The North American Veterinary Licensing Exam (NAVLE exam) is a comprehensive and challenging assessment for men and women who wish to enter this rewarding and fast-growing field of animal health care. The test was developed by the National Board of Veterinary Medical Examiners in consultation with a team of expert exam administrators.
The test consists of 360 multiple-choice questions and is administered twice a year by computer. Sixty of the questions are pretest questions, which are used to develop future versions of the exam. These questions, impossible to identify, do not contribute to the final score.
The NAVLE can be broken down into three activities: data gathering and interpretation (140 questions, 47 percent of the exam); health maintenance and problem management (140 items, 47 percent); and professional behavior, communication, and practice management (20 items, 7 percent). The data gathering and interpretation domain requires knowledge on how to obtain a history, perform a physical examination, and evaluate the environment (56 items, 19 percent); develop a problem list and a differential diagnosis list (42 items, 14 percent); and establish an accurate working or final diagnosis or conclusion (42 items, 14 percent). The section on health maintenance and problem management tests knowledge of how to identify and evaluate prevention, treatment, and management options (56 items, 19 percent of the exam); how to implement a plan of action (42 items, 14 percent); and how to assess outcomes (42 items, 14 percent).
Another way to break down the content of the NAVLE is by animal species: canine (72 items, 24 percent of the exam); feline (72 items, 24 percent); pet birds (9 items, 3 percent); other small animals (6 items, 2 percent); bovine (51 items, 17 percent); porcine (12 items, 4 percent); ovine/caprine/cervidae (9 items, 3 percent); equine (51 items, 17 percent); and poultry (6 items, 2 percent). There are also nine questions related to public health and food security (3 percent of the exam) and three non-species specific questions (1 percent).
Exam scores are sent directly to the licensing authority, which in turn reports them to candidates. Test takers who fail the NAVLE exam will receive a detailed report indicating the areas in which they need improvement.
NAVLE Exam Practice Questions
1. An 8-year-old thoroughbred mare is evaluated for a 1-year history of infertility and atypical aggressive behavior. Physical exam findings are normal except for an enlarged ovary discovered on rectal palpation. Ultrasonography demonstrates a multiloculated appearance of the enlarged ovary. Which of the following assays, when elevated, is the most consistent indicator of the presumptive diagnosis?
2. A 4-year-old ferret presents with weakness, depression, lethargy, ptyalism, and posterior paresis. The owner indicates that these symptoms usually occur every morning before feeding and typically become less pronounced after the patient eats. As of late, the symptoms have become more severe and prolonged. Which of the following is the most likely diagnosis?
a. Adrenal cortical neoplasia
e. Pancreatic exocrine adenocarcinoma
3. A distressed and vocalizing 7-year-old domestic shorthair cat is evaluated for acute bilateral hind-limb paralysis. On physical examination, a grade 3/6 left-sided systolic murmur is auscultated. The patient’s femoral pulses are absent and the footpads are cold and pale. There is also painful contracture of the gastrocnemius and quadriceps muscles. Which of the following conditions is the most likely diagnosis?
a. Intervertebral disc disease
b. Fibrocartilaginous infarct
c. Arterial thromboembolism
d. Spinal cord neoplasia
e. Viral myelitis
4. Which of the following is the most common cause of exophthalmos in cattle?
b. Extracranial meningioma
c. Retrobulbar lymphosarcoma
e. Orbital arteriovenous fistula
5. An 8-year-old Labrador Retriever is evaluated for progressive foreleg lameness of approximately 2 months’ duration. On physical examination, there is marked soft tissue swelling involving the carpus, and palpation of this area produces significant pain. Radiographs of the affected area demonstrate severe lysis of the distal radius with erosion of cortical bone. A needle biopsy displays osteoblasts with frequent mitotic figures, eccentric nuclei, and deeply basophilic cytoplasm. If amputation is elected by the owner, what is the most appropriate pharmacotherapy following the procedure?
1. E: Inhibin. The presumptive diagnosis in this case is granulosa cell tumor (GCT), which represents the most common neoplasia of the reproductive tract in mares. Mares with granulosa cell tumors may have elevated serum concentrations of estrogen, testosterone, and/or inhibin; however, inhibin is the hormone that is most consistently and reliably increased in affected mares, and is therefore a more reliable indicator of the disease. Inhibin is a hormone that may be produced by granulosa cell tumors and acts to suppress follicle-stimulating hormone (FSH) secretion by the anterior pituitary. As a result of this negative feedback, follicular growth of the contralateral ovary is severely decreased, with a resultant decrease in size.
2. B: Insulinoma. Insulinomas are the most common tumors in ferrets between 3 and 5 years of age. They are insulin-secreting beta-cell tumors that produce insulin, and thus, create clinical signs associated with hypoglycemia (ie. depression, collapse, seizures, lethargy, ptyalism, and paresis). The symptoms may be exacerbated following periods of glucose consumption or depletion, as seen with exercise or overnight fasting. Diagnosis is a blood glucose level of less than 60 mg/dL and an insulin level of greater than 250 pmol/L.
3. C: Arterial thromboembolism. Thrombus formation within the left heart with resultant systemic embolization at the aortic trifurcation is a serious and common sequela of myocardial disease in the cat. Clot formation within the left heart is ameliorated by decreased blood flow and endothelial damage associated with cardiac disease. When an embolus becomes loose and is transported into the systemic circulation, it will commonly occlude the distal aortic trifurcation and produce symptoms such as intense vocalization (pain), paralysis or paresis, absent femoral pulses, and cold extremities. Medical management involves treating the underlying heart disease, providing exercise restriction, and administering low-dose aspirin every 3 days.
4. C: Retrobulbar lymphosarcoma. Lymphosarcoma that invades the retrobulbar tissues is the most common cause of exophthalmos in cattle and usually carries an extremely poor prognosis because affected cattle usually live less than a year after diagnosis. Other physical exam findings may include lymphadenopathy or melena due to diffuse spread of the neoplasia.
5. E: Cisplatin. Based on the history and diagnostic findings of this patient, the presumptive diagnosis is osteosarcoma of the distal radius, which represents the most common bone neoplasia in large breed dogs. Once diagnosed, the treatment of choice is amputation of the affected limb followed by chemotherapy with the drug cisplatin, which usually affords a survival rate of little over a year.