Dr.Murali Krishna's Page

A 48-year-old man had experienced acute onset of erectile dysfunction 6 months earlier. He had no other medical problems. Pubertal development had been normal. He was the father of three children On further questioning, the patient said that he had lost his job 4 months ago. He was having problems in his relationship with his wife, and had increased his alcohol consumption from two beers a week to four beers a day. The physical examination was normal. The serum testosterone level was 450 ng/dL.… Continue

A 56-year-old man is seen because of progressive fatigue, dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. On physical examination his blood pressure is 160/60 mm Hg. There is no jugular venous distention, but systolic pulsations of the uvula are noted, as is quick collapse of the arterial pulses, which is seen in the nail beds with gentle pressure. The lungs are clear to percussion and auscultation. There is a diffuse and hyperdynamic apex beat that is displaced laterally and i… Continue

A 32-year-old woman who recently moved to the United States from Mexico is seen because of the recent onset of palpitations associated with dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea with hemoptysis. On physical examination, her blood pressure is 112/90 mm Hg and her heart rate is 120 per minute and irregularly irregular. Jugular venous distention to 10 cm H2O with a prominent V wave is noted, as are diminished arterial pulses and bibasilar rales (up to half of the lung fie… Continue

Case A 26-year-old woman who has mitral stenosis requires extensive dental surgery. Penicillin prophylaxis against streptococci is indicated, but the patient is allergic to penicillin. She states that 15 years ago she had hives and wheezing 30 minutes after she had taken oral penicillin. How would you determine whether the patient is likely to have an allergic reaction if she is treated with penicillin now? What do you do if the skin test result to penicillin is positive? What is the prevalence… Continue

Case A 34-year-old white man complains of neck pain. At the age of 22, the patient first noted low back, buttock, and spine pain. He had been involved in a motor vehicle accident to which he attributed some of his back pain. At that time, he saw a number of physicians who diagnosed mechanical LBP and recommended bed rest. However, he found this only seemed to make his back and buttock pain worse. Typically, he was very stiff in the morning for more than 2 hours but in the afternoon he felt bette… Continue