NIH Stroke Scale Certification Group D Exam Patients 1–6 Questions | 100% Correct Answers with Detailed Rationales (2026/2027 Edition)

NIH Stroke Scale Certification Group D Exam Patients 1–6
Questions | 100% Correct Answers with Detailed Rationales
(2026/2027 Edition)

NIH Stroke Scale (NIHSS) Certification Examination – Group D

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PATIENT 1: 68-Year-Old Male with Acute Left MCA Ischemic Stroke

BACKGROUND: 68-year-old male, right-handed, presents 90 minutes after sudden onset of
right-sided weakness and aphasia while eating breakfast. History of hypertension and atrial
fibrillation (not on anticoagulation). BP 178/96, HR 92 (irregular), afebrile.

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SECTION 1: Level of Consciousness (LOC)

Question 1

Patient 1 opens eyes spontaneously but is not oriented to place or time. He follows one-step
commands intermittently and requires repetition for two-step commands. What is the correct
LOC score?

0. Alert; keenly responsive
1. Not alert; but arousable by minor stimulation
2. Not alert; requires repeated stimulation
3. Coma; unresponsive or reflex responses only

Correct Answer: B

Rationale: The patient opens eyes spontaneously (not requiring stimulation) but is disoriented
and follows commands inconsistently. This meets criteria for score 1: not alert but arousable by
minor stimulation, with some impairment of consciousness.

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SECTION 2: Level of Consciousness: Questions

Question 2

,When asked the current month and his age, Patient 1 answers neither correctly. However, he
does follow some commands. What is the correct LOC Questions score?

0. Answers both correctly
1. Answers one correctly
2. Answers neither correctly
U. - Unable (intubated, language barrier, etc.)

Correct Answer: C

Rationale: The patient answers neither question correctly (month and age), which corresponds
to score 2. Command following is assessed separately in LOC Commands.

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SECTION 3: Best Gaze

Question 3

On examination, Patient 1 has a right gaze preference and fails to cross midline to the left on
voluntary gaze. The oculocephalic maneuver reveals full horizontal eye movements. What is the
correct Best Gaze score?

0. Normal
1. Partial gaze palsy
2. Forced deviation or total gaze paresis
U. - Unable to assess (orbital trauma, blindness)

Correct Answer: C

Rationale: The presence of a gaze preference with failure to cross midline indicates forced
deviation. The oculocephalic maneuver revealing full movements confirms the gaze deviation is
not due to a nuclear/fascicular lesion but rather a supranuclear gaze palsy. This scores 2.

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SECTION 4: Visual Fields

Question 4

,Visual field testing reveals Patient 1 distinguishes fingers in both temporal visual fields. There is
no extinction on simultaneous stimulation and no visual neglect. What is the correct Visual
Fields score?

0. No visual loss
1. Partial hemianopia
2. Complete hemianopia
3. Bilateral hemianopia or blind

Correct Answer: A

Rationale: The patient has intact visual fields to confrontation testing with no extinction or
neglect. This corresponds to score 0: no visual loss.

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SECTION 5: Facial Palsy

Question 5

Patient 1 shows asymmetry of the nasolabial fold on the right with complete paralysis of lower
facial muscles on the right. Forehead wrinkling is preserved bilaterally. What is the correct Facial
Palsy score?

0. Normal symmetric movements
1. Minor paralysis
2. Partial paralysis (total or near-total paralysis of lower face)
3. Complete paralysis of one or both sides

Correct Answer: C

Rationale: Complete paralysis of the lower face with preserved forehead wrinkling indicates a
central (upper motor neuron) facial palsy affecting primarily the lower face. This meets criteria
for score 2: partial paralysis.

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SECTION 6: Motor Arm

Question 6

, On motor arm testing, Patient 1's right arm shows no drift for 10 seconds but drifts to bed before
5 seconds. The left arm shows no drift for the full 10 seconds. What is the correct Motor Arm
score?

0. No drift in either arm
1. Drift in one arm
2. Some effort against gravity in one arm
3. No effort against gravity in one arm

Correct Answer: B

Rationale: The right arm drifts before 5 seconds (score 1), while the left arm has no drift (score
0). The Motor Arm score is determined by the worst (highest) score between the two limbs,
which is 1.

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SECTION 7: Motor Leg

Question 7

On motor leg testing, Patient 1's right leg drifts to bed within 5 seconds. The left leg holds the
30° position for the full 5 seconds without drift. What is the correct Motor Leg score?

0. No drift in either leg
1. Drift in one leg
2. Some effort against gravity in one leg
3. No effort against gravity in one leg

Correct Answer: B

Rationale: The right leg drifts within 5 seconds (score 1), while the left leg has no drift (score 0).
The Motor Leg score is the worst (highest) score between the two limbs, which is 1.

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SECTION 8: Sensory

Question 8