ESTUDYR
NIH Stroke Scale Group D
Case 1 — Regenerated MCQs (11 questions)
1. Level of consciousness — 1a. The patient is described as score 0 (Alert). Which description
matches that score?
A. Somnolent but arousable to voice
B. Requires repeated vigorous stimulation to arouse
C. ✔ Arouses normally; alert and keenly responsive.
D. Unresponsive to all stimuli
Rationale: NIHSS item 1a score 0 = alert (no reduction in level of consciousness). Other choices
correspond to higher scores.
2. LOC questions — 1b. The patient scores 0 (answers both questions correctly). Which best
describes that finding?
A. Answers one of two orientation questions correctly
B. ✔ Answers both LOC orientation questions correctly.
C. Answers neither question correctly
D. Patient is nonverbal and cannot answer
Rationale: 1b measures ability to answer two simple orientation questions; score 0 = both
correct.
3. LOC commands — 1c. The patient scores 0 (performs both tasks). Which statement is
correct?
A. Performs one task correctly only
B. Performs tasks slowly but eventually completes them
C. ✔ Performs both commands correctly and promptly.
D. Refuses to follow commands
Rationale: 1c score 0 = both tasks performed correctly; partial or absent performance gives
higher scores.
, ESTUDYR
4. Best gaze — 2. The patient scores 0 (normal). Which describes that?
A. Partial gaze palsy with some voluntary movement
B. Forced horizontal deviation of eyes
C. ✔ Normal horizontal eye movements and tracking.
D. Complete inability to move eyes horizontally
Rationale: Item 2 score 0 indicates no gaze deviation or palsy.
5. Visual fields — 3. The patient scores 0 (normal visual fields). Which is correct?
A. Partial hemianopia on confrontation
B. Quadrantanopia in one quadrant
C. ✔ Full visual fields on confrontation testing.
D. Complete bilateral hemianopia
Rationale: Score 0 = no visual field loss; partial or complete losses score higher.
6. Facial palsy — 4. The patient scores 0 (no facial weakness). Which describes this?
A. Mild facial droop on one side only detectable on close inspection
B. ✔ Symmetric facial movement; no detectable weakness.
C. Partial lower-face droop only when smiling
D. Complete hemifacial paralysis
Rationale: Item 4 score 0 = normal symmetry and movement.
7. Motor arm — 5a (left arm). The patient scores 0 (no drift). Which choice matches?
A. Some drift but does not hit bed within 10 seconds
B. ✔ Holds both arms up without drift for 10 seconds.
C. No movement at all
D. Moves only in response to painful stimulus
E. Minor weakness but can hold full 10 seconds with slight drift
Rationale: 5a score 0 = no drift for full 10 seconds. (Different numeric options correspond to
drift, some effort, or no movement.)
NIH Stroke Scale Group D
Case 1 — Regenerated MCQs (11 questions)
1. Level of consciousness — 1a. The patient is described as score 0 (Alert). Which description
matches that score?
A. Somnolent but arousable to voice
B. Requires repeated vigorous stimulation to arouse
C. ✔ Arouses normally; alert and keenly responsive.
D. Unresponsive to all stimuli
Rationale: NIHSS item 1a score 0 = alert (no reduction in level of consciousness). Other choices
correspond to higher scores.
2. LOC questions — 1b. The patient scores 0 (answers both questions correctly). Which best
describes that finding?
A. Answers one of two orientation questions correctly
B. ✔ Answers both LOC orientation questions correctly.
C. Answers neither question correctly
D. Patient is nonverbal and cannot answer
Rationale: 1b measures ability to answer two simple orientation questions; score 0 = both
correct.
3. LOC commands — 1c. The patient scores 0 (performs both tasks). Which statement is
correct?
A. Performs one task correctly only
B. Performs tasks slowly but eventually completes them
C. ✔ Performs both commands correctly and promptly.
D. Refuses to follow commands
Rationale: 1c score 0 = both tasks performed correctly; partial or absent performance gives
higher scores.
, ESTUDYR
4. Best gaze — 2. The patient scores 0 (normal). Which describes that?
A. Partial gaze palsy with some voluntary movement
B. Forced horizontal deviation of eyes
C. ✔ Normal horizontal eye movements and tracking.
D. Complete inability to move eyes horizontally
Rationale: Item 2 score 0 indicates no gaze deviation or palsy.
5. Visual fields — 3. The patient scores 0 (normal visual fields). Which is correct?
A. Partial hemianopia on confrontation
B. Quadrantanopia in one quadrant
C. ✔ Full visual fields on confrontation testing.
D. Complete bilateral hemianopia
Rationale: Score 0 = no visual field loss; partial or complete losses score higher.
6. Facial palsy — 4. The patient scores 0 (no facial weakness). Which describes this?
A. Mild facial droop on one side only detectable on close inspection
B. ✔ Symmetric facial movement; no detectable weakness.
C. Partial lower-face droop only when smiling
D. Complete hemifacial paralysis
Rationale: Item 4 score 0 = normal symmetry and movement.
7. Motor arm — 5a (left arm). The patient scores 0 (no drift). Which choice matches?
A. Some drift but does not hit bed within 10 seconds
B. ✔ Holds both arms up without drift for 10 seconds.
C. No movement at all
D. Moves only in response to painful stimulus
E. Minor weakness but can hold full 10 seconds with slight drift
Rationale: 5a score 0 = no drift for full 10 seconds. (Different numeric options correspond to
drift, some effort, or no movement.)
