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APEX NIH Stroke Scale Exam Actual Exam
2027/2028 | All Test Groups A-F Patients 1–6
Complete Test Bank with Verified Q&A |
Updated for NIHSS Certification | A+ Graded
TEST GROUP A – PATIENT 1
Clinical Scenario: A 72-year-old male presents to the emergency department with sudden onset
of right-sided weakness and difficulty speaking. On examination, he is awake but appears
confused. Family reports symptoms began approximately 2 hours ago. BP 180/95, HR 88, RR
16.
Video Description: Patient is lying in bed, eyes open. When examiner enters, patient turns head
slowly. He attempts to speak but words are slurred. Right face droops slightly when asked to
smile. He follows some commands slowly.
NIHSS SCORING:
1a. Level of Consciousness:
A. 0 - Alert; keenly responsive
B. 1 - Not alert, but arousable with minor stimulation [CORRECT]
C. 2 - Not alert, requires repeated stimulation to attend
D. 3 - Unresponsive or reflex responses only
Rationale: Patient is awake but confused. Requires verbal cues to maintain attention.
1b. LOC Questions (Month and Age):
A. 0 - Answers both correctly
B. 1 - Answers one correctly
C. 2 - Answers neither correctly [CORRECT]
Rationale: Patient is confused and aphasic. Unable to state month or age correctly.
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1c. LOC Commands (Open/close eyes, grip/release non-paretic hand):
A. 0 - Performs both correctly
B. 1 - Performs one correctly [CORRECT]
C. 2 - Performs neither correctly
Rationale: Patient can open/close eyes on command but unable to grip/release with left hand due
to comprehension deficit.
2. Best Gaze:
A. 0 - Normal
B. 1 - Partial gaze palsy [CORRECT]
C. 2 - Forced deviation or total gaze paresis not overcome by oculocephalic maneuver
Rationale: Gaze is deviated to the left (toward lesion) but can be overcome with oculocephalic
maneuver.
3. Visual Fields:
A. 0 - No visual loss
B. 1 - Partial hemianopia [CORRECT]
C. 2 - Complete hemianopia
D. 3 - Bilateral hemianopia or blind
Rationale: Patient shows inconsistency in recognizing fingers on right side, suggesting partial
right hemianopia.
4. Facial Palsy:
A. 0 - Normal symmetrical movement
B. 1 - Minor paralysis (flattened nasolabial fold, asymmetry on smiling) [CORRECT]
C. 2 - Partial paralysis (total or near-total paralysis of lower face)
D. 3 - Complete paralysis of one or both sides
Rationale: Right nasolabial fold is flattened; asymmetry present on smiling but forehead
movement preserved.
5a. Motor Arm - Left:
A. 0 - No drift; limb holds 90° (or 45°) for full 10 seconds [CORRECT]
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B. 1 - Drift; limb holds but drifts down before 10 seconds
C. 2 - Some effort against gravity; limb cannot get to or maintain position
D. 3 - No effort against gravity; limb falls
E. 4 - No movement
Rationale: Left arm is unaffected; holds position fully.
5b. Motor Arm - Right:
A. 0 - No drift
B. 1 - Drift
C. 2 - Some effort against gravity; cannot maintain 90° (or 45°) [CORRECT]
D. 3 - No effort against gravity
E. 4 - No movement
Rationale: Right arm falls immediately but has some movement against gravity when tested
supine.
6a. Motor Leg - Left:
A. 0 - No drift; holds 30° position for full 5 seconds [CORRECT]
B. 1 - Drift; leg falls by end of 5 seconds
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
E. 4 - No movement
Rationale: Left leg is unaffected; holds position fully.
6b. Motor Leg - Right:
A. 0 - No drift
B. 1 - Drift
C. 2 - Some effort against gravity; cannot maintain 30° [CORRECT]
D. 3 - No effort against gravity
E. 4 - No movement
Rationale: Right leg has weakness but some effort against gravity remains.
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7. Limb Ataxia:
A. 0 - Absent; no ataxia [CORRECT]
B. 1 - Present in one limb
C. 2 - Present in two limbs
Rationale: No dysmetria on finger-nose-finger or heel-shin testing. Weakness is present but not
ataxia.
8. Sensory:
A. 0 - Normal; no sensory loss
B. 1 - Mild-to-moderate sensory loss; patient feels pinprick is less sharp on right side
[CORRECT]
C. 2 - Severe to total sensory loss; no awareness of being touched
Rationale: Patient reports pinprick as "duller" on right arm and leg compared to left.
9. Best Language:
A. 0 - No aphasia; normal
B. 1 - Mild-to-moderate aphasia; some obvious loss of fluency or comprehension [CORRECT]
C. 2 - Severe aphasia; fragmentary expression, little comprehension
D. 3 - Mute, global aphasia; no usable speech or comprehension
Rationale: Patient has word-finding difficulty, mild comprehension deficit, but can
communicate basic needs.
10. Dysarthria:
A. 0 - Normal articulation
B. 1 - Mild-to-moderate dysarthria; slurred but intelligible [CORRECT]
C. 2 - Severe dysarthria or anarthria; unintelligible or mute
Rationale: Speech is slurred but examiner can understand words with effort.
11. Extinction and Inattention (formerly Neglect):
A. 0 - No neglect; normal [CORRECT]
B. 1 - Mild neglect; extinguishes to double simultaneous stimulation on right
C. 2 - Severe neglect; profound loss of awareness on right side
APEX NIH Stroke Scale Exam Actual Exam
2027/2028 | All Test Groups A-F Patients 1–6
Complete Test Bank with Verified Q&A |
Updated for NIHSS Certification | A+ Graded
TEST GROUP A – PATIENT 1
Clinical Scenario: A 72-year-old male presents to the emergency department with sudden onset
of right-sided weakness and difficulty speaking. On examination, he is awake but appears
confused. Family reports symptoms began approximately 2 hours ago. BP 180/95, HR 88, RR
16.
Video Description: Patient is lying in bed, eyes open. When examiner enters, patient turns head
slowly. He attempts to speak but words are slurred. Right face droops slightly when asked to
smile. He follows some commands slowly.
NIHSS SCORING:
1a. Level of Consciousness:
A. 0 - Alert; keenly responsive
B. 1 - Not alert, but arousable with minor stimulation [CORRECT]
C. 2 - Not alert, requires repeated stimulation to attend
D. 3 - Unresponsive or reflex responses only
Rationale: Patient is awake but confused. Requires verbal cues to maintain attention.
1b. LOC Questions (Month and Age):
A. 0 - Answers both correctly
B. 1 - Answers one correctly
C. 2 - Answers neither correctly [CORRECT]
Rationale: Patient is confused and aphasic. Unable to state month or age correctly.
,2
1c. LOC Commands (Open/close eyes, grip/release non-paretic hand):
A. 0 - Performs both correctly
B. 1 - Performs one correctly [CORRECT]
C. 2 - Performs neither correctly
Rationale: Patient can open/close eyes on command but unable to grip/release with left hand due
to comprehension deficit.
2. Best Gaze:
A. 0 - Normal
B. 1 - Partial gaze palsy [CORRECT]
C. 2 - Forced deviation or total gaze paresis not overcome by oculocephalic maneuver
Rationale: Gaze is deviated to the left (toward lesion) but can be overcome with oculocephalic
maneuver.
3. Visual Fields:
A. 0 - No visual loss
B. 1 - Partial hemianopia [CORRECT]
C. 2 - Complete hemianopia
D. 3 - Bilateral hemianopia or blind
Rationale: Patient shows inconsistency in recognizing fingers on right side, suggesting partial
right hemianopia.
4. Facial Palsy:
A. 0 - Normal symmetrical movement
B. 1 - Minor paralysis (flattened nasolabial fold, asymmetry on smiling) [CORRECT]
C. 2 - Partial paralysis (total or near-total paralysis of lower face)
D. 3 - Complete paralysis of one or both sides
Rationale: Right nasolabial fold is flattened; asymmetry present on smiling but forehead
movement preserved.
5a. Motor Arm - Left:
A. 0 - No drift; limb holds 90° (or 45°) for full 10 seconds [CORRECT]
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B. 1 - Drift; limb holds but drifts down before 10 seconds
C. 2 - Some effort against gravity; limb cannot get to or maintain position
D. 3 - No effort against gravity; limb falls
E. 4 - No movement
Rationale: Left arm is unaffected; holds position fully.
5b. Motor Arm - Right:
A. 0 - No drift
B. 1 - Drift
C. 2 - Some effort against gravity; cannot maintain 90° (or 45°) [CORRECT]
D. 3 - No effort against gravity
E. 4 - No movement
Rationale: Right arm falls immediately but has some movement against gravity when tested
supine.
6a. Motor Leg - Left:
A. 0 - No drift; holds 30° position for full 5 seconds [CORRECT]
B. 1 - Drift; leg falls by end of 5 seconds
C. 2 - Some effort against gravity
D. 3 - No effort against gravity
E. 4 - No movement
Rationale: Left leg is unaffected; holds position fully.
6b. Motor Leg - Right:
A. 0 - No drift
B. 1 - Drift
C. 2 - Some effort against gravity; cannot maintain 30° [CORRECT]
D. 3 - No effort against gravity
E. 4 - No movement
Rationale: Right leg has weakness but some effort against gravity remains.
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7. Limb Ataxia:
A. 0 - Absent; no ataxia [CORRECT]
B. 1 - Present in one limb
C. 2 - Present in two limbs
Rationale: No dysmetria on finger-nose-finger or heel-shin testing. Weakness is present but not
ataxia.
8. Sensory:
A. 0 - Normal; no sensory loss
B. 1 - Mild-to-moderate sensory loss; patient feels pinprick is less sharp on right side
[CORRECT]
C. 2 - Severe to total sensory loss; no awareness of being touched
Rationale: Patient reports pinprick as "duller" on right arm and leg compared to left.
9. Best Language:
A. 0 - No aphasia; normal
B. 1 - Mild-to-moderate aphasia; some obvious loss of fluency or comprehension [CORRECT]
C. 2 - Severe aphasia; fragmentary expression, little comprehension
D. 3 - Mute, global aphasia; no usable speech or comprehension
Rationale: Patient has word-finding difficulty, mild comprehension deficit, but can
communicate basic needs.
10. Dysarthria:
A. 0 - Normal articulation
B. 1 - Mild-to-moderate dysarthria; slurred but intelligible [CORRECT]
C. 2 - Severe dysarthria or anarthria; unintelligible or mute
Rationale: Speech is slurred but examiner can understand words with effort.
11. Extinction and Inattention (formerly Neglect):
A. 0 - No neglect; normal [CORRECT]
B. 1 - Mild neglect; extinguishes to double simultaneous stimulation on right
C. 2 - Severe neglect; profound loss of awareness on right side
