Cardiac: The point of maximumintensity intercostal space in the midclavicular line. Grade II/VI soft systolic murmr 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 mltiple healed scars over the Skin: There is a depigmented geographic rash over the thorax and upper extremities, which fs slightly scaling in places. Neurological: Examination is entirely within normal limits. IMPRESSION: 1. 2. 3. 4. 56. 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 periodontitis. PROGNOSTS: Fifty percent chance of achieving remission of his leukemia; median survival about one year in other patients with a similar disease. Jamas Mabry, M.D./C/10-+4-72 JM:kr D-X Rongelap (54) 09-44-40 3 ~3- , 10-5-72 SE Wieary end Phyvion! Enemination summery Cl Coneuitarion OC THE CLINICAL CENTER MATIOMAL INSTITUTES OF HEALTH Cc jr tod c == a7 ~- 142 - tetewes CD Contivnptlan MIN-PPP Mev, 571)