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Exam Review

Key Facts: Atestace AIM Exam

100

High-Yield Practice MCQs

OpenExamPrep

500 CZK

Official Exam Fee

Nařízení vlády č. 324/2018 Sb.

6 Domains

Core Curriculum Syllabus Areas

Věstník MZ ČR

3+ Members

Official Board Committee

Vyhláška č. 282/2019 Sb.

The Czech Atestace in Anaesthesiology and Intensive Care (AIM) is the state specialty certification governed by Zákon č. 95/2004 Sb. and Vyhláška č. 282/2019 Sb. The official examination is a practical and oral board exam before an at least 3-member committee with a statutory fee of 500 CZK (Nařízení vlády č. 324/2018 Sb.). This study bank delivers 100 clinical MCQs across 6 core syllabus areas.

Sample Atestace AIM Practice Questions

Try these sample questions to review concepts for the Atestace AIM exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 45-year-old healthy male is scheduled for elective laparoscopic cholecystectomy under total intravenous anaesthesia (TIVA). Which pharmacological property correctly describes the pharmacokinetic and pharmacodynamic profile of propofol?
A.Its primary sedative effect is mediated via competitive antagonism at NMDA glutamate receptors in the cortex.
B.Its metabolic clearance rate exceeds total hepatic blood flow, indicating substantial extrahepatic metabolism in the lungs and kidneys.
C.The context-sensitive half-time remains strictly constant at 3 minutes regardless of whether the infusion lasts 1 hour or 12 hours.
D.It produces marked stimulation of the baroreceptor reflex, leading to reflex compensatory tachycardia when arterial blood pressure drops.
Explanation: Propofol has a remarkably high total body clearance (1.5–2.2 L/min) that exceeds typical hepatic blood flow (~1.2 L/min), demonstrating significant extrahepatic elimination primarily occurring in the lungs and kidneys. It acts predominantly by allosterically enhancing gamma-aminobutyric acid (GABA) at GABAA receptors, increasing chloride ion conductance and hyperpolarizing neuronal membranes. Unlike volatile agents, propofol blunts the baroreceptor reflex, resulting in hypotension without compensatory tachycardia.
2An 82-year-old female with severe aortic stenosis and ischemic heart disease is undergoing emergency surgery for a perforated diverticulum. The anaesthesiologist considers etomidate for induction. What is the principal endocrine side effect associated with even a single induction dose of etomidate?
A.Irreversible destruction of adrenal cortical zona fasciculata cells leading to permanent Addisonian crisis.
B.Profound inhibition of thyroid peroxidase resulting in acute myxedema coma within 4 hours.
C.Reversible dose-dependent inhibition of 11-beta-hydroxylase, blocking conversion of 11-deoxycortisol to cortisol for up to 24 hours.
D.Stimulation of aldosterone synthase causing acute hyperaldosteronism, hypokalemia, and severe metabolic alkalosis.
Explanation: Etomidate contains an imidazole ring that binds directly to cytochrome P450 enzymes, specifically causing reversible inhibition of 11-beta-hydroxylase (CYP11B1) and to a lesser extent 17-alpha-hydroxylase. This blocks the enzymatic conversion of 11-deoxycortisol to cortisol and 11-deoxycorticosterone to corticosterone, producing adrenocortical suppression that persists for 12 to 24 hours even after a single bolus. In critically ill and septic patients, this transient adrenocortical insufficiency has been correlated with increased mortality in several clinical trials.
3A 28-year-old male with severe acute asthma refractory to nebulized bronchodilators requires urgent intubation for respiratory exhaustion. Ketamine is selected as the induction agent. What pharmacological mechanism explains both its bronchodilatory property and its dissociative state?
A.Non-competitive antagonism at NMDA receptors combined with indirect sympathomimetic release of endogenous catecholamines.
B.Direct agonism of mu-opioid receptors coupled with postsynaptic GABAA receptor activation in the hippocampus.
C.Selective blockade of muscarinic M3 receptors and inhibition of voltage-gated potassium channels in bronchial smooth muscle.
D.Irreversible inhibition of monoamine oxidase leading to massive extracellular accumulation of histamine and serotonin.
Explanation: Ketamine produces dissociative anaesthesia primarily by non-competitive antagonism of the N-methyl-D-aspartate (NMDA) receptor at the phencyclidine binding site within the ion channel, interrupting thalamocortical and limbic projections. Its bronchodilatory effect is mediated both by direct smooth muscle relaxation and by indirect sympathomimetic action through central sympathetic stimulation and inhibition of neuronal catecholamine reuptake. In patients with depleted catecholamine stores (such as prolonged septic shock), ketamine can unmask its direct myocardial depressant effect.
4Which of the following volatile anaesthetics has the lowest blood-gas partition coefficient, resulting in the most rapid wash-in and wash-out pharmacokinetics during clinical anaesthesia?
A.Isoflurane (blood-gas coefficient 1.40)
B.Sevoflurane (blood-gas coefficient 0.65)
C.Halothane (blood-gas coefficient 2.50)
D.Desflurane (blood-gas coefficient 0.42)
Explanation: Desflurane has a blood-gas partition coefficient of approximately 0.42 at 37°C, which is the lowest among modern potent volatile anaesthetics (compared to sevoflurane at 0.65, isoflurane at 1.40, and halothane at 2.50). A low blood-gas solubility means that very little anaesthetic dissolves in the blood before partial pressure rises in the alveoli and brain, enabling the fastest induction and prompt emergence independent of case duration. However, desflurane requires a heated pressurized vaporizer (Tec 6) due to its high vapor pressure (669 mmHg at 20°C) and boiling point near room temperature (22.8°C).
5During low-flow anaesthesia with sevoflurane, interaction between the volatile agent and strong alkaline carbon dioxide absorbents can lead to the formation of a toxic degradation byproduct. Which substance is produced, and what is the current clinical safety recommendation?
A.Carbon monoxide; fresh gas flow must be kept below 0.5 L/min to saturate hemoglobin.
B.Compound A; fresh gas flow should be maintained at >= 1 to 2 L/min, especially during prolonged procedures.
C.Phosgene; fresh gas flow must be supplemented with humidified nitrous oxide to accelerate scavenging.
D.Formaldehyde; soda lime must be pre-treated with potassium hydroxide to prevent renal tubular necrosis.
Explanation: Sevoflurane degrades in the presence of strong basic carbon dioxide absorbents (particularly those containing potassium hydroxide [KOH] or sodium hydroxide [NaOH]) into Compound A (fluoromethyl-2,2-difluoro-1-(trifluoromethyl)vinyl ether). Compound A causes dose-dependent proximal renal tubular necrosis in rats; while human nephrotoxicity is rarely documented, international and Czech societies (ČSARIM) recommend maintaining fresh gas flow at >= 1–2 L/min during sevoflurane anaesthesia to avoid high concentrations (> 25–50 ppm). Modern carbon dioxide absorbents without strong bases (such as calcium hydroxide without KOH/NaOH) eliminate Compound A formation.
6A 19-year-old male undergoing repair of a femur fracture under general anaesthesia with sevoflurane and rocuronium suddenly demonstrates unexplained progressive tachycardia, severe hypercapnia (ETCO2 82 mmHg despite hyperventilation), and generalized masseter spasm. Which pharmacological intervention and genetic pathology are primary in this life-threatening crisis?
A.Immediate administration of dantrolene sodium (2.5 mg/kg IV bolus); defect in the ryanodine receptor type 1 (RYR1) gene causing uncontrolled sarcoplasmic reticulum calcium release.
B.Immediate administration of high-dose calcium chloride (20 mg/kg IV); defect in dystrophin gene causing excessive sarcolemmal potassium influx.
C.Administration of neostigmine (0.05 mg/kg) and atropine; defect in acetylcholinesterase causing persistent nicotinic depolarization.
D.Administration of potassium chloride infusion; mutation in dihydropyridine receptor causing cellular hypokalemic paralysis.
Explanation: The patient is experiencing Malignant Hyperthermia (MH), an autosomal dominant pharmacogenetic myopathy most commonly caused by mutations in the RYR1 gene (or less frequently CACNA1S) encoding the skeletal muscle ryanodine receptor. Exposure to volatile anaesthetics or succinylcholine causes unregulated calcium release from the sarcoplasmic reticulum into the myoplasm, resulting in sustained muscle rigidity, hypermetabolism, rapid rise in ETCO2 (earliest and most sensitive sign), metabolic/respiratory acidosis, and hyperthermia. Immediate management requires stopping trigger agents, hyperventilating with 100% O2, active cooling, and administering dantrolene at an initial dose of 2.5 mg/kg IV repeated until signs abate (dantrolene blocks ryanodine receptor calcium channels).
7According to the guidelines of the Czech Society of Anaesthesiology, Resuscitation and Intensive Medicine (ČSARIM) and the European Society of Anaesthesiology and Intensive Care (ESAIC), what is the mandatory quantitative neuromuscular monitoring threshold required prior to safe tracheal extubation?
A.Train-of-Four (TOF) ratio >= 0.50 (50%) measured at the orbicularis oculi muscle.
B.Sustained head lift for 5 seconds without objective quantitative acceleromyography.
C.Train-of-Four (TOF) ratio >= 0.90 (90%) measured quantitatively at the adductor pollicis muscle.
D.Train-of-Four (TOF) count of 4 with palpable tactile absence of fade on manual stimulation.
Explanation: Current ČSARIM and ESAIC guidelines mandate quantitative neuromuscular monitoring before extubation, defining complete recovery as a Train-of-Four (TOF) ratio >= 0.90 (90%) measured at the adductor pollicis (innervated by the ulnar nerve). Clinical tests such as 5-second head lift, tongue protrusion, or manual tactile assessment of fade are subjective, unreliable, and cannot exclude residual neuromuscular blockade (TOF ratio 0.6–0.8), which is associated with airway obstruction, hypoxemia, and increased postoperative pulmonary complications.
8A 52-year-old male was intubated using rocuronium (0.6 mg/kg). At the end of surgery, quantitative neuromuscular monitoring reveals a deep block with no twitches on TOF stimulation, but a Post-Tetanic Count (PTC) of 2. What is the recommended dose of sugammadex to achieve rapid and complete reversal?
A.0.5 mg/kg of actual body weight
B.2.0 mg/kg of ideal body weight
C.16.0 mg/kg of lean body mass
D.4.0 mg/kg of actual body weight
Explanation: Sugammadex dosing is based on actual body weight and the depth of neuromuscular blockade at the time of reversal: 2.0 mg/kg is indicated for routine reversal of moderate block (reappearance of at least 2 twitches on TOF, T2); 4.0 mg/kg is required for reversal of deep block (defined as 0 twitches on TOF with 1–2 post-tetanic twitches on PTC); and 16.0 mg/kg is reserved for immediate rescue reversal 3 minutes after a high induction dose (1.2 mg/kg) of rocuronium in a cannot-intubate-cannot-oxygenate scenario.
9During elective surgery, an anaesthesiologist administers neostigmine (0.05 mg/kg) with glycopyrrolate when the patient already exhibits a spontaneous TOF ratio of 0.92. What paradoxical pharmacological complication can occur under these circumstances?
A.Severe acute tachyarrhythmia due to excessive nicotinic stimulation of atrial pacemakers.
B.Paradoxical muscle weakness and neuromuscular dysfunction caused by acetylcholine accumulation inducing depolarizing desensitization block.
C.Rapid irreversible inactivation of plasma pseudocholinesterase leading to delayed clearance of volatile agents.
D.Immediate severe bronchospasm refractory to high-dose beta-2 agonists due to complete beta-blockade.
Explanation: Neostigmine inhibits acetylcholinesterase, leading to acetylcholine accumulation in the synaptic cleft. When administered in the presence of full or near-complete neuromuscular recovery (TOF ratio > 0.90), the excessive concentration of synaptic acetylcholine causes persistent depolarization, receptor desensitization, and channel open-state inactivation, resulting in paradoxical muscle weakness, upper airway collapse, and impaired respiratory mechanics. Acetylcholinesterase inhibitors have a ceiling effect and should not be given without objective evidence of residual block (or when recovery is already near complete).
10A 35-year-old paraplegic patient who suffered a complete thoracic spinal cord transection 6 weeks ago requires urgent surgery for an acute incarcerated hernia. Why is succinylcholine strictly contraindicated in this patient?
A.Risk of fatal hyperkalemia due to proliferation of extrajunctional nicotinic acetylcholine receptors across the entire muscle sarcolemma.
B.High probability of triggering malignant hyperthermia specifically due to spinal denervation hypersensitivity.
C.Complete resistance to depolarizing blockade requiring massive doses that cause permanent renal cortical necrosis.
D.Rapid conversion of succinylcholine to toxic metabolites that selectively damage anterior horn motor neurons.
Explanation: Following denervation injuries (such as spinal cord transection, stroke, or severe burns) older than 24–48 hours, skeletal muscle fibers upregulate fetal and extrajunctional nicotinic acetylcholine receptors (containing alpha-7 homomers and alpha-1-beta-1-delta-gamma pentamers) along the entire sarcolemmal surface. When succinylcholine binds to these widespread receptors, extensive prolonged potassium efflux occurs, capable of elevating serum potassium by 2 to 7+ mmol/L within minutes, precipitating refractory cardiac arrest and ventricular fibrillation. This contraindication typically lasts from 48 hours to at least 1–2 years post-injury (or indefinitely in progressive neurodegenerative diseases).

About the Atestace AIM Exam

The Atestační zkouška v oboru Anesteziologie a intenzivní medicína is the qualifying examination for Czech specialist competence under Zákon č. 95/2004 Sb. and Vyhláška č. 282/2019 Sb. The current program requires a 30-month foundational trunk and at least 24 months of specialty training, followed by practical and oral assessment before an appointed committee; the practical assessment may use an OSCE format. This independent English-language MCQ bank reinforces clinical knowledge but is not an official translation or format simulation and does not substitute for oral, OSCE, or hands-on preparation.

Exam sponsor: Ministerstvo zdravotnictví České republiky (MZ ČR) / Lékařské fakulty / IPVZ. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Official format: Practical exam (patient assessment, anesthesia plan, intensive care bedside examination) + Oral theoretical exam (3 drawn question sets covering General Anaesthesia, Intensive Care, and Organ-Specific/Special Subspecialties before an at least 3-member committee). This bank provides 100 MCQs covering all 6 syllabus domains.

Time Limit

No fixed total duration is published; oral preparation is at least 30 minutes, with practical assessment as required by the specialty program.

Passing Score

Consensus of at least 3-member committee ('prospěl' / 'neprospěl')

Exam / Certification Fees

500 CZK (250 CZK practical, 250 CZK theoretical)

Exam sponsor website

Reported exam pass rate: Not published by MZ ČR. Graded dichotomously as Pass ('prospěl') or Fail ('neprospěl') by the state examination board. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

Not published

General Anaesthesia & Pharmacology

Intravenous and inhalational agents, neuromuscular blockers and reversal (sugammadex), TIVA/TCI, depth of anesthesia monitoring, and malignant hyperthermia

Not published

Airway Management

Anticipated and unanticipated difficult airway, videolaryngoscopy, fiberoptics, supraglottic airway devices, emergency front-of-neck access (eFONA), and extubation

Not published

Intensive Care & Organ Failure

Sepsis-3, septic shock, hemodynamic monitoring, ARDS lung-protective ventilation, AKI and CRRT, neurocritical care, and ECMO

Not published

Perioperative & Organ-Specific Anaesthesia

Cardiothoracic, vascular, and neuroanesthesia, thoracic one-lung ventilation, patient blood management, and ROTEM/TEG guided hemotherapy

Not published

Obstetric & Paediatric Anaesthesia

Labor analgesia, cesarean delivery, preeclampsia, peripartum hemorrhage, neonatal and infant physiology, and pediatric emergencies

Not published

Regional Anaesthesia & Resuscitation

Ultrasound peripheral blocks, spinal/epidural anesthesia, LAST treatment with intralipid, and ERC advanced life support protocols

Preparing for the Atestace AIM Exam

What You Need to Know

  • Passing score: Consensus of at least 3-member committee ('prospěl' / 'neprospěl')
  • Assessment: Official format: Practical exam (patient assessment, anesthesia plan, intensive care bedside examination) + Oral theoretical exam (3 drawn question sets covering General Anaesthesia, Intensive Care, and Organ-Specific/Special Subspecialties before an at least 3-member committee). This bank provides 100 MCQs covering all 6 syllabus domains.
  • Time limit: No fixed total duration is published; oral preparation is at least 30 minutes, with practical assessment as required by the specialty program.
  • Exam / certification fees: 500 CZK (250 CZK practical, 250 CZK theoretical) Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Atestace AIM: Suggested Study Strategy

1Thoroughly review pharmacological pharmacokinetics and pharmacodynamics (context-sensitive half-times, TCI models like Marsh and Schnider, sugammadex dosage rules).
2Memorize the ČSARIM and DAS difficult airway algorithms, specifically videolaryngoscopy indications, supraglottic device failure criteria, and emergency front-of-neck access (scalpel-bougie-tube).
3Master mechanical ventilation mechanics: driving pressure calculation, lung compliance, PEEP titration strategies, and prone positioning indications in ARDS.
4Understand viscoelastic testing interpretation (ROTEM EXTEM, INTEM, FIBTEM, HEPTEM; TEG) and algorithm-driven hemotherapy during massive perioperative bleeding.
5Review resuscitation specifics: European Resuscitation Council (ERC) ALS guidelines, post-resuscitation targeted temperature management, and lipid emulsion dosing for LAST.

Frequently Asked Questions

What is the official format of the Czech Atestace in Anaesthesiology and Intensive Care?

Under Zákon č. 95/2004 Sb. and Vyhláška č. 282/2019 Sb., the official examination is composed of two parts: a practical clinical examination conducted on an accredited clinical department (anesthesia induction/conduct and intensive care patient management) and an oral theoretical board examination before a committee of at least three appointed medical specialists. This online practice bank provides an English-language MCQ study adaptation based on the official educational program topics.

What are the official examination and retake fees?

Pursuant to Nařízení vlády č. 324/2018 Sb., the regular examination fee is 500 CZK (divided into 250 CZK for the practical part and 250 CZK for the theoretical part). For retakes, the statutory fee increases to 3,500 CZK for the first retake and 5,000 CZK for the second retake.

Who administers the examination and where is it held?

The examination is organized under the authority of the Ministry of Health of the Czech Republic (MZ ČR) in collaboration with the Institute for Postgraduate Medical Education (IPVZ) and medical faculties (such as 1. LF UK, 2. LF UK, 3. LF UK in Prague, LF MU in Brno, and LF UP in Olomouc).

What prerequisites are mandatory prior to registering for the atestace?

Candidates must have earned a MUDr. degree, completed the 30-month anesteziologický kmen and at least 24 months of specialized training, passed the required trunk assessment, completed mandatory rotations and courses, and fulfilled the current program's verified logbook requirements.

Which professional guidelines form the core of the exam content?

The examination tests evidence-based recommendations established by the Czech Society of Anaesthesiology, Resuscitation and Intensive Medicine (ČSARIM), the European Society of Anaesthesiology and Intensive Care (ESAIC), and the European Resuscitation Council (ERC).