100+ Free ACVSMR Practice Questions

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Question 1

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Which muscle fiber type has the highest oxidative capacity and greatest fatigue resistance?

Type IIb (fast-twitch glycolytic)

Type IIa (fast-twitch oxidative-glycolytic)

Type I (slow-twitch oxidative)

Type IIx (intermediate)

to track

2026 Statistics

Key Facts: ACVSMR Exam

100

FREE Practice Questions

OpenExamPrep ACVSMR question bank

Subspecialty Tracks

ACVSMR Canine and Equine Practitioner tracks

~12%

Rehabilitation Modalities Weight

Largest single domain on 2026 ACVSMR content outline

~$1,500-$2,500

2026 Certifying Exam Fee

ACVSMR (verify current schedule)

3 yr

Approved Residency

ACVSMR-approved residency training requirement

0-5

AAEP Lameness Grading

American Association of Equine Practitioners scale

The ACVSMR Certifying Exam is a multi-day specialty examination from the American College of Veterinary Sports Medicine and Rehabilitation with Canine and Equine tracks. Content includes rehabilitation modalities (~12%), canine orthopedic (~10%), equine orthopedic (~10%), MSK exam (~10%), diagnostic imaging (~10%), biomechanics (~8%), regenerative medicine (~8%), equine lameness (~8%), exercise physiology (~8%), therapeutic exercise (~8%), sports-specific conditioning (~8%), pain management (~5%), and nutrition (~5%). Exam fee ~$1,500-$2,500; requires completion of an ACVSMR-approved residency (3 years) plus a first-author peer-reviewed publication.

Sample ACVSMR Practice Questions

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

1Which muscle fiber type has the highest oxidative capacity and greatest fatigue resistance?

A.Type IIb (fast-twitch glycolytic)

B.Type IIa (fast-twitch oxidative-glycolytic)

C.Type I (slow-twitch oxidative)

D.Type IIx (intermediate)

Explanation: Type I slow-twitch oxidative fibers have the highest mitochondrial density, capillary supply, and myoglobin content, giving them the greatest aerobic capacity and fatigue resistance. They predominate in postural muscles and endurance athletes. Type IIa are intermediate; Type IIb/IIx are fast, powerful, but fatigue rapidly via anaerobic glycolysis.

2The ATP-phosphocreatine (ATP-PCr) energy system predominantly supplies energy for how long during maximal effort?

A.Up to 10 seconds

B.1-2 minutes

C.30-60 minutes

D.Several hours

Explanation: The ATP-PCr (phosphagen) system provides near-immediate, high-power ATP regeneration for ~5-10 seconds of maximal effort (sprinting greyhound, racing quarter horse out of gate). Anaerobic glycolysis takes over for 30 s-2 min (lactate rises), and oxidative phosphorylation dominates beyond 2-3 minutes.

3Lactate threshold in an exercising horse is best defined as:

A.The heart rate at which the horse refuses to continue

B.The exercise intensity at which blood lactate begins to accumulate above baseline (~4 mmol/L commonly used)

C.The point of peak VO2 consumption

D.The speed at which stride length plateaus

Explanation: Lactate threshold (onset of blood lactate accumulation, OBLA) is the intensity where lactate production exceeds clearance, conventionally marked at 4 mmol/L (V4) or at a clear inflection above resting (~1 mmol/L). V4 is a classic equine fitness marker — as fitness improves, V4 shifts to higher speeds.

4Which cardiovascular adaptation is most characteristic of endurance training in dogs and horses?

A.Decreased stroke volume

B.Reduced plasma volume

C.Increased left ventricular end-diastolic volume and stroke volume (eccentric hypertrophy)

D.Tachycardia at rest

Explanation: Endurance training produces eccentric cardiac hypertrophy — chamber enlargement with proportional wall thickening — raising end-diastolic volume and stroke volume. Resting heart rate falls (vagal tone), and plasma volume expands. These adaptations raise maximum cardiac output and VO2max.

5VO2max in racing Thoroughbreds may approach what value, among the highest in the animal kingdom?

A.30 mL O2/kg/min

B.60 mL O2/kg/min

C.100 mL O2/kg/min

D.180-200 mL O2/kg/min

Explanation: Elite Thoroughbreds reach VO2max values of 160-200 mL O2/kg/min (roughly 2-3x elite human endurance athletes). Contributing factors include splenic reserve of RBCs (hematocrit rises from ~40% to 60%+ during exercise), large heart (4-5 kg), and massive muscle mass (>55% body weight).

6The primary stimulus for mitochondrial biogenesis in skeletal muscle is activation of which master regulator?

A.mTOR

B.PGC-1α

C.NF-κB

D.PPARγ only

Explanation: PGC-1α (peroxisome proliferator-activated receptor gamma coactivator 1-alpha) is the transcriptional master regulator of mitochondrial biogenesis, induced by endurance exercise via AMPK, CaMK, and p38 MAPK signaling. mTOR drives protein synthesis/hypertrophy, not mitochondrial biogenesis.

7In a heat-stressed exercising sled dog, which adaptation or response is MOST protective?

A.Piloerection and shivering

B.Panting to increase evaporative heat loss from the upper airway

C.Peripheral vasoconstriction

D.Oliguria

Explanation: Dogs have minimal eccrine sweat glands and rely on panting (respiratory evaporation) as the primary thermoregulatory mechanism during exercise. Peripheral vasodilation also aids convective heat loss. Heat stroke occurs when these fail (>41°C/106°F core temp); exertional heat illness is a major cause of death in working and agility dogs.

8Which training zone most effectively raises lactate threshold without overtraining?

A.Zone 1 (<60% HRmax, active recovery)

B.Zone 5 (95-100% HRmax, maximal)

C.Zone 3-4 (tempo/threshold, ~75-90% HRmax) work

D.Zone 0 (stall rest)

Explanation: Tempo and threshold work performed at or just below lactate threshold (Zone 3-4) most effectively shifts the lactate-velocity curve rightward. Pure high-intensity (Zone 5) improves VO2max but risks overtraining; low-intensity (Zone 1-2) builds aerobic base. A polarized program combines all, with threshold work central.

9Which canine gait is a symmetric 2-beat diagonal gait used for efficient steady travel?

A.Walk

B.Trot

C.Canter

D.Gallop

Explanation: The trot is a symmetric, 2-beat, diagonal gait (RF+LH, then LF+RH) with a suspension phase. It is the most efficient gait for gait analysis (lameness exams) because diagonal limb pairs bear symmetric loads. Walk is a 4-beat lateral sequence; canter is a 3-beat asymmetric gait; gallop is a 4-beat asymmetric gait.

10Duty factor in gait analysis is defined as:

A.The percentage of the stride cycle during which a limb is in contact with the ground (stance/total)

B.The maximum joint angle achieved during swing

C.The vertical ground reaction force peak

D.The stride frequency in Hz

Explanation: Duty factor = stance time / stride time. A duty factor >0.5 means both limbs of a pair overlap on the ground (walking gaits); <0.5 indicates a suspension phase (trot, canter, gallop). Duty factor decreases as speed increases within a gait.

About the ACVSMR Exam

The ACVSMR Certifying Examination validates specialist-level knowledge in veterinary sports medicine and rehabilitation across two tracks — Canine and Equine. Content spans rehabilitation modalities (therapeutic ultrasound, laser/photobiomodulation, NMES, PEMF, UWTM, manual therapy), canine orthopedic conditions (CCL disease with TPLO/TTA, hip and elbow dysplasia, patellar luxation, OCD, iliopsoas and Achilles injuries), equine orthopedic conditions (navicular syndrome, SDFT/DDFT/suspensory injuries, sesamoiditis, ringbone, bone spavin, stress fractures), musculoskeletal exam, diagnostic imaging (radiography, ultrasound, CT, MRI, scintigraphy, gait analysis), biomechanics, regenerative medicine (PRP A-PRP/L-PRP, MSCs ASC/BM-MSC, IRAP, HA, ESWT), equine lameness (AAEP 0-5 grading, perineural/intrasynovial blocks), exercise physiology (PSSM1/PSSM2, RER, EIPH), therapeutic exercise, sports-specific conditioning, pain management (NSAIDs, grapiprant, anti-NGF Librela/Solensia, Adequan PSGAG), and nutrition. Requires ACVSMR-approved residency (3 years) plus scientific publication.

Questions

100 scored questions

Time Limit

Multi-day examination (written MCQ plus practical/oral sections)

Passing Score

Criterion-referenced standard set by ACVSMR examination committee

Exam Fee

~$1,500-$2,500 Certifying Examination fee (ACVSMR 2026 — verify current schedule) (American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR))

ACVSMR Exam Content Outline

~12%

Rehabilitation Modalities

Therapeutic ultrasound (continuous vs pulsed, 1 vs 3 MHz depth of penetration), TENS/NMES electrical stimulation, photobiomodulation (low-level laser class IIIb vs class IV), pulsed electromagnetic field (PEMF), cryotherapy and thermotherapy, hydrotherapy (underwater treadmill UWTM — buoyancy, viscous resistance, water depth for specific joint offload), manual therapy (joint mobilization Maitland grades I-IV, myofascial release, soft-tissue massage), kinesiology taping, orthotics and prosthetics.

~10%

Canine Orthopedic Conditions

Cranial cruciate ligament disease — TPLO (tibial plateau leveling osteotomy), TTA (tibial tuberosity advancement), extracapsular lateral suture, meniscal tears and bucket-handle lesions; hip dysplasia (PennHIP distraction index, OFA, FHO, juvenile pubic symphysiodesis JPS, double/triple pelvic osteotomy DPO/TPO, total hip replacement THR); elbow dysplasia (fragmented medial coronoid process FCP, OCD, ununited anconeal process UAP, incongruity); patellar luxation (Putnam grading I-IV); iliopsoas strain; supraspinatus and biceps tendinopathy.

~10%

Equine Orthopedic Conditions

Navicular syndrome/podotrochlosis (deep digital flexor tendinopathy, navicular bone remodeling, impar ligament), distal interphalangeal joint OA, proximal and distal sesamoiditis, osselets, ringbone (high/low), bone spavin (tarsometatarsal/distal intertarsal OA), bog spavin, curb, splints, bucked shins (dorsal metacarpal disease), stress fractures (humerus, tibia, pelvis, third metacarpal condyles), OCD (tarsocrural, stifle, fetlock), subchondral bone cysts, kissing spines, sacroiliac disease.

~10%

Musculoskeletal Examination

Canine orthopedic exam (observation, palpation, ROM goniometry, muscle mass/thigh girth, neurologic screen, joint-specific tests — Ortolani for hip laxity, cranial/caudal drawer, tibial compression, patellar palpation); equine lameness exam (visual gait analysis at walk, trot, on circle, hard vs soft surface; distal limb and upper limb flexion tests; hoof tester; perineural and intrasynovial diagnostic analgesia; AAEP lameness scale 0-5); myofascial trigger point assessment; postural and dynamic assessment.

~10%

Diagnostic Imaging

Radiography (orthogonal and oblique views, stress radiographs, standing equine navicular skyline), ultrasonography (tendon fiber pattern, cross-sectional area, lesion grading 1-4; SDFT, DDFT, suspensory ligament), CT (bone pathology, fracture configuration, cone-beam standing equine), MRI (soft tissue — meniscal tears, cartilage, bone marrow edema; 0.27T low-field standing equine vs 1.5/3T high-field), nuclear scintigraphy (bone phase for stress fractures and occult lameness), thermography, objective gait analysis (force plate, kinetic/kinematic motion capture, inertial sensors — Lameness Locator).

~8%

Biomechanics

Gait cycle phases (stance, swing, propulsion), ground reaction forces (vertical, craniocaudal, mediolateral), symmetry indices, canine gaits (walk, trot, pace, gallop — transverse vs rotary), equine gaits (walk, trot, canter, gallop, tölt, pace in gaited breeds), lever arms, joint kinematics, muscle-tendon unit mechanics (stretch-shortening cycle, elastic energy storage in SDFT), conformation and performance, farriery biomechanics (breakover point, medial-lateral balance, heel support, shoe weight and traction).

~8%

Regenerative Medicine

Platelet-rich plasma — A-PRP (pure) vs L-PRP (leukocyte-rich), platelet concentration factor 3-8x baseline, activation (calcium chloride/thrombin vs no activation); mesenchymal stem cells — adipose-derived (ASC) vs bone marrow-derived (BM-MSC), culture-expanded vs point-of-care; autologous conditioned serum (IRAP/Orthokine — IL-1Ra), autologous protein solution (Pro-Stride); hyaluronic acid (intra-articular Legend/Hyvisc); polyacrylamide hydrogel (Arthramid); extracorporeal shockwave therapy (focused vs radial ESWT); indications for tendon/ligament core lesions, OA, meniscal injury.

~8%

Equine Lameness

AAEP lameness grading 0-5 (0 imperceptible, 1 difficult to observe, 2 consistent under specific circumstances, 3 consistent at trot, 4 obvious, 5 minimal weight-bearing/non-weight-bearing), head nod (forelimb lameness — head up on sore limb during impact), pelvic hike/drop (hindlimb asymmetry), compensatory lameness patterns, flexion test interpretation (positive if worsens by 1+ grade), perineural blocks (palmar digital, abaxial sesamoid, low 4-point, high 4-point, lateral palmar), intra-articular blocks, SDFT/DDFT/suspensory injuries (proximal suspensory desmitis, branch desmitis, core lesion grading).

~8%

Exercise Physiology

Energy systems (phosphagen ATP-PCr, glycolytic, oxidative), VO2max (>150 mL/kg/min in elite horses, 80-130 mL/kg/min in dogs), muscle fiber types (Type I slow oxidative, Type IIA fast oxidative-glycolytic, Type IIX fast glycolytic), lactate threshold and V200, cardiovascular adaptation (splenic contraction, PCV rise), thermoregulation (sweating in horses, panting in dogs), EIPH (exercise-induced pulmonary hemorrhage — furosemide/Lasix prophylaxis), equine myopathies (PSSM1 GYS1 R309H mutation, PSSM2, RER — recurrent exertional rhabdomyolysis), overtraining syndrome.

~8%

Therapeutic Exercise

Proprioceptive retraining (cavaletti, wobble boards, physioballs, balance discs, uneven surfaces), core strengthening (belly lifts, back lifts, sternal lifts, tail pulls in horses; sit-to-stand, three-legged stand, cookie stretches in dogs), targeted muscle strengthening, stretching (static, dynamic, PNF), range of motion exercises, controlled leash walking protocols, aquatic exercise progression, sport-specific functional retraining, periodization of rehabilitation, return-to-sport criteria (objective outcome measures — CBPI, LOAD, goniometry, thigh girth).

~8%

Sports-Specific Conditioning

Canine disciplines — agility (acceleration/deceleration, jumping), flyball, dock diving, disc, herding, sledding/skijoring, detection and police K9, field trial and hunting; equine disciplines — racing (Thoroughbred flat, Standardbred harness, Quarter Horse), show jumping, dressage, eventing (cross-country), endurance, Western performance (reining, cutting, barrel racing), polo, draft; periodization (macrocycle, mesocycle, microcycle), tapering, cross-training, varied footing conditioning, heart rate training, return-to-work timelines.

~5%

Pain Management

Multimodal analgesia; canine NSAIDs (carprofen, meloxicam, deracoxib, grapiprant/Galliprant EP4 prostaglandin receptor antagonist, robenacoxib); equine NSAIDs (phenylbutazone, flunixin, firocoxib); opioids; gabapentinoids; amantadine NMDA antagonist; anti-NGF monoclonal antibodies (Librela/bedinvetmab canine, Solensia/frunevetmab feline); polysulfated glycosaminoglycan (Adequan PSGAG); pentosan polysulfate; intra-articular corticosteroids (triamcinolone, methylprednisolone); acupuncture and dry needling; validated chronic pain scales (CBPI, HCPI, LOAD).

~5%

Nutrition

Energy requirements (maintenance + activity factor), macronutrient ratios, omega-3 fatty acids (EPA/DHA) for OA and inflammation, glucosamine/chondroitin sulfate, green-lipped mussel, undenatured type II collagen (UC-II), equine PSSM feeding (low NSC <10%, high fat 20-25% DE), electrolytes for endurance, hydration, body condition scoring (1-9 canine WSAVA, 1-9 equine Henneke), muscle condition scoring, weight management for osteoarthritis and sport performance.

How to Pass the ACVSMR Exam

What You Need to Know

Passing score: Criterion-referenced standard set by ACVSMR examination committee
Exam length: 100 questions
Time limit: Multi-day examination (written MCQ plus practical/oral sections)
Exam fee: ~$1,500-$2,500 Certifying Examination fee (ACVSMR 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

ACVSMR Study Tips from Top Performers

1Canine CCL disease — key decision points: TPLO (tibial plateau leveling osteotomy) changes the tibial plateau angle to neutralize cranial tibial thrust and is widely considered the gold standard for medium/large breeds; TTA (tibial tuberosity advancement) advances the tuberosity to place the patellar tendon perpendicular to the tibial plateau. Always evaluate menisci at surgery (medial meniscal tear ~50% of CCL cases). Post-op rehab: controlled activity, ROM, UWTM starting ~2 weeks, return-to-sport 4-6 months with objective outcome measures.

2AAEP lameness grading 0-5 — memorize cold: 0 imperceptible under all circumstances; 1 difficult to observe, not consistent; 2 difficult at walk/trot straight but consistent under specific circumstances (circling, inclines, hard surfaces, flexion); 3 consistently observable at trot under all circumstances; 4 obvious at walk; 5 minimal weight-bearing in motion and/or at rest or complete inability to move. Head nod — head goes UP when the SORE forelimb impacts (offloading). Pelvic hike/drop identifies hindlimb lameness.

3PRP classifications — A-PRP (pure/leukocyte-poor) favored for intra-articular OA due to lower inflammatory burden from WBCs; L-PRP (leukocyte-rich) favored for tendon/ligament lesions where a transient inflammatory stimulus may aid remodeling. Platelet concentration factor typically 3-8x baseline. Activation with calcium/thrombin accelerates release vs non-activated preparations. MSCs — adipose-derived (ASC) are abundant and easily harvested; bone marrow-derived (BM-MSC) have classical chondrogenic potential. IRAP/Orthokine produces IL-1 receptor antagonist for OA modulation.

4PSSM1 vs PSSM2 vs RER (equine exertional myopathies): PSSM1 is caused by the GYS1 R309H gain-of-function mutation (Quarter Horses, draft breeds) — excess muscle glycogen and abnormal polysaccharide inclusions; manage with low NSC (<10% starch/sugar) and high fat (20-25% DE from fat). PSSM2 is a heterogeneous clinical diagnosis without a single validated genetic test. RER (recurrent exertional rhabdomyolysis) is seen in Thoroughbreds and Standardbreds and is thought to involve abnormal intracellular calcium regulation; managed with consistent exercise, low-starch/high-fat diet, and dantrolene.

5Modern pain pharmacology pearls: grapiprant (Galliprant) is an EP4 prostaglandin receptor antagonist — NOT a classic COX inhibitor — providing selective PGE2-mediated pain modulation with reduced GI/renal risk. Anti-NGF monoclonal antibodies — bedinvetmab (Librela, canine) and frunevetmab (Solensia, feline) — bind NGF and block TrkA signaling for OA pain; given as monthly subcutaneous injections. Adequan (PSGAG, polysulfated glycosaminoglycan) is a disease-modifying OA drug. Contrast with older NSAIDs (carprofen COX-preferential, meloxicam, deracoxib, robenacoxib).

Frequently Asked Questions

What is the ACVSMR Certifying Examination?

The ACVSMR Certifying Examination is administered by the American College of Veterinary Sports Medicine and Rehabilitation and is the required specialty examination for Diplomate status in veterinary sports medicine and rehabilitation. Candidates sit for either a Canine or an Equine track. Content spans rehabilitation modalities, orthopedic conditions, musculoskeletal examination, diagnostic imaging, biomechanics, regenerative medicine, equine lameness, exercise physiology, therapeutic exercise, sports-specific conditioning, pain management, and nutrition.

Who is eligible to take the ACVSMR exam?

Candidates must be licensed veterinarians (DVM/VMD or equivalent) who have completed an ACVSMR-approved residency training program — typically a minimum of 3 years of structured mentorship by ACVSMR diplomates. Candidates must also submit case logs demonstrating breadth of sports medicine and rehabilitation experience and satisfy the first-author peer-reviewed scientific publication requirement in an approved journal.

What is the format of the ACVSMR Certifying Exam?

The ACVSMR Certifying Examination is a multi-day specialty examination with written multiple-choice questions plus practical/oral components. Candidates sit for a track-specific exam (Canine or Equine). Items include clinical photographs, imaging (radiographs, ultrasound, MRI, scintigraphy), and gait analysis scenarios. The exam is blueprinted to the ACVSMR content outline and reflects specialist-level application of sports medicine and rehabilitation principles.

How much does the 2026 ACVSMR exam cost?

The 2026 ACVSMR Certifying Examination fee is approximately $1,500-$2,500 — always verify the current schedule on the ACVSMR website. Candidates also pay annual diplomate dues and Maintenance of Certification fees after passing. Cancellation and refund policies follow ACVSMR schedules with decreasing refunds as the exam date approaches. Retakes require re-registration and full fee payment within the allowed eligibility window.

When is the 2026 ACVSMR exam administered?

The ACVSMR Certifying Examination is typically offered annually. Applications generally open months in advance with credentialing deadlines well before the test date. Candidates must have a complete credentials packet approved by the ACVSMR Credentials Committee — including case logs and the publication requirement — before sitting. Exact 2026 dates should be confirmed on the ACVSMR examinations page at vsmr.org.

How is the exam scored?

ACVSMR uses criterion-referenced scoring with a passing standard set by the examination committee. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports provide domain-level feedback. Candidates must achieve passing performance across the written and practical/oral components to earn Diplomate status.

What are the highest-yield topics?

Highest-yield topics include CCL disease management (TPLO vs TTA decision-making), hip and elbow dysplasia workup, canine OCD and patellar luxation; equine navicular syndrome, SDFT/DDFT/suspensory injuries with ultrasound grading, and stress fractures; AAEP 0-5 lameness grading and perineural/intrasynovial block sequences; regenerative medicine (PRP A-PRP vs L-PRP, ASC vs BM-MSC, IRAP, ESWT indications); UWTM protocols; PSSM1 (GYS1) vs PSSM2 vs RER; EIPH management; anti-NGF Librela/Solensia mechanism; and grapiprant (EP4) as a novel NSAID class.

How should I study for this exam?

Use a structured 12-18 month plan across late residency. Map to the ACVSMR content outline: begin with anatomy, biomechanics and exercise physiology; then orthopedic conditions and diagnostic imaging (read radiographs, ultrasound, MRI daily); then rehabilitation modalities, regenerative medicine and pain management; finally therapeutic exercise and sport-specific conditioning. Integrate key references (Millis & Levine Canine Rehabilitation, Zink & Van Dyke Canine Sports Medicine, Ross & Dyson Lameness in the Horse, Hinchcliff Equine Exercise Physiology), ACVSMR/AAEP proceedings, and high-volume MCQ practice. Complete 2-3 full-length timed mock exams.