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Question 1
Incorrect
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Which of the following nerves is responsible for the symptoms of a patient with history of recurrent herpes simplex outbreaks on his face and presents with ophthalmic herpes zoster and a painful vesicle on the tip of his nose?
Your Answer: Nasopalatine nerve
Correct Answer: Nasociliary nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve.
The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 2
Correct
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Which of these organisms is commonly spread by droplet transmission?
Your Answer: Neisseria meningitidis
Explanation:Droplets are airborne particles greater than 5 µm in size. Droplet transmission occurs during talking, coughing and sneezing where respiratory droplets are generated.
Examples of organisms transmitted by the droplet route include:
Neisseria meningitidis
Respiratory syncytial virus
Parainfluenza virus
Bordetella pertussis
Influenza virusPoliovirus and Rotavirus are transmitted by the faeco-oral route
Hepatitis B is transmitted by Sexual route
Staphylococcus aureus is transmitted by direct contact
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 3
Correct
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A 7-days-old neonate is taken to the emergency department. She's pyretic, lethargic, and unresponsive, and her fontanelle has bulged. Antibiotics are started, and a lumbar puncture reveals Gram-negative rods. Which pathogen is most likely to be the cause:
Your Answer: Escherichia coli
Explanation:Among neonates, group B streptococci (GBS) are the most commonly identified causes of bacterial meningitis, implicated in roughly 50% of all cases. Escherichia coli(Gram-negative rods) accounts for another 20%. Thus, the identification and treatment of maternal genitourinary infections is an important prevention strategy.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 4
Correct
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A 6-year-old female is brought to the Ophthalmology Clinic by her mother with the complaint of itching, redness, and a watery discharge of the right eye. Past medical history revealed an upper respiratory tract infection one week ago.
On examination of the right eye, there is mild erythema of the palpebral conjunctiva and visible follicles seen on eversion of the eyelid, lid oedema, and subconjunctival petechial haemorrhages. The discharge is watery and not purulent.
You diagnose her with viral conjunctivitis. According to the current NICE guidelines, which ONE of the following management options would NOT be included for this patient?Your Answer: The child should be excluded from school until the infection has resolved
Explanation:The NICE guidelines do NOT recommend isolating a patient with viral conjunctivitis from others or skipping school or work. The disease is contagious, but the spread of the disease can be controlled by maintaining good hygiene practices such as:
1. frequent hand washing
2. use of separate flannels and towels
3. Avoid close contact with othersAntibiotic prescriptions are not part of the NICE guidelines for viral conjunctivitis as they will not affect the course of the disease. Most cases of viral conjunctivitis are self-limiting and resolve within one to two weeks.
The NICE guidelines recommend that symptoms may be eased with self-care measures such as:
1. Bathing/cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge
2. Cool compresses applied gently around the eye area
3. Use of lubricating drops or artificial tears -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 5
Correct
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A 35-year-old man, who was feeling unwell after his return from a business trip, was diagnosed with a disease that is known to be transmitted by a vector.
Among the following microorganisms, which of the following has a mode of transmission of being vector-borne?Your Answer: Plasmodium falciparum
Explanation:Plasmodium falciparum is a parasite that is vector-borne which is transmitted by the female Anopheles mosquito.
Bordetella pertussis is transmitted through the respiratory tract, via respiratory droplets or direct contact with infectious secretions.
Mycobacterium tuberculosis is transmitted via inhalation of infected respiratory droplets.
HIV may be transmitted via sexual contact, vertical transmission from mothers to infants, and among injection drug users sharing infected needles, as well as through transfusion of infected blood products.
Treponema pallidum transmission normally occurs during direct sexual contact with an individual who has an active primary or secondary syphilitic lesion.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 6
Incorrect
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A 35-year-old man presents with haemoptysis, night sweats, and weight loss. Further examinations were done and a diagnosis of tuberculosis is suspected.
Which of the following statements is considered correct regarding Mycobacterium tuberculosis?Your Answer: It Gram stains red
Correct Answer: It is impervious to decolourisation with acid
Explanation:Mycobacterium tuberculosis are part of the Mycobacteriaceae family. They are described to have the characteristics of a Gram-positive cell wall but they are not easily stained with Gram stain. This is because their cell wall contains a high lipid content, and this lipid allows the Mycobacteria to bind to alkaline stains with the application and help of heat. Once stained, they are able to resist decolorization even with the use of acid alcohol as the decolourizer, making them very difficult to decolorize, that is why they are known to be acid-fast.
The Ghon complex is a non-pathognomonic radiographic finding on a chest x-ray that is significant for pulmonary infection of tuberculosis. The location of the Ghon’s focus is usually subpleural and predominantly in the upper part of the lower lobe and lower part of the middle or upper lobe.
Skeletal tuberculosis of the spine is referred to as Pott disease.
The risk of reactivation TB is about 3.3% during the first year after a positive PPD skin test and a total of 5% to 15% thereafter in the person’s lifetime. Progression from infection to active disease varies with age and the intensity and duration of exposure. Reactivation TB occurs when there is an alteration or suppression of the cellular immune system in the infected host that favours
replication of the bacilli and progression to disease. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Incorrect
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A 73-year-old woman arrives at the emergency department 48 hours after being discharged from the hospital after a two-week stay for sepsis treatment. She has fever, productive cough with thick green sputum, and shortness of breath. An X-ray shows left lower lobe pneumonia. Which of the bacteria listed below is more likely to be the causative agent:
Your Answer: Streptococcus pneumoniae
Correct Answer: Pseudomonas aeruginosa
Explanation:Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization. Pneumonia that presents sooner should be regarded as community acquired pneumonia. VAP refers to nosocomial pneumonia that develops among patients on ventilators. Ventilator-associated pneumonia (VAP) is defined as pneumonia that presents more than 48 hours after endotracheal intubation.
Common bacteria involved in hospital-acquired pneumonia (HAP) include the following [10] :
Pseudomonas Aeruginosa
Staphylococcus aureus, including methicillin-susceptible S aureus (MSSA) and methicillin-resistant S aureus (MRSA)
Klebsiella pneumoniae
Escherichia coli -
This question is part of the following fields:
- Infections
- Microbiology
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Question 8
Incorrect
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You review a 37-year-old man with a history of intravenous drug abuse who admits to sharing needles in the past. He has a flu-like illness and a rash. Concerned he may be experiencing an HIV seroconversion illness, you order a test.
Which of these tests is most reliably used to diagnose HIV at this stage?
Your Answer: ELISA antibody test
Correct Answer: p24 antigen test
Explanation:Serum concentrations of the p24 antigen are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection. P24 is the viral protein that makes up most of the core of the HIV.
ELISA and other antibody tests, though a very sensitive way of detecting the presence of HIV, cannot be used in the early stages of the disease. This is because of the window period of 6-12 weeks before antibodies are produced. These tests will be negative during a seroconversion illness.
The ‘rapid HIV test’ is an HIV antibody test. It will also be negative during the ‘window period’ since it takes time for antibodies to be produced. It is called the ‘rapid test’ as it can detect antibodies in blood or saliva much quicker than the other antibody tests and results are often back within 20 minutes.
CD4 and CD8 counts are usually normal in the early stages of the HIV infection and cannot be used in this case.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 9
Incorrect
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Which of the following microbes adheres to the genital mucosa using fimbriae:
Your Answer: Chlamydia trachomatis
Correct Answer: Neisseria gonorrhoeae
Explanation:Infection of the genital mucosa by Neisseria gonorrhoeae involves attachment to and invasion of epithelial cells. Initial adherence of gonococci to columnar epithelial cells is mediated by type IV pili assembled from pilin subunit PilE proteins and pilus tip-associated PilC proteins, it then invades the epithelial layer, triggering a local acute inflammatory response.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 10
Correct
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Which of the following statements is considered correct regarding Klebsiella infections?
Your Answer: Klebsiella spp. are non-motile
Explanation:Klebsiella is a Gram-negative, rod-shaped, non-motile bacteria. The absence of motility distinguishes Klebsiella spp. from most other members of the family Enterobacteriaceae.
K. pneumoniae is the most commonly isolated species and has the distinct feature of possessing a large polysaccharide capsule. The capsule offers the organism protection against phagocytosis and antimicrobial absorption,
contributing to its virulence.Colonization of gram-negative bacilli in the respiratory tracts of hospitalized patients, particularly by K. pneumoniae, increases with the length of hospital stay. It is a frequent cause of lower respiratory tract infections among hospitalized patients and in immunocompromised hosts such as newborns,
elderly patients, and seriously ill patients on respirators. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 11
Incorrect
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Which of the following antibiotics is the first line of treatment for a patient who has been diagnosed with chlamydia infection?
Your Answer: Ceftriaxone
Correct Answer: Azithromycin
Explanation:The Centres for Disease Control and Prevention (CDC) recommends azithromycin, a single 1 g dose, and doxycycline, 100 mg bd for 7 days, as first-line medications for chlamydial infection treatment.
Second-line medications (such as erythromycin, penicillins, and sulfamethoxazole) are less effective and have more side effects
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 12
Incorrect
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A 18-year-old man returns from a trip to Ibiza with a severely painful left eye. He has copious mucopurulent discharge, is febrile and has left-sided tender preauricular lymphadenopathy. He attends the local eye casualty and is diagnosed with hyperacute conjunctivitis.
What is the SINGLE most likely causatiave organism?Your Answer: Chlamydia trachomatis
Correct Answer: Neisseria gonorrhoeae
Explanation:Hyperacute bacterial conjunctivitis is a severe, sight-threatening ocular infection that warrants immediate ophthalmic work-up and management. The infection has an abrupt onset and is characterized by a copious yellow-green purulent discharge that reaccumulates after being wiped away. Typically caused by infection with Neisseria gonorrhoeae.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 13
Correct
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A 24-year-old patient is suspected to have a possible acute hepatitis B infection and is currently under investigation.
Which of the following markers is considered the earliest indicator of acute infection in acute Hepatitis B?Your Answer: Hepatitis B surface Ag
Explanation:HBsAg is the serological hallmark of HBV infection. After an acute exposure to HBV, HBsAg appears in serum within 1 to 10 weeks. Persistence of this marker for more than 6 months implies chronic HBV infection.
Anti-HBs is known as a neutralizing antibody, and confers long-term immunity. In patients with acquired immunity through vaccination, anti-HBs is the only serological marker detected in serum.
HBcAg is an intracellular presence in infected hepatocyte, thus it is not identified in the serum. During acute infection, anti-HBc IgM and IgG emerges 1–2 weeks after the presence of HBsAg along with raised serum aminotransferase and symptoms. After 6 months of acute infection, anti-HBc IgM wears off. Anti-HBc IgG continues to detect in both patients with resolved HBV infection and chronic hepatitis B.
Hepatitis D virus, also known as the delta hepatitis virus, is a defective ssRNA virus that requires HBV for replication. The infection can occur in one of two clinical forms, co-infection or superinfection. In a co-infection, the patient is simultaneously infected with HBV and HDV. In a superinfection, an HDV infection develops in a patient with a chronic HBV infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 14
Correct
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A blood test of a 7-year-old child with a 6-day history of bloody diarrhoea reveals a low platelet count, anaemia, and impaired kidney function. What bacteria is suspected of causing such a condition?
Your Answer: Escherichia coli
Explanation:Escherichia coli produces shiga toxin that causes diarrhoea, hemorrhagic colitis, and haemolytic uremic syndrome.
Haemolytic uremic syndrome is characterized by anaemia, thrombocytopenia, and acute renal failure. Transmission of E. coli is possible after consuming contaminated, undercooked drinks and foods. E. coli enters the body via the faecal-oral pathway.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 15
Incorrect
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The monospot test for infectious mononucleosis uses which of the following types of red blood cell?
Your Answer: Pig red blood cells
Correct Answer: Horse red blood cells
Explanation:Infectious mononucleosis can be diagnosed using specific EBV antibodies and a variety if unrelated non-EBV heterophile antibodies. These antibodies can be detected by two main screening tests:
The monospot test uses horse red blood cells. It agglutinates in the presence of heterophile antibodies.
Sheep red blood cells is used in Paul-Bunnell test. The blood agglutinates in the presence of heterophile antibodies.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 16
Correct
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Question 17
Correct
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A 21-year-old student presents with fever, headache, malaise, fatigue, and muscle aches after returning from a trip to India. A diagnosis of malaria was suspected.
Which of the following statements is considered correct regarding malaria?Your Answer: Haemoglobinuria and renal failure following treatment is suggestive of Plasmodium falciparum
Explanation:Malaria results from infection with single-celled parasites belonging to the Plasmodium genus. Five species of Plasmodium are known to cause disease in humans: P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi.
Chloroquine remains the mainstay of treatment for uncomplicated vivax malaria.
The female Anopheles mosquito serves as the biologic vector and definitive host.
A complication of infection with P. falciparum is blackwater fever, a condition characterized by haemoglobinuria.
Plasmodium ovale has the longest incubation period, which can be up to 40 days. Plasmodium falciparum has a shorter incubation period of 7-14 days.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 18
Correct
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A 29-year-old woman presents with night sweats, fever, and haemoptysis. A diagnosis of tuberculosis was suspected.
Which of the following statements regarding the diagnosis of tuberculosis is considered correct?Your Answer: Mycobacteria tuberculosis can be typed using a RFLP method
Explanation:Although a variety of clinical specimens may be submitted to the
laboratory to recover MTB and NTM, respiratory secretions such
as sputum and bronchial aspirates are the most common. An
early-morning specimen should be collected on three consecutive
days, although recent studies have suggested that the addition of
a third specimen does not significantly increase the sensitivity
of detecting Mycobacteria.Mycobacterium tuberculosis appear red on acid-fast staining because they take up the primary stain, which is carbolfuchsin, and is not decolorized by the acid alcohol anymore.
Culture on Lowenstein-Jensen medium should be read within 5 to 7 days after inoculation and once a week thereafter for up to 8 weeks.
Nucleic acid amplification assays designed to detect M. tuberculosis complex
bacilli directly from patient specimens can be performed in as little as 6 to 8 hours on processed specimens. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 19
Correct
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Herpes simplex encephalitis has a predilection for which of the following sites:
Your Answer: Temporal lobe
Explanation:Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 20
Incorrect
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A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.
Which of these statements concerning indications and contraindications for vaccination is TRUE?
Your Answer: Premature infants should not be vaccinated according to the usual immunisation schedule
Correct Answer: Inactivated vaccines are safe in pregnancy
Explanation:All vaccines are contraindicated in individuals with: A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.
A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycinThere is no evidence that vaccinating pregnant women with inactivated vaccine or toxoids harms the woman or foetus.
The current protocol is that a child with history of egg allergy can be safely vaccinated with Fluenz tetra. However, if they had a previous severe anaphylaxis to egg requiring intensive care, then Flenz tetra is contraindicated.
BCG, yellow fever or oral typhoid vaccinations are not safe in HIV positive patients.
The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should not be implemented.
Concurrent antibiotic therapy is not a contraindication to vaccination.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 21
Correct
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Regarding gas gangrene, which of the following statements is CORRECT:
Your Answer: Infection is characterised by rapidly spreading tissue myonecrosis with crepitus.
Explanation:Gas gangrene usually occurs within 3 days of injury, and is characterised by pain, rapidly spreading oedema, myositis, necrosis, palpable crepitus and systemic toxicity. Diagnosis is clinical and laboratory confirmation should not delay urgent surgical intervention. Hyperbaric oxygen therapy can be considered in addition to surgery and antibiotic therapy, to stop toxin production and inhibit bacteria from replicating and spreading (as Clostridium spp. are obligate anaerobes).
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 22
Correct
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You received a patient with a 2-day history of diarrhoea and vomiting. Later, after examination, the patient was found to have progressive symmetric descending flaccid paralysis, initial development of blurred vision, dysphagia, and weakness of the upper limbs. The patient is apyrexial and his observations are all normal. Which of the following pathogens is responsible for the said symptoms?
Your Answer: Clostridium botulinum
Explanation:A botulism infection results in neuroparalysis caused by the neurotoxin generated by Clostridium botulinum.
Food-borne botulism symptoms often appear 12-36 hours after ingestion of the toxin-containing food and may include nausea, vomiting, stomach discomfort, and diarrhoea at first. The most common neurological pattern is an acute onset of bilateral cranial neuropathies with symmetric declining weakening.
Other distinguishing characteristics include the absence of fever, the absence of cognitive abnormalities, the presence of a normal heart rate and blood pressure, and the absence of sensory defects.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 23
Correct
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You are treating a patient with a Clostridium difficile infection. His condition was found to be antibiotic-associated. Which of the following pieces of advice on preventing the spread of this disease should you give this patient?
Your Answer: Washing hands with soap and water
Explanation:Clostridium difficile (C. diff) can cause colitis, or inflammation of the colon.
To prevent its spread, one should practice good hand hygiene, regularly clean areas of the home that may become contaminated with C. difficile, practice good hand hygiene, and clean surfaces, spills, and accidents.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 24
Correct
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A patient with a wound infection on his right leg has reddening and oedema of the surrounding muscles. His condition has worsened considerably over the past few hours with the area now appearing blackened. There is also palpable crepitus under the skin. You suspect gas gangrene.
Which statement about Clostridium perfringens is true?Your Answer: Gas gangrene is caused by the release of an alpha-toxin
Explanation:Clostridium perfringens, a Gram-positive, anaerobic, spore forming rod-shaped, pathogenic bacterium is the most commonly associated with gas gangrene (85-90% of cases), although other species can also be implicated.
Clostridium perfringens is capsulate and produces a range of toxins. Alpha-toxin is the most important and is the cause of gas gangrene.
Gas gangrene develops when a devitalized wound becomes infected with Clostridium perfringens spores from the environment. The spores germinate and multiplies in the ischaemic conditions, releasing toxins, which further damage tissues.
Usually, the clinical features of gas gangrene appear within 24 hours of injury.
Clostridium perfringens spores are not destroyed by cooking. During slow cooling and unrefrigerated storage, they germinate to form vegetative cells.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 25
Correct
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Cryptococcus neoformans is primarily implicated in which of the following conditions:
Your Answer: Chronic lymphocytic meningitis
Explanation:Cryptococcus neoformans typically causes a chronic lymphocytic meningitis in immunosuppressed patients or those with intense exposure e.g. pigeon fanciers.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 26
Correct
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Question 27
Correct
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A 22 year old student has recently returned from travelling around Kenya and presents to ED with a headache and persistent fever. Malaria is being considered as a potential diagnosis. Which of the following strains of malaria is most likely:
Your Answer: Plasmodium falciparum
Explanation:Malaria is an infectious disease transmitted by female of theAnophelesgenus of mosquito. It is a parasitic infection caused by the genusPlasmodium. Five species are recognized as causing disease in humans;Plasmodium falciparum,Plasmodium ovale,Plasmodium vivax,Plasmodium malariaeandPlasmodium knowlesi.
The classic symptom of malaria is the malarial paroxysm, a cyclical occurrence of a cold phase, where the patient experiences intense chills, a hot stage, where the patient feels extremely hot and finally a sweating stage, where the fever declines and the patient sweats profusely. On examination the patient may show signs of anaemia, jaundice and have hepatosplenomegaly without evidence of lymphadenopathy.Plasmodium falciparum is the most serious form and is responsible for most deaths. Severe or complicated malaria is suggested by the presence of impaired consciousness, seizures, hypoglycaemia, anaemia, renal impairment, respiratory distress and spontaneous bleeding.
Plasmodium falciparum is the most likely type in this case in view of the presentation.
Haemoglobinuria and renal failure following treatment is suggestive of blackwater fever, which is caused byPlasmodium falciparum. An autoimmune reaction between the parasite and quinine causes haemolysis, haemoglobinuria, jaundice and renal failure. This can be fatal.
The benign malarias: P.vivax, P. malariae and P.ovale are usually treated with chloroquine. A course of primaquine is also required in P.vivax and P.ovale infection. Artesunate is the drug treatment of choice for Plasmodium falciparum malaria. Quinine can still be used where artesunate is not available. Often combination therapy with drugs such as doxycycline or fansidar is also required. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 28
Correct
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A 5 day old, full term neonate is with a unilateral purulent eye discharge noticed earlier that day is brought in. On gram stain of the exudate, no bacteria are seen.
What is the most likely causative pathogen?
Your Answer: Chlamydia trachomatis
Explanation:Conjunctivitis occurring in the first 28 days of life (Ophthalmia neonatorum) is most commonly caused by Chlamydia trachomatis in the UK.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 29
Incorrect
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Regarding the varicella zoster virus, which of the following statements is CORRECT:
Your Answer: The varicella zoster vaccine is part of routine childhood immunisation.
Correct Answer: Contracting chickenpox infection while pregnant is associated with a higher risk of developing varicella pneumonitis.
Explanation:Chickenpox infection in neonates, adults/adolescents and pregnant women is associated with more severe disease. Varicella zoster pneumonitis typically occurs in pregnant women or immunocompromised individuals and is associated with a high mortality. A live attenuated-virus vaccine is available and recommended for non-immune healthcare workers but is not part of the routine childhood immunisation schedule. Antiviral treatment is not typically recommended in childhood chickenpox but is indicated for shingles.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 30
Incorrect
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Which statement concerning aerosol transmission is true?
Your Answer:
Correct Answer: They can be spread via ventilation systems in hospitals
Explanation:Aerosols are airborne particles less than 5 µm in size containing infective organisms.
They usually cause infection of both the upper and/or lower respiratory tract.
The organisms can remain suspended in the air for long periods and also survive outside the body.
They can be transmitted through the ventilation systems and can spread over great distances.
Some examples of organisms transmitted by the aerosol route include: Varicella zoster virus, Mycobacterium tuberculosis and measles virus
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
