Common Medicine and Pediatrics OPD Diseases: A Practical Guide for MBBS Interns

Introduction

Use local hospital protocols, national guidelines, and senior supervision for prescriptions, doses, antimicrobial choices, and referrals.

Part 1: Common Diseases in Medicine OPD

1. Acute upper respiratory tract infection

• Fever, sore throat, runny nose, cough, body ache
• Usually viral and self-limited

• Duration of illness
• Fever pattern, breathlessness, chest pain
• Sputum, wheeze, smoking history
• Examine throat, tonsils, cervical nodes, chest, oxygen saturation

• SpO₂ below normal or respiratory distress
• Confusion, hypotension, persistent high fever
• Focal chest signs suggesting pneumonia
• Elderly patient, major comorbidity, or immunosuppression

• Supportive care: fluids, rest, antipyretic if appropriate
• Avoid antibiotics for uncomplicated viral illness
• Give return precautions: worsening breathlessness, persistent fever, hemoptysis, reduced oral intake

2. Hypertension

• Measure blood pressure correctly after rest
• Use the appropriate cuff size
• Repeat measurement and, when possible, confirm on separate visits unless BP is severely elevated
• Assess cardiovascular risk: diabetes, smoking, dyslipidemia, kidney disease, prior stroke or coronary disease

• Headache, visual symptoms, chest pain, dyspnea
• Neurological deficit
• Renal symptoms
• Fundus examination when indicated
• ECG, urine examination, creatinine, glucose or HbA1c, lipid profile according to protocol

• Very high BP with chest pain, pulmonary edema, neurological deficit, seizure, altered sensorium, acute kidney injury, or visual loss
• Consider hypertensive emergency rather than routine OPD management

• Reduce salt intake
• Weight reduction if overweight
• Regular physical activity
• Avoid tobacco
• Medication adherence and regular BP monitoring

3. Type 2 Diabetes Mellitus

• Polyuria, polydipsia, weight loss, recurrent infections
• Detected incidentally during screening
• Neuropathy symptoms: burning feet, numbness
• Nonhealing wounds

• Blood glucose and HbA1c where available
• BP, weight/BMI, waist circumference
• Foot examination: ulcers, pulses, sensation
• Urine protein, kidney function, lipid profile
• Eye referral for retinal assessment when indicated

• Vomiting, abdominal pain, deep breathing, altered sensorium
• Severe dehydration or marked hyperglycemia
• Foot ulcer with cellulitis, ischemia, or systemic symptoms
• Hypoglycemia in a patient on glucose-lowering treatment

• Diet should be individualized, not simply “no sugar”
• Regular meals, physical activity, weight management
• Foot care: inspect daily, avoid barefoot walking, seek early care for wounds
• Explain symptoms and immediate treatment of hypoglycemia

4. Dyspepsia and Gastroesophageal Reflux Disease

• Epigastric burning or pain
• Bloating, early satiety, acidity, regurgitation
• Symptoms related to meals

• Dysphagia or odynophagia
• GI bleeding, melena, hematemesis
• Unexplained weight loss
• Persistent vomiting
• Anemia
• New symptoms in older age, depending on local referral policy
• Family history of upper GI cancer

• Review NSAID use, alcohol, tobacco, dietary triggers
• Lifestyle advice: smaller meals, avoid lying down after meals, weight management
• Acid suppression or H. pylori evaluation/treatment should follow local protocol

• Acute coronary syndrome can occasionally present with epigastric discomfort, especially in older adults and patients with diabetes.

5. Acute Gastroenteritis

• Loose stools, vomiting, abdominal cramps, fever

• Pulse, BP, urine output
• Dry tongue, thirst, sunken eyes, skin turgor
• Mental status
• Ability to drink
• Blood or mucus in stool
• Recent antibiotics, travel, contaminated food, sick contacts

• Oral rehydration solution is central for mild to moderate dehydration
• Continue nutrition where tolerated
• Antiemetics, antibiotics, stool tests, or IV fluid depend on clinical severity and cause
• Avoid indiscriminate antibiotic use

• Shock or severe dehydration
• Bloody diarrhea with systemic illness
• Severe abdominal pain or guarding
• Persistent vomiting or inability to drink
• Elderly, pregnant, immunocompromised, or major comorbidity

6. Urinary Tract Infection

• Dysuria, urinary frequency, urgency
• Suprapubic pain
• Fever or flank pain may suggest upper urinary tract involvement

• Pregnancy status
• Diabetes, renal disease, catheterization
• Recurrent infection
• Vaginal discharge or genital lesions, which may suggest another diagnosis
• Fever, chills, flank pain, vomiting

• Fever with flank pain or vomiting: possible pyelonephritis
• Male patient with UTI symptoms
• Pregnancy
• Recurrent or complicated infection
• Sepsis features or urinary obstruction

• Send urinalysis and culture when indicated before antibiotics, particularly in complicated or recurrent cases.
• Antibiotic selection should follow local resistance patterns and senior advice.

7. Low Back Pain

• Trauma
• Fever, weight loss, cancer history
• Long-term steroid use
• Bladder/bowel dysfunction
• Saddle anesthesia
• Progressive weakness or numbness
• Night pain or pain at rest
• Tuberculosis risk where relevant

• Encourage activity as tolerated rather than prolonged bed rest
• Analgesia and physiotherapy advice as appropriate
• Imaging is not routinely needed in uncomplicated acute mechanical pain

• Suspected cauda equina syndrome
• Severe/progressive neurological deficit
• Infection, malignancy, fracture, or inflammatory spinal disease suspected

8. Anemia

• Fatigue, dizziness, exertional breathlessness, palpitations
• Pallor may be found incidentally

• CBC with indices
• Dietary history
• Menstrual and obstetric history in women
• GI symptoms or bleeding
• Deworming, chronic disease, renal disease, drug history
• Examine for pallor, jaundice, edema, lymphadenopathy, hepatosplenomegaly

• Severe symptomatic anemia
• Active bleeding
• Hemolysis or pancytopenia
• Suspected malignancy or hematological disorder

Part 2: Common Diseases in Pediatrics OPD

Key principle in pediatric OPD

1. Weigh the child accurately.
2. Check allergies and prior medication use.
3. Calculate dose by weight where required.
4. Counsel the caregiver clearly in a language they understand.
5. Give written return precautions.

1. Acute Respiratory Infection

• Cough, cold, fever, sore throat
• Wheeze or fast breathing
• Poor feeding in infants

• Respiratory rate according to age
• Work of breathing: chest indrawing, nasal flaring, grunting
• SpO₂ where available
• Feeding ability and hydration
• Wheeze, crackles, stridor
• Immunization status

• Central cyanosis
• Severe chest indrawing
• Inability to drink or breastfeed
• Lethargy, convulsions, altered sensorium
• Stridor at rest
• Low oxygen saturation
• Apnea in young infants

• Viral upper respiratory infection
• Pneumonia
• Bronchiolitis
• Asthma/wheeze-associated respiratory illness
• Croup

2. Acute Diarrhea

• Number of stools and vomiting episodes
• Blood in stool
• Urine output
• Thirst and feeding
• Duration
• Recent antibiotics or unsafe food/water exposure

• General appearance and mental state
• Sunken eyes
• Thirst
• Skin pinch
• Capillary refill, pulse, urine output

• ORS is first-line for most children with some dehydration or risk of dehydration
• Continue breastfeeding and age-appropriate feeding
• Zinc supplementation is commonly used in pediatric diarrhea according to national protocols
• Antibiotics are not routine for uncomplicated watery diarrhea

• Severe dehydration or shock
• Blood in stool with systemic illness
• Persistent vomiting or inability to drink
• Suspected sepsis
• Infant with poor feeding or lethargy

3. Fever Without a Clear Focus

• Viral illness
• Malaria, dengue, enteric fever, urinary infection, depending on location and season
• Pneumonia, otitis media, pharyngitis

• Duration and pattern of fever
• Rash, cough, diarrhea, vomiting, urinary symptoms
• Travel, mosquito exposure, sick contacts
• Immunization history
• Drug history
• Warning symptoms: seizures, persistent vomiting, bleeding, poor feeding, reduced urine

• General condition, hydration, rash, lymph nodes
• Ear, throat, chest, abdomen
• Neurological assessment
• Look for hepatosplenomegaly where relevant

• Child appears toxic or lethargic
• Seizure, neck stiffness, non-blanching rash
• Respiratory distress
• Persistent vomiting, shock, bleeding
• Infant under 3 months with fever requires particularly careful assessment

4. Childhood Asthma and Recurrent Wheeze

• Recurrent cough, wheeze, breathlessness
• Night symptoms
• Triggered by dust, smoke, exercise, viral infection, weather change
• Personal or family history of atopy

• Respiratory effort, wheeze, air entry, SpO₂
• Growth and signs of chronic disease
• Inhaler technique if already prescribed

• Distinguish acute severe asthma from stable/recurrent wheeze
• Teach inhaler and spacer technique
• Identify triggers, especially tobacco smoke exposure
• Make an asthma action plan with senior guidance

• Silent chest, cyanosis, exhaustion
• Inability to speak/feed due to breathlessness
• Low oxygen saturation
• Poor response to initial bronchodilator treatment

5. Acute Otitis Media

• Ear pain, fever, irritability
• Tugging at ear in younger children
• Reduced hearing or ear discharge

• Otoscopy if trained and equipment available
• Look for tympanic membrane bulging, erythema, perforation, discharge
• Assess mastoid tenderness/swelling

• Post-auricular swelling or tenderness suggesting mastoiditis
• Toxic appearance
• Neurological symptoms
• Very young infant or immunocompromised child

6. Skin Diseases

• Scabies
• Impetigo
• Atopic dermatitis
• Fungal infections
• Pediculosis
• Viral exanthems

• Intense itching, often worse at night
• Lesions in finger webs, wrists, axillae, waist, genital area
• Family members may have symptoms

• Honey-colored crusted lesions, frequently around nose and mouth
• Check for fever, cellulitis, extensive lesions, or renal symptoms in follow-up when indicated

7. Nutritional Problems and Failure to Thrive

• Weight, height/length, MUAC where appropriate
• Plot growth on a standard growth chart
• Breastfeeding and complementary feeding history
• Dietary diversity and meal frequency
• Recurrent diarrhea, TB contact, chronic illness, developmental concerns

• Severe wasting, bilateral pitting edema
• Poor appetite, lethargy, hypoglycemia, hypothermia
• Severe anemia, dehydration, or infection
• Child unable to feed

8. Iron Deficiency Anemia

• Pallor, fatigue, poor appetite, irritability
• Poor school performance in older children
• Pica in some children

• Diet history, excessive cow’s milk intake where applicable
• Deworming history
• Chronic blood loss or recurrent infection
• CBC and further testing as indicated

• Confirm likely cause where possible
• Iron treatment and dietary counseling under pediatric protocol
• Reassess adherence and response
• Investigate non-response rather than repeatedly changing medication without assessment

OPD Documentation Format for Interns

• Name, age, sex, weight, date

• With duration

• Present illness
• Past illness
• Drug and allergy history
• Comorbidities
• Immunization and birth history in children
• Diet and development in children

• Vitals: temperature, pulse, respiratory rate, BP where appropriate, SpO₂
• General examination
• Systemic examination
• Hydration/nutrition status in children

• Provisional diagnosis
• Differential diagnosis
• Severity and danger signs

• Investigations
• Treatment as per unit protocol/senior advice
• Counseling
• Follow-up date
• Clear emergency return precautions

High-Yield OPD Red Flags

• Altered mental status, seizures, syncope, or focal neurological deficit
• Respiratory distress, cyanosis, low oxygen saturation, severe wheeze
• Shock, severe dehydration, persistent vomiting, inability to drink
• Chest pain, suspected acute coronary syndrome, severe hypertension with symptoms
• GI bleed, severe abdominal pain, guarding, jaundice with systemic illness
• Sepsis features: fever/hypothermia, tachycardia, hypotension, toxic appearance
• Pregnancy-associated symptoms or suspected ectopic pregnancy
• Infant with poor feeding, lethargy, fever, hypothermia, or respiratory distress
• Severe malnutrition, edema, or failure to thrive
• Suspected child abuse or neglect

Suggested Research Topics for an MBBS Intern

1. Pattern of common diseases in Medicine OPD over 3 months
2. Antibiotic prescribing patterns for acute respiratory infections
3. Prevalence of newly detected hypertension in adult OPD attendees
4. Diabetes screening and foot-examination documentation in Medicine OPD
5. Frequency and causes of anemia among adult women attending OPD
6. Common pediatric OPD diagnoses by age group
7. ORS and zinc prescription practices in children with acute diarrhea
8. Assessment of growth-chart documentation in pediatric OPD
9. Inhaler technique among children with asthma and their caregivers
10. Pattern of skin infections and scabies among pediatric OPD patients

Simple research method

• Design: Cross-sectional observational study or clinical audit
• Sample: Consecutive eligible OPD patients during a defined period
• Data collection: Age, sex, diagnosis, investigations, treatment given, referrals, outcome/follow-up
• Analysis: Frequency, percentage, age-wise distribution, sex-wise distribution, common prescriptions
• Ethics: Take departmental permission, avoid identifiers, maintain confidentiality

Conclusion