100+ Free ACVIM Practice Questions

Pass your ACVIM Veterinary Internal Medicine Certifying Examination (Cardiology, Neurology, Oncology, SAIM, LAIM) exam on the first try — instant access, no signup required.

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Variable by specialty; ACVIM publishes annual examination statistics on the certification site Pass Rate

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Question 1

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Which insulin is typically the first-line choice for initial regulation of canine diabetes mellitus in the United States?

Regular insulin IV CRI

Insulin glargine U-100

Porcine lente insulin (Vetsulin/Caninsulin)

NPH insulin PO

to track

2026 Statistics

Key Facts: ACVIM Exam

100

FREE Practice Questions

OpenExamPrep ACVIM question bank

~35%

SAIM Weight

Largest single domain across ACVIM content

3 yr

Approved Residency

ACVIM-approved residency in the chosen specialty

~$1,500-$2,500

2026 Exam Fees

ACVIM General + Specialty Certifying (verify schedule)

Specialties

SAIM, LAIM, Cardiology, Neurology, Oncology

Published Manuscript

First-author peer-reviewed publication credential requirement

The ACVIM Certifying Exam is a multi-day computer-based written examination from the American College of Veterinary Internal Medicine comprising a General Examination plus a Specialty Certifying Examination in SAIM, LAIM, Cardiology, Neurology, or Oncology. Content distribution: SAIM ~35%, LAIM ~16%, Cardiology ~13%, Oncology ~12%, Neurology ~11%, Diagnostics ~5%, EBM/ethics ~5%. Combined fees run ~$1,500-$2,500 for 2026; eligibility requires an ACVIM-approved 3-year residency and a published peer-reviewed manuscript.

Sample ACVIM Practice Questions

Try these sample questions to test your ACVIM exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which insulin is typically the first-line choice for initial regulation of canine diabetes mellitus in the United States?

A.Regular insulin IV CRI

B.Insulin glargine U-100

C.Porcine lente insulin (Vetsulin/Caninsulin)

D.NPH insulin PO

Explanation: Porcine lente insulin (Vetsulin/Caninsulin) is labeled for canine diabetes and is a common first-line choice, typically dosed 0.25-0.5 U/kg SC BID. PZI and glargine are more often used in cats. Insulin is never administered PO — it is destroyed by GI proteases.

2Which insulin is considered first-line for feline diabetes mellitus given its prolonged duration and higher remission rates?

A.NPH insulin

B.Regular (crystalline) insulin SC

C.Protamine zinc insulin (PZI) or glargine

D.Porcine lente (Vetsulin)

Explanation: PZI (ProZinc) and insulin glargine are preferred in cats because their longer duration improves glycemic control and tight regulation is associated with higher rates of diabetic remission. Vetsulin has a shorter duration in cats and is generally less favored as first-line.

3A diabetic dog presents collapsed, vomiting, with ketonuria, venous pH 7.12, and glucose 520 mg/dL. What is the FIRST therapeutic priority?

A.Immediate subcutaneous long-acting insulin

B.Oral potassium supplementation

C.IV fluid resuscitation with isotonic crystalloids

D.IV sodium bicarbonate bolus

Explanation: In DKA, the first priority is restoring intravascular volume with isotonic crystalloids (0.9% NaCl or LRS). Only after rehydration and potassium supplementation should regular insulin be started (CRI or hourly IM). Rapid bicarbonate correction and long-acting SC insulin are contraindicated initially.

4Which test best DIFFERENTIATES pituitary-dependent hyperadrenocorticism (PDH) from an adrenal tumor in a dog with confirmed Cushing's?

A.Basal cortisol

B.ACTH stimulation test

C.Low-dose dexamethasone suppression test (LDDST) showing suppression at 4h then escape at 8h, or endogenous ACTH

D.Urine cortisol:creatinine ratio

Explanation: LDDST is both a screening and differentiating test. Suppression at 4h with escape at 8h is consistent with PDH. Endogenous ACTH is high-normal to high in PDH and suppressed in adrenal tumors. Abdominal ultrasound and ACTH are the best differentiating tools.

5A young Standard Poodle presents with intermittent collapse, bradycardia (HR 48), Na 128, K 6.8, Na:K ratio 18. Most likely diagnosis?

A.Atypical (glucocorticoid-deficient) hypoadrenocorticism

B.Typical (mineralocorticoid + glucocorticoid deficient) Addison's disease

C.Primary hypothyroidism

D.Acute kidney injury

Explanation: Hyperkalemia with hyponatremia (Na:K <23-27) in a young-to-middle-aged dog suggests typical primary hypoadrenocorticism. Confirmation requires an ACTH stim showing inadequate pre- and post-stim cortisol (<2 μg/dL). Atypical Addison's lacks electrolyte changes.

6A middle-aged Golden Retriever has weight gain, alopecia, bradycardia, hypercholesterolemia, and mild non-regenerative anemia. Best initial confirmatory test?

A.TSH stimulation test

B.Total T4 alone

C.Free T4 by equilibrium dialysis combined with TSH

D.Thyroid scintigraphy

Explanation: Free T4 by equilibrium dialysis plus endogenous TSH is the most accurate screening combination for canine hypothyroidism. Low fT4ED + high TSH is diagnostic. Total T4 alone is affected by sick euthyroid, drugs, and non-thyroidal illness.

7A hypertensive dog has a large unilateral adrenal mass with vena caval invasion and paroxysmal episodes. Best pre-surgical confirmatory test for pheochromocytoma?

A.Urinary normetanephrine:creatinine ratio

B.Basal cortisol

C.T4

D.Serum insulin

Explanation: Urinary or plasma normetanephrine/metanephrine concentrations are the most reliable tests for pheochromocytoma. Pre-operative alpha-blockade with phenoxybenzamine for 1-2 weeks before adrenalectomy reduces perioperative hypertensive crisis risk.

8What is the most common cause of spontaneous hyperadrenocorticism in dogs?

A.Adrenocortical carcinoma

B.Pituitary adenoma secreting ACTH (80-85%)

C.Ectopic ACTH secretion

D.Iatrogenic steroid administration

Explanation: Approximately 80-85% of canine spontaneous Cushing's is pituitary-dependent (microadenoma of the pars distalis/intermedia). Adrenal tumors account for ~15-20%. Iatrogenic Cushing's from exogenous glucocorticoids is common but not 'spontaneous' primary disease.

9Which test is most SPECIFIC for canine pancreatitis?

A.Serum amylase

B.Serum lipase (total)

C.Spec cPL (pancreatic lipase immunoreactivity)

D.ALT

Explanation: Spec cPL is the most sensitive and specific serum test for canine pancreatitis (~80-90% sensitivity, >90% specificity). SNAP cPL is a useful screening rule-out. Total lipase and amylase lack specificity because they derive from multiple tissues.

10Per the WSAVA chronic enteropathy classification, what does 'FRE' stand for?

A.Fiber-Related Enteropathy

B.Food-Responsive Enteropathy

C.Fecal Recovery Enteritis

D.Feline Rectal Enteropathy

Explanation: Chronic enteropathies are now categorized by treatment response: FRE (food-responsive), ARE (antibiotic-responsive — increasingly called microbiota-responsive), IRE (immunosuppressant-responsive, formerly IBD), and NRE (non-responsive). Most dogs respond to a novel-protein or hydrolyzed diet trial first.

About the ACVIM Exam

The ACVIM Certifying Examination is the terminal board examination for diplomate status in veterinary internal medicine across five specialties — Small Animal Internal Medicine (SAIM), Large Animal Internal Medicine (LAIM), Cardiology, Neurology, and Oncology. Candidates complete a General In-Training Examination (GITE) during residency and then the General Examination plus a Specialty Certifying Examination at the end of training. Content spans SAIM (GI, hepatology, urinary — IRIS CKD/AKI, endocrine, hematology — IMHA/ITP, infectious — FIP GS-441524, tick-borne, parvo, respiratory), LAIM (equine colic, RAO, PPID, EMS, HYPP, strangles, PHF; ruminant DA, ketosis, Johne's, BVDV), cardiology (MMVD ACVIM 2019, DCM PROTECT, HCM, FATCAT, congenital), oncology (lymphoma CHOP, MCT Patnaik/Kiupel, OSA, HSA, TCC, FISS), and neurology (IVETF epilepsy, IVDD, GME/MUO, DM SOD1). Requires an ACVIM-approved 3-year residency and a published peer-reviewed manuscript.

Questions

100 scored questions

Time Limit

Multi-day CBT window (General Exam + Specialty Certifying Exam)

Passing Score

Criterion-referenced scaled score set by ACVIM (modified Angoff standard)

Exam Fee

~$1,500-$2,500 (ACVIM General + Specialty Certifying Examination fees, 2026 — verify current schedule) (American College of Veterinary Internal Medicine (ACVIM))

ACVIM Exam Content Outline

~35%

Small Animal Internal Medicine (SAIM)

GI (IBD, PLE, pancreatitis Spec cPL/fPL, EPI TLI), hepatology (PSS, chronic hepatitis, copper storage, hepatic lipidosis), urinary (IRIS CKD I-IV, AKI IRIS grading, UPC proteinuria, FLUTD, urolithiasis — struvite/oxalate/urate), endocrine (DM, DKA, HAC — LDDS/ACTH stim/HDDS, HPAA — Na:K, hyperthyroid T4/I-131, hypothyroid), hematology (IMHA Coombs, ITP, regenerative vs non-regenerative anemia), infectious (FeLV/FIV, FIP GS-441524, leptospirosis, ehrlichia/anaplasma/Lyme C6, parvovirus), respiratory (chronic bronchitis, feline asthma, PH sildenafil).

~16%

Large Animal Internal Medicine (LAIM)

Equine — colic (strangulating vs non, reflux, lactate), recurrent airway obstruction (RAO/equine asthma), PPID (pergolide; low-dose dex or ACTH testing), equine metabolic syndrome (insulin dysregulation, laminitis), HYPP (SCN4A, Impressive line Quarter Horses), neonatal isoerythrolysis, strangles (Streptococcus equi), Potomac horse fever (Neorickettsia risticii). Ruminant — displaced abomasum, ketosis, milk fever, Johne's (MAP), BVDV, BRD complex.

~13%

Cardiology

Myxomatous mitral valve disease (MMVD) per ACVIM 2019 consensus stages A/B1/B2/C/D with pimobendan at B2 (EPIC trial), DCM (Doberman PROTECT; grain-free diet-associated; taurine/carnitine), HCM (Maine Coon MYBPC3, Ragdoll), ARVC (Boxer), feline arterial thromboembolism (FATCAT — clopidogrel > aspirin), congenital (PDA, SAS, PS balloon valvuloplasty), arrhythmias (AF, VT), CHF therapy (furosemide/torsemide, pimobendan, ACEi, spironolactone).

~12%

Oncology

Lymphoma (B vs T, WHO, flow cytometry, PARR, CHOP Madison-Wisconsin; prednisone single-agent), mast cell tumors (Patnaik I/II/III cutaneous grading; Kiupel two-tier; c-KIT ITD — toceranib/masitinib; WLE 2-3 cm + one fascial plane), osteosarcoma (limb-spare, amputation + carboplatin/doxorubicin), hemangiosarcoma (splenic, RA — DIC), TCC (piroxicam ± mitoxantrone), mammary (OHE before first heat), feline injection-site sarcoma (3-2-1 rule), oral melanoma (ONCEPT vaccine), MDR1/ABCB1 Collie ivermectin/vincristine.

~11%

Neurology

Seizures (IVETF classification — idiopathic Tier I/II/III, structural, reactive; phenobarbital, KBr, levetiracetam, zonisamide; status — diazepam/midazolam), IVDD (Hansen I extrusion vs II protrusion, Schiff-Sherrington, deep pain), fibrocartilaginous embolism, GME/MUO (cytosine arabinoside, prednisone, cyclosporine), neoplasia (meningioma, glioma), vestibular (peripheral vs central), degenerative myelopathy (SOD1), myasthenia gravis (AChR, edrophonium), polyradiculoneuritis, Wobbler.

~5%

Diagnostics & Therapeutics

Echocardiography (M-mode, 2D, Doppler, LA:Ao, LVIDDN), ECG, abdominal/thoracic ultrasound, CT/MRI, endoscopy/bronchoscopy, CSF analysis, bone marrow, cytology and histopathology, PCR/serology, therapeutic drug monitoring (phenobarbital, cyclosporine, digoxin), fluid therapy and acid-base (anion gap, SID).

~5%

Evidence-Based Medicine & Ethics

Study design (RCT, cohort, case-control, systematic review, meta-analysis), levels of evidence, biostatistics (sensitivity/specificity, PPV/NPV, LR+/LR−, ROC), ACVIM consensus statements, informed consent, euthanasia and end-of-life ethics, antimicrobial stewardship, zoonoses and one-health, IACUC and research ethics.

How to Pass the ACVIM Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ACVIM (modified Angoff standard)
Exam length: 100 questions
Time limit: Multi-day CBT window (General Exam + Specialty Certifying Exam)
Exam fee: ~$1,500-$2,500 (ACVIM General + Specialty Certifying Examination fees, 2026 — verify current schedule)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ACVIM Study Tips from Top Performers

1MMVD ACVIM 2019 staging is testable cold: Stage A at-risk breed (CKCS, Dachshund) with no murmur; Stage B1 murmur without cardiac remodeling; Stage B2 murmur WITH remodeling (LA:Ao ≥1.6 and LVIDDN ≥1.7 by echo, or VHS >10.5 with VLAS criteria) — START PIMOBENDAN per EPIC trial (median delay to CHF ~15 months); Stage C active or prior CHF (furosemide, pimobendan, ACEi, spironolactone); Stage D refractory.

2IRIS CKD staging uses fasting serum creatinine (and SDMA): Stage 1 <1.4 mg/dL (dog) / <1.6 (cat), Stage 2 1.4-2.8 / 1.6-2.8, Stage 3 2.9-5.0 / 2.9-5.0, Stage 4 >5.0. Substage by UPC (proteinuria) and blood pressure. Treat proteinuria at UPC >0.5 (dog) or >0.4 (cat) with ACEi or telmisartan. Always check for pyelonephritis, renal calculi, and prerenal azotemia.

3Patnaik vs Kiupel MCT grading — Patnaik three-tier (I/II/III) for cutaneous canine MCT but variable inter-observer agreement; Kiupel two-tier (low-grade vs high-grade) is more reproducible and prognostic. c-KIT internal tandem duplication (ITD) in exon 11 = poor prognosis AND predicts response to toceranib (Palladia) or masitinib. Surgical margins 2-3 cm lateral + one clean fascial plane deep. SLNB and regional LN sampling increasingly standard.

4IVETF epilepsy classification — Tier I idiopathic epilepsy (age 6 mo-6 yr onset, normal inter-ictal exam, normal clinpath and minimum database); Tier II adds normal MRI and CSF; Tier III adds EEG. Initiate AEDs if ≥2 seizures within 6 months, cluster seizures, or status. Phenobarbital (dogs) — target trough 25-35 μg/mL, monitor ALT/ALP; KBr monotherapy or adjunct (NOT in cats — bronchitis); levetiracetam and zonisamide for intolerance or refractory cases.

5FIP therapy revolution — GS-441524 (nucleoside analog, prodrug of remdesivir) is now considered curative for effusive and non-effusive FIP, including neurologic and ocular forms, with reported response rates >80% after 84-day courses. Always confirm diagnosis (effusion cytology with Rivalta, immunohistochemistry, RT-PCR for FCoV spike mutation when available) before committing to therapy. Monitor CBC, globulins, A:G ratio, and clinical signs weekly.

Frequently Asked Questions

What is the ACVIM Certifying Examination?

The ACVIM Certifying Examination is the terminal board examination administered by the American College of Veterinary Internal Medicine. Candidates pursue diplomate status in one of five specialties — Small Animal Internal Medicine, Large Animal Internal Medicine, Cardiology, Neurology, or Oncology. Candidates complete a General In-Training Examination (GITE) during residency, then the General Examination and a Specialty Certifying Examination at the end of training.

Who is eligible to sit for the ACVIM exam?

Candidates must hold a DVM, VMD, or equivalent veterinary degree; complete a one-year internship or equivalent clinical experience; complete a three-year ACVIM-approved residency in the chosen specialty; submit credentials to the ACVIM Credentials Committee; and publish a first-author peer-reviewed research manuscript. A valid veterinary license is required.

What is the format of the ACVIM exam?

The ACVIM exam is a multi-day computer-based written examination with two components — the General Examination covering broad internal medicine and diagnostics, and a Specialty Certifying Examination covering the candidate's chosen subspecialty (SAIM, LAIM, Cardiology, Neurology, or Oncology). Items are single-best-answer MCQs with case-based vignettes, imaging, ECGs, echocardiograms, and cytology/histopathology.

How much does the 2026 ACVIM exam cost?

Combined General Examination and Specialty Certifying Examination fees run approximately $1,500-$2,500 for 2026 — always verify the current schedule on the ACVIM certification page. Candidates also pay a credentials application fee, annual dues after certification, and Maintenance of Certification (MOC) fees. Retakes require re-registration and fee payment per ACVIM policy.

When is the 2026 exam administered?

The ACVIM General and Specialty Certifying Examinations are typically offered once per year in a designated CBT testing window. Credentials submissions are due several months before the test, and candidates register for a specific appointment after credentials approval. Confirm 2026 dates on the ACVIM certification page.

How is the exam scored?

ACVIM uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance against the fixed cut-score, not against peers. Both the General Exam and the Specialty Certifying Exam must be passed to earn diplomate status.

What are the highest-yield topics?

Highest-yield topics include MMVD staging per ACVIM 2019 consensus with pimobendan at B2 (EPIC), DCM with PROTECT and grain-free diet association, FATCAT clopidogrel for feline ATE, IRIS CKD I-IV staging, IVETF epilepsy classification and AED pharmacology, IVDD Hansen I vs II with deep pain prognosis, Patnaik and Kiupel mast cell tumor grading with c-KIT-directed therapy, CHOP protocol for canine lymphoma, FIP therapy with GS-441524, PPID/EMS in equids, and MDR1/ABCB1 Collie drug sensitivity.

How should I study for this exam?

Use a structured plan across the 3-year residency with ~6-12 months of dedicated final review. Map to the ACVIM content outline: SAIM core (GI, hepatology, urinary, endocrine, hematology, infectious, respiratory) first, then cardiology, neurology, oncology, and LAIM (if relevant). Integrate ACVIM consensus statements, Ettinger and Feldman textbooks, JVIM landmark papers (EPIC, PROTECT, FATCAT, IVETF), the GITE, and high-volume MCQ practice. Complete 2-3 full-length timed mock exams.