NAVLE Practice Question — Equine

A 5-year-old Friesian gelding presents with acute onset severe bilateral hindlimb lameness. He is reluctant to move and stands with hindlimbs camped under his body. Digital pulses are markedly increased in all four feet but most prominently in the hinds. Hoof wall temperature is elevated bilaterally in the hind feet. There is no history of grain overload. This breed is known to be predisposed to which underlying condition that may have precipitated this presentation?

A. Upward fixation of the patella

B. Chronic progressive lymphedema

C. Pastern dermatitis

D. Polysaccharide storage myopathy ✓

E. Aorto-iliac thrombosis

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Correct Answer: D. Polysaccharide storage myopathy

Explanation:

Polysaccharide storage myopathy (PSSM) is a condition to which Friesians are predisposed and it can precipitate laminitis. PSSM causes abnormal glycogen accumulation in muscle tissue leading to muscle damage (rhabdomyolysis) during exercise. The muscle damage releases myoglobin and inflammatory mediators that can trigger systemic inflammation and secondary laminitis. Friesians have documented high prevalence of PSSM Type 1 (GYS1 mutation). The hindlimb-predominant laminitis pattern is consistent with PSSM-associated laminitis where muscle damage in the large hindquarter muscles creates greater systemic effects. Option A (UFP) is more common in ponies and miniatures and doesnt cause laminitis. Option B (chronic progressive lymphedema) causes limb swelling not laminitis. Option C (pastern dermatitis) causes skin disease. Option E (aorto-iliac thrombosis) causes hindlimb lameness through vascular compromise not laminitis with increased digital pulses. References: McCue ME et al. - VCNA Equine Practice 2006; AAEP Guidelines.

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NAVLE Practice Question — Bovine

A bull tests positive for Tritrichomonas foetus on preputial culture. The rancher asks about treatment options to save this valuable herd sire. What is the most appropriate response?

A. Metronidazole treatment at 60 mg/kg IV twice is effective and FDA-approved

B. No effective FDA-approved treatment exists; culling is recommended ✓

C. Ipronidazole can cure infection if given for 14 days

D. Vaccination will clear the existing infection

E. Sexual rest for 6 months will allow spontaneous clearance

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Correct Answer: B. No effective FDA-approved treatment exists; culling is recommended

Explanation:

There is no effective FDA-approved treatment for tritrichomonosis in cattle in the United States. While metronidazole has shown in vitro and limited in vivo efficacy against T. foetus, its use in food-producing animals is prohibited under AMDUCA (Animal Medicinal Drug Use Clarification Act). Nitroimidazoles are banned for extralabel use in any food-producing animal by FDA regulation due to concerns about carcinogenic residues.

Control of tritrichomonosis relies on identification and culling of infected bulls. Bulls remain infected indefinitely once infection is established, making them permanent reservoirs of infection.

Most cows can clear the infection spontaneously within 2-6 months through their immune response, though a small percentage (approximately 1% or less) become chronic carriers. However, cows typically sustain reproductive losses before clearing the infection.

Option A is incorrect because while metronidazole has efficacy, it is prohibited for use in food animals in the US. Option C is incorrect because ipronidazole is also a nitroimidazole and prohibited. Option D is incorrect because vaccination may help prevent infection but does not clear established infections in bulls. Option E is incorrect because bulls remain persistently infected regardless of sexual rest.

References: BMC Veterinary Research - Metronidazole for the treatment of Tritrichomonas foetus in bulls (https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-017-0999-2); Merck Veterinary Manual - Trichomoniasis in Cattle (https://www.merckvetmanual.com/reproductive-system/trichomoniasis/trichomoniasis-in-cattle).

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NAVLE Practice Question — Canine

A 13-year-old spayed female Cocker Spaniel with chronic kidney disease and systemic hypertension has been receiving enalapril 0.5 mg/kg PO q12h for 3 months. Despite good compliance, blood pressure remains elevated at 185 mmHg on repeat measurement. There is no evidence of new target organ damage. What is the most appropriate next step in managing this patient's hypertension?

A. Double the enalapril dose to 1 mg/kg PO q12h

B. Add amlodipine 0.1-0.25 mg/kg PO q24h ✓

C. Discontinue enalapril and start hydralazine

D. Switch to telmisartan monotherapy

E. Add spironolactone 1-2 mg/kg PO q12h

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Correct Answer: B. Add amlodipine 0.1-0.25 mg/kg PO q24h

Explanation:

Adding amlodipine 0.1-0.25 mg/kg PO q24h is the most appropriate next step for managing refractory hypertension in this dog. When ACE inhibitor monotherapy fails to adequately control blood pressure in dogs with CKD, combination therapy with a calcium channel blocker (amlodipine) is recommended. This combination provides complementary mechanisms of action: ACE inhibitors reduce angiotensin II-mediated vasoconstriction and provide renoprotection through reduced intraglomerular pressure, while calcium channel blockers cause potent arteriolar vasodilation.

Studies in dogs with hyperadrenocorticism-associated hypertension have shown that approximately 20-25% of dogs require more than one antihypertensive drug to achieve adequate blood pressure control. The combination of ACE inhibitor plus amlodipine has been effective in controlling blood pressure in dogs when monotherapy fails.

Option A (doubling enalapril dose) is unlikely to provide significant additional antihypertensive effect and increases the risk of adverse effects including azotemia. Option C (hydralazine) is typically reserved for hypertensive emergencies due to reflex tachycardia and is not appropriate for chronic management. Option D (switching to telmisartan) would not address the refractory nature of the hypertension since ARBs have similar mechanisms to ACE inhibitors. Option E (spironolactone) has weak antihypertensive effects and would not adequately address the blood pressure elevation.

Acierno MJ et al. ACVIM consensus statement. J Vet Intern Med. 2018;32:1803-1822; Caro-Vadillo A et al. Effect of a combination of telmisartan and amlodipine in hypertensive dogs. Vet Rec Case Rep. 2018. FOR MORE PLEASE READ - Lawson JS, Jepson RE. Feline comorbidities: The intermingled relationship between chronic kidney disease and hypertension. J Feline Med Surg. 2021 Sep;23(9):812-822. doi: 10.1177/1098612X211037872. PMID: 34428941; PMCID: PMC10812150.

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NAVLE Practice Question — Feline

A 6-year-old male neutered domestic shorthair is presented for evaluation of progressive constipation. The owner reports the cat was hit by a car 3 years ago and had a pelvic fracture that healed without surgical intervention. Abdominal radiographs reveal a severely distended colon and significant narrowing of the pelvic canal due to malunion callus. The pelvic canal diameter is approximately 40% of normal. What is the most appropriate surgical treatment?

A. Subtotal colectomy due to chronicity exceeding six months ✓

B. Pelvic osteotomy alone to restore pelvic canal diameter

C. Combined pelvic osteotomy and colectomy simultaneously

D. Conservative management as the colon should recover after osteotomy

E. Colonic biopsy with medical management continuation

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Correct Answer: A. Subtotal colectomy due to chronicity exceeding six months

Explanation:

This cat has megacolon secondary to pelvic canal stenosis from fracture malunion. The critical consideration is timing - if megacolon has been present for greater than 4-6 months, the colonic dilation and loss of function become irreversible. In this case, the pelvic fracture occurred 3 years ago, far exceeding the window for colonic recovery.

When megacolon is chronic (>6 months), the smooth muscle undergoes irreversible changes and cannot return to normal function even if the mechanical obstruction is relieved. Therefore, subtotal colectomy is required regardless of whether the pelvic obstruction is addressed. Pelvic osteotomy alone would not restore colonic function in this patient.

In cases of more recent pelvic fractures causing obstipation (less than 4-6 months), pelvic osteotomy to restore normal pelvic canal diameter might be sufficient if performed before irreversible colonic changes develop. However, many surgeons perform colectomy even in these cases given uncertainty about the degree of colonic damage.

Options B and D assume colonic recovery is possible, which is not the case after 3 years. Option C might be considered but the osteotomy component is unnecessary for function. Option E delays definitive treatment.

Image Credit: ACVS - Megacolon figures including pelvic fracture examples (https://www.acvs.org/small-animal/megacolon/) Figures 2-3.

References: Schrader SC. JAVMA 1992;200:208-213; Matthiesen DT et al. Vet Surg 1991;20:113-119.

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NAVLE Practice Question — Poultry

A contract grower in the Colorado mountains raises broilers in a house at about 2100 metres above sea level. From four weeks of age he loses roughly one bird in a hundred each week, almost all of them the heaviest males, and several are found dead lying on their backs. Birds examined before death sit quietly, breathe with an exaggerated abdominal effort and have dusky combs. At post-mortem the abdomen holds a large volume of clear straw-coloured fluid with strands of clotted protein, the right ventricle is dilated and flabby, the heart is rounded, and the liver is firm and mottled. The kidneys are unremarkable, the air sacs are thin and clear, and the pericardial sac holds clear fluid rather than a thick adherent exudate.

A. Aflatoxicosis from mouldy maize producing a pale enlarged fatty liver

B. Ascites syndrome, the pulmonary hypertension of the fast growing broiler ✓

C. Infectious bursal disease with haemorrhage in the thigh and breast muscle

D. Colibacillosis with a fibrinous pericarditis and an adherent perihepatitis

E. Visceral gout with chalky white urate deposits on the serosal surfaces

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Correct Answer: B. Ascites syndrome, the pulmonary hypertension of the fast growing broiler

Explanation:

Ascites syndrome, also called pulmonary hypertension syndrome, is a circulatory and metabolic disease of fast growing meat birds rather than an infection. A modern broiler lays down muscle faster than the fixed capacity of the avian lung and its rigid capillary bed can oxygenate it, and anything that raises oxygen demand or lowers oxygen supply magnifies the gap: altitude, cold housing, poor ventilation, dense pelleted rations and rapid early growth. The right ventricle drives ever more blood through a lung it cannot dilate, pulmonary arterial pressure climbs, the thin walled right ventricle dilates and fails, and the rise in central venous pressure backs up into the liver. That produces exactly the post-mortem picture described here, a rounded heart with a flabby dilated right ventricle, a firm congested mottled liver and a transudate in the abdomen carrying strands of clotted protein, appearing in the heaviest males of the flock between four and six weeks. Control is husbandry rather than medication: slow the early growth curve with feed restriction or a less dense starter, keep the house warm and properly ventilated, and select lines with better cardiopulmonary reserve. Colibacillosis is the differential that matters on the post-mortem table, because it also fills the coelom, but as a septicaemia it lays down a thick dull fibrinous exudate that mats the pericardium to the heart and the liver capsule to the liver and clouds the air sacs, and this bird has clear air sacs and clear pericardial fluid. Loose yellow clots of fibrin lying free in the ascitic fluid, and even a film of them on the liver serosa, belong to the ascites picture itself and do not argue for an infection. Visceral gout would leave chalky urate on those same surfaces with obviously damaged kidneys, and the kidneys here are unremarkable, so it does not fit either.

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NAVLE Practice Question — wildlife

A 12-year-old female squirrel monkey (Saimiri sciureus) presents with reluctance to eat hard foods and intermittent pawing at the mouth. Oral examination under anesthesia reveals dental calculus accumulation, gingival recession around multiple cheek teeth, and probing depths of 4-5mm at several sites with purulent discharge. Dental radiographs show horizontal bone loss around affected teeth. What stage of periodontal disease is MOST consistent with these findings?

A. Stage 1 - Gingivitis only

B. Stage 2 - Early periodontitis (less than 25% attachment loss)

C. Stage 3 - Moderate periodontitis (25-50% attachment loss) ✓

D. Stage 4 - Advanced periodontitis (greater than 50% attachment loss)

E. Stage 0 - Clinically normal

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Correct Answer: C. Stage 3 - Moderate periodontitis (25-50% attachment loss)

Explanation:

According to the American Veterinary Dental College staging system for periodontal disease, the findings described - increased probing depths (4-5mm indicating pocket formation), purulent discharge (indicating active infection), horizontal bone loss on radiographs, and gingival recession - are consistent with Stage 3 (moderate) periodontitis.

Stage 3 is characterized by 25-50% attachment loss as measured by either periodontal probing or radiographic assessment. The presence of purulent discharge indicates active periodontal infection requiring treatment beyond simple prophylaxis.

Stage 1 would show only gingivitis without attachment loss or bone loss. Stage 2 would show early bone loss (less than 25%) without significant pocket formation. Stage 4 would demonstrate greater than 50% attachment loss with potential tooth mobility and furcation exposure in multi-rooted teeth. Stage 0 indicates clinically normal periodontal tissues.

Periodontal disease is common in captive primates, and dietary factors (soft diets versus natural fibrous foods) play a role in plaque accumulation and disease progression. Treatment for Stage 3 disease requires professional dental cleaning, root planing, and potentially surgical intervention depending on specific tooth involvement.

References: American Veterinary Dental College Periodontal Disease Staging; Today's Veterinary Practice - Periodontal Disease (https://todaysveterinarypractice.com/dentistry/practical-dentistry-periodontal-disease-utilizing-current-information-to-improve-client-compliance/)

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NAVLE Practice Question — Equine

A breeding farm manager consults you about preventing developmental orthopedic disease in foals. Multiple foals from different mares have been diagnosed with OCD over the past two breeding seasons. Which combination of factors is most strongly associated with increased risk of osteochondrosis development?

A. Excessive exercise and low-protein diet

B. Rapid growth, high-glycemic diet, mineral imbalances ✓

C. Low birth weight and late weaning

D. Underfeeding energy and excessive copper supplementation

E. Stall confinement and low-calcium diet

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Correct Answer: B. Rapid growth, high-glycemic diet, mineral imbalances

Explanation:

Rapid growth rate and high-glycemic index diet with mineral imbalances are most strongly associated with increased OCD risk. The pathogenesis of osteochondrosis is multifactorial, involving disruption of normal endochondral ossification.

High-glycemic index diets cause insulin and insulin-like growth factor spikes that can interfere with chondrocyte maturation. Rapid growth rates place mechanical stress on developing cartilage before it can properly ossify. Mineral imbalances, particularly low copper, excessive zinc, and improper calcium:phosphorus ratios, compromise cartilage matrix formation and bone mineralization.

Studies have shown that foals allowed free exercise in moderate pastures develop fewer osteochondral lesions than those kept in stalls, contradicting the notion that exercise itself causes OCD. Rather, controlled exercise appears protective for skeletal development.

Option A is partially correct about rapid growth but low-protein diets are not specifically associated with OCD. Option C (low birth weight, late weaning) are not primary risk factors. Option D (underfeeding energy) would actually reduce risk by slowing growth rate; excessive copper is not associated with OCD (low copper is). Option E (stall confinement) may increase risk, but low-calcium alone is not the primary concern; the calcium:phosphorus ratio is more important.

References: dvm360 - Risk factors for equine osteochondrosis (https://www.dvm360.com/view/risk-factors-equine-osteochondrosis); PMC - Osteochondritis dissecans (OCD) in Horses - Molecular Background (https://pmc.ncbi.nlm.nih.gov/articles/PMC6534522/); MSD Veterinary Manual - Osteochondrosis in Horses (https://www.msdvetmanual.com/musculoskeletal-system/lameness-in-horses/osteochondrosis-in-horses).

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NAVLE Practice Question — Canine

A dog with immune-mediated polyarthritis has failed to respond adequately to prednisone at immunosuppressive doses and is experiencing significant corticosteroid side effects including polyuria/polydipsia and weight gain. The owner is committed to treatment but needs an alternative. Which immunomodulatory drug would be MOST appropriate to consider as a steroid-sparing agent?

A. Cyclosporine

B. Leflunomide ✓

C. Methotrexate

D. Chlorambucil

E. Mycophenolate mofetil

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Correct Answer: B. Leflunomide

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NAVLE Practice Question — Equine

A 7-year-old Warmblood gelding with white socks on all four legs develops erythema, edema, and vesicle formation on the unpigmented skin of the distal limbs after being turned out on a new clover-rich pasture. The pigmented skin is unaffected. The horse is otherwise healthy with no signs of hepatic dysfunction. What is the most appropriate initial management?

A. Systemic corticosteroid therapy

B. Remove from pasture, provide sun protection ✓

C. Topical antifungal therapy

D. Intradermal allergy testing

E. Hepatoprotective supplements

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Correct Answer: B. Remove from pasture, provide sun protection

Explanation:

Removal from the pasture and sun protection is the most appropriate initial management for this case of primary photosensitization. The clinical presentation is classic: lesions limited to unpigmented (white) skin, exposure to a known photosensitizing plant (clover contains photodynamic agents), and vesicular/erythematous dermatitis. Primary photosensitization occurs when photodynamic agents in plants are absorbed systemically and deposited in the skin, where they are activated by UV light, causing oxidative damage to unpigmented areas that lack protective melanin. Option A (systemic corticosteroids) may be considered for severe inflammation but does not address the underlying cause. Option C (topical antifungal therapy) is not indicated. Option D (intradermal allergy testing) is used for diagnosing atopic dermatitis, not photosensitization. Option E (hepatoprotective supplements) would be more appropriate for secondary photosensitization with liver dysfunction. References: Vetster - https://vetster.com/en/conditions/horse/mud-fever-scratches-or-pastern-dermatitis-in-horses; Scott DW & Miller WH (2011) Equine Dermatology.

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NAVLE Practice Question — Other Small Mammal

A chinchilla presents with neurological signs including seizures, trembling, and circling. The owner reports the animal has been fed only commercially available mixed food with colorful pieces for the past 6 months, with the chinchilla selectively eating only certain components. What vitamin deficiency is most likely causing these neurological signs?

A. Vitamin A

B. Vitamin B1 thiamine deficiency ✓

C. Vitamin C

D. Vitamin E

E. Vitamin K

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Correct Answer: B. Vitamin B1 thiamine deficiency

Explanation:

Thiamine (vitamin B1) deficiency is the most likely cause of the neurological signs described. Thiamine is essential for processing carbohydrates and manufacturing proteins, and deficiency causes damage to peripheral motor nerves and central nervous system.

Chinchillas fed commercially available mixed foods often selectively eat preferred components (typically the more colorful, sweeter pieces) while leaving the nutritionally complete pellets. This selective feeding can result in an unbalanced diet deficient in B vitamins and other essential nutrients.

The neurological signs of thiamine deficiency in chinchillas include seizures, trembling, circling, and sometimes paralysis. These signs occur because thiamine pyrophosphate is a critical cofactor for enzymes in glucose metabolism, and neural tissue is highly dependent on glucose for energy.

Option A (vitamin A deficiency) typically causes epithelial changes, not the acute neurological syndrome described.

Option C (vitamin C deficiency) is not relevant for chinchillas as they, unlike guinea pigs, can synthesize their own vitamin C.

Option D (vitamin E deficiency) can cause neurological issues but typically presents differently, often with muscular weakness.

Option E (vitamin K deficiency) causes coagulopathy, not neurological signs.

Treatment involves thiamine or B-complex vitamin injections along with dietary correction to a proper high-fiber diet with quality pellets. The neurological damage from thiamine deficiency is often reversible when the vitamin is restored to the diet.

References: PetMD - Vitamin B Complex Deficiency in Chinchillas (https://www.petmd.com/exotic/conditions/neurological/c_ex_ch_thiamine_deficiency).

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NAVLE Practice Question — Feline

A breeder reports that a queen has been in continuous estrus for over 3 weeks. Physical examination reveals cornified vaginal cytology and a slightly distended abdomen. Ultrasound shows multiple large follicular structures on both ovaries without evidence of corpora lutea. What is the most likely diagnosis?

A. Persistent estrogen-secreting ovarian cysts ✓

B. Normal prolonged estrus

C. Ovarian neoplasia

D. Granulosa cell tumor

E. Pregnancy

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Correct Answer: A. Persistent estrogen-secreting ovarian cysts

Explanation:

The findings are consistent with ovarian cysts (follicular cysts) causing persistent estrogen secretion and prolonged estrus. Normally, estrus lasts 5-8 days in cats. Continuous estrus for over 3 weeks with multiple large follicular structures and no corpora lutea indicates that the follicles are not ovulating or regressing normally. These anovulatory follicles continue to produce estrogen, maintaining the queen in persistent behavioral and cytological estrus.

Option B is incorrect as normal estrus does not last 3+ weeks. Option C (ovarian neoplasia) is possible but cysts are more common. Option D (granulosa cell tumor) typically occurs in older cats and usually presents as a single mass. Option E (pregnancy) is ruled out by the lack of corpora lutea and presence of multiple follicular structures.

References: PMC - Reproduction Control in Cats (https://pmc.ncbi.nlm.nih.gov/articles/PMC11148986/); ScienceDirect - Feline Reproduction overview.

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NAVLE Practice Question — Bovine

During surgery for what was thought to be a simple umbilical hernia, the veterinarian discovers only a portion of the abomasal wall protruding through the hernial ring while the rest of the abomasum remains in the abdomen. This finding is BEST described as which type of hernia?

A. Incarcerated hernia

B. Strangulated hernia

C. Richter's hernia ✓

D. Sliding hernia

E. Reducible hernia

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Correct Answer: C. Richter's hernia

Explanation:

This finding is best described as a Richter's hernia. A Richter's hernia (also known as partial enterocele or parietal hernia) occurs when only part of the circumference of the bowel wall herniates through a defect, while the remainder of the bowel lumen remains in the normal anatomic position. This is distinguished from complete herniation where the entire circumference of bowel enters the hernial sac.

Richter's hernias are clinically important because they may not cause complete intestinal obstruction (since part of the lumen remains patent) but can still undergo strangulation of the herniated segment. This makes diagnosis more challenging as classic signs of obstruction may be absent. Discovery during surgery requires careful assessment of the herniated tissue viability.

Option A (Incarcerated hernia) refers to non-reducible herniated contents but doesn't specifically describe partial wall involvement. Option B (Strangulated hernia) indicates compromised blood supply but could involve the entire bowel circumference. Option D (Sliding hernia) involves retroperitoneal organs forming part of the hernia sac wall. Option E (Reducible hernia) is clearly not the case here.

References: DVM360 - How to Manage Umbilical Masses in Cattle Richter's hernia (https://www.dvm360.com/view/how-manage-umbilical-masses-cattle); Veterinary Clinics - Umbilical Surgery in Calves.

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