Author: Steven McLaughlin

Dr. Mclaughlin is a graduate of Cornell School of Vet med, class of 91. He did mixed practice in northern NY on the shores of lake Ontario and in the high Andes as a Peace Corps volunteer in Ecuador, where he worked with campesino farmers and learned how not to ride a horse. As an epidemiologist “disease detective” for the U.S. Centers for Disease Control, Dr. Mclaughlin worked for 9 years on public health problems ranging from tuberculosis in prison inmates to polio in Nepal, elephantiasis in Haiti and Japanese encephalitis in China and India. His lifelong interest in teaching and effective learning models led him to start the Zuku Review in 2007.

Fast, Available, Decisive: Your Rule for Third-Order NAVLE® Questions

Posted on by Steven McLaughlin

Third-order NAVLE® questions follow a pattern: they ask you to make a mental leap, using information in front of you.

These questions start with a clinical case: i.e.: “You are presented with a 9 y/o female spayed DSH cat with a 2-month history of polyuria, polydipsia, increased appetite, and weight loss.” More information is usually provided, like additional history or bloodwork to interpret, but the question itself is some form of “What do you do NEXT?” It might be:

  • “What diagnostic tests do you want to order?”
  • “What is your treatment plan?”
  • “What do you tell the owner?”
  • “What is the prognosis?”

Why Third-Order Questions Feel Difficult

The bad news: These questions require more than simple recall

The good news: They ask us to think exactly the way vets do in clinical scenarios. So, the more you practice with these types of questions, the more you develop your critical thinking skills.

  • Process complex case information quickly
  • Form a short differential diagnosis list
  • Choose confirmatory diagnostics for the top differentials
  • Make a treatment plan
  • Prioritize/triage the next steps

The following classic case examples will walk you through answering third-order questions for NAVLE® success.

Example 1: Gastric Dilition/Volvulus (GDV)

A giant-breed dog presents with acute, non-productive retching, abdominal distension, and signs of shock. This signalment and clinical signs push GDV to the top of the differential list.

GDV is an acute, life-threatening condition in large and giant breeds that requires immediate intervention. Vets usually need to place a large-bore IV catheter to initiate stabilization with IV fluids FIRST.

So, what confirms the diagnosis? Abdominal radiographs, especially a right lateral view, often provide decisive evidence, including the classic compartmentalized gas pattern (a.k.a. “double bubble”). Use lab work (PCV, lactate, electrolytes) and ECG to prognosticate and guide IV fluid therapy, but not to confirm the diagnosis.

Your mindset for the NAVLE®:

  • Pick the fast, clinic-available confirmatory step: radiographs, not CT
  • Avoid jumping straight to exploratory surgery unless the question forces that choice by offering no other appropriate options

Once GDV is confirmed, stabilize aggressively with urgent medical (e.g., decompression, analgesia) and surgical (e.g., derotation and gastropexy +/- resection or splenectomy) management.

Example 2: Laminitis

An obese adult horse in spring presents with a short-strided gait, reluctance to turn, bounding digital pulses, and pain at the toe with hoof testers. This pattern fits laminitis.

Laminitis is inflammation of the hoof laminae that can cause separation/rotation of the third phalanx with respect to the hoof wall. The endocrinopathic etiology is most common and this signalment and presentation are classic.

On the NAVLE®, the confirmatory step often involves imaging or localization strategy (e.g., an abaxial nerve block). Radiographs of the feet help confirm by evaluating the distal phalanx position (is there rotation or sinking?) and guiding management including hoof trimming/support options.

The “Confirmatory Step” Rule

When a NAVLE® question assesses a classic condition, use this rule:

Choose the test that is:

  • Fast
  • Widely available
  • Decisive for the diagnosis or prognosis

That’s why radiographs beat CT in GDV and laminitis questions. You don’t always (or even often) need to choose the high-tech modalities; you simply need disciplined test-taking.

Fast, Available, Decisive: Your NAVLE® Decision Rule

Third-order NAVLE® questions reward clinical realism and practical decision-making. When you recognize a classic presentation, choose the fastest, most available test that confirms your diagnosis, and avoid unnecessary detours to protect both your time and confidence.

If the question is about treatment, favor options that are pragmatic, established, and accepted in clinical practice…not cutting edge, ultra-specialized, or unproven. This approach reduces second-guessing, keeps you moving through the exam, and mirrors how competent clinicians practice.

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Choanal vs. Cloacal Swabs in Birds: How to Choose the Right Sample on NAVLE®

Posted on by Steven McLaughlin

NAVLE® poultry questions rarely ask for the “ideal” diagnostic sample. They ask for the most practical and appropriate choice based on clinical signs, transmission route, biosecurity, and real-world practice.

What Each Swab Samples

Choanal Swab (Choanal Slit)

The choanal slit sits on the roof of the oral cavity and connects the nasal passages to the oral cavity and pharynx. A choanal swab targets upper respiratory secretions and organisms that colonize the choana, sinuses, and trachea.

The choanal cleft and trachea are among the most useful sites for confirming respiratory pathogens like Mycoplasma gallisepticum via culture or PCR.

Cloacal Swab

A cloacal swab targets the combined gastrointestinal/urogenital outlet and captures organisms shed in urine, feces, and genital secretions. Many multisystemic pathogens are shed through the GI tract, making this a handy sampling location.

For example, laboratories can isolate enteric pathogens (e.g., Salmonella spp. or E. coli) or pathogens that affect multiple systems (e.g., avian influenza, viruses, Newcastle disease virus) from cloacal swabs from domestic and wild birds.

How NAVLE® Tests this Decision

The NAVLE® often provides a classic flock-level scenario and then asks for the “best sample” for PCR/culture. Use this quick rule:

  • Respiratory clinical signs → choanal (or oropharyngeal/tracheal)
  • Diarrhea or waterfowl risk → cloacal
  • High-consequence outbreaks (e.g., avian influenza, exotic Newcastle disease virus) → collect both (when an option exists)

You do not need to memorize every organism’s shedding pattern to apply this rule.

When to Choose Choanal Swabs

Respiratory Disease Workups

If the vignette emphasizes respiratory effort, nasal/ocular discharge, sinus swelling, or rales, think “upper airway”.

Confirm M. gallisepticum infection using PCR on swabs taken from sites including the choanal cleft and trachea. While culture is also possible, the fastidious nature of Mycoplasma make molecular diagnostics the better choice.

Choose choanal (or choanal + tracheal) over cloacal when the case centers on respiratory disease.

Chlamydiosis-Style “Mixed System” Case

Some agents shed intermittently and affect multiple systems. For avian chlamydiosis in individual birds, the preferred samples for culture or PCR include conjunctival, choanal, and cloacal swabs.

When answer choices include a “collect multiple swabs” option (choanal + cloacal, sometimes with conjunctival), that option often wins.

When to Choose Cloacal Swabs

Waterfowl-Heavy Risk or GI Shedding Emphasis

When the prompt highlights duck, geese, ponds, pasture access, or fecal contamination, you should consider GI shedding.

For example, use of cloacal swab is appropriate for enteric pathogens such as salmonellosis (a.k.a fowl typhoid).

If the question focused on surveillance, waterfowl, or fecal shedding, choose cloacal (or “oropharyngeal + cloacal” if offered).

When “Both” Becomes the Best Answer

Some questions allude to taking more than one sample. You’ll notice this pattern when:

  • The block shows high morbidity/mortality
  • The differentials include a high-consequence reportable disease
  • The prompt mentions PCR, state lab, or regulatory response
  • The answer choices include both oropharyngeal/choanal and cloacal swabs

For avian influenza, for example, sample from both respiratory and GI routes (oropharyngeal and cloacal swabs) for virus isolation and/or PCR.

If the question gives you the option to “collect both”, take it, especially when the vignette implies an outbreak.

Practical Swab Tips Overlooked by NAVLE® Candidates

  • Match the sample to the question’s test. PCR requires a good organism load. Culture calls for good handling of an easy-to-grow bacteria, the right transport media, and quick submission.
  • First, think about where the organism lives. Respiratory pathogens colonize respiratory epithelium, enteric pathogens are shed in feces, and mixed agents may require multiple sites.
  • Don’t overthink “choanal vs. oropharyngeal.” Many NAVLE® items treat these as the same idea: a practical upper-respiratory sample.

Think Transmission First, Then Swab

Choosing between choanal and cloacal swabs comes down to one question: Where is the pathogen most likely shedding? When you anchor your decision to transmission route and clinical presentation, poultry diagnostics stop feeling ambiguous.

This simple framework lets you move quickly, avoid second-guessing, and select the answer the NAVLE® is designed to reward—clear, practical, and grounded in real veterinary decision-making.

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The Productivity Trap: Why More Studying Can Hurt Your NAVLE® Score

Posted on by Steven McLaughlin

NAVLE® prep sometimes feels like a contest of who can study harder. This mindset leads to lower performance and burnout.

You don’t pass by studying harder or longer every day. You pass by showing up consistently with enough energy and focus to think clearly for an all-day exam.

More Hours Doesn’t Always Mean Better Results

The NAVLE® assesses knowledge, but it also tests stamina. If you study until you feel depleted, you’re training your brain to work in a fatigued state. That fatigue shows up as slower reading, second-guessing, and careless mistakes.

When it comes to test prep, a steady routine outperforms study sprints.

Sleep: Your Most Underrated Study Tool

It is impossible to cram for an exam that tests the full scope of your training. When you sacrifice sleep for late-night cramming, you show up tired – and exhaustion will cost you more points than forgetting a few facts.

Protect your sleep, especially in the final stretch leading up to test day. Sleep supports clear thinking, emotional control, and consistency, which are the skills that will keep you calm and focused throughout a difficult block of questions.

Movement: Reduce Stress and Improve Focus

Daily movement helps you cope with stress and improves your ability to sit and focus without crashing. You don’t need a perfect fitness plan; you simply need an exercise activity you’re motivated to do.

To mix movement into your next study session, try:

  • Taking a brisk walk after a question block
  • A short lifting workout before starting your studies
  • Stretching between timed sets

Make it sustainable and enjoyable. Consistency wins.

Breaks: Train for a Marathon, Not a Sprint

Your brain needs recovery time to keep accuracy high. Structure your study time accordingly:

  • Study in blocks
  • Take short breaks (≤ 10 minutes) every 40-50 minutes
  • Take a longer reset (≤ 1 hour) halfway through your study day

When you treat NAVLE® prep like a marathon, you build endurance and protect motivation.

Focused vs. Diffuse Thinking

Focused thinking is active studying: answering questions, reviewing missed questions, and quizzing yourself. This might also include reviewing digital flashcards or completing a timed test.

Diffuse thinking happens when you step away: walking, showering, driving, or doing something relaxing. Diffuse time helps you make creative connections without forcing them.

Schedule time for both focused and diffuse thinking. When you only grind, you run the risk of getting stuck and burning out. When you alternate focus with recovery, you learn faster, remember more, and feel better.

Study Smarter to Stay Steady on Exam Day

Passing the NAVLE® is about protecting your energy so you can think clearly and critically for 7-8 demanding hours. Consistent sleep, regular physical activity, planned breaks, and repeatable routines keep your accuracy high when it matters most. When you train your brain in a rested, focused state, you reduce careless errors, manage stress better, and stay steady through difficult question blocks.

Show up prepared, not depleted, to give yourself the best chance to pass with confidence.

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No Zebras: How to Triage your NAVLE® Study for Maximum Points

Posted on by Steven McLaughlin

Don’t go chasing Zebras. The NAVLE® rewards candidates for recognizing common presentations, choosing practical diagnostics, and outlining reasonable treatment plans, the same skills new grads use on day one.

The Exam Focuses on Big, Common Problems

Examiners pull diagnoses from real-world caseloads. Bread-and-butter conditions like diabetes, LDA, parvovirus, and colic appear on the exam far more than rare curiosities. Focusing study time on high-yield problems is much more valuable than low-yield topics.

The 80/20 of Species: Where the Points Really Are

About three-quarters of scored questions come from just four species: dogs, cat, horse, and cow. Strong performance in these categories can carry your exam performance. After that, invest smartly: pigs deliver a solid return on study investment, and similarly, be sure to brush up on poultry and small ruminants concepts. You do not need to aim for 100%, you’re instead aiming to pass confidently.

What to Know for Each Disease (The Rule of Three)

Use this expert study tip for high-yield conditions.

Fold a sheet of paper in half, write the disease on top, and then list three essentials at the bottom:

  1. Classic case: signalment + typical history + key PE clues
  2. Diagnostic test of choice: practical, available, confirms or strongly supports
  3. Treatment plan: first-line therapy + key cautions
  4. If there’s space left on your page, add prevention for farm animal topics

Build an Active Study Loop (Not Passive Reading)

  • Create your own notes: brief, legible, image-anchored
  • Close the notes and quiz yourself, out loud or on paper
  • Use spaced retrieval: review concept again in 2-3 days, then weekly
  • Mix timed question sets with case prompts: “What test confirms?”, “What’s your first treatment?”

This type of study trains the same cognition the exam demands.

Structure Your Study for Success

Try this simple allocation that keeps momentum:

  • Spend about 2/3 of study time on practice testing (timed + review) based on your high-yield lists
  • Focus about 1/3 of study time on independent, active note-making for the big four species

Following this pattern sharpens recognition speed and builds decisive exam-day confidence.

Your Pragmatic Path to “No Zebras”

Prioritize the species and diseases the exam actually tests. Know the chain: classic case –> test –> treat and review concepts consistently. You’ll cut study “noise”, protect your time, and score more points on your path to NAVLE® success.

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How to Build a NAVLE® Study Plan That Works

Posted on by Steven McLaughlin

Studying for the NAVLE® can feel overwhelming. There’s a mountain of material, not enough time, and the high stakes don’t help. But what separates the students who pass with confidence from those who panic in the final weeks? 

A clear, flexible, and consistent study plan. 

At Zuku Review, we’ve helped over 75,000 veterinary students prep for boards, and we’ve seen exactly what works. Here’s how to create a two-phase NAVLE® study strategy that fits your schedule and sets you up for success.

Why a Study Plan Matters for NAVLE® Success

Too many students think, “I’ll just wing it. I’ll study when I can.” That might feel doable five months out, but when the exam is a few weeks away, things look very different. 

The students who do best aren’t the ones who know everything. They’re the ones who:

  • Understand their plan
  • Stick to a repeatable routine
  • Adapt when life throws curveballs

A plan gives you clarity, reduces decision fatigue, and ensures you’re making real progress, even on your busiest days.

The Two-Phase Study Strategy Explained

Your NAVLE® prep should unfold in two distinct phases:

Phase 1: First Pass (Start early, 3.5+ months out)

Goal: Build your foundation

Time Split

  • ⅔ on practice questions (Zuku Review Qbank)
  • ⅓ on active independent study (notes, flashcards, videos, Merck Vet Manual, etc.)

Format: Focused practice by species/topic. No time pressure. Review answers carefully.

Example Daily Routine (2 hours/day):

  • 90 minutes → Practice questions on bovine disease
  • 30 minutes → Skim notes on LDAs, quiz yourself, make flashcards or teach it out loud

Phase 2: Second Pass (Final 6–7 weeks)

Goal: Build stamina + retrieval

Time split:

  • ⅔ on timed tests (60-question blocks, random topics)
  • ⅓ on active re-review (skim notes big diseases, actively quiz yourself)

Mimic test day: Timed sessions, build stamina, short 5-10 min breaks between blocks.

This final stretch is when repetition solidifies your knowledge. You’re doing exactly what you’ll do on test day, so by the time the real thing comes, you’ll be ready.

Common Mistakes

Avoid these traps that can derail even the most motivated students:

  • Skipping the second pass: Practice questions alone aren’t enough, you must simulate the real NAVLE® with daily TIMED test practice.
  • Passive review: Reading without quizzing doesn’t stick. Turn your study into a game of “What do I remember?”
  • Overplanning: Ultra-detailed calendars sound great, but they rarely survive contact with the busy-ness of real life. Simple = sustainable.

Simple Beats Complex: How to Stay Consistent

You don’t need a color-coded spreadsheet to succeed. What you need is a habit. 

Design a daily or weekly rhythm that fits your real life. Zuku’s ready-made 3- and 6-month calendars can help, but feel free to simplify. If you can answer this one question each morning, you’re on the right track: “What’s one thing I’ll do today that gets me closer to NAVLE® success?”

Prioritizing Topics: Where to Focus Your Time

Not all topics carry equal weight. Here’s the breakdown:

  • 78% of NAVLE® questions focus on dogs, cats, horses, and cows
  • Prioritize your time on these species first
  • Add pigs, Small ruminants and poultry later if time allows (they’re point-rich but lower frequency)

Pro tip: Use your NAVLE® prep as a clinical tune-up. Focus on topics you’ll use in practice anyway, like endocrine disease, colic, or postpartum cow problems.

Confidence Comes from Repetition

There’s no magic formula for the NAVLE®. But there is a clear pattern:

  • Daily effort
  • Practice testing
  • Active review
  • Timed tests
  • Repeat

Stick with it, and you’ll walk into exam day feeling confident.

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