ESTUDYR
NIH Stroke Scale Group A
1. How many items are on the NIH Stroke Scale (NIHSS)?
A. 9
B. 10
C. 11 ✅
D. 12
Rationale: The NIHSS is an 11-item standardized neurologic exam used to quantify stroke
severity.
2. Item 1B (Level of Consciousness — Orientation): You ask “What month is it?” and “How old
are you?” — scoring: answers both correctly. What score do you assign?
A. 2
B. 0 ✅
C. 1
D. Not testable
Rationale: Item 1B is scored 0 when the patient answers both orientation questions correctly.
Score 1 for one correct; 2 if neither correct.
3. Item 1C (LOC — Commands): You ask the patient to “close your eyes,” “open them,” and
“make a fist.” The patient performs all three correctly on first attempt. What is the score?
A. 0 ✅
B. 1
C. 2
D. 3
Rationale: Item 1C is 0 when both commands (eyes and hand commands as a set of 3 tasks) are
performed correctly. Score 1 = one task correct; 2 = neither.
, ESTUDYR
4. Item 2 (Best Gaze — horizontal extraocular movements): The patient has a partial
horizontal gaze palsy (can look some directions but not full). What score?
A. 0
B. 1 ✅
C. 2
D. 3
Rationale: Item 2 = 1 for partial gaze palsy (impaired but not forced deviation). Score 2 = forced
deviation / total gaze palsy.
5. Item 3 (Visual fields): The patient has a complete hemianopia on one side. What score?
A. 0
B. 1
C. 2 ✅
D. 3
Rationale: Item 3 = 2 for complete hemianopia (loss of half the visual field). 1 =
partial/quadrantanopia; 3 = bilateral hemianopia (blindness).
6. Item 5A / 5B (Motor — Arm drift): While testing the left arm (extend 90° sitting / 45°
supine), the arm falls before 10 seconds but does not hit the bed. What score for that arm?
A. 0
B. 1 ✅
C. 2
D. 3 or 4
Rationale: Item 5 (arm) = 1 when there is drift (falls) before 10 seconds but without hitting
support. Score 2 = some effort against gravity but cannot maintain position; 3 = no effort
against gravity (falls immediately); 4 = no movement.
7. Item 5A / 5B (Arm) distinction: If an arm shows no voluntary movement at all, what score
is appropriate?
NIH Stroke Scale Group A
1. How many items are on the NIH Stroke Scale (NIHSS)?
A. 9
B. 10
C. 11 ✅
D. 12
Rationale: The NIHSS is an 11-item standardized neurologic exam used to quantify stroke
severity.
2. Item 1B (Level of Consciousness — Orientation): You ask “What month is it?” and “How old
are you?” — scoring: answers both correctly. What score do you assign?
A. 2
B. 0 ✅
C. 1
D. Not testable
Rationale: Item 1B is scored 0 when the patient answers both orientation questions correctly.
Score 1 for one correct; 2 if neither correct.
3. Item 1C (LOC — Commands): You ask the patient to “close your eyes,” “open them,” and
“make a fist.” The patient performs all three correctly on first attempt. What is the score?
A. 0 ✅
B. 1
C. 2
D. 3
Rationale: Item 1C is 0 when both commands (eyes and hand commands as a set of 3 tasks) are
performed correctly. Score 1 = one task correct; 2 = neither.
, ESTUDYR
4. Item 2 (Best Gaze — horizontal extraocular movements): The patient has a partial
horizontal gaze palsy (can look some directions but not full). What score?
A. 0
B. 1 ✅
C. 2
D. 3
Rationale: Item 2 = 1 for partial gaze palsy (impaired but not forced deviation). Score 2 = forced
deviation / total gaze palsy.
5. Item 3 (Visual fields): The patient has a complete hemianopia on one side. What score?
A. 0
B. 1
C. 2 ✅
D. 3
Rationale: Item 3 = 2 for complete hemianopia (loss of half the visual field). 1 =
partial/quadrantanopia; 3 = bilateral hemianopia (blindness).
6. Item 5A / 5B (Motor — Arm drift): While testing the left arm (extend 90° sitting / 45°
supine), the arm falls before 10 seconds but does not hit the bed. What score for that arm?
A. 0
B. 1 ✅
C. 2
D. 3 or 4
Rationale: Item 5 (arm) = 1 when there is drift (falls) before 10 seconds but without hitting
support. Score 2 = some effort against gravity but cannot maintain position; 3 = no effort
against gravity (falls immediately); 4 = no movement.
7. Item 5A / 5B (Arm) distinction: If an arm shows no voluntary movement at all, what score
is appropriate?
