Royal College of Veterinary Surgeons Membership Exam (RCVS) Equine Medicine and Surgery Syllabus

Equine Medicine and Surgery syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Equine Medicine and Surgery in Royal College of Veterinary Surgeons Membership Exam (RCVS), not a summary of it.

1. 1

   Equine Internal Medicine

   4 topics

   • Gastrointestinal disease and colic
     • Colic assessment and the surgical decision
     • Diarrhoea, colitis and weight loss
     • Equine gastric ulcer syndrome
   • Respiratory disease
     • Equine asthma and inflammatory airway disease
     • Infectious respiratory disease and strangles
   • Endocrine and metabolic disease
     • Pituitary pars intermedia dysfunction
     • Equine metabolic syndrome and laminitis link
   • Infectious and neurological disease
     • Notifiable equine diseases and reporting
     • Ataxia and neurological assessment
2. 2

   Equine Lameness and Orthopaedics

   4 topics

   • Lameness examination
     • Gait evaluation and flexion tests
     • Diagnostic nerve and joint blocks
   • Foot and distal limb conditions
     • Laminitis pathophysiology and management
     • Foot abscess and navicular disease
   • Joint and soft tissue injury
     • Osteoarthritis and joint medication
     • Tendon and ligament injury
   • Diagnostic imaging in lameness
3. 3

   Equine Surgery, Anaesthesia and Reproduction

   4 topics

   • Equine anaesthesia
     • Standing sedation and field anaesthesia
     • Recovery and anaesthetic risk in the horse
   • Common surgical procedures
     • Castration techniques and complications
     • Wound management and bandaging
   • Reproduction and stud medicine
     • Breeding soundness and dystocia
     • Neonatal foal care
   • Dentistry and routine care

Equine Medicine and Surgery flashcards for Royal College of Veterinary Surgeons Membership Exam (RCVS)

19 of 60 cards from the Equine Medicine and Surgery deck — real questions with worked answers.

1. What is the normal heart rate range for an adult horse at rest, and what rate suggests significant pain or cardiovascular compromise in colic?

   Normal resting HR is 28-44 bpm. A heart rate persistently above 60 bpm in a colic case suggests significant pain, dehydration, or cardiovascular compromise and is a poor prognostic indicator (often >80 bpm with strangulating lesions).

2. In equine colic, what does reflux (>2 L net) obtained on nasogastric intubation indicate, and why is decompression life-saving?

   Net reflux >2 L indicates gastric/small intestinal distension or proximal obstruction (e.g. proximal enteritis, small intestinal strangulation, ileus). Horses cannot vomit, so the stomach can rupture; nasogastric decompression relieves pressure and prevents fatal gastric rupture.

3. What is the classic signalment and lesion for a pedunculated lipoma causing colic?

   Older horses (typically >15 years), especially ponies and geldings. A pedunculated lipoma on a stalk wraps around small intestine causing a strangulating obstruction — surgical emergency requiring resection.

4. Define a left dorsal displacement of the large colon (nephrosplenic entrapment) and one non-surgical management option.

   The large colon migrates and becomes trapped over the nephrosplenic ligament, lateral to the spleen. Non-surgical options: phenylephrine (to contract/shrink the spleen) combined with exercise (lunging/jogging), or rolling under general anaesthesia.

5. What peritoneal fluid findings indicate intestinal compromise/devitalisation in colic?

   Serosanguineous colour, elevated total protein (>25 g/L), elevated lactate (peritoneal lactate higher than blood lactate), elevated WBC, and presence of bacteria/plant material (suggesting rupture or necrosis).

6. What is the most common cause of acute colitis with rapid endotoxaemia in adult horses, and a key clinical sign?

   Salmonella, Clostridioides difficile/perfringens, and right dorsal colitis (NSAID toxicity) are common; colitis-X. Key signs: profuse watery diarrhoea, fever, severe endotoxaemia, hypovolaemia and toxic mucous membranes (toxic line/injected gums).

7. Differentiate a simple (obstructive) from a strangulating colic lesion in terms of blood supply and prognosis.

   Simple obstruction: lumen blocked but blood supply intact (e.g. impaction) — better prognosis, often medical. Strangulating: blood supply occluded causing ischaemia/necrosis (e.g. volvulus, lipoma) — rapid deterioration, severe pain, requires urgent surgery with resection.

8. What is the gold-standard diagnostic test for grass sickness (equine dysautonomia), and what causes it?

   Definitive diagnosis is histopathology of autonomic ganglia (chromatolysis of neurons), often via ileal biopsy. It is associated with the neurotoxin of Clostridium botulinum type C, causing degeneration of autonomic and enteric neurons; phenylephrine eye drop test (reversal of ptosis) supports diagnosis.

9. What is recurrent airway obstruction (RAO/'heaves') in the horse and its main trigger?

   RAO is a chronic, reversible inflammatory lower airway disease (equine asthma, severe form) characterised by bronchospasm, neutrophilic inflammation and mucus. Main trigger is inhaled organic dust/mould from hay and bedding; managed by environmental change, corticosteroids and bronchodilators.

10. Define exercise-induced pulmonary haemorrhage (EIPH) and the diagnostic finding.

    EIPH is bleeding from pulmonary capillaries into airways during strenuous exercise (especially racehorses), due to stress failure of capillaries from high pulmonary pressures. Diagnosed by blood in the trachea on post-exercise endoscopy or haemosiderophages on BAL cytology.

11. What organism causes strangles, and what is the classic clinical presentation?

    Streptococcus equi subspecies equi. Presentation: fever, mucopurulent nasal discharge, and abscessation of submandibular/retropharyngeal lymph nodes that may rupture. Complications: guttural pouch empyema/chondroids, 'bastard strangles', and purpura haemorrhagica.

12. What is the carrier site for persistent Streptococcus equi infection, and how is the carrier state cleared?

    The guttural pouch (often with chondroids/empyema). Carrier state is cleared by guttural pouch lavage, removal of chondroids (endoscopic/basket), and topical/systemic penicillin; screen with guttural pouch lavage qPCR/culture.

13. Describe equine Cushing's disease (PPID) pathophysiology and the classic clinical sign.

    Pituitary Pars Intermedia Dysfunction: loss of dopaminergic inhibition leads to hyperplasia/adenoma of pars intermedia and excess POMC-derived hormones (ACTH). Classic sign: hypertrichosis/hirsutism (long, curly, non-shedding coat); also laminitis, PU/PD, muscle wasting, immunosuppression.

14. What is the recommended endocrine test for diagnosing PPID, and what affects interpretation?

    Basal plasma ACTH concentration (or TRH stimulation test for early cases). Interpretation must use season-adjusted reference ranges because ACTH rises physiologically in autumn (August-October).

15. Define Equine Metabolic Syndrome (EMS) and its central feature.

    EMS is a collection of risk factors for endocrinopathic laminitis. Central feature is insulin dysregulation (resting hyperinsulinaemia, excessive insulin response to oral sugars, and/or tissue insulin resistance), usually with obesity/regional adiposity (cresty neck). Diagnosed by oral sugar test.

16. What is the first-line pharmacological treatment for PPID?

    Pergolide, a dopamine receptor agonist, which restores dopaminergic inhibition of the pars intermedia.

17. What is the most common type of laminitis seen in practice today and its mechanism?

    Endocrinopathic laminitis (associated with EMS/PPID hyperinsulinaemia) is the most common. Mechanism: insulin activates IGF-1 receptors in the lamellae, causing lamellar dysadhesion and failure of the dermal-epidermal bond, leading to distal phalanx rotation/sinking.

18. What is equine grass sickness's typical clinical triad in the acute form?

    Acute grass sickness: severe colic/gastric distension with reflux, dysphagia and drooling, and patchy sweating with muscle fasciculations (especially triceps). Also tachycardia, ptosis, and gut stasis; usually fatal within days.

19. What is the agent of equine influenza, and the hallmark clinical sign?

    Equine influenza virus (Orthomyxovirus, H3N8). Hallmark: sudden onset high fever and a harsh, dry, hacking cough that spreads rapidly through a yard; managed by rest (1 week per day of fever) and vaccination control.

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