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1. A 4 year old child is brought to your GP practice by her mother. She has painful crusted lesions on her face and neck, mostly localized around her mouth. Her face feels hot to the touch. She is other well. What is the SINGLE most likely diagnosis?
   • First-Line / Correct Key: Impetigo
   • Clinical Rationale: Contact Dermatitis: usually presents with itching and redness of a single affected area.
Chicken pox: presents with systemic symptoms such as pyrexia, malaise. Vesicles
present on the face, neck and trunk
Measles: Hard K sounds → Koplik spots, Cough, Conjunctivitis, Coryza
Impetigo:
Impetigo is a common condition. It most often affects children alt

2. A 33 year old woman who recently came from India has a nodular patch on both her shins which is reddish brown. The nodules are slightly raised above the surrounding skin. She also has a fever and feels unwell. What is the SINGLE most probable diagnosis?
   • First-Line / Correct Key: Erythema nodosum
   • Clinical Rationale: Erythema nodosum is the most likely diagnosis here. The reason they give a history of
coming from India with fever and feeling of being unwell is to point you towards the
direction of tuberculosis. Erythema nodosum can occur with the primary infection of TB.
THE DIFFERENT ERYTHEMAS
Erythema Multiforme
o Target lesions
o If symptoms are severe and i

3. A 29 year old man has developed a red, raised rash on his trunk after playing football. The rash is becoming increasingly itchy over the past few hours and has now spread to his arms. His past medical history includes asthma which was diagnosed when he was 7 years old. What is the SINGLE most appropriate management?
   • First-Line / Correct Key: Oral chlorpheniramine
   • Clinical Rationale: Correct Answer: Oral chlorpheniramine

This man is suffering from urticaria. Oral antihistamines would be indicated.
Since this is an allergic reaction, the only two reasonable options are A and C in this
question. However, in the context of allergic reactions, IM adrenaline should only be
used in anaphylactic shock whereby the patient would have b

4. A 39 year old man presents with numerous pink umblicated papules on his genitals, thighs, and lower abdomen. They are small measuring 1-3 mm. White material can be expressed when pinching the papules. He is a known HIV positive patient. What is the SINGLE most likely diagnosis?
   • First-Line / Correct Key: Molluscum contagiosum
   • Clinical Rationale: Molluscum contagiosum (pox virus) are white or pink papules with an umblicated
(depressed) central punctum.  They may be found anywhere on the skin.  They resolve
spontaneously but can take around 6 to 24 months.  If squeezed, they produce a
cheesy material.  They usually affect children.  They are also especially seen in patients
with decreased im

5. A 22 year old woman complains of recent onset of severe itching and wheals which followed a viral infection. On inspection, numerous wheals of all sizes are noticed on her skin. The wheals tend to come and go within hours. What is the SINGLE most likely diagnosis?
   • First-Line / Correct Key: Urticaria
   • Clinical Rationale: Majority of urticarial wheals tend to last less than 24 hours.  New lesions would tend to
appear within hours or days.  They are intensely itchy.
Acute urticaria - "Here today and gone tomorrow"
Aspirin is one of the medications that could elicit an episode of urticaria by causing
direct release of histamine from mast cells.  Other medications that

6. A 15 year old girl presents with an itchy and scaly rash over her face and the extensor surfaces of her arms. Her grandmother also suffers from a similar skin disease. Her mom is worried that the rash is contagious. Which of the following is the best advice that you can give her?
   • First-Line / Correct Key: The rash is not contagious
   • Clinical Rationale: Correct Answer: The rash is not contagious

The diagnosis here is psoriasis.  The stem mentions presence on the extensor surfaces
and a familial predisposition.  Therefore the correct answer is to tell her that the rash is
not contagious and reassure her.
Note:  Scabies arises on the flexor surfaces and very rarely on the extensor surfaces.
PSORIAS

7. A 39 year old woman is treated with amoxicillin for a community acquired pneumonia. Four days into her treatment, she develops a flattish rash over the backs of her hands and feet. Since the initial presentation of the rash, the flattish lesions have hence gotten bigger to form slighly raised patches. The patches, which resemble papules, have also started to spread toward her trunk. These lesions have a dusky red blistering centre with a surrounding pale area and the patient reports mild itching. What is the SINGLE most likely diagnosis?
   • First-Line / Correct Key: Erythema multiforme
   • Clinical Rationale: The lesion in this stem describes a target lesion.  This is consistent with erythema
multiforme.  Mycoplasma pneumoniae, which is the likely pathogen that she has been
infected with, is one of the common pathogens known to cause erythema multiforme.

8. A 3 year old male patient presents to the clinic with his mother. His mother complains that he has developed a rash localized at his flexures particularly at the popliteal and antecubital fossae, which manifested this morning. Upon further questioning, it was revealed that the patient had been ill because of an upper respiratory tract infection two days ago. He was diagnosed with eczema a year ago and has been using emollients. He was delivered via uncomplicated vaginal delivery and appears to be healthy and well nourished. He has no other medical history of note and is taking no other chronic medications. What is the SINGLE most appropriate management for this patient?
   • First-Line / Correct Key: Topical corticosteroids
   • Clinical Rationale: Atopic eczema usually begins between ages 3 and 12 months and usually starts on the
scalpe and face.  As they get older, it may localize in the flexures.
If flare-ups of atopic eczema occur, then corticosteroids are effective in controlling and
supressing symptoms in most cases.  Topical corticosteroids for atopic eczema should
be prescribed for ap

9. A 4 year old male patient presents to the GP surgery with the complaint of a rash. His mother, who accompanies him, complains of a rash that occurs on her son's creases of his elbows, behind his knees and his hands. This rash has been worsening over the past few weeks. She reports that her son tries to scratch the aforementioned areas and that the itching causes him distress. He has no other medical conditions and is not on any medication. His mother reports the pregnancy and birth to have had no complications. On examination, there is dryiness of the skin and redness at the flexures of the elbows and knees. What is the SINGLE most appropriate treatment for this patient's condition?
   • First-Line / Correct Key: Topical emollients
   • Clinical Rationale: Correct Answer: Topical emollients

This child has atopic dermatitis or eczema.  Children often have skin flexures involved.
Emollients form the basis of eczema management and should be used as first line.  It
should be used at least twice a day and after a bath even when eczema is under
control.
Topicl steroids is used as second line.  They are es

10. A 44 year old man complains of a solitary, shiny, red nodule which has been growing on his nose for several months. It is firm with a central depression. It is 0.6 cm in size. What is the SINGLE most likely diagnosis?
   • First-Line / Correct Key: Basal cell carcinoma
   • Clinical Rationale: The clues for basal cell carcinoma in the exam are descriptions of a pearly white
umbilicated ulcer with central depression anywhere in the face with rolled edges or
inverted edge. These are hints pointing towards the diagnosis of basal cell carcinoma.
Ulcers presenting above the neck in the PLAB exam are almost inevitably basal cell
carcinoma.
BAS

11. A 67 year old builder has a persistent nodular lesion on upper part of his right pinna. On examination, there is a central depression and raised areas with telangiectasia around the lesion. It is 0.5 cm in size. What is the SINGLE most likely diagnosis?
   • First-Line / Correct Key: Basal cell carcinoma
   • Clinical Rationale: Correct Answer: Basal cell carcinoma

Please see Q-10

12. A 38 year old man presents with an acute infection of the skin on the leg. A diagnosis of cellulitis has been made. He has no known allergies. What is the SINGLE best choice of antibiotic to be prescribed?
   • First-Line / Correct Key: Flucloxacillin
   • Clinical Rationale: Cellulitis is an infection of the dermis and subcutaneous tissue.The most common
causative organisms are Streptococcus or Staphylococcus spp. but they can be caused
by a wide range of both aerobic and anaerobic bacteria.
Flucloxacillin in adults is usually given as first-line in uncomplicated infection. In
sufficient doses, this covers both beta-ha

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1. Clinical Accuracy

Correct medical facts, physiological mechanisms, and clinical judgment.

2. Guideline Alignment

Adheres to contemporary clinical guidelines (WHO, AHA, ESC, NICE).

3. Tanzania STG Compliance

Considers Tanzanian MoH Standard Treatment Guidelines & NEMLIT.

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Sudden Cardiac Arrest in Ward 4

ACLS Immediate Initial Action:

Defibrillation Decision:

Next Priority Action:

Patient Resuscitated!

Arrest Protocol Timed Out

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