100+ Free TEMI Adulto (AMIB / AMB) Practice Questions

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2026 Statistics

Key Facts: TEMI Adulto (AMIB / AMB) Exam

100 Questions

Written Theoretical & Practical Examination Items

AMIB Edital nº 1898/2026 — TEMI Adulto

70% (7.0/10)

Minimum Passing Score per Eliminatory Phase

Regulamento da Prova de Título AMIB / AMB

R$ 930,00

Registration Fee for AMIB/AMB Members (Sócios Adimplentes)

Edital nº 1898/2026 — AMIB

100 Points

Maximum Curricular Score for CNRM ICU Residency (Anexo VI)

Tabela de Pontuação Curricular — AMIB / AMB

Res. CFM 2.173/17

Official Brazilian Legal Protocol for Brain Death Determination

Conselho Federal de Medicina (CFM)

Permanent RQE

Specialist Registration Qualification in Intensive Care Medicine

Conselho Federal de Medicina (CFM)

The TEMI Adulto is the official Brazilian board certification for adult intensive care physicians administered by AMIB and AMB under Edital nº 1898/2026. Requiring a 70% passing score across both the Prova Teórica and Prova Prática, it rigorously tests Hemodynamic Monitoring, Shock, Mechanical Ventilation & ARDS, Neurocritical Care, CRRT, Acid-Base Disorders, Sepsis, and Critical Care Ethics.

Sample TEMI Adulto (AMIB / AMB) Practice Questions

Try these sample questions to test your TEMI Adulto (AMIB / AMB) exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old intubated patient with septic shock is mechanically ventilated in volume-controlled mode (tidal volume 8 mL/kg predicted body weight, PEEP 10 cmH2O, zero spontaneous respiratory efforts). Arterial line analysis reveals a Pulse Pressure Variation (PPV) of 16%. Which condition is a mandatory physiological prerequisite for PPV to accurately predict fluid responsiveness?

A.Absence of spontaneous breathing efforts and regular sinus rhythm without significant cardiac arrhythmias.

B.Spontaneous breathing triggering with pressure support ventilation (PSV) below 10 cmH2O.

C.Presence of moderate-to-severe right ventricular failure with pulmonary hypertension.

D.Tidal volume set between 4 and 6 mL/kg of predicted body weight with active patient triggering.

Explanation: Pulse Pressure Variation (PPV) reliably predicts fluid responsiveness (threshold typically > 12–13%) only when cardiopulmonary interactions are strictly controlled: passive mechanical ventilation without spontaneous breathing efforts, tidal volume >= 8 mL/kg PBW, regular sinus cardiac rhythm, and normal right ventricular function. Spontaneous breathing efforts induce unpredictable intrathoracic pressure swings that invalidate PPV.

2During the resuscitation of a patient with vasodilatory shock, the intensivist performs a Passive Leg Raise (PLR) test. Which measurement method is recommended to accurately assess the hemodynamic response during PLR?

A.Real-time continuous measurement of cardiac output or stroke volume within 60 to 90 seconds.

B.Isolated measurement of radial arterial systolic blood pressure after 5 minutes.

C.Monitoring central venous pressure (CVP) elevation at 3 minutes.

D.Assessment of urine output increase over the subsequent 2 hours.

Explanation: The Passive Leg Raise (PLR) test acts as a transient, reversible autotransfusion of approximately 300 mL of venous blood from the lower extremities. Its peak hemodynamic effect occurs within 60–90 seconds and must be evaluated using direct, real-time continuous stroke volume or cardiac output monitoring (e.g., echocardiographic LVOT VTI, arterial pulse contour analysis, or bioreactance); isolated blood pressure changes lack sensitivity.

3In a critically ill patient monitored with a pulmonary artery catheter (Swan-Ganz), which physiological condition will cause the Pulmonary Artery Occlusion Pressure (PAOP / wedge pressure) to overestimate true Left Ventricular End-Diastolic Pressure (LVEDP)?

A.Catheter tip wedged in West Zone 1 or Zone 2 under high positive end-expiratory pressure (PEEP).

B.Severe aortic regurgitation with preserved mitral valve function.

C.Severe left ventricular systolic dysfunction with elevated filling pressures.

D.Catheter tip accurately positioned in West Zone 3 below the left atrium.

Explanation: For PAOP to reflect left atrial pressure and LVEDP, a continuous column of blood must exist between the catheter tip and the left atrium, which only occurs in West Zone 3 (where pulmonary arterial and venous pressures exceed alveolar pressure, Pa > Pv > PA). In West Zones 1 or 2, or under high PEEP, alveolar pressure exceeds venous pressure (PA > Pv), compressing the capillary bed and causing the transducer to measure alveolar pressure rather than left atrial pressure.

4In transpulmonary thermodilution (e.g., PiCCO system), which parameter directly quantifies pulmonary edema and correlates strongly with ARDS severity and ICU mortality?

A.Extravascular Lung Water Index (EVLWI).

B.Global End-Diastolic Volume Index (GEDVI).

C.Intrathoracic Blood Volume Index (ITBVI).

D.Cardiac Function Index (CFI).

Explanation: Extravascular Lung Water Index (EVLWI, normal range 3–7 mL/kg) measures the volume of fluid in the pulmonary interstitial and alveolar spaces. Elevated EVLWI (> 10 mL/kg) directly reflects pulmonary microvascular permeability and hydrostatic edema, serving as a validated prognostic marker in ARDS and septic shock.

5A patient with septic shock has a Mean Arterial Pressure (MAP) of 68 mmHg on norepinephrine, Central Venous Oxygen Saturation (ScvO2) of 74%, but arterial blood lactate continues to rise (4.8 mmol/L). Venous-to-arterial carbon dioxide difference (Pv-aCO2 / PCO2 gap) is calculated at 9 mmHg (normal <= 6 mmHg). How should this elevated PCO2 gap be interpreted?

A.Systemic tissue hypoperfusion and microvascular stagnation despite macrohemodynamic pressure targets.

B.Adequate global cardiac output with primary cellular cytopathic dysoxia.

C.Hyperventilation-induced respiratory alkalosis with tissue hyperperfusion.

D.Severe arterial hypoxemia resulting in decreased CO2 clearance.

Explanation: The venous-to-arterial PCO2 difference (Pv-aCO2 gap, normal <= 6 mmHg) is inversely related to cardiac output and microvascular blood flow according to the modified Fick principle for CO2. An elevated PCO2 gap (> 6 mmHg) indicates microvascular stagnation, tissue hypoperfusion, or inadequate systemic blood flow to wash out CO2 produced by cellular metabolism, even when ScvO2 appears normalized.

6The ratio between venous-to-arterial PCO2 difference and arterial-to-venous oxygen content difference (Pv-aCO2 / Da-vO2) is measured in a critically ill patient. What does a Pv-aCO2 / Da-vO2 ratio greater than 1.4 mmHg/mL O2 indicate?

A.Presence of global anaerobic metabolism and oxygen-supply dependency.

B.Exclusive aerobic metabolism with high cardiac output state.

C.Severe respiratory acidosis due to acute hypercapnic respiratory failure.

D.Intravascular fluid overload with elevated right atrial pressure.

Explanation: The Pv-aCO2 / Da-vO2 ratio is a bedside surrogate for the respiratory quotient (VCO2 / VO2). Under aerobic conditions, the respiratory quotient is 0.7–0.9. When tissue hypoxia triggers anaerobic metabolism, CO2 production increases relative to O2 consumption due to bicarbonate buffering of excess hydrogen ions from lactic acidosis, elevating the Pv-aCO2 / Da-vO2 ratio above 1.4, which signals systemic anaerobic metabolism.

7In Point-of-Care Ultrasonography (POCUS), what echocardiographic finding characterizes severe acute cor pulmonale in acute massive pulmonary embolism?

A.Right ventricular end-diastolic dimension greater than the left ventricle, McConnnell's sign, and paradoxical septal shift.

B.Global left ventricular hypokinesis with severe mitral valve regurgitation and collapsed inferior vena cava.

C.Left ventricular hypertrophy with normal right ventricular dimensions and hyperdynamic apex.

D.Left ventricular outflow tract velocity-time integral (LVOT VTI) greater than 25 cm with aortic valve stenosis.

Explanation: Acute massive pulmonary embolism causing acute cor pulmonale presents on echocardiography with right ventricular dilatation (RV/LV end-diastolic diameter ratio > 1.0), paradoxical interventricular septal flattening toward the LV in systole/diastole (D-shaped left ventricle), McConnell's sign (akinesia of the RV free wall with sparing and hyperkinesia of the RV apex), and a plethoric, non-collapsible IVC.

8The Venous Excess Ultrasound (VExUS) score grades systemic venous congestion in critically ill patients. Which combination of Doppler findings corresponds to VExUS Grade 3 (severe venous congestion)?

A.Dilated Inferior Vena Cava (IVC >= 2.0 cm) with severe pulsatility/reversal in at least two veins (hepatic systolic reversal, portal pulsatility >= 50%, or discontinuous intrarenal venous flow).

B.Collapsible IVC (< 1.5 cm) with continuous portal venous Doppler flow and continuous intrarenal venous flow.

C.Dilated IVC with normal forward hepatic systolic wave and portal vein pulsatility index of 15%.

D.Normal IVC diameter with isolated continuous monophasic femoral vein flow.

Explanation: VExUS Grade 3 (severe congestion) requires an enlarged IVC (>= 2.0 cm with < 50% collapsibility) combined with severe Doppler abnormalities in at least two organ vascular beds: systolic reversal of the hepatic vein flow (S wave reversed/above baseline), portal vein pulsatility fraction >= 50%, or completely discontinuous (biphasic or monophasic diastolic) intrarenal venous flow.

9When assessing fluid responsiveness using the Left Ventricular Outflow Tract Velocity-Time Integral (LVOT VTI) during a mini-fluid challenge (100–150 mL crystalloid over 1 minute) or PLR, what percentage increase in VTI indicates fluid responsiveness?

A.>= 10% to 15% increase in LVOT VTI.

B.>= 3% to 5% increase in LVOT VTI.

C.>= 35% to 40% increase in LVOT VTI.

D.>= 50% increase in LVOT VTI.

Explanation: Because LVOT diameter is constant in a given patient, changes in LVOT VTI directly parallel changes in stroke volume. An increase of >= 10% to 15% in LVOT VTI following a Passive Leg Raise or mini-fluid challenge reliably identifies a patient on the ascending limb of the Frank-Starling curve (fluid responder).

10An underdamped arterial line waveform tracing produces which artifactual distortion on the bedside monitor?

A.Falsely elevated systolic blood pressure, falsely low diastolic blood pressure, and prominent dicrotic ringing.

B.Falsely low systolic blood pressure and falsely elevated diastolic blood pressure with loss of the dicrotic notch.

C.Inaccurate mean arterial pressure (MAP) with normal systolic and diastolic peaks.

D.Complete flattening of the waveform with pulse pressure equal to zero.

Explanation: Underdamping (excessive dynamic resonance in the tubing-catheter system) causes overshoot of high-frequency components, leading to an artificially elevated systolic blood pressure, an artificially decreased diastolic blood pressure, and multiple reverberant oscillations. Importantly, Mean Arterial Pressure (MAP) is derived by integration of the area under the curve and remains accurate even with moderate underdamping or overdamping.

About the TEMI Adulto (AMIB / AMB) Exam

The Título de Especialista em Medicina Intensiva — Área Adulto (TEMI Adulto) is the premier specialist certification awarded to Brazilian intensive care physicians by the Associação de Medicina Intensiva Brasileira (AMIB) under the authority of the Associação Médica Brasileira (AMB) and the Conselho Federal de Medicina (CFM). Governed by AMIB Edital nº 1898/2026, the certification process verifies advanced clinical expertise in managing multi-organ failure, hemodynamic collapse, refractory respiratory failure, acute neurological catastrophes, severe sepsis, and critical metabolic derangements in adult intensive care units. The examination comprises two eliminatory assessment phases: a comprehensive written Prova Teórica (objective multiple-choice exam) and a simulation-based Prova Prática / Teórico-Prática evaluating clinical vignettes, point-of-care ultrasound, mechanical ventilation waveforms, blood gas curves, and crisis management, complemented by an exhaustive Anexo VI curricular scoring evaluation where completed CNRM-accredited intensive care residency earns full eligibility points. This practice bank provides an English-language study adaptation of 100 verified questions matching AMIB's rigorous clinical standards and Brazilian regulatory frameworks.

Assessment

Two sequential eliminatory stages run by the Associação de Medicina Intensiva Brasileira with the AMB under Edital nº 1898/2026, scoped to the ÁREA ADULTO (AMIB certifies Medicina Intensiva Pediátrica through a separate process). Etapa 1: Prova Teórica of 90 four-option multiple-choice questions lasting 4 hours, assessed jointly with an Análise Curricular scored from 0 to 100 (Anexo VI). Etapa 2: Prova Prática using simulation stations and clinical scenarios that assess technical skills, decision-making, communication and professional attitudes.

Time Limit

Etapa 1: 4 hours. Etapa 2: simulation stations on a separate day.

Passing Score

Etapa 1 combines the theoretical mark with the curricular score: a curricular score of 100 requires a minimum of 48 correct answers, a score between 50 and 99 requires 49, and a score below 50 requires 50. Etapa 2 requires at least 70% on the Prova Prática, corresponding to a final average of 3,5 or higher.

Exam Fee

R$ 1.890,00 (associados adimplentes da AMIB e da AMB) / R$ 3.050,00 (não associados ou associados inadimplentes) (Associação de Medicina Intensiva Brasileira (AMIB) — Associação Médica Brasileira (AMB))

TEMI Adulto (AMIB / AMB) Exam Content Outline

24%

Monitorização Hemodinâmica e Choque Circulatório

Invasive and non-invasive hemodynamic monitoring, arterial line waveform analysis, central venous pressure (CVP), cardiac output determination (Swan-Ganz thermodilution, transpulmonary thermodilution PiCCO/EV1000), dynamic preload responsiveness indices (PPV, SVV, passive leg raise), critical care echocardiography / POCUS, VExUS score, venous blood gas interpretation (ScvO2, Pv-aCO2, Pv-aCO2/Da-vO2 ratio), and multi-etiology shock resuscitation (septic, cardiogenic, hypovolemic, obstructive) with vasoactive pharmacology.

20%

Ventilação Mecânica e Insuficiência Respiratória / SDRA

Pathophysiology and management of acute respiratory failure, Berlin Definition of ARDS, protective lung ventilation (tidal volume, plateau pressure, driving pressure, mechanical power), prone positioning protocol, PEEP titration strategies, recruitment maneuvers, ECMO indications (EOLIA criteria), patient-ventilator asynchronies (flow starvation, double triggering, reverse triggering, ineffective efforts), and evidence-based weaning/extubation protocols.

16%

Neurointensivismo e Protocolo de Morte Encefálica

Severe traumatic brain injury (TBI) and Brain Trauma Foundation guidelines, intracranial pressure (ICP) monitoring, cerebral perfusion pressure (CPP) optimization, tiered ICP management, hyperosmolar therapy, decompressive craniectomy, aneurysmal subarachnoid hemorrhage (SAH), vasospasm and delayed cerebral ischemia (DCI), acute ischemic stroke reperfusion protocols, status epilepticus, and the official Brazilian legal protocol for Brain Death determination under Resolução CFM nº 2.173/2017 with donor management.

12%

Insuficiência Renal Aguda e Terapia Renal Substitutiva Contínua (CRRT)

KDIGO acute kidney injury classification, biomarker utility, fluid overload pathophysiology, Continuous Renal Replacement Therapy (CRRT) modalities (CVVH, CVVHD, CVVHDF, PIRRT/SLED), regional citrate anticoagulation (RCA) protocols, citrate accumulation vs toxicity, electrolyte balancing during dialysis, and dialytrauma prevention.

10%

Distúrbios Hidroeletrolíticos e Equilíbrio Ácido-Base Complexo

Physicochemical Stewart approach to acid-base (Apparent and Effective Strong Ion Difference - SID, Total Weak Non-Volatile Acids - Atot, Strong Ion Gap - SIG), traditional Anion Gap and Delta-Delta ratio, lactic acidosis types, emergent hyperkalemia algorithms, safe correction of dysnatremias (prevention of osmotic demyelination syndrome), severe hypophosphatemia, and calcium/magnesium homeostasis.

10%

Sepse, Infecções Graves na UTI e Farmacocinética de Antimicrobianos

Surviving Sepsis Campaign 2021/2023 guidelines, Sepsis-3 criteria (SOFA vs qSOFA), 1-hour sepsis bundle, crystalloid selection, antimicrobial stewardship, PK/PD optimization in critically ill patients (augmented renal clearance, increased volume of distribution, prolonged/continuous beta-lactam infusions), and management of multidrug-resistant pathogens (KPC, NDM, OXA-48, MRSA, Pseudomonas, Acinetobacter) and invasive fungal infections.

Sedação, Analgesia, Delirium, Nutrição, Bioética e Cuidados Paliativos

PADIS guidelines for ICU sedation and analgesia, RASS and CPOT scales, CAM-ICU/ICDSC delirium screening and prevention, dexmedetomidine, propofol infusion syndrome (PRIS), neuromuscular blockade monitoring (TOF), ICU-acquired weakness (ICUAW), ESPEN/BRASPEN enteral/parenteral nutrition, glycemic control, APACHE II/IV and SAPS III prognostic scores, orthothanasia (Resolução CFM nº 1.805/2006), advance directives (Resolução CFM nº 1.995/2012), and end-of-life decision-making.

How to Pass the TEMI Adulto (AMIB / AMB) Exam

What You Need to Know

Passing score: Etapa 1 combines the theoretical mark with the curricular score: a curricular score of 100 requires a minimum of 48 correct answers, a score between 50 and 99 requires 49, and a score below 50 requires 50. Etapa 2 requires at least 70% on the Prova Prática, corresponding to a final average of 3,5 or higher.
Assessment: Two sequential eliminatory stages run by the Associação de Medicina Intensiva Brasileira with the AMB under Edital nº 1898/2026, scoped to the ÁREA ADULTO (AMIB certifies Medicina Intensiva Pediátrica through a separate process). Etapa 1: Prova Teórica of 90 four-option multiple-choice questions lasting 4 hours, assessed jointly with an Análise Curricular scored from 0 to 100 (Anexo VI). Etapa 2: Prova Prática using simulation stations and clinical scenarios that assess technical skills, decision-making, communication and professional attitudes.
Time limit: Etapa 1: 4 hours. Etapa 2: simulation stations on a separate day.
Exam fee: R$ 1.890,00 (associados adimplentes da AMIB e da AMB) / R$ 3.050,00 (não associados ou associados inadimplentes)

Keys to Passing

Work through all 100 available questions
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TEMI Adulto (AMIB / AMB) Study Tips from Top Performers

1Master Dynamic Hemodynamic Indices and Limits: Understand that PPV and SVV require controlled mechanical ventilation (tidal volume >= 8 mL/kg PBW, zero spontaneous respiratory efforts, sinus rhythm, closed chest). When these criteria are not met, utilize the Passive Leg Raise (PLR) test with real-time continuous cardiac output monitoring.

2Integrate POCUS and VExUS Grading into Resuscitation: Learn to interpret inferior vena cava (IVC) collapsibility, lung ultrasound B-lines (interstitial syndrome), left ventricular outflow tract velocity-time integral (LVOT VTI), and venous congestion grading using the Venous Excess Ultrasound (VExUS) score (hepatic vein, portal vein, and intrarenal venous Doppler).

3Internalize Lung-Protective Mechanical Ventilation Targets: Memorize the mathematical formulas for Driving Pressure (Pplateau - PEEP <= 14 cmH2O) and Mechanical Power. Know the strict inclusion and timing criteria for early prone positioning (PaO2/FiO2 < 150 with PEEP >= 10 for >= 16 consecutive hours) based on the PROSEVA trial.

4Master Regional Citrate Anticoagulation (RCA) for CRRT: Know the difference between citrate accumulation (rising total-to-ionized calcium ratio > 2.5, worsening metabolic acidosis with increased anion gap) and citrate overload (metabolic alkalosis with preserved ratio), and the precise titration of systemic calcium chloride replacement.

5Apply the Stewart Acid-Base Physical-Chemical Framework: Differentiate between apparent SID (SIDa = Na + K + Ca + Mg - Cl - lactate), effective SID (SIDe = HCO3 + Albumin- + Pi-), and the Strong Ion Gap (SIG = SIDa - SIDe). Recognize that unmeasured anions elevate SIG, while hyperchloremic metabolic acidosis reduces SID.

6Execute Rapid Sepsis-3 and Antimicrobial PK/PD Adjustments: Implement the 1-hour Surviving Sepsis bundle (measure lactate, blood cultures prior to antibiotics, broad-spectrum antibiotics within 1h, 30 mL/kg balanced crystalloids for hypotension/lactate >= 4 mmol/L, norepinephrine for MAP >= 65 mmHg). Account for Augmented Renal Clearance (ARC) by increasing beta-lactam doses or using continuous infusions.

Frequently Asked Questions

What is the TEMI Adulto and who administers the examination?

The TEMI Adulto (Título de Especialista em Medicina Intensiva — Área Adulto) is the official specialist title examination administered by the Associação de Medicina Intensiva Brasileira (AMIB) in partnership with the Associação Médica Brasileira (AMB) and recognized by the Conselho Federal de Medicina (CFM). Passing this exam and satisfying curricular requirements grants the legal right to register as a board-certified intensivist (RQE in Medicina Intensiva) in Brazil.

What are the eligibility pathways defined in AMIB Edital nº 1898/2026 Anexo VI?

Under AMIB Edital nº 1898/2026, eligibility is evaluated through the Anexo VI scoring matrix (maximum 100 points). Completion of a CNRM-accredited Medical Residency Program in Adult Intensive Care Medicine (Residência Médica em Medicina Intensiva Adulto credenciada pela CNRM/MEC) automatically confers 100 points. Alternatively, practicing physicians without residency can qualify by accumulating validated clinical practice time in accredited ICUs, AMIB training center (CEPETI) fellowships, publications, and post-graduate credits totaling the required threshold.

Does TEMI cover Pediatric Intensive Care Medicine as well?

No. AMIB and AMB certify Adult Intensive Care (Medicina Intensiva Adulto) and Pediatric Intensive Care (Medicina Intensiva Pediátrica) through entirely separate editais, examinations, and competency frameworks. This certification module is strictly scoped to the Adult title (TEMI Adulto).

How is the TEMI Adulto examination structured across phases?

The examination features two eliminatory stages: Phase 1 is the Prova Teórica (written objective multiple-choice exam testing foundational critical care physiology, pathology, pharmacology, and clinical guidelines), and Phase 2 is the Prova Prática / Teórico-Prática (interactive clinical vignettes, bedside procedural simulations, mechanical ventilation waveform adjustments, echocardiography/POCUS loops, and arterial blood gas interpretation). Candidates must achieve a minimum grade of 7.0 (70%) in each eliminatory phase.

What is the official Brazilian legal protocol for Brain Death determination?

Brain death determination in Brazil is strictly governed by Resolução CFM nº 2.173/2017. It mandates: (1) known severe, irreversible brain damage; (2) absence of confounding factors (hypothermia < 35°C, severe hypotension, metabolic coma, or residual sedative/neuromuscular blocking agents with proven washout); (3) two distinct clinical examinations conducted by two qualified physicians (at least one trained in neurology, neurosurgery, intensive care, or emergency medicine), with minimum observation intervals (1 hour for patients >= 2 years of age); (4) a standardized positive Apnea Test demonstrating PaCO2 > 55 mmHg without spontaneous respiratory effort; and (5) at least one mandatory confirmatory ancillary test demonstrating total absence of electrical activity (EEG), cerebral perfusion (angiography/transcranial Doppler), or metabolic activity.

Why is this OpenExamPrep practice bank presented in English?

This practice module provides 100 high-yield multiple-choice questions in English designed to build rigorous conceptual mastery for intensivists and medical scholars. It retains all official Brazilian statutory terms, CFM resolutions (e.g., CFM nº 2.173/2017, nº 1.805/2006, nº 1.995/2012), AMIB guidelines, and Anvisa standards within an internationalized, bilingual study framework.