NIHSS - Group A Questions with Correct Answers
2025
1. A patient is alert, responds to questions appropriately,
and follows commands. What is the score for LOC 1a?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: A score of 0 indicates alert and fully
responsive. No stupor or coma.
2. A patient requires repeated painful stimulation to
achieve any movement. What is the score for LOC 1a?
A) 0
B) 1
C) 2
D) 3
1
,Answer: C) 2
Rationale: Score 2 = requires repeated or strong/painful
stimuli to move. Score 1 = drowsy but responds to minor
stimulation.
3. For question 1b (LOC questions), you ask: “What month
is it?” and “How old are you?” The patient says “March”
(correct) and “55” (actual age is 54). What score?
A) 0
B) 1
C) 2
D) Untestable
Answer: A) 0
Rationale: Only one correct answer is needed for each
question. Age off by 1 year is accepted as correct.
4. A patient has aphasia but follows simple commands.
How should you score 1b (LOC questions)?
A) 0
B) 1
2
,C) 2
D) Untestable
Answer: B) 1
Rationale: Aphasia makes questions untestable for verbal
response → score 1 due to language barrier.
5. The patient is asked to open and close eyes. They open
eyes but do not close them. Score for 1c (LOC commands):
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: One command performed correctly is sufficient
for score 0. They opened eyes — that counts.
6. Which command is NOT allowed for item 1c?
A) Open/close eyes
B) Make a fist/let go
3
, C) Stick out tongue
D) Grip/release my fingers
Answer: C) Stick out tongue
Rationale: Only two specific commands are allowed:
open/close eyes AND grip/release (or fist/open hand).
Sticking out tongue is not standardized.
7. A patient with severe dysarthria cannot speak but
follows commands perfectly. Score 1c:
A) 0
B) 1
C) 2
D) Untestable
Answer: A) 0
Rationale: Commands test motor response, not speech.
Dysarthria does not affect scoring.
8. What is the maximum score for item 1a (LOC)?
A) 1
B) 2
4
2025
1. A patient is alert, responds to questions appropriately,
and follows commands. What is the score for LOC 1a?
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: A score of 0 indicates alert and fully
responsive. No stupor or coma.
2. A patient requires repeated painful stimulation to
achieve any movement. What is the score for LOC 1a?
A) 0
B) 1
C) 2
D) 3
1
,Answer: C) 2
Rationale: Score 2 = requires repeated or strong/painful
stimuli to move. Score 1 = drowsy but responds to minor
stimulation.
3. For question 1b (LOC questions), you ask: “What month
is it?” and “How old are you?” The patient says “March”
(correct) and “55” (actual age is 54). What score?
A) 0
B) 1
C) 2
D) Untestable
Answer: A) 0
Rationale: Only one correct answer is needed for each
question. Age off by 1 year is accepted as correct.
4. A patient has aphasia but follows simple commands.
How should you score 1b (LOC questions)?
A) 0
B) 1
2
,C) 2
D) Untestable
Answer: B) 1
Rationale: Aphasia makes questions untestable for verbal
response → score 1 due to language barrier.
5. The patient is asked to open and close eyes. They open
eyes but do not close them. Score for 1c (LOC commands):
A) 0
B) 1
C) 2
D) 3
Answer: A) 0
Rationale: One command performed correctly is sufficient
for score 0. They opened eyes — that counts.
6. Which command is NOT allowed for item 1c?
A) Open/close eyes
B) Make a fist/let go
3
, C) Stick out tongue
D) Grip/release my fingers
Answer: C) Stick out tongue
Rationale: Only two specific commands are allowed:
open/close eyes AND grip/release (or fist/open hand).
Sticking out tongue is not standardized.
7. A patient with severe dysarthria cannot speak but
follows commands perfectly. Score 1c:
A) 0
B) 1
C) 2
D) Untestable
Answer: A) 0
Rationale: Commands test motor response, not speech.
Dysarthria does not affect scoring.
8. What is the maximum score for item 1a (LOC)?
A) 1
B) 2
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