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Question 1
Correct
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What is the mechanism of action of penicillin antibiotics:
Your Answer: Inhibition of bacterial cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 2
Incorrect
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A 64-year-old man presents with an acute episode of gout. He has a history of chronic heart failure and hypertension. His current medications include ramipril and furosemide.
Which of the following statements regarding the treatment of gout is true? Select ONE answer only.Your Answer: NSAIDs are the treatment of choice for patients with a history of heart failure
Correct Answer: Colchicine has a role in prophylactic treatment
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 3
Correct
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Which of the following is NOT a common side effect of adenosine:
Your Answer: Yellow vision
Explanation:Common side effects of adenosine include:
Apprehension
Dizziness, flushing, headache, nausea, dyspnoea
Angina (discontinue)
AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 4
Incorrect
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A patient presents to your clinic with fever of unknown origin. His blood results shows a markedly elevated C-Reactive Protein (CRP) level.
Which of these is responsible for mediating the release of CRP?
Your Answer: IL-9
Correct Answer: IL-6
Explanation:C-reactive protein (CRP) is an acute phase protein produced by the liver hepatocytes. Its production is regulated by cytokines, particularly interleukin 6 (IL-6) and it can be measured in the serum as a nonspecific marker of inflammation.
Although a high CRP suggest an acute infection or inflammation, it does not identify the cause or location of infection.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 5
Incorrect
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A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration is 1246 pg/mL.
Glucagon INHIBITS which of the following processes? Select ONE answer only.Your Answer: Gluconeogenesis
Correct Answer: Glycolysis
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 6
Incorrect
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A 26-year-old female cuts her hand on a knife while preparing dinner but the bleeding stops within a few minutes.
Which one of the following cells will be among the first to be present at the wound site to be involved in haemostasis?Your Answer: Neutrophils
Correct Answer: Platelets
Explanation:Platelets are the first cells to be attracted to the wound site due to the release of the Von Willebrand factor from the damaged endothelium. Platelets, in turn, release cytokines such as platelet-derived growth factor, which will attract other inflammatory cells to the wound site.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 7
Incorrect
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A patient is complaining of painless jaundice. His bilirubin levels are abnormally high.
Which of the following statements about bile is correct?Your Answer: Approximately 50-100 ml of bile is produced per day
Correct Answer: Bile acids are amphipathic
Explanation:The liver produces bile on a constant basis, which is then stored and concentrated in the gallbladder. In a 24-hour period, around 400 to 800 mL of bile is generated.
Bile is involved in the following processes:
Fats are broken down into fatty acids.
Waste products are eliminated.
Cholesterol homeostasis is the balance of cholesterol in the body.The enteric hormones cholecystokinin and secretin are primarily responsible for bile secretion. When chyme from an unprocessed meal enters the small intestine, they are released, and they play the following function in bile secretion and flow:
Cholecystokinin promotes gallbladder and common bile duct contractions, allowing bile to reach the intestine.
Secretin enhances the secretion of bicarbonate and water by biliary duct cells, increasing the amount of bile and its flow into the gut.Bile acids have a hydrophobic and hydrophilic area, making them amphipathic. Bile acids’ amphipathic nature allows them to perform the following crucial functions:
Emulsification of lipid aggregates increases the surface area of fat and makes it easier for lipases to digest it.
Lipid solubilization and transport: solubilizes lipids by creating micelles, which are lipid clumps that float in water. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 8
Incorrect
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A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus minimus muscle.
Which of the following nerves innervates the gluteus minimus muscle?Your Answer: Inferior gluteal nerve
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is the smallest muscle of the glutei. It is located just beneath the gluteus medius muscle. Gluteus minimus predominantly acts as a hip stabilizer and abductor of the hip.
The superior gluteal nerve innervates the gluteus minimus. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 9
Correct
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A patient presents with a fever, headache and neck stiffness. A CSF sample of someone with meningococcal meningitis typically shows:
Your Answer: All of the above
Explanation:CSF analysis typically shows:
cloudy turbid appearance
raised WCC – predominantly neutrophils
high protein
low glucose (typically < 40% of serum glucose)
Gram-negative diplococci seen under microscopy -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 10
Incorrect
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Regarding the management of gout, which of the following statements is CORRECT:
Your Answer: Colchicine is used as a long term therapy for prevention of gout.
Correct Answer: Allopurinol may cause an acute attack of gout when first started.
Explanation:Allopurinol is a treatment for the prevention of gout. The initiation of treatment may precipitate an acute attack, and should be covered with an NSAID or colchicine, continued for at least one month after the hyperuricaemia has been corrected. Colchicine is not indicated for long term prevention of gout. NSAIDs are first line for acute gout; colchicine is an alternative in whom NSAIDs are contraindicated, not tolerated or ineffective (including in people taking anticoagulants). Ibuprofen is not recommended for acute gout, given it has only weak anti-inflammatory properties; naproxen, diclofenac or indometacin are indicated instead.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 11
Incorrect
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One of the benefits of wound healing through first intention is:
Your Answer:
Correct Answer: Minimisation of scar tissue formation
Explanation:Primary wound healing, or healing by first intention, occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents. Healing by first intention can occur when the wound edges are opposed, the wound is clean and uninfected and there is minimal loss of cells and tissue i.e. surgical incision wound. The wound margins are joined by fibrin deposition, which is subsequently replaced by collagen and covered by epidermal growth.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 12
Incorrect
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Which of these drugs may reduce the efficacy of contraception?
Your Answer:
Correct Answer: Carbamazepine
Explanation:Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 13
Incorrect
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You have been called to review a patient and his management in the resuscitation room. A very sick patient has been started on mannitol in his treatment protocol.
Out of the following, what is NOT an FDA-recognized indication for the use of mannitol?
Your Answer:
Correct Answer: Congestive cardiac failure
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
Mannitol has four FDA approved uses clinically:
1. Reduction of intracranial pressure and brain mass
2. reduce intraocular pressure if this is not achievable by other means
3. promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage
4. promote diuresis to promote the excretion of toxic substances, materials, and metabolitesIt can be used in rhabdomyolysis-induced renal failure, especially in crush injuries. Mannitol reduces osmotic swelling and oedema in the injured muscle cells and helps restore skeletal muscle function.
It is a low molecular weight compound and can be freely filtered at the glomerulus and not reabsorbed. This way increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
1. Anuria due to renal disease
2. Acute intracranial bleeding (except during craniotomy)
3. Severe cardiac failure
4. Severe dehydration
5. Severe pulmonary oedema or congestion
6. Known hypersensitivity to mannitol -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 14
Incorrect
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Which of these statements about experimental studies is true?
Your Answer:
Correct Answer: Randomisation serves to remove potential bias
Explanation:In experimental studies, the researcher introduces an intervention and studies the effect. The study subjects are allocated into different groups by the investigator through the use of randomisation. Randomisation serves to remove any potential bias.
A cohort study is a form of longitudinal, observational study that follows a group of patients (the cohort) over a period of time to monitor the effects of exposure to a proposed aetiological factor upon them.
A case-control study is a type observational study. Here, patients who have developed a disease are identified and compared on the basis of proposed causative factors that occurred in the past, to a control group.
Clinical trials are experimental studies. Examples include: double blind, single blind, and unblinded studies(both patient and researcher are aware of the treatment they receive)
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This question is part of the following fields:
- Evidence Based Medicine
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Question 15
Incorrect
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Which of the following is NOT a common side effect of antihistamines:
Your Answer:
Correct Answer: Tremor
Explanation:Common side effects of antihistamines may include:
Anticholinergic effects (blurred vision, dry mouth, urinary retention)
Headache
Gastrointestinal disturbances
Psychomotor impairment (sedation, dizziness and loss of appetite)
These side effects are significantly reduced with second-generation agents. -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 16
Incorrect
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All these structures make up the portal triad EXCEPT?
Your Answer:
Correct Answer: Branches of the hepatic vein
Explanation:The portal triad, is made up of a portal arteriole (a branch of the hepatic artery), a portal venule (a branch of the hepatic portal vein) and a bile duct. Also contained within the portal triad are lymphatic vessels and vagal parasympathetic nerve fibres.
Branches of the hepatic vein is not part of the portal triad
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 17
Incorrect
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Which of the following is NOT an adverse effect associated with statin therapy:
Your Answer:
Correct Answer: Aplastic anaemia
Explanation:Adverse effects of statins include:, Headache, Epistaxis, Gastrointestinal disorders (such as constipation, flatulence, dyspepsia, nausea, and diarrhoea), Musculoskeletal and connective tissue disorders (such as myalgia, arthralgia, pain in the extremity, muscle spasms, joint swelling, and back pain), Hyperglycaemia and diabetes, Myopathy and rhabdomyolysis, Interstitial lung disease and Hepatotoxicity
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 18
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:
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 19
Incorrect
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You see a 30-year-old man who has come to the department with a very tender right elbow. On examination, the elbow is very hot and red, and appears to be acutely inflamed.
Which SINGLE statement regarding acute inflammation is FALSE?Your Answer:
Correct Answer: Reduced extravascular osmotic pressure leads to oedema
Explanation:Inflammation can be divided intoacute inflammation, which occurs over seconds, minutes, hours, and days, andchronic inflammation, which occurs over longer periods.
Acute inflammationcommences within seconds or minutes following the injury of tissues. There are numerous potential stimuli for an acute inflammatory response including infections (bacterial, viral, fungal, parasitic), tissue necrosis, foreign bodies, and Immune reactions (hypersensitivity reactions). The chief cell type of acute inflammation is the neutrophil.
There are three main processesthat occur in the acute inflammatory response:
Increased blood flow
Increased capillary permeability
Neutrophil migration
1. Increased blood flow:
Vasoactive mediators are released, such as nitric oxide, histamine, bradykinins, and prostaglandin E2. These mediators cause vasodilatation and increased blood flow to the area (causing redness and heat).
2. Increased capillary permeability:
The vasoactive mediators also cause increased capillary permeability by causing endothelial cell contraction that widens the intercellular gaps of venules. This allows an outpouring of protein-rich fluid (exudate) into the extracellular tissues that results in a reduction of intravascular osmotic pressure and an increase in extravascular/interstitial pressure. The increased interstitial osmotic pressure leads to oedema.
3. Neutrophil migration:
Neutrophils leave the vasculature through the following sequence of events:
Margination and rolling: neutrophils flow nearer the vessel wall, rather than in the axial stream, which is referred to as margination. Following margination the neutrophils begin rolling along the surface of the vascular endothelium.
Activation and adhesion: then as a result of interaction with endothelial cell adhesion molecules (CAMs) that is mediated by selectins, the neutrophils are activated and adhere to the endothelium.
Transmigration: once bound to the endothelium, neutrophils squeeze through gaps between adjacent endothelial cells into the interstitial fluid, in a process calleddiapedesis. -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 20
Incorrect
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What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your Answer:
Correct Answer: 10 ml of 1 in 10,000 adrenaline solution
Explanation:Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.
IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.
For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 21
Incorrect
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You are giving a presentation on the immune system as part of your peer-to-peer teaching sessions. Yu are currently discussing phagocytes. Macrophages are derived from which of the following cells:
Your Answer:
Correct Answer: Monocytes
Explanation:Monocytes spend only a short time in the marrow and, after circulating for 20-40 hours, leave the blood to enter the tissues where they become macrophages. Macrophages form the reticuloendothelial system in the liver, spleen and lymph nodes. The lifespan of macrophages may be as long as several months or even years. In tissues the macrophages become self-replicating without replenishment from the blood. They assume specific functions in different tissues e.g. dendritic cells which are involved in antigen presentation to T-cells. Macrophages may be activated by cytokines such as IFN-gamma, contact with complement or direct contact with the target cell through leucocyte adhesion molecules.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 22
Incorrect
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A 68-year-old man with BPH presents to the emergency department in significant pain secondary to urinary retention. What is the location of the neuronal cell bodies that are responsible for urinary bladder discomfort sensation?
Your Answer:
Correct Answer: Dorsal root ganglia of spinal cord levels S2, S3 and S4
Explanation:The activation of stretch receptors with visceral afferents relayed through the pelvic nerve plexus and into the pelvic splanchnic nerves causes bladder pain. The sensory fibres of spinal nerves S2 – S4 enter the dorsal root ganglia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Incorrect
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Angiotensin II acts to cause all but which one of the following effects:
Your Answer:
Correct Answer: Inhibit release of ADH from the posterior pituitary gland
Explanation:Angiotensin II acts to:
Stimulate release of aldosterone from the zona glomerulosa of the adrenal cortex (which in turn acts to increase sodium reabsorption)
Cause systemic vasoconstriction
Cause vasoconstriction of the renal arterioles (predominant efferent effect thus intraglomerular pressure is stable or increased, thereby tending to maintain or even raise the GFR)
Directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters)
Stimulate synthesis and release of ADH from the hypothalamus and posterior pituitary respectively
Stimulate the sensation of thirst
Potentiate sympathetic activity (positive feedback)
Inhibit renin production by granular cells (negative feedback) -
This question is part of the following fields:
- Physiology
- Renal
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Question 24
Incorrect
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A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that she has a full, plethoric aspect to her face, as well as significant supraclavicular fat pads, when you examine her. She has previously been diagnosed with Cushing's syndrome.
Which of the following biochemical profiles best supports this diagnosis?Your Answer:
Correct Answer: Hypokalaemic metabolic alkalosis
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.
A typical biochemical profile can help establish a diagnosis of Cushing’s syndrome. The following are the primary characteristics:
Hypokalaemia
Alkalosis metabolique -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 25
Incorrect
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A lung function test is being performed on a male patient. For this patient, which of the following volumes for functional residual capacity is considered a normal result?
Your Answer:
Correct Answer: 2.0 L
Explanation:The volume of air that remains in the lungs after a single breath is known as functional residual capacity (FRC). It is calculated by combining the expiratory reserve volume and residual volume. In a 70 kg, average-sized male, a normal functional residual capacity is approximately 2100 mL.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 26
Incorrect
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Detection of urinary Bence-Jones protein would be most suggestive of which of the following malignancies:
Your Answer:
Correct Answer: Multiple myeloma
Explanation:Bence Jones proteins are monoclonal immunoglobulin light chains found in urine (and plasma) of some patients with myeloma. Because of their relatively small size, light chains are readily excreted into the urine. The presence of significant amounts of Bence Jones proteins in urine is indicative of malignant B cell proliferation.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Incorrect
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Which of the following is first-line for management of status epilepticus:
Your Answer:
Correct Answer: Intravenous lorazepam
Explanation:First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 28
Incorrect
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A 75-year-old man with rheumatoid arthritis had gained weight, developed resistant hypertension, muscle weakness, and ankle oedema. This patient is most likely suffering from what condition?
Your Answer:
Correct Answer: Cushing's syndrome
Explanation:Overuse of cortisol medication, as seen in the treatment of patients with chronic asthma or rheumatoid arthritis, can cause Cushing’s syndrome.
Weight gain, thin arms and legs, a round face, increased fat around the base of the neck, a fatty hump between the shoulders, easy bruising, wide purple stretch marks primarily on the abdomen, breasts, hips, and under the arms, weak muscles, hirsutism, hypertension, erectile dysfunction, osteoporosis, frontal alopecia, acne, depression, poor wound healing, and polycythaemia are all clinical features of Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 29
Incorrect
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You are taking care of a 55-year-old male patient with a direct inguinal hernia. In explaining his hernia, which of the following layers was compromised and had resulted in his condition?
Your Answer:
Correct Answer: Transversalis fascia
Explanation:Direct inguinal hernias are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or heavy lifting.
A direct inguinal hernia protrudes through the Transversalis fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 30
Incorrect
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Regarding atracurium, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Effects such as flushing, tachycardia and hypotension can occur due to significant histamine release.
Explanation:Cardiovascular effects such as flushing, tachycardia, hypotension and bronchospasm are associated with significant histamine release; histamine release can be minimised by administering slowly or in divided doses over at least 1 minute. Atracurium undergoes non-enzymatic metabolism which is independent of liver and kidney function, thus allowing its use in patients with hepatic or renal impairment. Atracurium has no sedative or analgesic effects. All non-depolarising drugs should be used with care in patients suspected to be suffering with myasthenia gravis or myasthenic syndrome, as patients with these conditions are extremely sensitive to their effects and may require a reduction in dose.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
