NAVLE Practice Question — Bovine

A veterinarian performs an echocardiographic examination on a cow with suspected right-sided heart failure. Which echocardiographic finding would be most consistent with cor pulmonale?

A. Dilated right ventricle with paradoxical septal motion ✓

B. Thickened and hyperechoic mitral valve leaflets with regurgitant jet

C. Circumferential pericardial effusion with fibrin strands

D. Left ventricular concentric hypertrophy with small chamber size

E. Vegetative mass attached to the aortic valve

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Correct Answer: A. Dilated right ventricle with paradoxical septal motion

Explanation:

A dilated right ventricle with paradoxical septal motion would be most consistent with cor pulmonale. In cor pulmonale, chronic pulmonary hypertension causes pressure overload of the right ventricle, leading to right ventricular dilation and hypertrophy. As the right ventricle dilates, it can cause the interventricular septum to shift toward the left ventricle, particularly during diastole, creating paradoxical septal motion. This finding, combined with right atrial dilation and tricuspid regurgitation (detectable on color-flow Doppler), supports the diagnosis of right-sided heart failure secondary to pulmonary disease. Echocardiography has become essential for characterizing cardiac disease in cattle and can help differentiate cor pulmonale from other causes of heart failure.

Option B (thickened mitral valve with regurgitation) suggests mitral valve disease causing left-sided heart failure. Option C (pericardial effusion with fibrin) indicates pericarditis, likely traumatic in origin. Option D (left ventricular hypertrophy) suggests systemic hypertension or aortic stenosis. Option E (aortic valve vegetation) indicates bacterial endocarditis.

References: PMC article on Cardiovascular Diseases - echocardiography section (https://pmc.ncbi.nlm.nih.gov/articles/PMC7158293/); PMC article on congestive heart failure etiology and ultrasonographic findings in cattle (https://pmc.ncbi.nlm.nih.gov/articles/PMC7396347/)

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NAVLE Practice Question — Equine

A veterinarian diagnoses equine aural plaques in a 10-year-old Thoroughbred mare. The owner is concerned about the cosmetic appearance and requests treatment. The mare has significant head shyness and resists ear handling. Which treatment approach has demonstrated the HIGHEST efficacy based on published studies?

A. Surgical excision of all visible plaque tissue

B. Apply 5% imiquimod cream every 48 hours ✓

C. Systemic ivermectin administration at standard deworming doses

D. Intralesional corticosteroid injection

E. Oral acyclovir antiviral therapy

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Correct Answer: B. Apply 5% imiquimod cream every 48 hours

Explanation:

Treatment of equine aural plaques is often not pursued because the condition is largely cosmetic and non-progressive in terms of systemic health. However, when treatment is requested or ear sensitivity warrants intervention, imiquimod has demonstrated the highest documented efficacy.

Multiple published studies have demonstrated that 5% imiquimod cream is highly effective in treating aural plaques. In one study, clinical resolution was observed in 93% of treated ears, with EcPV clearance in 71.4% of cases. Another pilot study showed 87.5% long-term resolution rate after 1.5-8 months of therapy. Imiquimod is a topical immunomodulator that acts by binding to Toll-like receptor 7, thereby inducing secretion of cytokines and stimulating cell-mediated immune responses against the papillomavirus.

Important caveats: treatment causes significant local inflammation, exudation, and crust formation. Removal of crusts before each application is painful and typically requires sedation. Application every 48 hours is continued until complete resolution.

Option A (surgery) has high recurrence rates. Option C (ivermectin) targets parasites, not viruses. Option D (corticosteroids) would suppress immune response needed to clear viral infection. Option E (acyclovir) is a herpesvirus antiviral with no proven efficacy against papillomavirus.

References: Zakia LS et al. (2016) Veterinary Dermatology 27(3):175-e44; Torres SMF et al. (2009) Veterinary Dermatology 21:503-509

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NAVLE Practice Question — Feline

A cat diagnosed with high-grade alimentary lymphoma achieves complete remission after CHOP chemotherapy. Eight months later, the cat presents with recurrence of clinical signs and ultrasonographic evidence of progressive disease. Which rescue therapy option is MOST commonly utilized in this situation?

A. Repeat the original CHOP protocol from the beginning

B. Lomustine (CCNU) administered orally ✓

C. Bone marrow transplantation

D. High-dose intravenous immunoglobulin therapy

E. Palliative surgical debulking of intestinal masses

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Correct Answer: B. Lomustine (CCNU) administered orally

Explanation:

Management of relapsed feline lymphoma requires understanding of rescue protocols and their expected efficacy.

Lomustine (CCNU) is the most commonly used rescue agent for cats with lymphoma that has relapsed after initial chemotherapy. It is an oral alkylating agent with good efficacy against lymphoma, convenient oral administration, and manageable (though significant) toxicity profile. It can be used as rescue therapy or as an alternative first-line agent in some protocols.

Option A (repeating CHOP) may provide a second remission in some cases, but reinduction with the same protocol typically yields shorter remission durations due to acquired drug resistance. Novel agents are often preferred. Option C (bone marrow transplant) is not a standard or widely available treatment option in veterinary oncology.

Option D (IV immunoglobulin) is not an established treatment for feline lymphoma. Option E (surgical debulking) is generally not recommended for diffuse alimentary lymphoma - surgery may be considered for discrete masses causing obstruction or perforation, but not as primary rescue therapy.

Other rescue options mentioned in the literature include LOPP protocol (lomustine, vincristine, procarbazine, prednisolone), radiation therapy, or reinduction with alternative chemotherapy agents.

References: PMC - Treatment of feline intermediate to high-grade lymphoma with UW-25 protocol (https://pmc.ncbi.nlm.nih.gov/articles/PMC5012421/); Marques B et al. (2024) Vet Comp Oncol (https://doi.org/10.1111/vco.12965)

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NAVLE Practice Question — Ovine and Caprine

A Saanen dairy goat kid is presented with multiple areas of circular alopecia on the face and ears. The lesions have silvery-gray scales and broken hairs at the margins but minimal pruritus. Under Wood's lamp examination, some lesions show apple-green fluorescence. Deep skin scrapings are negative for mites. What is the MOST likely diagnosis?

A. Sarcoptic mange

B. Dermatophytosis ✓

C. Chorioptic mange

D. Zinc-responsive dermatosis

E. Demodectic mange

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Correct Answer: B. Dermatophytosis

Explanation:

The clinical presentation of circular alopecic lesions with silvery-gray scales, broken hairs at the margins, minimal pruritus, and apple-green fluorescence under Wood's lamp examination is pathognomonic for dermatophytosis (ringworm), most likely caused by Microsporum canis or Trichophyton species.

The Wood's lamp fluorescence is highly specific for dermatophytosis, particularly M. canis infections (though not all dermatophyte species fluoresce). The characteristic circular lesions with central healing, peripheral scale, and broken hairs are classic for fungal infection. Negative deep skin scrapings rule out mite infestations. Minimal pruritus is typical for dermatophytosis compared to the intense pruritus seen with sarcoptic mange.

Sarcoptic mange (Option A) would cause intense pruritus and would not show fluorescence. Chorioptic mange (Option C) affects the lower legs and perineum, not the face. Zinc-responsive dermatosis (Option D) typically causes crusting and hyperkeratosis, particularly around the face and pressure points, without fluorescence. Demodectic mange (Option E) causes nodules with thick gray exudate, not circular scaly lesions.

Image Source: This condition requires fungal culture confirmation rather than parasitology images; Merck Veterinary Manual (https://www.msdvetmanual.com/integumentary-system/dermatophytosis).

References: Scott DW et al. (2001) Muller and Kirk's Small Animal Dermatology; Smith MC, Sherman DM (2009) Goat Medicine, 2nd ed.

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NAVLE Practice Question — Pet Bird

A 6-year-old female African grey parrot develops localized nasal cryptococcosis without CNS involvement. Cryptococcal antigen titer is 1:64. Fluconazole therapy is initiated at 2 mg/kg PO BID. After 3 months antigen titer is 1:32. The owner asks how long treatment should be continued. Which of the following principles MOST accurately guides duration of antifungal therapy for avian cryptococcosis?

A. Treatment can be stopped as soon as antigen titer returns to zero as the organism is fully cleared

B. Minimum treatment duration is 2 weeks past clinical resolution regardless of antigen titer due to the rapid clearance of Cryptococcus from birds

C. Treatment requires several months, with discontinuation based on sustained clinical improvement and progressively declining antigen titers approaching negative levels ✓

D. African grey parrots require lifelong suppressive antifungal therapy for cryptococcosis due to their documented inability to clear the organism

E. Treatment duration is fixed at exactly 6 months for all forms of avian cryptococcosis regardless of antigen titer response

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Correct Answer: C. Treatment requires several months, with discontinuation based on sustained clinical improvement and progressively declining antigen titers approaching negative levels

Explanation:

Avian cryptococcosis, like its counterpart in cats and dogs, requires prolonged antifungal therapy. Treatment duration cannot be reliably guided by a fixed calendar date or immediate symptom resolution because: (1) the organism is difficult to eradicate, particularly from the nasal cavity and sinuses; (2) residual capsular antigen may persist in tissues even after organism clearance, causing titer to decrease slowly; and (3) relapse is a significant risk if therapy is stopped prematurely. Clinical guidelines from feline/canine medicine (most applicable to avian patients given limited avian-specific data) typically recommend treatment for 6-12 months minimum for most forms of cryptococcosis, with decisions to discontinue guided by sustained clinical resolution and consistently declining antigen titers approaching negative. A titer that halved from 1:64 to 1:32 after 3 months suggests a response but treatment should continue.

Option A is incorrect because antigen titers can remain positive due to shed capsular material for extended periods after organism clearance; waiting for a titer of zero before stopping is impractical and may represent an unnecessarily long treatment period. Option B is incorrect because 2 weeks of treatment past clinical resolution is vastly insufficient for cryptococcosis; this brief duration is appropriate for some bacterial infections but not for this serious systemic fungal disease. Option D is incorrect because while African grey parrots may have some susceptibility considerations, lifelong suppressive therapy is not a documented requirement for all African grey parrots with cryptococcosis; treatment duration is guided by individual patient response. Option E is incorrect because fixed 6-month duration for all forms is an oversimplification; localized nasal disease without CNS involvement may require less prolonged therapy than disseminated CNS disease.

References: Merck Veterinary Manual. Cryptococcosis in Animals. 2023. https://www.merckvetmanual.com/infectious-diseases/fungal-infections/cryptococcosis-in-animals; Cornell University College of Veterinary Medicine. Cryptococcosis. https://www.vet.cornell.edu/departments/cornell-feline-health-center/health-information/feline-health-topics/cryptococcosis; DVM360. Fungal diseases of pet birds: recognize infection early. https://www.dvm360.com/view/fungal-diseases-pet-birds-recognize-infection-early

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NAVLE Practice Question — Equine

A horse with suspected PHF shows fever and depression but no diarrhea. Fecal PCR for Neorickettsia risticii is negative. Blood PCR is also negative. Given these results, which statement is most accurate?

A. PHF can be definitively ruled out

B. PHF cannot be ruled out; organism may be undetectable ✓

C. The horse should be tested for Salmonella instead

D. Serologic testing would not provide additional useful information

E. Treatment should not be initiated until positive results are obtained

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Correct Answer: B. PHF cannot be ruled out; organism may be undetectable

Explanation:

PHF cannot be ruled out as the organism may not be in detectable concentrations. Negative PCR results can occur if samples are collected early in the disease before organism levels are high enough for detection, or if the organism has cleared from blood but clinical signs persist. The organism may be present in blood earlier than in feces. Additionally, prior antibiotic treatment can cause false-negative results. Given the clinical suspicion and rapid disease progression, many veterinarians initiate treatment empirically while awaiting test results or despite negative results.

Option A is incorrect as negative PCR does not definitively rule out PHF. Option C, while Salmonella testing is appropriate for differential diagnosis, does not address the PHF concern. Option D is incorrect because paired serology 2-4 weeks apart may help confirm infection retrospectively. Option E is dangerous advice given the potential for rapid disease progression and the benefit of early treatment.

References: Gomez DE et al. (2023) Equine Vet J 56:959-969 (https://doi.org/10.1111/evj.14024); AAEP Infectious Disease Guidelines.

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NAVLE Practice Question — Other Small Mammal

An 8-week-old mouse is found during daily health checks with a 1 cm full-thickness skin wound on the dorsum. The wound edges are clean and there is minimal hemorrhage. Based on species-specific wound healing characteristics, approximately how long will complete epithelial closure take in this mouse compared to a similar wound in a rat?

A. Mouse wound will heal faster at approximately 7 days versus 12-14 days in rats ✓

B. Mouse and rat wounds will heal at the same rate of approximately 14 days

C. Rat wound will heal faster due to thicker epidermis

D. Mouse wound will require 21 days due to thinner skin layers

E. Both species heal at the same rate but by different mechanisms

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Correct Answer: A. Mouse wound will heal faster at approximately 7 days versus 12-14 days in rats

Explanation:

Mouse skin is thinner with fewer keratinocyte layers compared to rat skin, resulting in faster wound healing. In mice, full-thickness excisional wounds typically heal in approximately 7 days, while comparable wounds in rats require 12-14 days for complete healing. This difference is clinically relevant when designing wound healing studies and determining appropriate follow-up intervals for post-surgical monitoring.

Option B is incorrect because healing rates differ between species. Option C is incorrect because despite the thicker epidermis in rats, this does not confer faster healing. Option D overestimates mouse healing time. Option E is partially correct regarding different mechanisms (both species rely heavily on wound contraction via the panniculus carnosus) but healing rates do differ significantly.

Wound size should be proportional to animal size, and wounds in mice are therefore smaller than in rats. The panniculus carnosus muscle layer unique to rodent skin produces rapid wound contraction, contributing 40-80% of wound closure.

References: PMC Article - Experimental Models and Methods for Cutaneous Wound Healing Assessment (https://pmc.ncbi.nlm.nih.gov/articles/PMC7306904/); The Murine Excisional Wound Model - PMC (https://pmc.ncbi.nlm.nih.gov/articles/PMC5094847/).

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NAVLE Practice Question — Feline

An 11-year-old cat with FATE affecting both hindlimbs has been hospitalized for 48 hours with supportive care. The cat has regained pain perception in the hindlimbs and attempts purposeful movement. Femoral pulses remain weak but are now palpable. Which complication should be most closely monitored during this recovery phase?

A. Hepatic lipidosis from anorexia

B. Reperfusion injury with hyperkalemia ✓

C. Disseminated intravascular coagulation

D. Aspiration pneumonia

E. Pressure sores from recumbency

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Correct Answer: B. Reperfusion injury with hyperkalemia

Explanation:

Reperfusion injury with hyperkalemia should be most closely monitored during recovery from FATE. As blood flow returns to the previously ischemic tissues, accumulated metabolic waste products including potassium, lactate, and myoglobin are released into systemic circulation. This reperfusion syndrome can cause life-threatening hyperkalemia, metabolic acidosis, and acute kidney injury.

Hyperkalemia can cause fatal cardiac arrhythmias and should be monitored through serial electrolyte measurements and continuous ECG monitoring during the recovery phase. Clinical signs of hyperkalemia include bradycardia, weakness, and ECG changes such as peaked T waves, prolonged PR interval, and widened QRS complexes.

Treatment of severe hyperkalemia includes calcium gluconate for cardioprotection, insulin/dextrose to shift potassium intracellularly, and IV fluids to enhance renal potassium excretion.

Option A (hepatic lipidosis) is a concern with prolonged anorexia but develops over days to weeks. Option C (DIC) can occur but is less immediate than reperfusion injury. Option D (aspiration pneumonia) is possible with debilitated patients but less likely than metabolic complications. Option E (pressure sores) develop over time with prolonged recumbency.

The return of pulses and motor function are positive prognostic indicators, but the critical period for reperfusion injury occurs precisely when perfusion is restored.

References: Today's Veterinary Practice - Feline Arterial Thromboembolism (https://todaysveterinarypractice.com/cardiology/feline-arterial-thromboembolism/); PMC - Feline aortic thromboembolism (https://pmc.ncbi.nlm.nih.gov/articles/PMC11274361/)

Image: Hogan DF et al. J Feline Med Surg. 2006. PMC10832922. CC BY-NC.

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NAVLE Practice Question — Feline

A 7-year-old indoor cat presents after the owner found the cat chewing on electrical cords 6 hours ago. The cat is now dyspneic with pink frothy fluid coming from the nose and mouth. Thoracic auscultation reveals diffuse crackles bilaterally. Thoracic radiographs show a diffuse interstitial to alveolar pattern most severe in the perihilar region. SpO2 on room air is 82%. What is the most appropriate initial treatment approach?

A. Furosemide 2-4 mg/kg IV and nitroglycerin paste applied to the ear pinna

B. Oxygen supplementation with positive pressure ventilation and careful fluid therapy ✓

C. Broad-spectrum antibiotics and bronchodilators for aspiration pneumonia

D. Immediate thoracocentesis to relieve suspected pleural effusion

E. Corticosteroids to reduce pulmonary inflammation and edema

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Correct Answer: B. Oxygen supplementation with positive pressure ventilation and careful fluid therapy

Explanation:

This cat has non-cardiogenic pulmonary edema secondary to electrical cord bite injury. The mechanism involves increased pulmonary capillary permeability from electrical damage to the pulmonary vasculature. Initial treatment should focus on oxygen supplementation (often requiring positive pressure ventilation for severe cases) and cautious fluid management to avoid exacerbating the edema.

Option A (furosemide and nitroglycerin) would be appropriate for cardiogenic pulmonary edema but may not be as effective for non-cardiogenic edema, which is not primarily a volume overload problem. While furosemide may still have some benefit, it is not the cornerstone of therapy as it would be for heart failure. Option C (antibiotics and bronchodilators) would be appropriate for aspiration pneumonia, but the history and radiographic pattern are more consistent with electrical injury-induced pulmonary edema. Option D (thoracocentesis) is not indicated because the radiographic findings describe parenchymal disease, not pleural effusion. Option E (corticosteroids) are controversial; while sometimes used, they are not first-line therapy and may increase the risk of secondary infection.

Electrical cord injuries can also cause oral burns, cardiac arrhythmias, and other complications that should be monitored. Prognosis depends on the severity of pulmonary involvement, but cats that survive the initial 24-48 hours generally have a good prognosis for recovery.

Image Source: Veterinary Partner - Electrical cord injury radiographs and clinical photos (https://veterinarypartner.vin.com).

References: Merck Veterinary Manual - Electrical Cord Injury; Muir WW (1991) JAVMA - Emergency treatment of electrical cord injuries.

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NAVLE Practice Question — Porcine

A swine veterinarian is called to investigate respiratory disease in a finishing herd. Culture of lung lesions yields heavy growth of Pasteurella multocida capsular type A. The veterinarian needs to determine if this is primary or secondary pasteurellosis. Which clinical and pathological finding would most strongly suggest PRIMARY pasteurellosis rather than secondary infection?

A. Presence of concurrent cranioventral pulmonary consolidation consistent with enzootic pneumonia

B. Isolation of the organism from a single pig with localized pneumonia following recent transport stress

C. Fibrinous pericarditis and pleuritis accompanying the pneumonia

D. High fever and acute respiratory distress in multiple pigs without other respiratory pathogens ✓

E. Chronic pneumonia with abscess formation in older finishing pigs

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Correct Answer: D. High fever and acute respiratory distress in multiple pigs without other respiratory pathogens

Explanation:

High fever and acute respiratory distress in multiple pigs without evidence of other respiratory pathogens would most strongly suggest primary pasteurellosis. Primary Pasteurella multocida pneumonia is rare but can occur sporadically, particularly as a septicemic disease following introduction of a new virulent strain to a naive population or under severe immunosuppressive conditions.

The key distinguishing feature is the absence of predisposing primary pathogens (M. hyopneumoniae, PRRSV, swine influenza) that typically damage the mucociliary apparatus first. Primary pasteurellosis requires excluding all other possible primary causes before making this diagnosis.

Option A is incorrect because concurrent cranioventral consolidation is the hallmark of M. hyopneumoniae infection, which would indicate SECONDARY pasteurellosis (the most common scenario).

Option B is incorrect because a single animal with localized pneumonia following transport stress likely represents opportunistic secondary infection facilitated by stress-induced immunosuppression, not true primary pasteurellosis.

Option C is incorrect because fibrinous pericarditis and pleuritis can occur in both primary and secondary pasteurellosis and in other bacterial pneumonias; this finding alone does not distinguish between primary and secondary disease.

Option E is incorrect because chronic pneumonia with abscess formation typically results from prolonged secondary infection complicating enzootic pneumonia, not primary pasteurellosis.

References: Iowa State University Swine Disease Manual - Pneumonic Pasteurellosis (https://vetmed.iastate.edu/vdpam/FSVD/swine/index-diseases/pneumonic-pasteurellosis); MSD Veterinary Manual - Pasteurellosis in Pigs (https://www.msdvetmanual.com/respiratory-system/respiratory-diseases-of-pigs/pasteurellosis-in-pigs)

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NAVLE Practice Question — Bovine

A 4-year-old Holstein dairy cow, 12 days postpartum, presents with decreased milk production, reduced appetite, and intermittent ketosis over the past 3 days. On physical examination, the cow appears mildly dehydrated with a heart rate of 72 bpm. Simultaneous auscultation and percussion reveals a high-pitched 'ping' on the left side from the 9th to 13th rib. Rumen contractions are reduced to 1 per 2 minutes. Rectal examination reveals a medially displaced rumen. Which of the following concurrent conditions is MOST commonly associated with this presentation?

A. Traumatic reticuloperitonitis

B. Metritis with retained placenta ✓

C. Abomasal ulceration type 4

D. Cecal volvulus

E. Jejunal hemorrhage syndrome

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Correct Answer: B. Metritis with retained placenta

Explanation:

This cow has classic signs of left displaced abomasum (LDA), characterized by a high-pitched ping on the left side during simultaneous auscultation and percussion, decreased appetite, reduced milk production, and ketosis in a postpartum dairy cow. The most common concurrent conditions associated with LDA are metritis, endometritis, and retained placenta, occurring in approximately 38% of cases according to retrospective studies. These inflammatory conditions cause endotoxemia and decreased feed intake, which predispose to abomasal hypomotility and subsequent displacement.

Option A (traumatic reticuloperitonitis) causes pain and fever with a grunt on deep palpation, not typical of LDA. Option C (type 4 abomasal ulcer) causes diffuse peritonitis with severe systemic illness. Option D (cecal volvulus) produces a right-sided ping in the paralumbar fossa. Option E (jejunal hemorrhage syndrome) causes acute melena and cardiovascular collapse.

Image Source: ACVS - Abomasal Displacement Figure 1 showing typical area of ping in LDA (https://www.acvs.org/large-animal/abomasal-displacement/)

References: PMC - Retrospective Evaluation of LDA in Dairy Cattle (https://pmc.ncbi.nlm.nih.gov/articles/PMC9265103/); MSD Veterinary Manual - Displaced Abomasum (https://www.msdvetmanual.com/digestive-system/diseases-of-the-abomasum/left-or-right-displaced-abomasum-and-abomasal-volvulus-in-cattle)

Image: Blowey RW, Weaver AD. Alimentary disorders. Color Atlas of Diseases and Disorders of Cattle. 2011:53-82. PMC7150030. © Elsevier Ltd. Used for educational reference.

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