The short answer
This guide holds 12 original practice questions on veterinary pain management and analgesia, each with a short rationale tied to a published source. The questions cover three areas: the physiology of pain, recognizing pain and using pain scales, and the main classes of analgesic drugs. Our desk wrote every question from the cited guidelines and reference texts. None is an exam item. The guide also summarizes what the exam owner's public study page says about the test.
Key takeaways
- The Merck Veterinary Manual lists five processes in the physiology of pain: transduction, transmission, modulation, projection and perception [2].
- The 2022 ISFM consensus guidelines name three feline acute pain tools with reported validity: the Glasgow CMPS-Feline, the UNESP-Botucatu short form and the Feline Grimace Scale [5].
- The ISFM guidelines list an intervention score of 5/20 or higher for the Glasgow CMPS-Feline, 4/12 or higher for the UNESP-Botucatu short form, and 0.4/1.0 or higher for the Feline Grimace Scale [5].
- Merck classifies buprenorphine as a partial mu agonist and butorphanol as an agonist-antagonist, and attributes ketamine's analgesia to NMDA receptor antagonism [4].
- Merck states that acetaminophen should not be used in cats because of fatal methemoglobinemia [4].
About these questionsPractice questions written by our editorial team for study purposes. These are not real VTNE items and are not affiliated with AAVSB.
The VTNE content outline and its domains
The American Association of Veterinary State Boards (AAVSB) publishes a content outline for the VTNE and calls it "one of the most important materials to review" before the exam [1]. According to the AAVSB study page, its practice tests assess performance across the exam's 10 domain areas, come in three versions, cost $50 USD per attempt, and contain 75 questions over 90 minutes [1]. The fetched study page does not list the domain names or their weights, so this guide does not state them. AAVSB says the species covered follow the AVMA accreditation skills list for veterinary technology students, and that practice-test questions are copyrighted and may not be memorized or copied [1].
Pain physiology
Question 1
A nociceptor at a wound site turns a mechanical stimulus into an electrical nerve signal. Which physiologic process of pain does this step represent?
- A. Modulation
- B. Projection
- C. Transduction
- D. Perception
Answer: C. The Merck Veterinary Manual defines transduction as converting a stimulus into an action potential at specialized receptors or free nerve endings. Modulation, projection and perception are later steps in the same five-process sequence [2].
Question 2
Which primary afferent fibers carry the immediate, sharp pain felt at the moment of injury?
- A. Unmyelinated C fibers
- B. Small, thinly myelinated A-delta fibers
- C. Descending fibers from the brain stem
- D. Cortical projection neurons
Answer: B. Merck describes A-delta fibers as small in diameter with a thin myelin sheath and says they carry immediate sharp pain. It describes unmyelinated C fibers as carrying slower, longer-lasting dull or burning pain [2].
Question 3
A cat recovering from surgery reacts painfully to gentle stroking near its incision, a touch that would not ordinarily hurt. Which glossary term from the ISFM guidelines fits this finding?
- A. Hyperalgesia
- B. Transduction
- C. Persistent postoperative pain
- D. Allodynia
Answer: D. The ISFM guidelines define allodynia as "pain due to stimulation of damaged tissue by a stimulus that would not normally be perceived as painful" and call it a clinical sign of peripheral and central sensitisation [5]. The same glossary defines hyperalgesia as an exaggerated response to a stimulus that would already be painful [5].
Pain recognition and pain scales
Question 4
Which of the following is not one of the five facial action units scored on the Feline Grimace Scale?
- A. Respiratory rate
- B. Ear position
- C. Whisker position
- D. Orbital tightening
Answer: A. According to the ISFM guidelines and a review by Bradley Simon in Today's Veterinary Practice, the five action units are ear position, orbital tightening, muzzle tension, whisker position and head position, each rated from 0 to 2 [5][7].
Question 5
A technician scores a hospitalized cat with the Glasgow CMPS-Feline. According to the ISFM consensus table, what total indicates that analgesia is required?
- A. 4/12 or higher
- B. 0.4/1.0 or higher
- C. 5/20 or higher
- D. 8/30 or higher
Answer: C. The ISFM table lists 5/20 or higher for the Glasgow CMPS-Feline, 4/12 or higher for the UNESP-Botucatu short form, and 0.4/1.0 or higher for the Feline Grimace Scale [5]. Simon's review also gives 5 out of 20 for the Glasgow feline scale and 8 out of 30 for the longer UNESP-Botucatu composite scale [7]. The ISFM panel notes that a veterinarian may give rescue analgesia below the cut-off if the cat may be in pain [5].
Question 6
A dog scores low on a pain scale after a procedure that is expected to be painful. According to the Merck Veterinary Manual, how can the team most accurately determine whether the dog is in pain?
- A. Check heart and respiratory rates, since these changes are specific to pain
- B. Give a dose of analgesic and monitor the response
- C. Withhold analgesia until pacing or vocalization appears
- D. Accept the low score as proof that no pain is present
Answer: B. Merck states that giving an analgesic and monitoring the response is the most accurate way to tell whether a patient is in pain, and that analgesia should be given when pain is likely even if scores are low [3]. Merck also says physiologic parameters cannot reliably separate pain from fear, anxiety or other stressors [3].
Question 7
Which of the following is an owner-completed questionnaire that Merck reports has been validated for chronic pain from canine osteoarthritis?
- A. Feline Grimace Scale
- B. UNESP-Botucatu short form
- C. Glasgow CMPS-Feline
- D. Canine Brief Pain Inventory
Answer: D. Merck names the Helsinki Chronic Pain Index and the Canine Brief Pain Inventory as owner-completed questionnaires validated for canine osteoarthritis, and says the latter has also been validated for canine bone cancer [3]. Today's Veterinary Nurse lists both among clinical metrology instruments for chronic pain in dogs [8].
Analgesic drug classes
Question 8
In the Merck discussion of opioids, buprenorphine is the named example of which category?
- A. Partial mu agonist
- B. Pure mu agonist
- C. NMDA receptor antagonist
- D. Alpha-2 adrenergic agonist
Answer: A. Merck separates mu agonists (morphine, hydromorphone, fentanyl), partial mu agonists (buprenorphine) and agonist-antagonists (butorphanol) [4].
Question 9
Under which DEA schedule do the Merck analgesic tables list butorphanol?
- A. Schedule II
- B. Schedule III
- C. Schedule IV
- D. Not a controlled substance
Answer: C. The Merck tables list butorphanol as DEA Schedule IV, buprenorphine as Schedule III, and morphine, hydromorphone, methadone and fentanyl as Schedule II [4].
Question 10
A patient receives ketamine during anesthesia to help limit central sensitization. Which receptor action does Merck credit for ketamine's analgesic effect?
- A. Neurokinin-1 receptor antagonism
- B. Noncompetitive NMDA receptor antagonism
- C. Cyclooxygenase inhibition
- D. Alpha-2 adrenergic agonism
Answer: B. Merck attributes ketamine's analgesia to noncompetitive, nonspecific antagonism of NMDA receptors and says blocking these receptors prevents or decreases wind-up [4]. Merck uses wind-up as its term for peripheral and central sensitization [2].
Question 11
A cat sedated with dexmedetomidine is given atipamezole to hasten recovery. According to Merck, what happens to the analgesia the alpha-2 agonist had been providing?
- A. It continues unchanged for 24 hours
- B. It is enhanced by the antagonist
- C. It is converted into a local nerve block
- D. It is lost once the drug is reversed
Answer: D. Merck says alpha-2 antagonists such as atipamezole reverse both central and peripheral effects, and that "once reversed, however, these drugs provide no analgesia" [4]. The ISFM guidelines say an alpha-2 antagonist should always be available when these drugs are used [5].
Question 12
Which drug does Merck describe as contraindicated in cats because of the risk of fatal methemoglobinemia?
- A. Acetaminophen
- B. Gabapentin
- C. Robenacoxib
- D. Buprenorphine
Answer: A. Merck attributes the risk to cats' inadequate glucuronidation of acetaminophen [4]. The ISFM guidelines likewise say deficient glucuronidation of phenolic compounds such as acetaminophen causes life-threatening methaemoglobinaemia in cats [5]. Merck notes that robenacoxib is one of only two NSAIDs FDA-approved for cats in the US [4].
