Cardiac: The point of maximum intensity of the cardiac impulse is in the fifth incercosctal space in the midclavicular line, Cardiac rhythm is regular, There is a Crade LI/VI sofe systolic murmur head best at the aortic arca, radiating slightly toward the left sternal border but not toward the neck, aplits normally. Bones, Muscles, and Joints: bral angle tnederncss, The second heart sound The bones ara not tender, Thare is no costovertes- Abdomen: The abdomen is soft, nontender, Bowel sounds are normal. licpaiic span to percussion is 10 cm, Liver spleen, and kidneys are not palpable, and there are no abnormal abdominal masses or bruits. Genitalia: Rectal: Normal male. Examination is normnsl. Extremities; The extremities are normal, with multiple healed scars over the legs. Skin: There is a depigmenred geographic rash over the thorax and upper extremitiles, which is slightly scaling in places. Neurological: Examination is entirely within normal limits, TMPRESSION: Auk 1. 2, 3. « « + Acute granulocytic leukemia, History of resection of thyroid nodule, clinically euthyroid now. Tinea versicolor, Mild cutaneous furunculosis, Chronic left oticis media, Partially erupted right lower third molar with perflodonticits. PROCNOSTS: Fifty percent chance of achieving remisafon of his leukemia; median survival abouc one year in other patients with a similar discase, James Mabry, M.D,/C/10-4-72 JM:ike D-X 10-5-72 Clicas tCO89 Rongelap (54) 09-44-40 3 TC Wietery end Phymeel Esemnumetion -3- THE CLINICAL CENTER NATIONAL INSTITUTES OF HEALIN Semmens 1 Comuttonen OD hetlewwe T) Conwimvosion mine dew. $711