Medical OPD

Common medical problems in a busy OPD: typhoid, malaria, UTI, chest infection and more.

• Typhoid (enteric fever)Diagnose with a blood culture, not a Widal or Typhidot. Treat with azithromycin for uncomplicated typhoid, and meropenem for severe or XDR typhoid.
• MalariaTest every fever in an endemic area. Severe malaria needs IV artesunate now. Uncomplicated falciparum gets an ACT, vivax gets chloroquine or an ACT plus primaquine after a G6PD test.
• Cough and chest infection in OPDCount the breathing rate, check SpO₂, use CRB-65. Most acute coughs are viral. A cough over 2 weeks needs a TB test.
• Urinary tract infection (cystitis)Burning, frequency and cloudy urine in a young woman: treat without a dip. Send a culture in men, pregnancy and anyone over 65.
• PyelonephritisFever, loin pain and UTI symptoms. Culture first, the right antibiotic for the right length, and scan anyone not improving.
• Gastroenteritis in adultsMost settle with fluids. Look for dehydration, blood, severe pain and high-risk patients, and remember typhoid, cholera and amoebic dysentery.
• Headache in OPDScreen every headache with SNOOP. No red flags and a normal exam? Treat migraine or tension headache and look for painkiller overuse.
• Calf pain and deep vein thrombosis (DVT)Wells score first. "Likely" means an ultrasound; "unlikely" means a D-dimer. Start anticoagulation if the scan will be delayed.
• Moderate asthma attack in OPDMeasure peak flow, give salbutamol through a spacer and prednisolone, check inhaler technique, and send home only if peak flow is above 75%.
• CellulitisUsually one leg. Draw the line, find the entry point and judge severity. Two red legs are rarely cellulitis.
• Urticaria and allergic reactionsLook at the airway first. Skin only? A non-sedating antihistamine. Any airway, breathing or circulation problem? IM adrenaline.
• Shingles (herpes zoster)Painful blisters in one band on one side. Start an antiviral within 72 hours if eligible, and check the nose tip for eye involvement.
• ImpetigoGolden crusts around the mouth and nose in a child. Small patch: cream. Widespread or blistering: oral antibiotics. Look for scabies underneath.
• Insect bites, stings and scorpionsBig itchy swelling within a day is a reaction, not infection. Watch for anaphylaxis, treat scorpion stings in children seriously, and think Congo fever after tick bites.