100+ Free Atestace Vnitřní lékařství Practice Questions
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Key Facts: Atestace Vnitřní lékařství Exam
5 Years
Total Postgraduate Specialty Training Duration (60 Months)
Věstník MZ ČR Vzdělávací program
500 CZK
Statutory Initial Examination Fee (250 Practical + 250 Theoretical)
Nařízení vlády č. 324/2018 Sb.
3+ Members
Minimum Size of Statutory State Examination Board
Vyhláška č. 282/2019 Sb.
2 Parts
Bedside Practical Clinical Exam + Oral Theoretical Board Exam
Zákon č. 95/2004 Sb.
L3 License
Independent Specialist Medical Qualification (Specializovaná způsobilost)
Česká lékařská komora (ČLK)
Max 2 Retakes
Maximum Allowed Retake Attempts (3 Total Attempts)
Vyhláška č. 282/2019 Sb.
The Czech Specialty Examination in Internal Medicine (Atestace Vnitřní lékařství) certifies independent specialist practice under Zákon č. 95/2004 Sb. and Vyhláška č. 282/2019 Sb. It consists of a clinical bedside practical exam and an oral theoretical board exam before a 3+ member committee. This practice bank provides 100 verified English-language clinical MCQs with comprehensive explanations aligned with official Czech and European guidelines.
Sample Atestace Vnitřní lékařství Practice Questions
Try these sample questions to test your Atestace Vnitřní lékařství exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 58-year-old man presents to a regional Czech community hospital emergency department with 90 minutes of crushing retrosternal chest pain radiating to the left jaw and diaphoresis. His ECG reveals 3 mm ST-segment elevations in leads V1–V4 with reciprocal ST depressions in inferior leads. The local hospital lacks a catheterization laboratory, and the expected transport time to the nearest PCI center in Prague is 45 minutes (estimated door-to-wire time is 75 minutes). According to the European Society of Cardiology (ESC) and Czech Society of Cardiology (ČKS) guidelines for acute STEMI, what is the most appropriate reperfusion strategy?
2A 64-year-old woman with a history of anterior myocardial infarction 6 months ago presents to the outpatient cardiology clinic for routine follow-up. Transthoracic echocardiography reveals a left ventricular ejection fraction (LVEF) of 32% with anterior wall akinesis, and her NT-proBNP is elevated at 1,450 pg/mL. She currently has mild dyspnea on climbing one flight of stairs (NYHA Class II). She is taking ramipril 5 mg daily and bisoprolol 5 mg daily. Her blood pressure is 124/76 mmHg, heart rate 68 bpm, eGFR 68 mL/min/1.73 m², and serum potassium 4.4 mmol/L. According to ESC and Czech Society of Internal Medicine guidelines, which therapeutic optimization represents the standard 'four-pillar' foundation for heart failure with reduced ejection fraction (HFrEF)?
3A 72-year-old male with known ischemic cardiomyopathy is admitted to the internal medicine acute ward with severe orthopnea, bilateral leg edema up to the mid-thighs, and a 5 kg weight gain over 10 days. On physical examination, his blood pressure is 148/92 mmHg, heart rate is 88 bpm regular, oxygen saturation is 91% on room air, jugular venous distention is present to the angle of the jaw, and bilateral inspiratory crackles are heard over the lower half of the lung fields. Extremities are warm with brisk capillary refill (warm-and-wet hemodynamic profile). Laboratory tests show serum creatinine 115 µmol/L and potassium 4.2 mmol/L. What is the most appropriate initial pharmacological intervention?
4A 69-year-old diabetic woman presents to the emergency department with intermittent retrosternal tightness occurring at rest over the past 12 hours. Her ECG shows dynamic 1.5 mm horizontal ST-segment depressions in leads V4–V6 and a flat T wave in aVL. High-sensitivity cardiac troponin T (hs-cTnT) is 142 ng/L (upper reference limit 14 ng/L), and repeat testing at 1 hour is 210 ng/L. Her GRACE risk score is calculated at 155 points (high risk). She is pain-free following sublingual nitroglycerin, with BP 130/80 mmHg and HR 74 bpm. According to the ESC guidelines on non-ST-elevation acute coronary syndromes (NSTE-ACS), what is the recommended timing for invasive coronary angiography?
5A 61-year-old man undergoes successful primary PCI with drug-eluting stent implantation to the proximal LAD for an acute anterior STEMI. Four hours post-procedure in the coronary care unit, he becomes cold, clammy, and confused. Vital signs: blood pressure 76/48 mmHg (MAP 57 mmHg), heart rate 118 bpm sinus tachycardia, respiratory rate 26 breaths/min, and SpO2 89% on ambient air. Bedside echocardiography demonstrates an LVEF of 20% with severe global anterior/apical akinesis and no mechanical complications (no ventricular septal rupture or acute mitral regurgitation). Arterial blood gas reveals pH 7.24, PaO2 62 mmHg, and lactate 5.2 mmol/L. Urine output is 10 mL/h. Which vasoactive and supportive management strategy is most appropriate according to ESC and ČKS acute cardiovascular care guidelines?
6A 71-year-old male is diagnosed with newly detected paroxysmal atrial fibrillation during a routine health check. His medical history includes well-controlled hypertension on amlodipine and type 2 diabetes mellitus on metformin. He has no history of stroke, TIA, thromboembolism, or vascular disease, and his echocardiogram reveals normal left ventricular function without valvular abnormalities. His estimated glomerular filtration rate is 75 mL/min/1.73 m². What is his CHA2DS2-VASc score, and what is the guideline-recommended antithrombotic management?
7A 68-year-old woman with known chronic heart failure and an LVEF of 28% presents to the emergency department with acute palpitations and fatigue. Her ECG confirms atrial fibrillation with a rapid ventricular response of 145 bpm. Her blood pressure is 112/70 mmHg, and she has mild bibasilar crackles without peripheral hypoperfusion. Which of the following pharmacological agents is the most appropriate first-line choice for acute ventricular rate control in this patient?
8A 54-year-old male executive presents with typical exertional retrosternal angina provoked by climbing hills, relieved within 3 minutes of rest. He is a non-smoker with treated hypercholesterolemia. His baseline resting ECG is entirely normal, and resting echocardiography demonstrates an LVEF of 62% without regional wall motion abnormalities. His calculated clinical pre-test probability of obstructive coronary artery disease is intermediate (28%). According to the ESC guidelines on Chronic Coronary Syndromes (CCS), which diagnostic test is recommended as the preferred initial non-invasive anatomical examination in patients with an intermediate pre-test probability and high likelihood of good image quality?
9An 82-year-old woman is referred for evaluation of progressive exertional dyspnea (NYHA Class III) and an episode of near-syncope while walking to the grocery store. Physical examination reveals a harsh late-peaking systolic ejection murmur (grade 4/6) radiating to the carotids with a delayed and diminished carotid pulse (pulsus parvus et tardus). Transthoracic echocardiography shows a calcified trileaflet aortic valve with a peak transaortic velocity of 4.4 m/s, mean transvalvular gradient of 48 mmHg, and calculated aortic valve area of 0.65 cm² (0.40 cm²/m² indexed). Her STS surgical risk score is 5.2% (intermediate risk), and transfemoral access is anatomically favorable on CT. What is the recommended management according to ESC and Czech valvular heart disease guidelines?
10A 48-year-old male with a history of bicuspid aortic valve presents with high spiking fevers (up to 39.2°C), night sweats, and anorexia for 3 weeks. Examination reveals a new early diastolic blowing murmur along the left sternal border and subungual splinter hemorrhages. Three independent sets of blood cultures drawn 12 hours apart grow Streptococcus gallolyticus (formerly S. bovis). Transesophageal echocardiography (TEE) reveals an 11 mm oscillating vegetation on the aortic valve with moderate-to-severe aortic regurgitation. What additional clinical screening examination is mandatory in this patient?
About the Atestace Vnitřní lékařství Exam
The Atestační zkouška v oboru Vnitřní lékařství is the definitive state specialty board examination in the Czech Republic required to achieve independent specialist qualification (specializovaná způsobilost) in Internal Medicine under Zákon č. 95/2004 Sb. The examination is administered by accredited medical faculties (Lékařské fakulty UK, MU, UP, OU) in collaboration with the Institute for Postgraduate Medical Education (IPVZ) and the Ministry of Health of the Czech Republic (MZ ČR). The statutory assessment is structured into two mandatory parts: (1) A bedside practical clinical examination where the candidate examines an inpatient, develops a comprehensive differential diagnosis, formulates acute and chronic therapeutic plans, interprets laboratory/imaging/ECG findings, and defends a drafted clinical discharge report, followed by (2) An oral theoretical board examination conducted before a state examination committee of at least 3 appointed academic and clinical experts under Vyhláška č. 282/2019 Sb., where the candidate draws three broad theoretical questions from the curriculum published in Věstník MZ ČR. Please note: The official assessment is an oral and bedside practical examination; this practice bank represents an English-language MCQ study adaptation based on official Věstník MZ ČR educational programs and international clinical guidelines (ČIS ČLS JEP, ESC, EASL, KDIGO, ERS, EULAR).
Assessment
Performance-based assessment
Time Limit
No fixed total duration is published; oral preparation is at least 30 minutes, with bedside practical assessment as required by the specialty program.
Passing Score
Pass / Fail ('prospěl' / 'neprospěl') by consensus determination of the statutory examination committee
Exam Fee
500 CZK (initial attempt); 3,500 CZK (1st retake); 5,000 CZK (2nd retake) (Ministerstvo zdravotnictví České republiky (MZ ČR) / Lékařské fakulty / IPVZ)
Atestace Vnitřní lékařství Exam Content Outline
Cardiology & Vascular Medicine
Acute coronary syndromes (STEMI, NSTEMI, timing of coronary angiography, dual antiplatelet therapy, GP IIb/IIIa inhibitors), chronic coronary syndromes, heart failure with reduced and preserved ejection fraction (quadruple GDMT: ARNI/ACEi, beta-blocker, MRA, SGLT2i, device therapy with ICD/CRT), supraventricular and ventricular arrhythmias, atrial fibrillation (thromboembolic risk by CHA2DS2-VASc, bleeding risk by HAS-BLED, DOAC dosing and reversal, rate vs rhythm control), arterial hypertension workup (24h ABPM criteria, resistant hypertension, secondary causes including primary aldosteronism and renal artery stenosis), infective endocarditis (Duke criteria, blood cultures, empiric and targeted antibiotic regimens, surgical indications), valvular heart diseases (aortic stenosis severity, TAVI vs SAVR indications, mitral regurgitation), pericardial diseases (acute pericarditis, cardiac tamponade Beck's triad, constrictive pericarditis), acute aortic dissection (Stanford type A vs B, emergency blood pressure lowering, surgical vs endovascular repair), and peripheral artery disease.
Gastroenterology, Hepatology & Nephrology
Acute pancreatitis (revised Atlanta classification, severity stratification, early fluid resuscitation, indications for CT and enteral nutrition), peptic ulcer disease and Helicobacter pylori eradication regimens, acute upper and lower gastrointestinal bleeding (Forrest classification, endoscopic hemostatic modalities, restrictive transfusion targets, vasoactive octreotide/terlipressin infusions), inflammatory bowel diseases (differentiation between Crohn's disease and ulcerative colitis, biologic therapy, acute severe colitis rescue therapy), acute liver failure (King's College criteria, N-acetylcysteine, emergency liver transplantation), liver cirrhosis complications (management of ascites, diagnostic paracentesis and spontaneous bacterial peritonitis criteria, hepatorenal syndrome-AKI diagnosis and terlipressin/albumin treatment, hepatic encephalopathy), viral hepatitis B and C therapy, KDIGO acute kidney injury staging (prerenal vs acute tubular necrosis, fractional excretion of sodium/urea, urgent indications for renal replacement therapy), chronic kidney disease progression and nephroprotection (SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, ACEi/ARB), nephrotic vs nephritic glomerulopathies, and severe electrolyte derangements (hyponatremia workup, SIADH vs cerebral salt wasting, strict correction limit <= 8-10 mmol/L in 24h to prevent osmotic demyelination syndrome, and hyperkalemia emergency stabilization with IV calcium and insulin-glucose).
Pulmonology & Critical Care Medicine
Community-acquired pneumonia (CURB-65 / CRB-65 risk stratification, outpatient vs inpatient antibiotic selection, atypical pathogens), hospital-acquired and ventilator-associated pneumonia, acute exacerbations of COPD (indications for non-invasive ventilation BiPAP, systemic corticosteroids, short-acting bronchodilators, antibiotics according to Anthonisen criteria), bronchial asthma stepwise management (GINA guidelines, inhaled corticosteroid-formoterol as preferred reliever and controller), acute pulmonary embolism (Wells score, age-adjusted D-dimer, PESI/sPESI risk stratification, hemodynamic instability definitions, systemic thrombolysis vs anticoagulation), interstitial lung diseases (idiopathic pulmonary fibrosis HRCT honeycombing, antifibrotic agents pirfenidone and nintedanib, sarcoidosis staging), acute respiratory distress syndrome (ARDS Berlin definition, lung-protective mechanical ventilation with Vt 4-8 mL/kg PBW, plateau pressure <= 30 cmH2O, prone positioning for P/F ratio < 150), sepsis and septic shock (Sepsis-3 definitions, SOFA score, Surviving Sepsis Campaign 1-hour resuscitation bundle, balanced crystalloids, norepinephrine as first-line vasopressor), and pleural effusions (Light's criteria differentiating exudate from transudate).
Endocrinology, Metabolism & Rheumatology
Type 1 and Type 2 diabetes mellitus management (lifestyle intervention, metformin, SGLT2 inhibitors and GLP-1 receptor agonists with proven cardiovascular and nephroprotective benefits, individualized HbA1c targets), diabetic ketoacidosis and hyperosmolar hyperglycemic state resuscitation (fluid deficits, potassium monitoring before insulin infusion, continuous low-dose regular insulin, resolution criteria), thyroid disorders (Graves' disease TSH receptor antibodies, toxic multinodular goiter, Hashimoto's thyroiditis, thyrotoxic storm management with thionamides, iodine, beta-blockers, and corticosteroids, myxedema coma), primary vs secondary adrenal insufficiency (Addison's disease, cosyntropin stimulation test, emergency hydrocortisone for adrenal crisis), Cushing's syndrome diagnostic screening (24h urinary free cortisol, late-night salivary cortisol, low-dose dexamethasone suppression test), calcium homeostasis and primary hyperparathyroidism, osteoporosis management (DXA T-score <= -2.5, FRAX tool, antiresorptive bisphosphonates/denosumab and osteoanabolic teriparatide), rheumatoid arthritis (ACR/EULAR classification, early methotrexate initiation, biological DMARDs), seronegative spondyloarthropathies, systemic lupus erythematosus (ANA, anti-dsDNA, lupus nephritis staging), polymyalgia rheumatica and giant cell arteritis (immediate high-dose corticosteroid therapy to prevent permanent visual loss), and crystal arthropathies (acute gout vs calcium pyrophosphate deposition disease, colchicine, NSAIDs, allopurinol/febuxostat urate-lowering therapy).
Hematology & Medical Oncology
Comprehensive evaluation and differential diagnosis of anemias (microcytic hypochromic anemias: iron deficiency with low ferritin vs anemia of chronic disease with elevated ferritin/hepcidin vs thalassemia; macrocytic anemias: vitamin B12 deficiency with methylmalonic acid elevation vs folate deficiency; hemolytic anemias: Coombs positive autoimmune hemolytic anemia, microangiopathic hemolytic anemia with schistocytes, cold agglutinin disease), monoclonal gammopathies (monoclonal gammopathy of undetermined significance MGUS vs smoldering multiple myeloma vs active multiple myeloma using SLiM-CRAB criteria: >= 60% bone marrow plasma cells, serum free light chain ratio >= 100, > 1 MRI focal lesion, hypercalcemia, renal impairment, anemia, bone lytic lesions), myeloproliferative neoplasms (polycythemia vera JAK2 V617F, essential thrombocythemia, primary myelofibrosis) and myelodysplastic syndromes, acute myeloid and lymphoid leukemias, Hodgkin and non-Hodgkin lymphomas, deep vein thrombosis and venous thromboembolism anticoagulation duration (provoked vs unprovoked), bleeding and thrombotic disorders (immune thrombocytopenia ITP, thrombotic thrombocytopenic purpura TTP ADAMTS13 deficiency, disseminated intravascular coagulation DIC, heparin-induced thrombocytopenia HIT type II 4T score), oncologic emergencies (febrile neutropenia empiric broad-spectrum coverage within 1 hour, superior vena cava syndrome, malignant spinal cord compression emergency dexamethasone and MRI, tumor lysis syndrome rasburicase/allopurinol and aggressive hydration, hypercalcemia of malignancy with IV bisphosphonates), and solid tumor staging and management (colorectal cancer, gastric adenocarcinoma, lung carcinoma).
How to Pass the Atestace Vnitřní lékařství Exam
What You Need to Know
- Passing score: Pass / Fail ('prospěl' / 'neprospěl') by consensus determination of the statutory examination committee
- Assessment: Performance-based assessment
- Time limit: No fixed total duration is published; oral preparation is at least 30 minutes, with bedside practical assessment as required by the specialty program.
- Exam fee: 500 CZK (initial attempt); 3,500 CZK (1st retake); 5,000 CZK (2nd retake)
Keys to Passing
- 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 Vnitřní lékařství Study Tips from Top Performers
Frequently Asked Questions
What is the Atestační zkouška v oboru Vnitřní lékařství and what qualification does it confer in the Czech Republic?
The Atestační zkouška v oboru Vnitřní lékařství is the official state medical specialty board examination in Internal Medicine in the Czech Republic governed by Act No. 95/2004 Coll. (Zákon č. 95/2004 Sb.) and Decree No. 282/2019 Coll. (Vyhláška č. 282/2019 Sb.). Passing this examination grants the physician 'specializovaná způsobilost' (independent specialist license, Level L3 competence) in Internal Medicine, authorizing autonomous, unsupervised inpatient and outpatient clinical practice, opening a private internal medicine clinic, and directing hospital departments.
How is the statutory Czech specialty examination structured?
Under Vyhláška č. 282/2019 Sb., the examination comprises two mandatory sequential components: (1) A practical clinical examination (praktická část) conducted at an accredited clinical hospital bedside, where the candidate performs a comprehensive examination of an assigned patient, formulates differential diagnoses, designs acute and long-term diagnostic and therapeutic plans, interprets ECG/imaging/laboratory data, and defends a written discharge case summary; and (2) A theoretical oral examination (teoretická část) conducted before a state examination board of at least 3 appointed academic and clinical experts, where the candidate draws three broad questions covering the full scope of internal medicine.
What fees are required to take the examination?
Under Czech Government Decree No. 324/2018 Coll. (Nařízení vlády č. 324/2018 Sb.), the statutory examination fee is 500 CZK for the regular initial examination (split as 250 CZK for the practical part and 250 CZK for the theoretical part). If a candidate fails, the fee for the first retake is 3,500 CZK (2,000 CZK practical, 1,500 CZK theoretical), and for the second retake it is 5,000 CZK (3,000 CZK practical, 2,000 CZK theoretical).
What are the eligibility requirements and training prerequisites?
Candidates must hold a MUDr. degree or recognized equivalent, complete the 30-month interní kmen and another 30 months of accredited specialty training, satisfy the required rotations, courses, and verified procedural logbook, and meet the current program's application requirements. The current program does not require an atestační thesis.
How is the examination graded and what is the passing standard?
The examination is graded as 'prospěl' (passed) or 'neprospěl' (failed) based on the unanimous or majority consensus of the state examination committee. The committee evaluates diagnostic safety, clinical pathophysiological reasoning, treatment appropriateness, and alignment with national (ČIS ČLS JEP) and European clinical guidelines.
What is the nature of this 100-question practice bank?
While the statutory Czech examination is a bedside clinical practical and oral theoretical board exam, this question bank provides an English-language multiple-choice question (MCQ) study adaptation. It comprises 100 rigorous clinical scenario questions authored strictly according to the official curriculum of Věstník MZ ČR and evidence-based standards from ČIS ČLS JEP, ESC, EASL, KDIGO, ERS, and EULAR to help candidates consolidate core theoretical knowledge, clinical diagnostics, and therapeutic decision-making.