NIH Stroke Scale | Groups A–F (Patients 1–6) |
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Section 1: General Principles and Scoring Criteria (Q1–Q20)
1. According to the NIHSS, a total score of 0 indicates:
A. A mild stroke
B. No stroke symptoms
C. The patient is in a coma
D. The test was not completed
Answer: B
Rationale: A score of 0 on the NIHSS indicates no stroke symptoms. The scale
ranges from 0–42, with higher scores indicating greater severity.
2. For item 1A (Level of Consciousness), a patient who is not alert but arouses to
minor stimulation (e.g., speaking) to obey commands is scored as:
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Item 1A scoring: 0 = Alert; 1 = Not alert, but arousable by minor
stimulation; 2 = Requires repeated stimulation; 3 = Reflex movements only or
unresponsive.
3. The two standardized questions for item 1B (LOC Questions) are:
A. "What is your name?" and "Where are you?"
B. "What month is it?" and "How old are you?"
C. "What day of the week is it?" and "What year is it?"
D. "Who is the President?" and "Where is the hospital?"
Answer: B
Rationale: The standardized questions are the current month and the patient's
age. This tests orientation, not general knowledge.
,4. For item 1C (LOC Commands), you ask the patient to perform two tasks. If the
patient is aphasic, you should:
A. Score a 2 automatically
B. Use a noxious stimulus to get a response
C. Demonstrate the task (pantomime) and then score the result
D. Skip the item and mark it as "untestable"
Answer: C
Rationale: If the patient does not respond to command, the task should be
demonstrated to them (pantomime), and the result scored based on whether
they follow none, one, or two commands.
5. For item 2 (Best Gaze), a patient with a partial gaze palsy (one eye does not
abduct fully) should be scored as:
A. 0
B. 1
C. 2
D. Untestable
Answer: B
Rationale: Item 2 scoring: 0 = Normal; 1 = Partial gaze palsy; 2 = Forced deviation
or total gaze paresis.
6. For item 3 (Visual Fields), a patient with a complete hemianopia is scored as:
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Item 3 scoring: 0 = No visual loss; 1 = Partial hemianopia; 2 = Complete
hemianopia; 3 = Bilateral hemianopia.
7. For item 4 (Facial Palsy), a patient with minor paralysis (flattened nasolabial
fold, asymmetry on smiling) is scored as:
A. 0
B. 1
,C. 2
D. 3
Answer: B
Rationale: Item 4 scoring: 0 = Normal symmetrical movements; 1 = Minor
paralysis; 2 = Partial paralysis; 3 = Complete paralysis.
8. For item 5 (Motor Arm), the patient is asked to hold the arm at 90 degrees
(sitting) or 45 degrees (supine) for how many seconds?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: B
Rationale: For motor arm testing, the patient holds the arm at 90 degrees (sitting)
or 45 degrees (supine) for 10 seconds.
9. For item 6 (Motor Leg), the patient is asked to hold the leg at 30 degrees for
how many seconds?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: A
Rationale: For motor leg testing, the patient holds the leg at 30 degrees for 5
seconds.
10. For item 7 (Limb Ataxia), ataxia is scored only if present out of proportion to
weakness. A score of 2 indicates:
A. No ataxia
B. Ataxia in one limb
C. Ataxia in two limbs
D. Untestable
Answer: C
Rationale: Item 7 scoring: 0 = Absent; 1 = Present in one limb; 2 = Present in two
limbs.
, 11. For item 8 (Sensory), a patient with mild-to-moderate sensory loss (feels
pinprick less sharp on the affected side) is scored as:
A. 0
B. 1
C. 2
D. Untestable
Answer: B
Rationale: Item 8 scoring: 0 = Normal; 1 = Mild-to-moderate sensory loss; 2 =
Severe to total sensory loss.
12. For item 9 (Best Language), a patient with mild-to-moderate aphasia is
scored as:
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild-to-moderate aphasia; 2 =
Severe aphasia; 3 = Mute or global aphasia.
13. For item 10 (Dysarthria), a patient with mild-to-moderate dysarthria (slurs
some words but can be understood) is scored as:
A. 0
B. 1
C. 2
D. Untestable
Answer: B
Rationale: Item 10 scoring: 0 = Normal; 1 = Mild-to-moderate dysarthria; 2 =
Severe dysarthria; 9 = Intubated or other physical barrier.
14. For item 11 (Extinction/Inattention), a patient with visual, tactile, auditory,
spatial, or personal inattention is scored as:
A. 0
B. 1
2025/2026 Updated Edition – Complete, Real
and Authentic (and Solved | PACKAGE DEAL)
Section 1: General Principles and Scoring Criteria (Q1–Q20)
1. According to the NIHSS, a total score of 0 indicates:
A. A mild stroke
B. No stroke symptoms
C. The patient is in a coma
D. The test was not completed
Answer: B
Rationale: A score of 0 on the NIHSS indicates no stroke symptoms. The scale
ranges from 0–42, with higher scores indicating greater severity.
2. For item 1A (Level of Consciousness), a patient who is not alert but arouses to
minor stimulation (e.g., speaking) to obey commands is scored as:
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Item 1A scoring: 0 = Alert; 1 = Not alert, but arousable by minor
stimulation; 2 = Requires repeated stimulation; 3 = Reflex movements only or
unresponsive.
3. The two standardized questions for item 1B (LOC Questions) are:
A. "What is your name?" and "Where are you?"
B. "What month is it?" and "How old are you?"
C. "What day of the week is it?" and "What year is it?"
D. "Who is the President?" and "Where is the hospital?"
Answer: B
Rationale: The standardized questions are the current month and the patient's
age. This tests orientation, not general knowledge.
,4. For item 1C (LOC Commands), you ask the patient to perform two tasks. If the
patient is aphasic, you should:
A. Score a 2 automatically
B. Use a noxious stimulus to get a response
C. Demonstrate the task (pantomime) and then score the result
D. Skip the item and mark it as "untestable"
Answer: C
Rationale: If the patient does not respond to command, the task should be
demonstrated to them (pantomime), and the result scored based on whether
they follow none, one, or two commands.
5. For item 2 (Best Gaze), a patient with a partial gaze palsy (one eye does not
abduct fully) should be scored as:
A. 0
B. 1
C. 2
D. Untestable
Answer: B
Rationale: Item 2 scoring: 0 = Normal; 1 = Partial gaze palsy; 2 = Forced deviation
or total gaze paresis.
6. For item 3 (Visual Fields), a patient with a complete hemianopia is scored as:
A. 0
B. 1
C. 2
D. 3
Answer: C
Rationale: Item 3 scoring: 0 = No visual loss; 1 = Partial hemianopia; 2 = Complete
hemianopia; 3 = Bilateral hemianopia.
7. For item 4 (Facial Palsy), a patient with minor paralysis (flattened nasolabial
fold, asymmetry on smiling) is scored as:
A. 0
B. 1
,C. 2
D. 3
Answer: B
Rationale: Item 4 scoring: 0 = Normal symmetrical movements; 1 = Minor
paralysis; 2 = Partial paralysis; 3 = Complete paralysis.
8. For item 5 (Motor Arm), the patient is asked to hold the arm at 90 degrees
(sitting) or 45 degrees (supine) for how many seconds?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: B
Rationale: For motor arm testing, the patient holds the arm at 90 degrees (sitting)
or 45 degrees (supine) for 10 seconds.
9. For item 6 (Motor Leg), the patient is asked to hold the leg at 30 degrees for
how many seconds?
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer: A
Rationale: For motor leg testing, the patient holds the leg at 30 degrees for 5
seconds.
10. For item 7 (Limb Ataxia), ataxia is scored only if present out of proportion to
weakness. A score of 2 indicates:
A. No ataxia
B. Ataxia in one limb
C. Ataxia in two limbs
D. Untestable
Answer: C
Rationale: Item 7 scoring: 0 = Absent; 1 = Present in one limb; 2 = Present in two
limbs.
, 11. For item 8 (Sensory), a patient with mild-to-moderate sensory loss (feels
pinprick less sharp on the affected side) is scored as:
A. 0
B. 1
C. 2
D. Untestable
Answer: B
Rationale: Item 8 scoring: 0 = Normal; 1 = Mild-to-moderate sensory loss; 2 =
Severe to total sensory loss.
12. For item 9 (Best Language), a patient with mild-to-moderate aphasia is
scored as:
A. 0
B. 1
C. 2
D. 3
Answer: B
Rationale: Item 9 scoring: 0 = No aphasia; 1 = Mild-to-moderate aphasia; 2 =
Severe aphasia; 3 = Mute or global aphasia.
13. For item 10 (Dysarthria), a patient with mild-to-moderate dysarthria (slurs
some words but can be understood) is scored as:
A. 0
B. 1
C. 2
D. Untestable
Answer: B
Rationale: Item 10 scoring: 0 = Normal; 1 = Mild-to-moderate dysarthria; 2 =
Severe dysarthria; 9 = Intubated or other physical barrier.
14. For item 11 (Extinction/Inattention), a patient with visual, tactile, auditory,
spatial, or personal inattention is scored as:
A. 0
B. 1
