, NIH STROKE SCALE (NIHSS) GROUP B CERTIFICATION
TEST PRACTICE EXAM EXAM MULTIPLE CHOICE
QUESTIONS WITH ANSWERS AND ITALICIZED RATIONALES
131 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Accurately score all NIHSS items in varied and nuanced clinical presentations
2 Differentiate between similar neurological findings and apply precise scoring criteria
3 Interpret NIHSS scores to guide acute stroke management and prognostication
4 Recognize common pitfalls and scoring errors to ensure reliable and valid assessments
5 NIH Stroke Scale
6 NIHSS
7 Group B Certification Test PRACTICE EXAM Exam Multiple Choice Questions with Answers and
Italicized Rationales
8 Foundations of Neurology / Stroke Medicine
9 Applied Neurology / Stroke Medicine
10 Advanced Neurology / Stroke Medicine
11 Neurology / Stroke Medicine Review
Page 1
,Q1 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
In a patient with aphasia who is unable to follow commands, how does the NIHSS
instruct the examiner to assess motor function of the limbs?
A. Score the limb as 0 because the patient cannot cooperate
B. Use a painful stimulus to elicit withdrawal and score based on the response CORRECT
C. Score the limb as 4 (no movement) due to inability to follow commands
D. Assess the limb passively and score based on muscle tone
RATIONALE: The NIHSS explicitly directs that if the patient is aphasic, the examiner should use
a painful stimulus to elicit a withdrawal response, and score the motor response accordingly. This
ensures that motor function is assessed even without verbal comprehension. Options A, C, and
D are incorrect because they either skip the assessment or use inappropriate methods that do
not reflect the scale's instructions.
Q2 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
A patient with a dense left hemianopia is asked to look at the examiner's nose. The
examiner holds up fingers in both visual fields simultaneously. The patient only
reports seeing the fingers on the right side. What score should be assigned for the
visual field item?
A. 0 - No visual loss
B. 1 - Partial hemianopia
C. 2 - Complete hemianopia CORRECT
D. 3 - Bilateral hemianopia
RATIONALE: The patient demonstrates a complete left hemianopia, as they do not perceive any
stimuli on the left side even with double simultaneous stimulation. A score of 2 is assigned for
complete hemianopia. A score of 1 would be for partial hemianopia or extinction, and 3 for
bilateral hemianopia (blindness).
Page 2
, Q3 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
Which of the following best describes the NIHSS scoring for a patient who holds
the right arm at 90 degrees for 5 seconds but then drifts down to the bed within
the next 5 seconds?
A. 1 - Drift, limb holds 90 degrees but drifts down before full 10 seconds CORRECT
B. 2 - Some effort against gravity, limb cannot reach or maintain 90 degrees
C. 3 - No effort against gravity, limb falls immediately
D. 4 - No movement
RATIONALE: The NIHSS motor arm item requires the limb to be held for 10 seconds. If the limb
drifts down before 10 seconds but does not hit the bed, it scores 1. A score of 2 is for the limb
that cannot maintain 90 degrees and falls to the bed but has some effort against gravity. Score 3
is for no effort against gravity, and 4 for no movement.
Q4 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
A patient with a right hemispheric stroke appears to ignore the left side of space.
When asked to describe a complex picture, they only describe details on the right
side. However, when presented with a simultaneous tactile stimulus on the left
hand, they report feeling it. What is the most appropriate NIHSS score for
extinction?
A. 0 - No neglect
B. 1 - Visual extinction only
C. 2 - Hemi-inattention in more than one modality
D. 2 - Profound hemi-inattention or neglect in more than one modality CORRECT
RATIONALE: The patient shows clear visual neglect (ignoring left side of picture) but no
extinction on tactile testing. However, the NIHSS extinction item scores 1 if there is extinction to
simultaneous stimulation in one sensory modality, and 2 if hemi-inattention is profound or occurs
in more than one modality. Here, visual neglect without tactile extinction represents
hemi-inattention in one modality (visual), but the neglect is profound, so a score of 2 is
appropriate. Option C is incorrect because it requires more than one modality, which is not
present. Option B is incorrect because it only mentions visual extinction, but the patient has
neglect, not just extinction.
Page 3
TEST PRACTICE EXAM EXAM MULTIPLE CHOICE
QUESTIONS WITH ANSWERS AND ITALICIZED RATIONALES
131 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Accurately score all NIHSS items in varied and nuanced clinical presentations
2 Differentiate between similar neurological findings and apply precise scoring criteria
3 Interpret NIHSS scores to guide acute stroke management and prognostication
4 Recognize common pitfalls and scoring errors to ensure reliable and valid assessments
5 NIH Stroke Scale
6 NIHSS
7 Group B Certification Test PRACTICE EXAM Exam Multiple Choice Questions with Answers and
Italicized Rationales
8 Foundations of Neurology / Stroke Medicine
9 Applied Neurology / Stroke Medicine
10 Advanced Neurology / Stroke Medicine
11 Neurology / Stroke Medicine Review
Page 1
,Q1 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
In a patient with aphasia who is unable to follow commands, how does the NIHSS
instruct the examiner to assess motor function of the limbs?
A. Score the limb as 0 because the patient cannot cooperate
B. Use a painful stimulus to elicit withdrawal and score based on the response CORRECT
C. Score the limb as 4 (no movement) due to inability to follow commands
D. Assess the limb passively and score based on muscle tone
RATIONALE: The NIHSS explicitly directs that if the patient is aphasic, the examiner should use
a painful stimulus to elicit a withdrawal response, and score the motor response accordingly. This
ensures that motor function is assessed even without verbal comprehension. Options A, C, and
D are incorrect because they either skip the assessment or use inappropriate methods that do
not reflect the scale's instructions.
Q2 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
A patient with a dense left hemianopia is asked to look at the examiner's nose. The
examiner holds up fingers in both visual fields simultaneously. The patient only
reports seeing the fingers on the right side. What score should be assigned for the
visual field item?
A. 0 - No visual loss
B. 1 - Partial hemianopia
C. 2 - Complete hemianopia CORRECT
D. 3 - Bilateral hemianopia
RATIONALE: The patient demonstrates a complete left hemianopia, as they do not perceive any
stimuli on the left side even with double simultaneous stimulation. A score of 2 is assigned for
complete hemianopia. A score of 1 would be for partial hemianopia or extinction, and 3 for
bilateral hemianopia (blindness).
Page 2
, Q3 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
Which of the following best describes the NIHSS scoring for a patient who holds
the right arm at 90 degrees for 5 seconds but then drifts down to the bed within
the next 5 seconds?
A. 1 - Drift, limb holds 90 degrees but drifts down before full 10 seconds CORRECT
B. 2 - Some effort against gravity, limb cannot reach or maintain 90 degrees
C. 3 - No effort against gravity, limb falls immediately
D. 4 - No movement
RATIONALE: The NIHSS motor arm item requires the limb to be held for 10 seconds. If the limb
drifts down before 10 seconds but does not hit the bed, it scores 1. A score of 2 is for the limb
that cannot maintain 90 degrees and falls to the bed but has some effort against gravity. Score 3
is for no effort against gravity, and 4 for no movement.
Q4 ACCURATELY SCORE ALL NIHSS ITEMS IN VARIED AND NUANCED CLINICAL
PRESENTATIONS
A patient with a right hemispheric stroke appears to ignore the left side of space.
When asked to describe a complex picture, they only describe details on the right
side. However, when presented with a simultaneous tactile stimulus on the left
hand, they report feeling it. What is the most appropriate NIHSS score for
extinction?
A. 0 - No neglect
B. 1 - Visual extinction only
C. 2 - Hemi-inattention in more than one modality
D. 2 - Profound hemi-inattention or neglect in more than one modality CORRECT
RATIONALE: The patient shows clear visual neglect (ignoring left side of picture) but no
extinction on tactile testing. However, the NIHSS extinction item scores 1 if there is extinction to
simultaneous stimulation in one sensory modality, and 2 if hemi-inattention is profound or occurs
in more than one modality. Here, visual neglect without tactile extinction represents
hemi-inattention in one modality (visual), but the neglect is profound, so a score of 2 is
appropriate. Option C is incorrect because it requires more than one modality, which is not
present. Option B is incorrect because it only mentions visual extinction, but the patient has
neglect, not just extinction.
Page 3
