Steven I McLaughlin DVM, MPH, DACVPM
20 minutes


So here's the structure of the NAVLE®. This is 360 question multiple choice test. Takes all day, OK? You take the questions 60 at a time and they give you 65 minutes on average. That's like a minute per question. If you want to spend 45 precious minutes on one chicken question, you can do that, but I would not recommend it. Somewhere between 10 and 20 percent of all the questions on your NAVLE® the day you take it wILl have pictures on them. On average, about 15 percent. In Zuku, over a third of all of our questions have images, and all of our expert presentations have lots of images in them because it helps, you remember. In fact, even if you later see a question like that poodle where there's no picture, if you've earlier studied that disease and you saw a picture of it, the picture is the thing that will come up in your head. So if you use images when you study, it'll help you when you take the test. Be aware 60 questions they throw at you that day, they don't even count. OK, those are being validated for later NAVLE®'s. You will not know which ones they are. They are randomly scattered throughout the day. OK. Just answer every question as best you can, and then they're going to grade you on 300.


We have a question from the boards. "How do you prep for this if you are a slower reader?" I would actually kind of encourage everybody to read a little more deliberately anyway, because it's easy to mess up by missing a detail. If you are somebody who has gotten accommodations in school to take tests, to get more time, or to have a silent room or something like that, you can also get accommodations for the NAVLE®. You just have to make sure once you have you been approved to take the NAVLE®, you immediately follow up with the board and you request an accommodation, and typically you just have to show some documentation that you have a particular issue. OK? That's a great question, by the way.


Breaks. When you show up at the testing center, you have 45 minutes of break time. You can use it however you want little time, all at once. But by the time most people get to their NAVLE®, you guys are like just taking ninjas and most people can knock out 60 questions in less than 65 minutes. They'll take any minutes you didn't use and they add it to your available break time. You will have great time. Take breaks. Studies of decision fatigue show very clearly that the more tired we get, the worse we are at making good decisions. If you try to complete all six blocks in a row with no breaks, you will do worse. You're not helping yourself, and it's not a race. OK? Just be aware when you start a block of 60 questions, that is not the time to raise your hand and say, I got to go tinkle. OK? You do that stuff in between blocks. Now sometimes people ask me, they say, "Well, what if I have, you know, like an emergency?" And I say, Well, you know, yeah, if you have like a physical type issue in the middle of a test and you have to take a break, yes, you can stop the clock, but do not do it lightly. All right.


So I told you, I tell you some of the stories from the boards over the years. Here's the first one. One year guy called us up and he's like, "Geez, Doc, man, I had a really bad day on my test." I'm like, Well, what happened? It's like, "Well, I had food poisoning, and I threw up on my keyboard in the middle of my NAVLE®." So they let him take a break, right? And I'm hearing this. I'm thinking, OK, it's bad enough that you're the guy throwing up on your keyboard in the middle of your boards, right? What if you're the person sitting next to the guy who's throwing up on his keyboard, I'd be like, "Oh my God!! This is going to be a really hard test!" Anyway, that that happened. But that's an example of you don't stop the test lightly. Yes, you can if you feel sick, for sure, but don't do it lightly.


So here's a fun pop quiz for everybody. On a letter grade scale A, B, C or D, what letter grade do you need to pass your NAVLE®? A, B, C or D, just tell me and chat, everybody. Yes, correct. C. C equals DVM, everybody.  So, yeah, C's get degrees, all right. You only need a C to pass your boards, that basically means you need roughly 70 percent right of the questions that count.


Here's a wonderful take home message right here. Everybody over three quarters of all the points that count are in only four species dog, cat, cow and horse. So if you will pardon a foul pun, you can wing get on chickens, you're going to be OK, but you cannot wing it on the big four. If you get enough right in the big four, it doesn't matter what happens down here. OK, now I'm not suggesting don't study down here because there's lots of ways to pick up some nice points. All right? But this is where the heavy lifting happens. All right? Now down here we have what I call left field topics, things where there might only be two questions or three questions; ethics, llamas, deer, reptiles. I think these are your friend, they freak people out, but they're your friend because you just studied the biggest of the biggest of the things, and that's likely what's going to be on your boards.


I'm a former public health epidemiologist everybody, what deer disease do you think everybody is most worried about and really matters? There's only one. Yes. Chronic wasting, right, chronic wasting, for sure. Do they get other things? Yeah, absolutely they get other things. They get tuberculosis, they get brucellosis to get bluetongue, malignant catarrh, all you name it. But man, if you see the word "deer" on your NAVLE®, I would at least consider that chronic wasting could be one of the diseases. You know, llamas, two or three questions that count unless you really, really like llamas, I wouldn't study them very much. My personal favorite llama disease berserk male syndrome. Poorly socialized males causing trouble. Who's ever heard of that? That's a real thing, by the way.


Aquatics NAVLE®. We just added aquaculture and fish stuff to the NAVLE®'s. So now we have that in Zuku. I think this is primarily because, you know, farm to food fish is such a big thing nowadays. We've all probably had farmed mussels, farmed salmon and things like that. So, you know, learn a few big ones, call it good, and that's the way you play the game.


Let's see. I saw a question before I go too much further. I think somebody has something about do later tests, ah, "is there data showing that later blocks scored lower anyway, even with breaks." I've never seen any data about relative scores on one block versus another. I doubt it exists because in the 360 they throw at you you, it's completely randomized. So that even if you're taking the same test as the person sitting next to you, it's different questions in different blocks, but it's the same basic group of questions, so I don't think there's any difference.


Here's pass rates most recent that are available senior students like you from accredited schools. The most recent data is that first attempt pass rates are 89 percent. It's been going down over the years, but that's still roughly nine out of 10. The pass rate for Zuku for people who complete the material - emphasis on "they completed the material", which means they did 80 percent of the questions, is 98 plus percent. OK? Just don't look at these high pass rates and go Heck, man. Why study? I mean, he looks confident, doesn't he? Yes, that's a dental student. I mean, i'll respect the dental students. The reason people pass is because they prepare and in a minute, I think I'm going to try to, I think I'm going to be able to give you a good reason to prepare effectively for your boards, which has something motivating to do with it, which isn't just to have this horrible hurdle.


I won't belabor these points, but this is just to say testing centers, it's a little bit rigid when you show up. Less people can take tests at a time on any given day right now because of COVID and because of COVID sometimes testing centers have had to close because somebody showed up that coughed, had symptoms. So just be aware you may have to be flexible on when you take your test. OK?


So, what are NAVLE®'s format questions really like? Well, first of all, I've mentioned already, you can expect to see lots of what we call "leap" questions. These are what I call second and third order questions where they give you a case, they show some findings, and then they make a leap and they say, "What do you do next? What test would you do? What do you tell the owner?" OK? And in Zuku, we have a lot of these. We work hard to make our questions as much like the NAVLE® as possible. Second, kind of hand in hand, you can expect to see some long questions where they'll give you lots of information, just like real life and only some of it's actually relevant to what's going on. Another way questions get long is offering clin path information, and we've added a thing recently this year where you get to see clin path results just like in the real world. This could feel intimidating at first, but it's really, really useful because we use I mean, we use clin path every day, you know, any day in practice, you're probably going to be looking at some CBCs and panels and UA's. It's super useful to raise your comfort level with these. And then finally, yeah, you'll see some leftfield topics. OK?


So here's an example. This will be another pole question. This is a third order leap question. We have a four year old standardbred gelding. Horse is presented with a four week history of exercise intolerance and recent history of pulling up abruptly in a race, so they kind of slow down in the middle of the race. There's an irregularly irregular heart rhythm that's audible during a physical after, and an echo doesn't show any physical abnormalities of the heart. Here's TPR and you know, looking at it, looking at it, looking at it, but basically normal. Here's an ECG and you're starting to sweat because you're like, Oh my God, I don't really read these things very well. But. Hmm. Well, I mean, I'd be a cardiologist, but this does not look right to me. Then you say double hmm, I may not be a horse expert, but I do vaguely remember there is that one big arrhythmia in horses. I think this might be it. I think some people might have told me already in chat, does anybody want to take a stab what they think this is? What do you guys think this might be, this is THE big arrhythmia in horses? Yeah, Li correct, Alison. Very good. Very good. OK. So this is this arrhythmia is atrial fibrillation. Guess what? That's not your question. OK, here's your question. The boards will ask you something else, like what is the correct prognosis for conversion to sinus rhythm and return to racing function in this horse? OK, so they're not telling you that it's a fib, I gave you that hint, but you're looking at this and you're expected to roughly get in the ballpark of a fib or some sort of arrhythmia. And what they're asking is what's the prognosis for going back to a normal rhythm with treatment and racing again? Here's a clue. If you get a prognosis question on a multiple choice test, prognosis tends to be either really good or really bad. So if you have no idea whatsoever, just pick one end of the spectrum either good or bad, and you've just narrowed it down to 50-50 and you just increase your odds of getting it right with a guess to 50-50. Now you guys tell me you go to Las Vegas, what odds you want to bet on. One out of two or one out of five. You want one out of two, don't you? So if you don't know, narrow it down to two, take what we call in the adult education field a wild guess and move on. OK. If you don't know and you see a prognosis question, remember it's tends to be really good or really bad. OK, guys, a couple more seconds. So I'm going to close this down. Yeah, just guess, it's OK. Get those guesses in. A couple more and three, two one. OK, here's your results. The majority of people said there was a good prognosis, which is in fact correct. OK, if you picked grave, OK, you narrowed it down to two. You took a wild guess you might have missed it, but I bet you don't miss it next time. The whole value of doing practice questions is the ones you missed, they sting a little bit, and in Zuku, the ones you miss, get recycled back at you again later randomly until you get them right. That way, the missed questions reinforce. So in a way, missing questions and feeling that sting, that's the value. That's why we call it practice testing. Just like when you do yoga, you're doing practice. Nobody expects you to get 100 the first time or even the second time. We're just trying to get better. OK? By the way, then when you get right by accident, those are less helpful. All right? So it's good prognosis. If a horse has been symptomatic with a fibr for less than four months. Prognosis is good to convert them back to normal rhythm, and they can race again. I mean, a few of those horses will still go back and have a fib later, but that's basically what you do. Good job, everybody.


All right. Here's another example of a question this is a long question. Nine year old female spayed cat presents with a two month history of weight loss, polyuria, polydipsia, and polyphagia. Cat seems to be BAR and happy, basically healthy. About to show you some lab work, and then you see this question what treatment do you do? And you're like, Oh my God, I don't even know what it is, OK, don't panic. Remember how I said, Let's get in the ballpark first before we look at the blood work. So, get in the ballpark. I see a chronic history here, eating a lot and losing weight. Now we all know what that probably is, but, hand in hand with eating a lot and losing weight, I see polyuria, polydipsia.  So how am I going to get eating, losing weight and PUPD in one diagnosis? So there's two biggies on the differential here. What are the two big diseases we're thinking up here? Diabetes, for sure. Hypothyroid, for sure. Good job, good job, everybody. So, yeah, hypothyroid for sure. But hyperthyroid, I don't think of PUPD too much. So it's on my diff. But you know, I would certainly think of of diabetes. And I'd also think of maybe third on the list might be renal something or other. You might say hungry tumor, but usually they're sicker. Who knows? But basically diabetes, hypothyroid, maybe renal. So let's now look at the blood work, and you look at that and your eyes roll back in your head and you're like, Oh my God, where do I start? OK, well, let's think about it. Thyroid. No, he's not really hypothyroid. OK, renal? No BUN looks OK. Creatinine looks OK. All right. What about diabetes? Whoa, my goodness. Look at that. That is a very high blood sugar, and it's probably too high to be stress induced. And even if it's not a fasting glucose, it's still too darn high. And if you wanted the icing on the cake, pardon my pun, I see sugar in the urine. So, sugar in the urine, high, high blood sugar, fasting or not. We're looking at a diabetic. This is a happy diabetic, right? He's BAR. He's just lose a little weight. What are we going to do? He's not acidotic. He's not ketotic. Here's your options. It's a multiple choice test, remember? Now, maybe you don't know much about diabetes. No problem. Cross out the choices you don't like, which you can do in Zuku, you can hide them and then pick the ones you like. Is he getting methimazole? No, because we know he's not hypothyroid, right? Is he getting a renal diet, nah, because his kidneys are OK? So we're not going to use that. Is he getting antibiotics? Probably not. Not obvious, no to that. So it's either this one or this one, it's the last one. Whoopsie. Sorry, sorry. I guess I thought there was a little highlighter there. You give him a low carb, high protein diet. Get him on some insulin. Often these cats will eventually go to remission, and you don't even need insulin anymore. And I've actually got a cat like that. We got him through DKA, put him on insulin and the right diet, and after a month, he stopped needing insulin. He's like, He's freaking immortal. He's like, I've had him for three or four more years since then.


OK, here's a leftfield question. I picked deer on purpose, because I don't think anybody will know this unless you get the Zuku question of the day. Client who raises North American farm dear asks you to remove the entire soft antler of several animals during the first two months of growth. This is a practice called velveting. Here's the velvet. This is this vascular tissue on the living horn. And so here's your question the way the NAVLE® he might want to ask it, OK? The question is, "what should you tell the client?" Now, if you know what, you're going to know it, but if you don't know it, OK, then remember what I said. Cross out the choices you don't like the look of and take a guess. All right. But the real key to questions where you don't know the answer is to quick and dirty, just admit, you know, I do not know this. I'm not going to sweat this too much. I do know something so I'm going to cross out the choices. I don't like the look of narrow it down and take a guess. And as I said earlier, you can cross stuff out and Zuku and hide it and then just pick from what's left. Now you might still miss this one question, OK? But over 360 questions, if you do this habit of guessing strategically consistently, you will get more questions, right.  You'd be amazed how many people we consult with every year who just barely missed passing them NAVLE® by like four or five questions. If you do this consistently, you will get four or five more questions, correct just by random chance alone, because 50/50 is better than one out of five. OK? Even more important, you didn't waste time, you didn't freak out, and you move on to the next question, and for all I know, that question is about hamsters and you are the world expert on hamster medicine. OK? So get your last choices in here, guys. Just take a guess. The whole point of this was that you weren't supposed to know the answer. A couple more seconds than I'll close it. Three. Two. One. Get it in and OK, here's the results, so kind of all over the map here, but the short answer is, in fact, AVMA says you can perform this procedure in the United States, and Canada concurs, with proper analgesia. If you do it humanely, it's permissible here. Basically, there's a an Asian market for this stuff. If you do it humanely, it's fine for the animal. There are a few countries that don't permit it. I think Australia might be one. But basically, what I hope to happen here is, if you guessed you didn't waste time or stress out, you just gave it your best shot and move on. OK.