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  This is an a online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. The patient/ attender was informed the purpose of the information being acquired. An informed consent was taken from patient/ attender and there is omission of information that was requested to be omitted. 83yr old male came with complaints of  shortness of breath since 10 days. chief  complaints:  cough since 14 days Fever since 12 days shortness of breath since 10 days History of Presenting illness: Patient was admitted to ICU 16 days back with  breathlessness. It was insidious in onset and
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OSCE

  PREFINAL OSCE Pathophysiology An uninjured healthy lung contains an intact respiratory epithelial layer and alveolar space patrolled by resident alveolar macrophages. Type I and type II pneumocytes contribute to regulation of alveolar contents, including surfactant, and maintain the integrity of the alveolar-capillary barrier.  Following infection or inj ury, an influx of innate immune cells such as neutrophils and monocytes migrate from the circulation into the interstitial and alveolar spaces,  • During respiratory distress, damage to the epithelial and endothelial layers results in breakdown of the alveolar-capillary barrier and accumulation of edematous fluid and debris in the alveolar spaces. Pro-inflammatory and destructive functions of alveolar macrophages, monocytes, and neutrophils co ntribute to disease pathology.  • The consequence is the loss of alveolar-capillary barrier function. This disruption permits the accumulation of proteinaceous fluid in the alveolar space coupl
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ADRENAL TUMORS [131 durga T]

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ADRENAL GLAND TUMORS Adrenal tumors are cancerous or noncancerous growths on the adrenal glands  The adrenal glands are located above the kidneys and have two parts, the adrenal cortex and the adrenal medulla. The adrenal cortex secretes hormones including cortisol and aldosterone. The adrenal medulla produces dopamine, epinephrine and norepinephrine. There are different types of adrenal tumors, and they can be either cancerous or noncancerous (benign). Aside from categorizing them as noncancerous (benign) or cancerous (malignant), they are categorized as functioning or nonfunctioning. Functioning tumors lead to overproduction of one or more of the normal adrenal hormones. CAUSES: The cause of most adrenal tumors is unknown. Some hereditary conditions have been linked to an increased risk of developing an adrenal tumor. The hereditary conditions include: Carney complex Li-Fraumeni syndrome Multiple endocrine neoplasia type 2 Neurofibromatosis type 1 MAJOR PROBLEMS: Adrenal tumors can c
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