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NIH Stroke Scale Group B
Actual 2025 Patient 1-6
Questions and Answers 100%
Correct
1. Patient 1: A 65-year-old male presents with slurred speech and inability to name objects.
When asked to describe the "precarious painter" picture, he produces minimal speech
with errors. How would you score Item 9 (Best Language) on the NIHSS?
a. 0 – No aphasia, normal
b. 1 – Mild to moderate aphasia
c. 2 – Severe aphasia
d. 3 – Mute, global aphasia
Correct Answer: b. Mild to moderate aphasia
Rationale: Item 9 assesses language using tasks like describing a picture. Mild to
moderate aphasia (score 1) is indicated when the patient has some loss of fluency or
comprehension but can produce recognizable speech with errors, as per NIHSS
guidelines. Severe aphasia (score 2) or mute/global aphasia (score 3) would involve
greater impairment or no speech output.
2. Patient 2: A 72-year-old female is alert but answers only one of two questions correctly
(month and age) due to a language barrier. How would you score Item 1b (Level of
Consciousness Questions) on the NIHSS?
a. 0 – Answers both questions correctly
b. 1 – Answers one question correctly
c. 2 – Answers neither question correctly
d. 3 – Comatose, unresponsive
Correct Answer: b. Answers one question correctly
Rationale: Item 1b scores the patient’s ability to answer two questions (month and age).
A score of 1 is given if one question is answered correctly or if a language barrier
prevents a full evaluation, as specified in NIHSS scoring rules. The patient’s alertness
rules out a coma score (3).
3. Patient 3: A 58-year-old male has weakness in his left arm, with some effort against
gravity but inability to resist moderate force. How would you score Item 5a (Motor Arm
– Left) on the NIHSS?
a. 0 – No drift, normal
b. 1 – Drift, limb holds position but drifts before 10 seconds
c. 2 – Some effort against gravity
, 2
d. 3 – No effort against gravity
Correct Answer: c. Some effort against gravity
Rationale: Item 5a assesses arm strength. A score of 2 is assigned when the arm can
move against gravity but cannot sustain resistance or hold the position fully, as described
in the NIHSS protocol. This matches the patient’s presentation.
4. Patient 4: A 67-year-old female cannot follow verbal commands to raise her eyebrows or
close her eyes due to unresponsiveness. She grimaces symmetrically to pain. How would
you score Item 4 (Facial Palsy) on the NIHSS?
a. 0 – Normal symmetrical movement
b. 1 – Minor paralysis
c. 2 – Partial paralysis
d. 3 – Complete paralysis
Correct Answer: a. Normal symmetrical movement
Rationale: Item 4 evaluates facial movement symmetry. A symmetrical grimace in
response to pain, even in an unresponsive patient, scores 0, as it indicates no paralysis.
The NIHSS emphasizes observed performance without assumptions.
5. Patient 5: A 70-year-old male has a right-sided visual field defect detected during
confrontation testing, with extinction to double simultaneous stimulation. How would
you score Item 11 (Extinction and Inattention) on the NIHSS?
a. 0 – No abnormality
b. 1 – Visual, tactile, or auditory extinction
c. 2 – Profound hemi-inattention
d. 3 – Bilateral inattention
Correct Answer: b. Visual, tactile, or auditory extinction
Rationale: Item 11 assesses neglect or extinction. Extinction to double simultaneous
stimulation, as observed, scores 1, indicating partial inattention. Profound inattention
(score 2) or bilateral inattention (score 3) requires more severe deficits.
6. Patient 6: A 62-year-old female is intubated and unable to speak but follows commands
appropriately. How would you score Item 10 (Dysarthria) on the NIHSS?
a. 0 – Normal articulation
b. 1 – Mild to moderate dysarthria
c. 2 – Severe dysarthria
d. 9 – Untestable (intubated)
Correct Answer: d. Untestable (intubated)
Rationale: Item 10 evaluates speech clarity. For intubated patients, dysarthria cannot be
assessed, so a score of 9 (untestable) is assigned, as per NIHSS guidelines. This ensures
no assumptions are made about speech ability.
7. Patient 1: The same 65-year-old male has no movement in his right leg when tested
against gravity. How would you score Item 6a (Motor Leg – Right) on the NIHSS?
a. 0 – No drift, normal
b. 1 – Drift, limb holds position but drifts before 5 seconds
c. 3 – No effort against gravity
d. 4 – No movement
Correct Answer: d. No movement
Rationale: Item 6a assesses leg strength. A score of 4 is assigned when there is no
NIH Stroke Scale Group B
Actual 2025 Patient 1-6
Questions and Answers 100%
Correct
1. Patient 1: A 65-year-old male presents with slurred speech and inability to name objects.
When asked to describe the "precarious painter" picture, he produces minimal speech
with errors. How would you score Item 9 (Best Language) on the NIHSS?
a. 0 – No aphasia, normal
b. 1 – Mild to moderate aphasia
c. 2 – Severe aphasia
d. 3 – Mute, global aphasia
Correct Answer: b. Mild to moderate aphasia
Rationale: Item 9 assesses language using tasks like describing a picture. Mild to
moderate aphasia (score 1) is indicated when the patient has some loss of fluency or
comprehension but can produce recognizable speech with errors, as per NIHSS
guidelines. Severe aphasia (score 2) or mute/global aphasia (score 3) would involve
greater impairment or no speech output.
2. Patient 2: A 72-year-old female is alert but answers only one of two questions correctly
(month and age) due to a language barrier. How would you score Item 1b (Level of
Consciousness Questions) on the NIHSS?
a. 0 – Answers both questions correctly
b. 1 – Answers one question correctly
c. 2 – Answers neither question correctly
d. 3 – Comatose, unresponsive
Correct Answer: b. Answers one question correctly
Rationale: Item 1b scores the patient’s ability to answer two questions (month and age).
A score of 1 is given if one question is answered correctly or if a language barrier
prevents a full evaluation, as specified in NIHSS scoring rules. The patient’s alertness
rules out a coma score (3).
3. Patient 3: A 58-year-old male has weakness in his left arm, with some effort against
gravity but inability to resist moderate force. How would you score Item 5a (Motor Arm
– Left) on the NIHSS?
a. 0 – No drift, normal
b. 1 – Drift, limb holds position but drifts before 10 seconds
c. 2 – Some effort against gravity
, 2
d. 3 – No effort against gravity
Correct Answer: c. Some effort against gravity
Rationale: Item 5a assesses arm strength. A score of 2 is assigned when the arm can
move against gravity but cannot sustain resistance or hold the position fully, as described
in the NIHSS protocol. This matches the patient’s presentation.
4. Patient 4: A 67-year-old female cannot follow verbal commands to raise her eyebrows or
close her eyes due to unresponsiveness. She grimaces symmetrically to pain. How would
you score Item 4 (Facial Palsy) on the NIHSS?
a. 0 – Normal symmetrical movement
b. 1 – Minor paralysis
c. 2 – Partial paralysis
d. 3 – Complete paralysis
Correct Answer: a. Normal symmetrical movement
Rationale: Item 4 evaluates facial movement symmetry. A symmetrical grimace in
response to pain, even in an unresponsive patient, scores 0, as it indicates no paralysis.
The NIHSS emphasizes observed performance without assumptions.
5. Patient 5: A 70-year-old male has a right-sided visual field defect detected during
confrontation testing, with extinction to double simultaneous stimulation. How would
you score Item 11 (Extinction and Inattention) on the NIHSS?
a. 0 – No abnormality
b. 1 – Visual, tactile, or auditory extinction
c. 2 – Profound hemi-inattention
d. 3 – Bilateral inattention
Correct Answer: b. Visual, tactile, or auditory extinction
Rationale: Item 11 assesses neglect or extinction. Extinction to double simultaneous
stimulation, as observed, scores 1, indicating partial inattention. Profound inattention
(score 2) or bilateral inattention (score 3) requires more severe deficits.
6. Patient 6: A 62-year-old female is intubated and unable to speak but follows commands
appropriately. How would you score Item 10 (Dysarthria) on the NIHSS?
a. 0 – Normal articulation
b. 1 – Mild to moderate dysarthria
c. 2 – Severe dysarthria
d. 9 – Untestable (intubated)
Correct Answer: d. Untestable (intubated)
Rationale: Item 10 evaluates speech clarity. For intubated patients, dysarthria cannot be
assessed, so a score of 9 (untestable) is assigned, as per NIHSS guidelines. This ensures
no assumptions are made about speech ability.
7. Patient 1: The same 65-year-old male has no movement in his right leg when tested
against gravity. How would you score Item 6a (Motor Leg – Right) on the NIHSS?
a. 0 – No drift, normal
b. 1 – Drift, limb holds position but drifts before 5 seconds
c. 3 – No effort against gravity
d. 4 – No movement
Correct Answer: d. No movement
Rationale: Item 6a assesses leg strength. A score of 4 is assigned when there is no
