APEX NIH Stroke Scale Group A Patients
1–6 (Complete) – Verified Answers –
2025/2026 Edition
Question 1: Level of Consciousness (Item 1a)
A patient is alert, keenly responsive, and answers questions appropriately
without stimulation. What is the correct score for Item 1a?
a) 1
b) 2
c) 3
d) 0
Correct Answer: d) 0
Explanation: Item 1a assesses overall alertness. A score of 0 indicates the
patient is fully alert and responsive. Higher scores apply to decreased
alertness (1 = drowsy but arousable, 2 = stuporous, 3 =
coma/unresponsive). This is the baseline for normal function and is one of
the most frequently tested items due to its role in initial stroke triage.
Question 2: LOC Questions (Item 1b)
The patient is asked their age and the current month. They answer neither
correctly (e.g., due to confusion or aphasia). What is the score for Item 1b?
a) 0
b) 1
c) 2
d) UN (untestable)
Correct Answer: c) 2
,Explanation: Item 1b tests orientation with two specific questions (month
and age). Score 0 = both correct; 1 = one correct; 2 = neither correct. Even
in aphasia or coma, if not testable due to intubation, it would be UN, but
confusion/orientation deficits score 2. This distinguishes orientation from
comprehension issues.
Question 3: Best Gaze (Item 2)
The patient shows partial gaze palsy, with abnormal horizontal eye
movements corrected by oculocephalic maneuver. What is the score?
a) 0
b) 1
c) 2
Correct Answer: b) 1
Explanation: Item 2 tests voluntary horizontal eye movements. 0 = normal;
1 = partial gaze palsy (abnormal in one or both directions, but not forced
deviation); 2 = forced deviation or total palsy not overcome by
oculocephalic reflex. Partial palsy is common in milder strokes and often
tested against full conjugate deviation.
Question 4: Visual Fields (Item 3)
Testing with finger counting reveals complete hemianopia on one side.
What is the score?
a) 1
b) 2
c) 3
d) 0
Correct Answer: b) 2
Explanation: Item 3 uses confrontation (finger counting in quadrants). 0 =
no loss; 1 = partial hemianopia or quadrantanopia; 2 = complete
hemianopia; 3 = bilateral hemianopia or blindness. Hemianopia indicates
occipital or optic radiation involvement and is a key prognostic indicator.
Question 5: Facial Palsy (Item 4)
, The patient shows minor paralysis (flattened nasolabial fold, slight
asymmetry on smiling). What is the score?
a) 0
b) 1
c) 2
d) 3
Correct Answer: b) 1
Explanation: Item 4 assesses facial symmetry at rest and with movement
(smile/show teeth). 0 = normal; 1 = minor paralysis (common in mild
central facial weakness); 2 = partial paralysis (lower face); 3 = complete
unilateral paralysis. Minor asymmetry is subtle but frequently missed in
exams.
Question 6: Motor Arm - Left (Item 5a)
The left arm is held at 90° but drifts down before 10 seconds without hitting
the bed. What is the score?
a) 0
b) 1
c) 2
d) 3
Correct Answer: b) 1
Explanation: Motor items (5a/5b for arms) test drift against gravity for 10
seconds. 0 = no drift; 1 = drift but doesn't hit bed; 2 = some effort against
gravity; 3 = no effort; 4 = no movement. Drift is a hallmark of upper motor
neuron weakness in stroke.
Question 7: Limb Ataxia (Item 7)
Finger-nose-finger and heel-shin testing shows ataxia out of proportion to
weakness in one limb. What is the score?
a) 0
b) 1
1–6 (Complete) – Verified Answers –
2025/2026 Edition
Question 1: Level of Consciousness (Item 1a)
A patient is alert, keenly responsive, and answers questions appropriately
without stimulation. What is the correct score for Item 1a?
a) 1
b) 2
c) 3
d) 0
Correct Answer: d) 0
Explanation: Item 1a assesses overall alertness. A score of 0 indicates the
patient is fully alert and responsive. Higher scores apply to decreased
alertness (1 = drowsy but arousable, 2 = stuporous, 3 =
coma/unresponsive). This is the baseline for normal function and is one of
the most frequently tested items due to its role in initial stroke triage.
Question 2: LOC Questions (Item 1b)
The patient is asked their age and the current month. They answer neither
correctly (e.g., due to confusion or aphasia). What is the score for Item 1b?
a) 0
b) 1
c) 2
d) UN (untestable)
Correct Answer: c) 2
,Explanation: Item 1b tests orientation with two specific questions (month
and age). Score 0 = both correct; 1 = one correct; 2 = neither correct. Even
in aphasia or coma, if not testable due to intubation, it would be UN, but
confusion/orientation deficits score 2. This distinguishes orientation from
comprehension issues.
Question 3: Best Gaze (Item 2)
The patient shows partial gaze palsy, with abnormal horizontal eye
movements corrected by oculocephalic maneuver. What is the score?
a) 0
b) 1
c) 2
Correct Answer: b) 1
Explanation: Item 2 tests voluntary horizontal eye movements. 0 = normal;
1 = partial gaze palsy (abnormal in one or both directions, but not forced
deviation); 2 = forced deviation or total palsy not overcome by
oculocephalic reflex. Partial palsy is common in milder strokes and often
tested against full conjugate deviation.
Question 4: Visual Fields (Item 3)
Testing with finger counting reveals complete hemianopia on one side.
What is the score?
a) 1
b) 2
c) 3
d) 0
Correct Answer: b) 2
Explanation: Item 3 uses confrontation (finger counting in quadrants). 0 =
no loss; 1 = partial hemianopia or quadrantanopia; 2 = complete
hemianopia; 3 = bilateral hemianopia or blindness. Hemianopia indicates
occipital or optic radiation involvement and is a key prognostic indicator.
Question 5: Facial Palsy (Item 4)
, The patient shows minor paralysis (flattened nasolabial fold, slight
asymmetry on smiling). What is the score?
a) 0
b) 1
c) 2
d) 3
Correct Answer: b) 1
Explanation: Item 4 assesses facial symmetry at rest and with movement
(smile/show teeth). 0 = normal; 1 = minor paralysis (common in mild
central facial weakness); 2 = partial paralysis (lower face); 3 = complete
unilateral paralysis. Minor asymmetry is subtle but frequently missed in
exams.
Question 6: Motor Arm - Left (Item 5a)
The left arm is held at 90° but drifts down before 10 seconds without hitting
the bed. What is the score?
a) 0
b) 1
c) 2
d) 3
Correct Answer: b) 1
Explanation: Motor items (5a/5b for arms) test drift against gravity for 10
seconds. 0 = no drift; 1 = drift but doesn't hit bed; 2 = some effort against
gravity; 3 = no effort; 4 = no movement. Drift is a hallmark of upper motor
neuron weakness in stroke.
Question 7: Limb Ataxia (Item 7)
Finger-nose-finger and heel-shin testing shows ataxia out of proportion to
weakness in one limb. What is the score?
a) 0
b) 1
