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NAVLE Practice Question — Pet Bird

A 10-year-old male Eclectus parrot being managed with clomipramine (1 mg/kg PO BID) for feather destructive behavior calls the owner in 2 weeks. The owner reports the bird is occasionally regurgitating after medication administration and appears mildly drowsy. Physical examination findings are otherwise normal and the bird is eating and maintaining weight. Which of the following is the most appropriate recommendation?

A. Immediately discontinue clomipramine and begin haloperidol

B. Mild regurgitation and drowsiness are expected, transient clomipramine effects. ✓

C. Prescribe metoclopramide to counteract the regurgitation while continuing clomipramine

D. Add fluoxetine concurrently to enhance serotonergic effect

E. Switch to naltrexone at standard avian doses immediately

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Correct Answer: B. Mild regurgitation and drowsiness are expected, transient clomipramine effects.

Explanation:

Clomipramine is a tricyclic antidepressant (TCA) that inhibits serotonin and norepinephrine reuptake with antidopaminergic effects. Reported adverse effects in birds include occasional regurgitation and drowsiness, which are documented in the literature as typically mild and often transient. Since the bird is maintaining weight and is otherwise normal, the owner should be reassured and instructed to monitor closely. The medication should only be discontinued if adverse effects worsen or the bird stops eating. Abrupt discontinuation of TCAs can cause rebound effects.

Option A (immediately switching to haloperidol) is overly aggressive for mild known transient adverse effects. Haloperidol is a reasonable next consideration if clomipramine fails to produce benefit after an adequate trial of 8–12 weeks.

Option C (adding metoclopramide) is not indicated; metoclopramide combined with a TCA could potentially increase CNS adverse effects and is not recommended without stronger indication.

Option D (adding fluoxetine) is contraindicated; combining two serotonergic drugs risks serotonin syndrome, a potentially life-threatening condition.

Option E (switching to naltrexone) is premature; naltrexone has limited evidence in avian medicine and is not a standard second-line agent for early drug side effects. A minimum 8–12 week trial should be completed before concluding the drug is ineffective.

References: ResearchGate - Medication for Behavior Modification in Birds. https://www.researchgate.net/publication/322179048_Medication_for_Behavior_Modification_in_Birds; VIN - Feather Plucking (Lightfoot). https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11131&catId=29212&id=3843995; Hausmann Farris KE et al. J Avian Med Surg. 2025;38(4):202-207. https://pubmed.ncbi.nlm.nih.gov/39772381/

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NAVLE Practice Question — Feline

A 14-year-old cat has a heart base mass identified on echo at the aortic root. Cytology shows neuroendocrine cells. What is the most likely tumor?

A. Hemangiosarcoma

B. Thymoma

C. Chemodectoma ✓

D. Lymphoma

E. Mesothelioma

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Correct Answer: C. Chemodectoma

Explanation:

Chemodectomas (aortic body tumors) are the most common heart base tumor and arise from chemoreceptor cells. They are rare in cats but should be on the differential for heart base masses with neuroendocrine cytology.

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NAVLE Practice Question — Canine

A 7-year-old male neutered Cocker Spaniel is presented for evaluation of chronic regurgitation and weight loss over 3 months. The owner reports the dog extends his head and neck while eating and sometimes gags after meals. A contrast esophagram under fluoroscopy shows gastroesophageal reflux during the study. Endoscopy reveals diffuse esophageal erythema with hyperemia but no ulceration or stricture. Esophageal biopsies show hyperplastic thickening of the basal cell layer with elongation of stromal papillae. Which combination of medications is most appropriate for initial management?

A. Metoclopramide and sucralfate only

B. Omeprazole ✓

C. cisapride

D. and sucralfate

E. Famotidine and prednisone only

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Correct Answer: B. Omeprazole

Explanation:

The combination of omeprazole, cisapride, and sucralfate represents the most comprehensive initial management approach for this dog with confirmed gastroesophageal reflux disease (GERD). This multimodal therapy addresses the condition through three complementary mechanisms.

Omeprazole, a proton pump inhibitor, provides superior gastric acid suppression compared to H2-receptor antagonists, which is essential in cases of documented reflux esophagitis. Cisapride, a prokinetic agent, increases lower esophageal sphincter tone and accelerates gastric emptying, reducing the frequency and duration of reflux episodes. Sucralfate acts as a mucosal protectant, adhering to damaged esophageal tissue and providing a barrier against further acid exposure.

The histopathologic findings of basal cell hyperplasia and stromal papillae elongation are characteristic of chronic reflux-induced esophageal damage and indicate the need for aggressive acid suppression and mucosal protection.

Option A lacks adequate acid suppression (no PPI). Option C (famotidine and prednisone) provides weaker acid suppression and corticosteroids are controversial for stricture prevention. Option D (metronidazole and famotidine) is inappropriate as metronidazole targets bacterial infections, not reflux. Option E (maropitant and omeprazole) lacks the prokinetic and mucosal protective components.

References: Vet Clin Small Anim 51 (2021) - Esophagitis in Cats and Dogs; VCA Animal Hospitals - GERD in Dogs.

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NAVLE Practice Question — Canine

A 13-year-old spayed female Poodle presents with neurologic signs including disorientation and head pressing. Blood glucose measured on a handheld glucometer is 35 mg/dL. Abdominal ultrasound reveals a large hepatic mass. After glucose supplementation stabilizes the patient, what is the most likely mechanism of hypoglycemia associated with hepatic tumors?

A. Decreased hepatic gluconeogenesis from tumor replacement of hepatocytes

B. Tumor production of insulin-like growth factor-2 ✓

C. Direct glucose consumption by rapidly dividing tumor cells

D. Autoimmune destruction of pancreatic beta cells

E. Insulin secretion by neuroendocrine tumor cells

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Correct Answer: B. Tumor production of insulin-like growth factor-2

Explanation:

Tumor production of insulin-like growth factor-2 (IGF-2) is the most likely mechanism of hypoglycemia associated with hepatic tumors in dogs. This paraneoplastic syndrome, often called non-islet cell tumor hypoglycemia, has been documented in association with both hepatocellular carcinoma and hepatocellular adenoma in dogs. It is also associated with mesenchymal tumors in humans and other species.

IGF-2 is structurally similar to insulin and can bind to insulin receptors, causing increased glucose uptake by peripheral tissues. Large tumors may produce sufficient quantities of IGF-2 to cause clinically significant hypoglycemia. Unlike insulinoma-associated hypoglycemia, serum insulin levels are typically low or low-normal in affected patients because the tumor-derived IGF-2 suppresses endogenous insulin secretion while simultaneously promoting glucose uptake.

The neurologic signs of disorientation and head pressing in this patient are consistent with neuroglycopenia, as the brain is highly dependent on glucose as an energy source. Immediate treatment with intravenous dextrose is essential, followed by frequent small meals and consideration of glucocorticoid therapy to promote gluconeogenesis. Definitive treatment requires surgical excision of the tumor if possible.

Option A (decreased gluconeogenesis) can contribute but is not the primary mechanism unless massive tumor replacement occurs. Option C (direct glucose consumption) contributes minimally to hypoglycemia. Option D (autoimmune beta cell destruction) would cause hyperglycemia from insulin deficiency, not hypoglycemia. Option E (insulin secretion by neuroendocrine tumor) describes insulinoma, which arises from pancreatic islet cells, not hepatocytes.

References: Leifer CE et al. JAVMA 1985;186:53-55; Bailey MQ. Vet Clin North Am Small Anim Pract 2020.

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NAVLE Practice Question — Porcine

During investigation of vesicular disease outbreak on a pig farm, the veterinarian observes that some young pigs that recently died have pale, streaky cardiac lesions visible on cut section of the myocardium. These mottled areas give the heart a striped appearance. No vesicular lesions were observed on these particular piglets before death. Based on this finding, which vesicular disease is MOST likely responsible for this outbreak?

A. Swine vesicular disease ✓

B. Senecavirus A infection

C. Foot-and-mouth disease

D. Vesicular stomatitis

E. Vesicular exanthema of swine

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Correct Answer: A. Swine vesicular disease

Explanation:

Foot-and-mouth disease is most likely responsible for this outbreak based on the presence of tiger heart lesions in young pigs. The mottled, streaky myocardial lesions described are pathognomonic for FMD-associated viral myocarditis in young animals. These lesions occur due to FMD virus replication in cardiac myocytes, causing acute myocardial necrosis.

The pale, streaky appearance results from multifocal areas of myocardial degeneration and necrosis alternating with normal tissue, creating the characteristic striped or mottled pattern sometimes called tiger heart. This is an important diagnostic finding because affected young animals may die suddenly from cardiac failure, sometimes before developing visible vesicular lesions on the feet or mouth.

High mortality in neonatal and young pigs with myocardial involvement is a hallmark of FMD that distinguishes it from other vesicular diseases. While all vesicular diseases cause similar external lesions, the internal pathology differs significantly.

Option A (Senecavirus A) causes neonatal mortality but through different mechanisms without the characteristic tiger heart lesions.

Option B (swine vesicular disease) is typically a mild disease that does not cause myocarditis or sudden death.

Option D (vesicular stomatitis) does not cause cardiac lesions or mortality.

Option E (vesicular exanthema) similarly does not involve cardiac pathology.

IMAGE SOURCE: CFSPH Iowa State - FMD Tiger Heart description (https://www.cfsph.iastate.edu/Factsheets/pdfs/foot_and_mouth_disease.pdf)

References: Iowa State Swine Disease Manual - FMD (https://webhost-dev.cvm.iastate.edu/swine-disease-manual/index-of-diseases/foot-and-mouth-disease-fmd/); WOAH - FMD Disease Card (https://www.woah.org/en/disease/foot-and-mouth-disease/)

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