Studime te rasteve Case studies

1. Foshnja Laila ; Mosha 10 muajshe Baby Laila : age 10 months Nena e sjell qe ta vizitoni ju duke ju thene se ajo ka pasur sekrecione nga hunda dhe kolle per 2 jave. Ajo zgjohet naten me kolle. Mother brings her to see you saying she has had a runny nose and cough for 2 weeks. She wakes at night with cough 10 Cfare lloj informacioni kerkoni me shume? What other information would you want? Nena ju tregon se ajo ka vjelle me raste, Kishte pasur ethe per disa dite. Ajo ka 3 dhembe dhe ka jarge nga goja. Mother says she has vomited occasionally. She has had a fever some days. She has 3 teeth , and dribbles 11 Cfare lloj ekzaminimi do kerkoni t'i beni? What examination would you make? Laila duket mire dhe ka temperature normale. Membranat timpanike duken normale.Fyti; tonsilat lehtesisht te inflamuara pa eksudat, dhe gjendrat cervikale lehtesisht ta zmadhuara. Kafazi i kraharorit eshte i paster, me zhurma normale te frymemarrjes. Laila looks well and has normal temperature. Tympanic membranes look normal. Throat: tonsils slightly inflamed with no exudate, and cervical glands slightly enlarged. Chest clear, with normal breath sounds. 12 Sa prej kritereve te Centorit jane prezente? How many of the Centor criteria are present. 13 Cili eshte menaxhimi/trajtimi yt? What is your management? 2. Xhemi ; mosha 9 Jamie : aged 9 Nena e sjell Xhemin qe ta vizitoni ju me 3 dite histori me ethe, letargji dhe veshtiresi ne gelltitje. Mother brings Jamie to see you with a 3 day history of fever, lethargy and difficulty swallowing. 14 Cfare lloj informacioni tjeter keni nevoje? What other information do you need? Ai ka kaluar nje episod te ngjashem nje vit me pare , i cili kishte qene tonsilit, dhe u trajtua me antibiotike. Nuk kishte as kolle dhe as dhimbje veshi. He had a similar episode 1 year ago which was tonsillitis and settled with antibiotics. He has had no cough or earache 15 Cfare ekzaminimi do i beni? What examination do you make? Xhemi ka nje temperature prej 38.2 grade C. Membranat e tij timpanike duken normale.

Fyti- tonsila te medha te skuqura me eksudat dhe gjendra cervikale te zmadhuara. Kafazi i kraharorit eshte i paster. Jamie has a temperature of 38.2 deg C. His tympanic membranes look normal. Throat huge red tonsils with exudate and enlarged cervical glands. Chest is clear. 16 Sa prej kritereve te Centorit i perkojne atij. How many of the Centor criteria does he meet. 17 Cili eshte menaxhimi/trajtimi yt? What is your management?

3.Eduardi ;mosha 2 Edward : aged 2 Nena e sjell Eduardin qe ta shikoni ju me 2 jave histori me hunde me sekrecione dhe kolle. Mother brings Edward to see you with a 2 week history of cough and runny nose. 18 Per cfare pyesni tjeter? What else do you ask Eduarti eshte ndjere me raste i nxehte dhe shfaqet duke terhequr veshin e tij te djathte. Ai nuk ka pasur te vjella dhe gjendja e tij eshte e njejte me ate te 10 diteve me pare. Edward has occasionally felt hot and appears to pull at his right ear. He has not vomited, and his condition is the same as 10 days ago 19 Cfare ekzaminimi do i beni? What examination do you make? Ne ekzaminim; Ai duket mire pervec hundes me sekrecione. Ai eshte afebril. Fyti i tij duket normal dhe nuk ka gjendra cervikale. Membrana timpanike e djathe e tij eshte e skuqur dhe eshte e lehtesisht e dale jashte. Nuk ndjehen gjendra cervikale te zmadhuara . Kafazi i kraharorit eshte i paster. On examination: he looks well despite his runny nose. He is afebrile. His throat looks normal and he has no cervical glands. His right tympanic membrane is red and bulging slightly. No enlarged cervical glands felt. Chest is clear. 20 Cili eshte menaxhimi/trajtimi yt? What is your management? 4. Jakobi ; mosha 18 muajsh Jacob : age 18 months Nena e sjell ate qe ta shikoni ju me 1 dite anamneze me keputje dhe shfaqet grindavec. Naten e kaluar ai u zgjua me nje kolle te ashper lehese dhe duke qare. Mother brings him to see you with a 1 day history of being snuffly and fretful. Last night he woke with a barking croupy cough and crying 21 Per cfare lloj informacioni me shume keni nevoje? What other information do you need? Ai eshte i ulur ne preherin e nenes se tij i merzitur. Nderkohe qe ai merr fryme , ai ben

nje zhurme qe i ngjan lehjes. Ai i ka bere te gjitha vaksinat. He is sitting on his mothers lap, unhappy. As he breathes in he makes a barking noise. He has had all his immunisations 22 Cfare ekzaminimi do i beni? What examination do you make?

Ai nuk eshte i cianozuar, ka takikardi dhe ethe, por frymemarrja e tij eshte me ritem normal, dhe nuk ka recesion/terheqje te brinjeve. Fyti eshte i skuqur. Veshet- membranat timpanike jane normale. Zhurmat e frymemarrjes jane normale pervec nje zhurme te ashper ne inspirim. Ai ka krup. He is not cyanosed, has a tachycardia and fever, but his breathing is normal rate, with no rib recession. Throat is red. Ears- tympanic membranes normal. Breath sounds normal apart from occasional croupy noise on inspiration. He has croup. 23 Cfare mjekimi i jepni? What treatment do you give? 5. Denisa ; mosha 25 Denise : age 25 Denisa vjen ne kliniken tuaj. Ajo ka qene me te ftohte ne javen e kaluar. Ajo eshte trajtuar me paracetamol dhe shurup per kollen. Tani ajo ka dhimbje koke, siper dhe poshte syve te saj. Denise comes to your clinic. She has had a cold for the last week. She has taken Paracetamol and cough linctus. Now she has a headache, above and below her eyes. 24 Per cfare informacioni tjeter keni nevoje? What other information would you like? Si fillim ajo nuk kishte temperature , por ne 2 ditet e fundit ajo ka qene me temperature dhe e paafte per pune. Syte i ndjen te rende por jo te dhimbshem. Ajo eshte e vetedijshme per rrjedhjen e shpifur qe i kalon nga pas fytit te saj, i cili i shkakton asaj kolle, dhke kur ajo ngjit shkallet dhimbja siper syve te saj behet me e ashper. Initially she had no temperature, but the last 2 days she has been feverish and off work. Her ears feel heavy but not painful. She is aware of nasty discharge coming down the back of her throat, which causes her coughing, and when she climbs the stairs the pain above her eyes is worse. 25 Cfare ekza minimi i beni? What examination do you make? Denisa ka temperature 37.5 grade C. Sinuset frontale dhe maksilare jane te dhimbshem. Membranat e saj timpanike duken te trashe por nuk jane te skuqur. Fyti i saj eshte lehtesisht i skuqur dhe kraharori eshte i paster. Denise has a temperature of 37.5 deg C. her frontal and maxillary sinuses are tender. Her tympanic membranes look dull but not red. Her throat is slightly red and her chest clear

26 Cfare diagnoze i vin dhe cili eshte trajtimi juaj? What diagnosis do you make and what is your management? 27 Cili do te jete menaxhimi/ trajtimi juaj ? What would be your management