiac rhythm is regular. There is a the aortic area, radiating slightly the neck. The second heart sound The bones are not tender. There is no costoverte- Abdomen: The abdomen is soft, nontender. Bowel sounds are normal. Hepatic span to percussion is 10 cm. Liver spleen, and kidneys are not palpable, and there are no abnormal abdominal masses or bruits. Genitalia: Rectal: legs. Normal male, Examination is normal. Extremities: The extremities are normal, with multiple healed scars over the Skin: There is a depigmented geographic rash over the thorax and upper extremities, which is slightly scaling in places. Neurological: Examination is entirely within normal limits. IMPRESSION: 1. 2. 3. 4. 5. 6. Acute granulocytic leukemia. History of resection of thyroid nodule, clinically euthyroid now. Tinea versicolor. Mild cutaneous furunculosis. Chronic left otitis media. Partially erupted right lower third molar with pericdontitis. PROGNOSIS: Fifty percent chance of achieving remission of his leukemia; median survival about one year in other patients with a similar disease. James Mabry, M.D./C/10-4-72 IM:kr D-X 10-5-72 CLINICAL RECORD TH History end Physical Examination Rongelap (54) 09-44-40 3 -3- THE CLINICAL CENTER NATIONAL INSTITUTES OF HEALTH - 142 - Ol Summary C1 Consultation C1 Pellew-up DD Continuation NIH-O99 (Rev, 5-71}