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Question 1
Incorrect
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Carbon dioxide is principally transported in the blood in which form?
Your Answer: Carboxyhaemoglobin
Correct Answer: Bicarbonate
Explanation:Carbon dioxide is transported in the blood in various forms:
– Bicarbonate (80–90%)
– Carbamino compounds (5–10%)
– Physically dissolved in solution (5%).
Carbon dioxide is carried on the haemoglobin molecule as carbamino-haemoglobin; carboxyhaemoglobin is the combination of haemoglobin with carbon monoxide. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 2
Incorrect
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In relation to the muscles of facial expression, It is true to say:
Your Answer: The occipitofrontalis muscle consists of three parts.
Correct Answer: They are in the same subcutaneous plane as the platysma muscle
Explanation:The facial muscles generally originate from the facial bones and attach to the skin, in the same plane as the platysma muscle. They are all innervated by cranial nerve VII (the facial nerve). The occipitofrontalis muscle consists of two parts: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Correct
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A 42-year-old woman is admitted with sepsis and right flank pain. Twenty-four hours ago, she was started on trimethoprim, by the GP, for a urinary tract infection (UTI).Which of the following organisms is the most likely causative agent?
Your Answer: E. coli
Explanation:Ascending infection of the urinary tract is most commonly caused by Escherichia coli (E.coli). Other organisms may be accountable. However, these are less common.
E. coli are gram-negative rods. They have a wide range of subtypes and some are normal gut commensals. Most varieties of E. coli are harmless or cause relatively brief diarrhoea. But a few nasty strains, such as E. coli O157:H7, can cause severe abdominal cramps, bloody diarrhoea, and vomiting. Some strains of E. coli are also resistant to a large number of antibiotics used to treat gram-negative infections.
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 4
Incorrect
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The pterygoid plexus receives tributaries from which of the following veins?
Your Answer: Internal jugular vein
Correct Answer: Maxillary vein
Explanation:The pterygoid plexus of veins is the main venous component associated with the infratemporal fossa. It receives tributaries corresponding to the branches of the internal maxillary artery. This plexus communicates freely with the anterior facial vein; it also communicates with the cavernous sinus, by branches through the foramen of Vesalius, foramen ovale and foramen lacerum. The (internal) maxillary vein is a short trunk which accompanies the first part of the (internal) maxillary artery. It is formed by a confluence of the veins of the pterygoid plexus and passes backward between the sphenomandibular ligament and the neck of the mandible and unites with the temporal vein to form the posterior facial vein. It carries blood away from the infratemporal fossa.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 5
Incorrect
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Which of the following coagulation factors cross-links fibrin?
Your Answer: Factor X
Correct Answer: Factor XIII
Explanation:Factor XIII, also known as fibrin stabilizing factor, is an enzyme of the coagulation cascade that crosslinks fibrin. Deficiency of FXIII may cause bleeding tendency but paradoxically, it may also predispose to thrombosis.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Incorrect
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The proximal tubule is the portion of the ductal system of the nephron of the kidney which leads from Bowman's capsule to the loop of Henle. Which of the following is most likely to be seen in a sample of fluid leaving the proximal tubule?
Your Answer: It will have more K+ than plasma
Correct Answer: It will have no amino acids
Explanation:The proximal tubule is the portion of the duct system of the nephron leading from Bowman’s capsule to the loop of Henlé. The most distinctive characteristic of the proximal tubule is its brush border (or ‘striated border’). The luminal surface of the epithelial cells of this segment of the nephron is covered with densely packed microvilli forming a border which greatly increases the luminal surface area of the cells, presumably facilitating their reabsorptive function. Glucose, amino acids, inorganic phosphate, and some other solutes are100% reabsorbed via secondary active transport through co-transporters driven by the sodium gradient out of the nephron.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 7
Incorrect
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A 43-year-old male with no significant medical history is currently being kept nil-by-mouth for an elective bilateral inguinal hernia repair. Which of the following describes the best fluid regimen for this patient over the following 24 hours?
Your Answer: 2 L Hartmann’s solution and 1 L 5% dextrose with 20 mmol potassium
Correct Answer: 1 L normal saline with 20 mmol potassium and 2 L 5% dextrose with 20 mmol potassium in each bag
Explanation:If patients need IV fluids for routine maintenance alone, restrict the initial prescription to:
25–30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50–100 g/day of glucose to limit starvation ketosis.
Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in 24 hours). Potassium should not be added to intravenous fluid bags as this is dangerous.Sodium chloride 0.9%, with or without additional potassium, is one of the most commonly used IV fluids in UK practice.
Glucose 5% solution provides a useful means of giving free water for, once the glucose is metabolised, the fluid is distributed throughout total body water. It is, therefore, a potentially useful means of correcting or preventing simple dehydration and the glucose content will also help to prevent starvation ketosis, although it is important to recognize that it will not make much of a contribution to covering patients overall nutritional needs. The use of 5% glucose, will increase risks of significant hyponatraemia, particularly in children, the elderly, patients on diuretics and those with excess ADH due to osmotic and non-osmotic stimuli (a problem is seen quite frequently in hospitalized patients). Nevertheless, hyponatremia is likely to be avoided by not exceeding recommended volumes of maintenance IV fluids and by careful monitoring of patients’ clinical volume status and electrolyte measurements.
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This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 8
Incorrect
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The renal cortex and medulla, if seen under the microscope, is lacking one of the following:
Your Answer: Capillaries
Correct Answer: Squamous epithelium
Explanation:Capillaries, Henle’s loop, collecting ducts, Bertin columns and type IV collagen in glomerular basement membrane are all structures present in the renal cortex or medulla. The squamous epithelium is the only one that is lacking in both the renal cortex and medulla, because normally it is not found above the outer urethra.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 9
Incorrect
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A 29-year-old female presents with a history of increasingly severe ano-rectal pain for the past 24 hours. On examination, she has a low-grade fever, and the skin surrounding the anus appears normal. She has not, however, tolerated an attempted digital rectal examination (DRE). What is the most likely diagnosis?
Your Answer: Fissure-in-ano
Correct Answer: Intersphincteric abscess
Explanation:Presence of fever and severe pain point towards the diagnosis of an abscess rather than a fissure. Although fissures may be painful, they do not, in themselves, cause fever. Moreover, a case of fissure-in-ano typically presents with bright red PR bleed.
The management option for intersphincteric abscess includes examination of the ano-rectum under general anaesthesia and drainage of the sepsis.
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This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 10
Correct
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A 35-year-old woman is in a comatose state following a traumatic head injury, and is receiving intravenous (IV) antibiotics and IV fluids containing saline and 5% dextrose. A serum biochemistry analysis is performed five days later which shows a low serum potassium level. This is most likely to be due to:
Your Answer: Nothing per oral regimen
Explanation:In this patient the cause for hypokalaemia is insufficient consumption of potassium as she is nil-per mouth with no intravenous supplementation. Parenteral nutrition has been used for comatose patients, although enteral feeding is usually preferable, and less prone to complications.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 11
Correct
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A 55-year old lady underwent a major surgery for repair of an aortic aneurysm. Her blood pressure was low throughout the intra-operative and the post-operative period, along with increasing serum creatinine and urea. Microscopic examination of her urine showed multiple granular and hyaline casts. What is the likely condition the patient is suffering from?
Your Answer: Acute tubular necrosis
Explanation:The most common predisposing factor leading to acute tubular necrosis is ischemia, typically seen in hospitalized patients with low blood pressure.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 12
Incorrect
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The middle meningeal artery is the largest among the arteries that supplies that dura mater of the brain. What is the terminal branch of the middle meningeal artery?
Your Answer: Sphenopalatine artery
Correct Answer: Maxillary artery
Explanation:The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges. The middle meningeal artery is typically the third branch of the first part of the maxillary artery, one of the two terminal branches of the external carotid artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 13
Correct
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How are amino acids transported across the luminal surface of the small intestinal epithelium?
Your Answer: Co-transport with sodium ions
Explanation:Once complex peptides are broken down into amino acids by the peptidases present in the brush border of small intestine, they are ready for absorption by at least four sodium-dependent amino acid co-transporters – one each for acidic, basic, neutral and amino acids, present on the luminal plasma membrane. These transporters first bind sodium and can then bind the amino acids. Thus, amino acid absorption is totally dependent on the electrochemical gradient of sodium across the epithelium. The basolateral membrane in contrast, possesses additional transporters to carry amino acids from the cell into the blood, but these are sodium-independent.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 14
Incorrect
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During a case presentation, a 26 year old is said to have fractured his pelvis and shattered his coccyx following a motorbike accident. It is mentioned that he is likely to have lacerated his middle sacral artery from this kind of injury. Where does the middle sacral artery branch from?
Your Answer: Internal Iliac artery
Correct Answer: Abdominal aorta
Explanation:The middle sacral artery arises from behind the aorta a little above the point of its bifurcation to descend down in front of L4,5, the sacrum and coccyx.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 15
Incorrect
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C5a (a complement component) is a potent?
Your Answer: Opsonin
Correct Answer: Anaphylotoxin
Explanation:C5a is a strong chemoattractant as well as an anaphylotoxin and is involved in the recruitment of inflammatory cells such as neutrophils, eosinophils, monocytes, and T lymphocytes. It is also involved in activation of phagocytic cells, release of granule-based enzymes and generation of oxidants. All of which contribute to innate immune functions.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 16
Incorrect
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A 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?
Your Answer: Aplastic anaemia
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 17
Correct
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A 63 year old lawyer presents with marked agitation after undergoing a transurethral resection of the prostate which took one hour to perform. He has a heart rate of 105 beats per minute and his blood pressure is 170/100mmHg. He is suspected to be in a fluid overloaded state. Lab results reveal a sodium level of 120mmol/L. Which of the following is the most likely cause of this presentation?
Your Answer: TURP syndrome
Explanation:Complications of Transurethral Resection: TURP
T URP syndrome
U rethral stricture/UTI
R etrograde ejaculation
P erforation of the prostateTURP syndrome can cause a wide variety of symptoms that include asymptomatic hyponatremia, ECG changes, fatigue, vomiting, confusion, visual loss, coma and death. In a conscious and alert patient, changes in the mental state of may be the first sign of TURP syndrome and bladder perforation.
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This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 18
Incorrect
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A 27-year-old builder presents with a reducible swelling in the right groin, it is increasing in size and has not been operated on previously. What is the best course of action?
Your Answer: Laparoscopic Bassini repair
Correct Answer: Open Lichtenstein repair
Explanation:The patient has a right groin hernia since he has a reducible lump and a history of carrying heavy objects.
Inguinal hernias present with a reducible lump in the groin.
A third of patients scheduled for surgery have no pain, and severe pain is uncommon (1.5% at rest and 10.2% on movement).
Inguinal hernias are at risk of irreducibility or incarceration, which may result in strangulation and obstruction; however, unlike with femoral hernias, strangulation is rare.
Inguinal hernias are often classified as direct or indirect, depending on whether the hernia sac bulges directly through the posterior wall of the inguinal canal (direct hernia) or passes through the internal inguinal ring alongside the spermatic cord, following the coursing of the inguinal canal (indirect hernia).Surgery is the only curative treatment.
If patients with asymptomatic inguinal hernia are medically fit, they should be offered repair
Mesh repair is associated with the lowest recurrence rates of hernia
Laparoscopic repair is suggested for recurrent and bilateral inguinal hernias, though it may also be offered for primary inguinal hernia repair
The EuraHS recommendations:
– For Primary unilateral Hernia: Mesh repair, Lichtenstein or endoscopic repair are recommended. Endoscopic repair only if expertise is available.
– Primary bilateral: Mesh repair, Lichtenstein or endoscopic.
– Recurrent inguinal hernia: Mesh repair, modifying the technique with respect to the previous technique.
– If previously anterior: Consider open preperitoneal mesh or endoscopic approach (if expertise is present).
– If previously posterior: Consider an anterior meshIn inguinal hernia tension-free repair, synthetic non-absorbable flat meshes (or composite meshes with a non-absorbable component) should be used.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 19
Correct
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A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:
Your Answer: Vibratory sensations from the ipsilateral arm
Explanation:At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.
Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 20
Incorrect
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A 19-year-old female presents to the oncology clinic after noticing a painless neck lump. On examination, she is noted to have bilateral thyroid masses and multicentric nodules near the base of the thyroid. Her corrected calcium level is 2.18 mg/dL. Which of the following is the most likely diagnosis?
Your Answer: Follicular thyroid carcinoma
Correct Answer: Medullary carcinoma of the thyroid associated with multiple endocrine neoplasia
Explanation:Based on the aforementioned findings in this case, the most likely diagnosis is medullary carcinoma of the thyroid associated with multiple endocrine neoplasia (MEN).
Medullary thyroid cancer is a tumour of the parafollicular cells (C cells) of the thyroid and is neural crest in origin. It may be familial and occur as part of the MEN 2A disease spectrum. Less than 10% of thyroid cancers are of this type with patients typically presenting as children or young adults. Diarrhoea occurs in 30% of the cases. In association with MEN syndromes, medullary thyroid cancers are always bilateral and multicentric. Spread may either be lymphatic or haematogenous, and as these tumours are not derived primarily from thyroid cells, they are not responsive to radioiodine.
Toxic nodular goitre is very rare. In sporadic medullary carcinoma of the thyroid, patients typically present with a unilateral solitary nodule and it tends to spread early to the lymph nodes in neck.
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This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
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Question 21
Incorrect
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A man had an injury to his right brachial plexus. After examination by the doctor they found that the diaphragm and the scapula were unaffected however the patient could not abduct his arm. When helped with abducting his arm to 45 degrees he was able to continue the movement. This means that he was unable to initiate abduction. Where is the likely site of injury?
Your Answer: Posterior cord
Correct Answer: Suprascapular nerve
Explanation:The loss of ability to initiate abduction means paralysis of the supraspinatus muscle. This muscle is supplied by the supraclavicular nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 22
Correct
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A 64 year old man has been in ICU with ARDS for a week following acute pancreatitis. He is being mechanically ventilated. Which of the following is the best option for maintenance of the patency of his airway?
Your Answer: Tracheostomy
Explanation:Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea. It is most often performed in patients who have had difficulty weaning off a ventilator, followed by those who have suffered trauma or a catastrophic neurologic insult. High-flow oxygen via tracheostomy may reduce the inspiratory effort and enhance tidal volume by delivering high-flow oxygen and facilitate weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction.
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This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 23
Correct
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A 46 year old woman is taken to the A&E department with a full thickness burn on her chest which is well circumscribed. Her saturation was reduced to 92% on 15L of Oxygen, blood pressure of 104/63 mmHg and HR 106 bpm. What is the best management step?
Your Answer: Escharotomy
Explanation:Answer: Escharotomy
Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliant. Hence, the underlying tissues have an increased available volume to expand into, preventing further tissue injury or functional compromise.
Full-thickness circumferential and near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment syndrome. This is caused by the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits. The excessive fluid causes the intracompartmental pressures to increase, resulting in collapse of the contained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that which requires intervention to prevent tissue death.
The circumferential eschar over the torso can lead to significant compromise of chest wall excursions and can hinder ventilation. Abdominal compartment syndrome with visceral hypoperfusion is associated with severe burns of the abdomen and torso. (A literature review by Strang et al found the prevalence of abdominal compartment syndrome in severely burned patients to be 4.1-16.6%, with the mean mortality rate for this condition in these patients to be 74.8%). Similarly, airway patency and venous return may be compromised by circumferential burns involving the neck.
Performing an escharotomy will therefore improve ventilation.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 24
Correct
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What percentage of the cardiac output is delivered to the brain?
Your Answer: 15%
Explanation:Among all body organs, the brain is most susceptible to ischaemia. Comprising of only 2.5% of total body weight, the brain receives 15% of the cardiac output. Oxygen extraction is also higher with venous oxygen levels approximating 13 vol%, and arteriovenous oxygen difference of 7 vol%.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 25
Incorrect
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Intravenous diazepam was administered to a man who was brought to the emergency department with status epilepticus. He was administered 15 l/min oxygen via a reservoir bag mask. Blood investigations showed sodium = 140 mmol/l, potassium = 4 mmol/l and chloride = 98 mmol/l. His arterial blood gas analysis revealed pH 7.08, p(CO2)= 61.5 mmHg, p(O2) = 111 mmHg and standard bicarbonate = 17 mmol/l. This patient had:
Your Answer: Metabolic acidosis
Correct Answer: Mixed acidosis
Explanation:Acidosis with high p(CO2) and low standard bicarbonate indicates mixed acidosis. Lower p(O2) is due to breathing of 70% oxygen. The prolonged seizures lead to lactic acidosis and the intravenous diazepam is responsible for the respiratory acidosis. Treatment includes airway manoeuvres and oxygen, assisted ventilation if needed, and treatment with fluids.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 26
Correct
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A 42 year old truck driver undergoes a live related renal transplant and he was progressing well until 15 days following the transplant. He is noted to have swelling overlying the transplant site and swelling of the ipsilateral limb. Urine output is acceptable and creatinine unchanged. Which of the following is the most likely cause?
Your Answer: Lymphocele
Explanation:Lymphocele has been defined as a lymph-filled collection in the retroperitoneum without an epithelial lining. In kidney transplanted patients, lymphocele is a pseudocystic entity with lymph content covered with a hard fibrous capsule frequently localized around the graft. Lymphocele is one of the most common complications after kidney transplantation. It is usually asymptomatic, but can cause pressure on the kidney transplant, ureter, bladder, and adjacent vessels with deterioration of graft function, ipsilateral leg oedema, and external iliac vein thrombosis. Peritoneal fenestration is a well-established method for treatment.
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This question is part of the following fields:
- Generic Surgical Topics
- Organ Transplantation
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Question 27
Incorrect
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On exploration of an axillary wound, a branch from the third part of the axillary artery was found to be transected. Which of the following arteries would have been likely injured?
Your Answer: Lateral thoracic
Correct Answer: Anterior humeral circumflex
Explanation:The axillary artery gives off many branches from the first, second, or third parts along its course. The third part of the axillary artery gives off two branches: the anterior humeral circumflex artery and the posterior humeral circumflex artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 28
Correct
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Vincristine is a chemotherapy agent used to treat a number of types of cancer. Which of the following is a recognised major side-effect of vincristine?
Your Answer: Peripheral neuropathy
Explanation:Vincristine is an alkaloid chemotherapeutic agent. It is used to treat a number of types of cancer including acute lymphocytic leukaemia, acute myeloid leukaemia, Hodgkin’s disease, neuroblastoma, and small cell lung cancer among others. The main side-effects of vincristine are peripheral neuropathy and constipation.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29
Correct
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Diuretics that act on the ascending limb of the loop of Henle produce:
Your Answer: Reduced active transport of sodium
Explanation:The loop of Henlé leads from the proximal convoluted tubule to the distal convoluted tubule. Its primary function uses a counter current multiplier mechanism in the medulla to reabsorb water and ions from the urine. It can be divided into four parts:
1. Descending limb of loop of Henlé – low permeability to ions and urea, while being highly permeable to water 2. Thin ascending limb of loop of Henlé – not permeable to water, but it is permeable to ions
3. Medullary thick ascending limb of loop of Henlé – sodium (Na+), potassium (K+) and chloride (Cl–) ions are reabsorbed by active transport. K+ is passively transported along its concentration gradient through a K+ channel in the basolateral aspect of the cells, back into the lumen of the ascending limb.
4. The cortical thick ascending limb – the site of action where loop diuretics such as furosemide block the K+/Na+/2Cl− co-transporters = reduced active transport. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 30
Incorrect
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Skin infiltration by neoplastic T lymphocytes is seen in:
Your Answer: Hairy cell leukaemia
Correct Answer: Mycosis fungoides
Explanation:Mycosis fungoides is a chronic T-cell lymphoma that involves the skin and less commonly, the internal organs such as nodes, liver, spleen and lungs. It is usually diagnosed in patients above 50 years and the average life expectancy is 7-10 years. It is insidious in onset and presents as a chronic, itchy rash, eventually spreading to involve most of the skin. Lesions are commonly plaque-like, but can be nodular or ulcerated. Symptoms include fever, night sweats and weight loss. Skin biopsy is diagnostic. However, early cases may pose a challenge due to fewer lymphoma cells. The malignant cells are mature T cells (T4+, T11+, T12+). The epidermis shows presence of characteristic Pautrier’s micro abscesses are present in the epidermis.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
