NIH Stroke Scale Certification Group D
Exam (2025/2026) – Patient 1–6 (60
Questions, 100% Verified Correct
Answers) | Updated for Clinical Accuracy
Patient 1: Caucasian Male, 75 y.o. – Mild Right Hemiparesis
(Post-Ischemic Stroke)
Scenario: Alert, slurred speech, mild right facial droop, right arm/leg weakness. Responds
appropriately but slowly. No aphasia or neglect.
1. 1a: Level of Consciousness – Responsive without stimulation.
0 (Alert)
Rationale: No arousal needed; score 0 per NIHSS for keen responsiveness.
2. 1b: LOC Questions (Month/Age) – Answers both correctly.
0 (Both correct)
Rationale: Accurate orientation; no disorientation.
3. 1c: LOC Commands (Eyes/Fist) – Performs both tasks.
0 (Both correct)
Rationale: Follows commands bilaterally; no deficit.
4. 3: Visual Fields – Full fields on confrontation.
0 (No loss)
Rationale: No hemianopia; intact vision.
5. 4: Facial Palsy – Mild right asymmetry on smiling.
1 (Minor paralysis)
Rationale: Right nasolabial fold flattening; score 1 for subtle weakness.
6. 5b: Motor Arm – Right – Arm drifts, hits bed before 10 seconds.
2 (Drift; hits bed)
Rationale: Moderate weakness; falls before time limit.
7. 6b: Motor Leg – Right – Leg drifts, does not hit bed in 5 seconds.
1 (Drift; no bed)
Rationale: Mild weakness; partial failure.
8. 8: Sensory – Normal pinprick response bilaterally.
0 (Normal)
Rationale: No sensory loss; full awareness.
9. 9: Best Language – Mild dysarthria, fluent comprehension.
0 (No aphasia)
Rationale: Naming/repetition intact; no language deficit.
, 10. 11: Extinction/Neglect – No inattention on double stimulation.
0 (Normal)
Rationale: No neglect; bilateral awareness.
Total Score for Patient 1: 4 (Mild stroke; aligns with 2025 tPA candidacy.)
Patient 2: African American Male, 55 y.o. – Left Facial
Weakness and Aphasia
Scenario: Drowsy, confused, left-sided droop, hesitant speech. Struggles with commands.
11. 1a: Level of Consciousness – Responsive but drowsy.
0 (Alert)
Rationale: Minimal stimulation; score 0 for near-normal alertness.
12. 1b: LOC Questions – Neither month nor age correct.
2 (Neither correct)
Rationale: Aphasia-related disorientation; score 2 per guidelines.
13. 1c: LOC Commands – Performs with cues.
0 (Both correct)
Rationale: Executes tasks despite language issues; score based on action.
14. 2: Best Gaze – No deviation; follows midline.
0 (Normal)
Rationale: No oculomotor impairment.
15. 4: Facial Palsy – Moderate left droop on smile.
1 (Minor)
Rationale: Asymmetry with voluntary movement possible.
16. 5b: Motor Arm – Right – No drift; full strength.
0 (No drift)
Rationale: Symmetric arm function.
17. 6b: Motor Leg – Right – No drift.
0 (No drift)
Rationale: Normal leg strength.
18. 8: Sensory – Mild left hypoesthesia.
1 (Mild loss)
Rationale: Reduced sensation on left; score 1.
19. 9: Best Language – Expressive aphasia; naming impaired.
2 (Moderate aphasia)
Rationale: Limited language; score 2 for partial fluency.
20. 10: Dysarthria – Moderate slurring, partially intelligible.
1 (Moderate)
Rationale: Speech effortful; score 1.
Total Score for Patient 2: 7 (Moderate stroke; aphasia-driven score.)
Exam (2025/2026) – Patient 1–6 (60
Questions, 100% Verified Correct
Answers) | Updated for Clinical Accuracy
Patient 1: Caucasian Male, 75 y.o. – Mild Right Hemiparesis
(Post-Ischemic Stroke)
Scenario: Alert, slurred speech, mild right facial droop, right arm/leg weakness. Responds
appropriately but slowly. No aphasia or neglect.
1. 1a: Level of Consciousness – Responsive without stimulation.
0 (Alert)
Rationale: No arousal needed; score 0 per NIHSS for keen responsiveness.
2. 1b: LOC Questions (Month/Age) – Answers both correctly.
0 (Both correct)
Rationale: Accurate orientation; no disorientation.
3. 1c: LOC Commands (Eyes/Fist) – Performs both tasks.
0 (Both correct)
Rationale: Follows commands bilaterally; no deficit.
4. 3: Visual Fields – Full fields on confrontation.
0 (No loss)
Rationale: No hemianopia; intact vision.
5. 4: Facial Palsy – Mild right asymmetry on smiling.
1 (Minor paralysis)
Rationale: Right nasolabial fold flattening; score 1 for subtle weakness.
6. 5b: Motor Arm – Right – Arm drifts, hits bed before 10 seconds.
2 (Drift; hits bed)
Rationale: Moderate weakness; falls before time limit.
7. 6b: Motor Leg – Right – Leg drifts, does not hit bed in 5 seconds.
1 (Drift; no bed)
Rationale: Mild weakness; partial failure.
8. 8: Sensory – Normal pinprick response bilaterally.
0 (Normal)
Rationale: No sensory loss; full awareness.
9. 9: Best Language – Mild dysarthria, fluent comprehension.
0 (No aphasia)
Rationale: Naming/repetition intact; no language deficit.
, 10. 11: Extinction/Neglect – No inattention on double stimulation.
0 (Normal)
Rationale: No neglect; bilateral awareness.
Total Score for Patient 1: 4 (Mild stroke; aligns with 2025 tPA candidacy.)
Patient 2: African American Male, 55 y.o. – Left Facial
Weakness and Aphasia
Scenario: Drowsy, confused, left-sided droop, hesitant speech. Struggles with commands.
11. 1a: Level of Consciousness – Responsive but drowsy.
0 (Alert)
Rationale: Minimal stimulation; score 0 for near-normal alertness.
12. 1b: LOC Questions – Neither month nor age correct.
2 (Neither correct)
Rationale: Aphasia-related disorientation; score 2 per guidelines.
13. 1c: LOC Commands – Performs with cues.
0 (Both correct)
Rationale: Executes tasks despite language issues; score based on action.
14. 2: Best Gaze – No deviation; follows midline.
0 (Normal)
Rationale: No oculomotor impairment.
15. 4: Facial Palsy – Moderate left droop on smile.
1 (Minor)
Rationale: Asymmetry with voluntary movement possible.
16. 5b: Motor Arm – Right – No drift; full strength.
0 (No drift)
Rationale: Symmetric arm function.
17. 6b: Motor Leg – Right – No drift.
0 (No drift)
Rationale: Normal leg strength.
18. 8: Sensory – Mild left hypoesthesia.
1 (Mild loss)
Rationale: Reduced sensation on left; score 1.
19. 9: Best Language – Expressive aphasia; naming impaired.
2 (Moderate aphasia)
Rationale: Limited language; score 2 for partial fluency.
20. 10: Dysarthria – Moderate slurring, partially intelligible.
1 (Moderate)
Rationale: Speech effortful; score 1.
Total Score for Patient 2: 7 (Moderate stroke; aphasia-driven score.)
