100+ Free Czech Neurology Board Examination Practice Questions

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Sample Czech Neurology Board Examination Practice Questions

Try these sample questions to test your Czech Neurology Board Examination exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 64-year-old man presents to the emergency department with sudden-onset right-sided hemiparesis and expressive aphasia that started 75 minutes ago. Non-contrast cranial CT reveals an ASPECTS score of 10 with no intracranial hemorrhage. Blood pressure is 165/92 mmHg, and blood glucose is 6.8 mmol/L. According to European Stroke Organisation (ESO) and Czech Neurological Society guidelines, what is the most appropriate immediate therapy?

A.Intravenous recombinant tissue plasminogen activator (alteplase 0.9 mg/kg)

B.Oral acetylsalicylic acid 300 mg immediately

C.Continuous intravenous unfractionated heparin infusion

D.Intravenous administration of mannitol 20% 250 mL

Explanation: Intravenous thrombolysis with recombinant tissue plasminogen activator (alteplase 0.9 mg/kg, maximum 90 mg) is the established standard of care for acute ischemic stroke presenting within 4.5 hours of symptom onset in the absence of contraindications. The patient is within the standard therapeutic window, has an ASPECTS score of 10 indicating no extensive early ischemic changes, and exhibits permissive blood pressure. Antiplatelet therapy should be deferred for 24 hours following IV thrombolysis once follow-up neuroimaging rules out intracranial hemorrhage.

2A 71-year-old woman is evaluated 2 hours after acute onset of left hemiplegia, neglect, and forced right conjugate eye deviation (NIHSS 18). Non-contrast CT shows an ASPECTS score of 8, and CT angiography demonstrates an occlusion of the right M1 segment of the middle cerebral artery. After initiating intravenous thrombolysis, what is the next mandatory therapeutic intervention?

A.Observation in the intensive care unit until the IV thrombolytic infusion finishes

B.Immediate mechanical thrombectomy by neurointerventional catheterization

C.Urgent decompressive hemicranectomy within 4 hours

D.Immediate administration of intravenous clopidogrel 300 mg loading dose

Explanation: Mechanical thrombectomy is indicated for patients with acute ischemic stroke caused by a large vessel occlusion in the anterior circulation within 6 hours of onset and ASPECTS >= 6. Intravenous thrombolysis should be initiated without delaying transfer and preparation for endovascular thrombectomy. Randomised trials have demonstrated high recanalization rates and marked improvements in 90-day functional independence with endovascular therapy in large-vessel anterior circulation occlusions.

3A 58-year-old woman awakens at 07:00 with right hemiparesis and aphasia. She was last seen in her normal state at 23:00 when going to sleep. Emergency brain MRI reveals an acute diffusion restriction (DWI positive) in the left middle cerebral artery territory with no corresponding hyperintensity on fluid-attenuated inversion recovery (FLAIR negative). What is the clinical significance of this MRI finding regarding reperfusion therapy?

A.The DWI-FLAIR mismatch proves ischemic necrosis is irreversible, making any reperfusion contraindicated

B.The absence of a FLAIR lesion proves the deficit is a transient ischemic attack, so thrombolysis is contraindicated

C.The DWI-FLAIR mismatch indicates that the stroke onset is likely within 4.5 hours, making IV thrombolysis indicated

D.The finding indicates vasogenic edema from an underlying neoplasm rather than ischemic infarction

Explanation: In wake-up strokes or strokes of unknown onset, a DWI-FLAIR mismatch (presence of acute ischemic lesion on DWI but absence of marked hyperintensity on FLAIR) indicates that the ischemic event likely occurred within the preceding 4.5 hours. The WAKE-UP trial demonstrated that patients with this imaging profile achieve significantly better functional outcomes with intravenous alteplase compared to placebo without excess mortality. This enables guideline-supported intravenous thrombolysis in properly selected unknown-onset ischemic strokes.

4An 80-year-old man is found with severe left hemiplegia (NIHSS 16) 14 hours after he was last known to be well. Non-contrast CT shows no hemorrhage with an ASPECTS of 8. CT perfusion shows an ischemic core volume of 15 mL and a hypoperfused penumbral volume of 95 mL (mismatch volume 80 mL, mismatch ratio 6.3). CTA demonstrates right proximal internal carotid artery occlusion. Based on the DAWN and DEFUSE 3 trials, what is the best clinical management?

A.Initiate high-dose intravenous dexamethasone to prevent reperfusion injury

B.Administer full-dose intravenous alteplase

C.Withhold intervention because the 6-hour therapeutic window has elapsed

D.Proceed urgently with endovascular mechanical thrombectomy

Explanation: Based on the DAWN and DEFUSE 3 trials and ESO guidelines, endovascular mechanical thrombectomy is recommended in selected patients with anterior circulation large vessel occlusion presenting in the extended 6–24 hour window who meet clinical-core or perfusion mismatch criteria. This patient has a small core (15 mL) and substantial penumbral tissue (mismatch volume 80 mL, ratio > 1.8), representing salvageable brain tissue that strongly benefits from recanalization. Age up to 80 or beyond is not an exclusion criterion when imaging criteria are satisfied.

5A 66-year-old hypertensive man arrives at the stroke unit 90 minutes after the onset of acute left-sided weakness. His initial blood pressure is 200/115 mmHg. He is otherwise eligible for intravenous thrombolysis. What is the blood pressure threshold required prior to starting alteplase infusion, and how should it be managed?

A.Blood pressure must be lowered to < 185/110 mmHg using IV antihypertensives (e.g., urapidil or labetalol) before initiating alteplase

B.Blood pressure must be immediately lowered to < 140/90 mmHg using sodium nitroprusside before alteplase

C.Thrombolysis is permanently contraindicated if the initial systolic pressure exceeds 185 mmHg upon admission

D.Alteplase should be started immediately, as thrombolysis itself naturally lowers arterial blood pressure

Explanation: International and Czech guidelines mandate that blood pressure must be reduced to systolic < 185 mmHg and diastolic < 110 mmHg prior to administering intravenous thrombolysis, and maintained < 180/105 mmHg for at least 24 hours post-thrombolysis. Preferred intravenous agents in Czech practice include urapidil (an alpha-1 blocker and 5-HT1A agonist) or labetalol, which provide rapid, titratable blood pressure control without causing sudden intracranial hypoperfusion. Lowering pressure below these strict cutoffs prevents symptomatic intracerebral hemorrhage.

6A 62-year-old male with poorly controlled hypertension presents 2 hours after acute onset of severe headache, vomiting, and right hemiplegia. Cranial CT demonstrates a 25 mL spontaneous intracerebral hemorrhage in the left putamen with mild surrounding edema. His blood pressure is 195/105 mmHg, GCS is 13, and he is not taking any antithrombotic medications. According to ESO guidelines, what is the recommended blood pressure target and approach?

A.Maintain systolic blood pressure between 180 and 200 mmHg to preserve cerebral perfusion pressure

B.Rapidly lower systolic blood pressure to a target between 130 and 140 mmHg using titratable IV antihypertensives

C.Immediately lower systolic blood pressure to < 110 mmHg using an aggressive nitroglycerin infusion

D.Avoid all antihypertensive therapy during the first 48 hours to prevent watershed ischemia

Explanation: In acute spontaneous intracerebral hemorrhage presenting within 6 hours of onset with elevated systolic blood pressure (150–220 mmHg), rapid lowering of SBP to a target of 130–140 mmHg is recommended to curb hematoma expansion without increasing renal adverse events or cerebral ischemia. The INTERACT-2 and ATACH-2 trials confirmed that maintaining SBP in the 130–140 mmHg range is safe and reduces hematoma growth, whereas dropping below 120 mmHg increases renal complications. Continuous intravenous infusion of titratable agents such as urapidil or labetalol is preferred.

7A 48-year-old woman presents to the emergency room with a sudden, excruciating 'thunderclap' headache that peaked within seconds during physical exertion. A high-quality non-contrast head CT performed 8 hours after symptom onset is completely normal. What is the mandatory next step to definitively rule out aneurysmal subarachnoid hemorrhage?

A.Discharge the patient with oral triptans for an acute atypical migraine attack

B.Obtain an electroencephalogram (EEG) to rule out an ictal cephalalgia

C.Perform a lumbar puncture to assess for opening pressure, red blood cells, and spectrophotometric xanthochromia

D.Schedule an outpatient unenhanced cranial MRI in 4 weeks

Explanation: When clinical suspicion of subarachnoid hemorrhage (SAH) remains high despite a normal non-contrast CT head, a lumbar puncture is mandatory. Cerebrospinal fluid analysis should be performed at least 6 to 12 hours after symptom onset to allow for the enzymatic breakdown of red blood cells into oxyhemoglobin and bilirubin, which is reliably detected as xanthochromia by spectrophotometry or centrifugation. If the lumbar puncture is completely normal (no red blood cells and no xanthochromia), SAH can be excluded with near 100% sensitivity.

8A 52-year-old man undergoes successful endovascular coiling of a ruptured anterior communicating artery aneurysm on day 1 post-ictus. What pharmacological intervention is routinely indicated in all aneurysmal subarachnoid hemorrhage patients to prevent delayed cerebral ischemia (DCI) and improve functional outcome?

A.Continuous intravenous high-dose methylprednisolone for 14 days

B.Prophylactic hypervolemic-hypertensive-hemodilution ('triple-H') therapy

C.Intravenous tranexamic acid continuous infusion for 21 days

D.Oral nimodipine 60 mg every 4 hours for 21 consecutive days

Explanation: Oral nimodipine (60 mg every 4 hours for 21 days) is the only pharmacological agent universally proven in randomized clinical trials to reduce delayed cerebral ischemia (DCI) and poor functional outcomes in aneurysmal subarachnoid hemorrhage. Its primary benefit is neuroprotection and microcirculatory dilation rather than macroscopic reversal of large-vessel vasospasm. 'Triple-H' therapy has been abandoned in favor of maintaining euvolemia and induced hypertension only when symptomatic vasospasm develops.

9A 29-year-old woman taking combined oral contraceptives presents with a 4-day history of progressively worsening holocranial headache, papilledema, and a secondary generalized tonic-clonic seizure. MR venography confirms superior sagittal sinus and right transverse sinus thrombosis. Brain MRI also reveals a small venous hemorrhagic infarction in the right parietal cortex. What is the first-line therapeutic management?

A.Full therapeutic anticoagulation with body-weight-adjusted low-molecular-weight heparin (LMWH)

B.Withholding anticoagulation due to the intracerebral hemorrhage and placing an inferior vena cava filter

C.Immediate surgical craniotomy and surgical thrombectomy of the superior sagittal sinus

D.High-dose intravenous aspirin 1000 mg daily plus clopidogrel 75 mg daily

Explanation: European Academy of Neurology (EAN) and ESO guidelines state that therapeutic anticoagulation (preferably with subcutaneous low-molecular-weight heparin or IV unfractionated heparin) is the first-line treatment for cerebral venous and sinus thrombosis (CVST), even in the presence of baseline venous hemorrhagic infarction. Hemorrhagic transformation in CVST is driven by elevated venous and capillary hypertension; recanalization achieved through anticoagulation reduces venous pressure and arrests the progression of both ischemia and hemorrhage. The presence of intracranial hemorrhage is not a contraindication to heparin in CVST.

10A 74-year-old woman with non-valvular atrial fibrillation taking dabigatran etexilate 150 mg twice daily presents 1 hour after sudden onset of coma (GCS 6). CT shows a large left lobar intracerebral hemorrhage (volume 45 mL). Her last dose of dabigatran was taken 3 hours ago. What is the specific and most appropriate reversal agent to administer immediately?

A.Andexanet alfa high-dose bolus and infusion

B.Idarucizumab 5 g IV in two consecutive 2.5 g infusions

C.Four-factor prothrombin complex concentrate (4F-PCC) 50 IU/kg

D.Intravenous Vitamin K (phytomenadione) 10 mg with fresh frozen plasma

Explanation: Idarucizumab is a humanized monoclonal antibody fragment (Fab) that specifically binds dabigatran with an affinity 350 times higher than that of thrombin, neutralizing its anticoagulant effect within minutes. The standard therapeutic dose is 5 g administered intravenously as two consecutive 2.5 g infusions. It is the preferred, first-line antidote for dabigatran-associated life-threatening bleeding under Czech and European guidelines.

About the Czech Neurology Board Examination Exam

The Atestační zkouška v oboru Neurologie is the statutory specialty examination after at least 54 months of postgraduate training (30-month neurological trunk plus at least 24 months of specialty training). It combines practical clinical assessment with defense of submitted written work and two expert oral questions. This independent 100-question English MCQ bank supports curriculum review but is not an official translation or format simulation.

Assessment

The specialty program requires practical examination of one patient or equivalent clinical analysis. The theoretical examination comprises defense of the submitted written work plus two expert questions before an appointed at least 3-member board. Both parts are graded pass/fail (prospěl/a).

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

Pass (prospěl/a) evaluated across practical and theoretical parts by unanimous or majority committee vote

Exam Fee

500 CZK for first attempt (250 CZK practical, 250 CZK theoretical); 3,500 CZK for 1st retake; 5,000 CZK for 2nd retake under Government Regulation No. 324/2018 Coll. (Ministerstvo zdravotnictví České republiky (MZ ČR) / Lékařské fakulty / Institut postgraduálního vzdělávání ve zdravotnictví (IPVZ))

Czech Neurology Board Examination Exam Content Outline

Not published

Cerebrovascular Diseases & Stroke

Acute ischemic stroke, IV thrombolysis, mechanical thrombectomy, secondary prevention, intracerebral hemorrhage, subarachnoid hemorrhage, and cerebral venous sinus thrombosis.

Not published

Epilepsy & Paroxysmal Disorders

Status epilepticus management, focal and generalized epilepsies, antiseizure medications, EEG patterns, syncope differential, and autoimmune encephalitis.

Not published

Neurodegenerative Diseases & Movement Disorders

Parkinson's disease, atypical parkinsonian syndromes (PSP, MSA, CBD), tremor, dystonia, Alzheimer's disease, frontotemporal dementia, Lewy body dementia, and amyotrophic lateral sclerosis.

Not published

Neuromuscular Disorders & Neuroimmunology/MS

Multiple sclerosis diagnostic criteria (McDonald 2017/revised) and disease-modifying therapies, NMOSD, MOGAD, Guillain-Barré syndrome, CIDP, myasthenia gravis, and myopathies.

Not published

Neuro-Oncology, Neuroinfections & Headache

Primary CNS tumors, intracranial metastases, bacterial and viral neuroinfections, neuroborreliosis, primary and secondary headache disorders, and intracranial hypertension.

How to Pass the Czech Neurology Board Examination Exam

What You Need to Know

Passing score: Pass (prospěl/a) evaluated across practical and theoretical parts by unanimous or majority committee vote
Assessment: The specialty program requires practical examination of one patient or equivalent clinical analysis. The theoretical examination comprises defense of the submitted written work plus two expert questions before an appointed at least 3-member board. Both parts are graded pass/fail (prospěl/a).
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 fee: 500 CZK for first attempt (250 CZK practical, 250 CZK theoretical); 3,500 CZK for 1st retake; 5,000 CZK for 2nd retake under Government Regulation No. 324/2018 Coll.

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
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Czech Neurology Board Examination Study Tips from Top Performers

1Focus on time-critical protocols for acute stroke: intravenous thrombolysis indications/contraindications up to 4.5 hours (or extended window with perfusion imaging) and mechanical thrombectomy criteria up to 24 hours.

2Master the 2017 McDonald diagnostic criteria for multiple sclerosis, differentiating typical demyelinating lesions from NMOSD (anti-AQP4) and MOGAD (anti-MOG antibodies).

3Understand the staged pharmacological management of status epilepticus (benzodiazepines followed by levetiracetam, valproate, or fosphenytoin, followed by anesthetic infusions for refractory status).

4Be thoroughly prepared to differentiate Parkinson's disease from atypical parkinsonian disorders (PSP, MSA, CBD, DLB) based on early falls, autonomic failure, gaze palsy, and levodopa responsiveness.

Frequently Asked Questions

What is the official format of the Czech Atestace in Neurology?

The current specialty program requires practical examination of one patient or equivalent clinical analysis. The theoretical part before an appointed at least 3-member committee comprises defense of submitted written work and two expert questions.

How does this practice bank relate to the official board examination?

This practice bank is an English-language multiple-choice question (MCQ) study tool designed to test the core factual, pathophysiological, and clinical decision-making competencies outlined in the official Věstník MZ ČR educational program and Czech Neurological Society guidelines. It is an independent preparation resource and does not replace in-person bedside clinical training or oral examination practice.

What are the official examination fees and retake regulations?

Under Government Regulation No. 324/2018 Coll., the fee for the regular first examination attempt is 500 CZK (250 CZK practical, 250 CZK theoretical). If a candidate fails, up to two retakes are allowed, with statutory fees of 3,500 CZK for the first retake and 5,000 CZK for the second retake.

Which clinical guidelines are reflected in the neurology questions?

The questions reflect consensus clinical practice guidelines established by the Czech Neurological Society (ČNS ČLS JEP), European Stroke Organisation (ESO), European Academy of Neurology (EAN), and International League Against Epilepsy (ILAE).