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APEX NIH STROKE SCALE GROUP A PATIENT 1-
6 Actual Exam 2026/2027 Complete Questions and
Verified Answers with Detailed Rationales Pass
Guaranteed - A+ Graded
Section 1: Patient 1
Patient Presentation: 68-year-old male, last known well 2 hours ago. Found by wife slumped in
chair, unable to speak clearly. History of hypertension and atrial fibrillation. Alert but confused
about date and location. Follows commands slowly. Right facial droop noted. Right arm and leg
weakness.
NIHSS Scoring:
1a. Level of Consciousness: 1 [CORRECT SCORE] – Alert but not fully oriented to time and
place; requires stimulation to attend but is not obtunded.
1b. LOC Questions (Month, Age): 1 [CORRECT SCORE] – Answers one question correctly
(knows age) but misses other (wrong month); partial credit for one correct answer.
1c. LOC Commands (Open/Close Eyes, Grip/Release): 0 [CORRECT SCORE] – Performs
both commands correctly despite slowed processing; no evidence of motor inability to follow
commands.
2. Best Gaze: 1 [CORRECT SCORE] – Gaze preference to the left but can be overcome
with oculocephalic maneuver; partial gaze palsy indicating right hemisphere
involvement.
3. Visual Fields: 0 [CORRECT SCORE] – No visual field cut identified on confrontation
testing; able to see fingers in all quadrants bilaterally.
4. Facial Palsy: 1 [CORRECT SCORE] – Minor right facial flattening with preserved
forehead movement; some weakness noted but not complete paralysis.
5. Motor Arm - Left: 0 [CORRECT SCORE] – Holds arm at 90 degrees (sitting) or 45
degrees (supine) for full 10 seconds without drift; no weakness detected.
6. Motor Arm - Right: 2 [CORRECT SCORE] – Arm falls immediately or cannot reach
position; no effort against gravity; severe right arm weakness consistent with left
hemisphere stroke.
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7. Motor Leg - Left: 0 [CORRECT SCORE] – Holds leg at 30 degrees for full 5 seconds
without drift; no weakness detected.
8. Motor Leg - Right: 2 [CORRECT SCORE] – Leg falls immediately or cannot reach
position; no effort against gravity; severe right leg weakness.
9. Limb Ataxia: 0 [CORRECT SCORE] – No ataxia detected in finger-to-nose or heel-to-
shin testing; weakness is pyramidal, not cerebellar.
10. Sensory: 1 [CORRECT SCORE] – Diminished sensation to pinprick on right face, arm,
and leg compared to left; aware of being touched but asymmetry present.
11. Best Language: 2 [CORRECT SCORE] – Severe aphasia with fragmentary expression;
limited comprehension; able to identify only a few items or unable to follow commands
reliably.
12. Dysarthria: 1 [CORRECT SCORE] – Mild to moderate dysarthria; slurred speech but
some words intelligible; worse than baseline but able to communicate partially.
13. Extinction/Inattention: 1 [CORRECT SCORE] – Inattention to right side on double
simultaneous stimulation; extinguishes right-sided stimulus when both sides stimulated
simultaneously.
Total Score: 12 – Moderate Stroke (6-15 range)
Section 2: Patient 2
Patient Presentation: 54-year-old female, sudden onset left-sided weakness and numbness 45
minutes ago. Fully alert and oriented. Speech is clear. Unable to move left arm or leg. History of
migraine, no prior stroke.
NIHSS Scoring:
1a. Level of Consciousness: 0 [CORRECT SCORE] – Fully alert, spontaneously attends, and is
completely oriented to person, place, and time.
1b. LOC Questions (Month, Age): 0 [CORRECT SCORE] – Answers both questions correctly
with no errors; fully oriented.
1c. LOC Commands (Open/Close Eyes, Grip/Release): 0 [CORRECT SCORE] – Performs
both commands correctly and promptly; no hesitation or motor impairment in command
following.
2. Best Gaze: 0 [CORRECT SCORE] – Normal gaze with no deviation; eyes move
conjugately in all directions without forced deviation or nystagmus.
APEX NIH STROKE SCALE GROUP A PATIENT 1-
6 Actual Exam 2026/2027 Complete Questions and
Verified Answers with Detailed Rationales Pass
Guaranteed - A+ Graded
Section 1: Patient 1
Patient Presentation: 68-year-old male, last known well 2 hours ago. Found by wife slumped in
chair, unable to speak clearly. History of hypertension and atrial fibrillation. Alert but confused
about date and location. Follows commands slowly. Right facial droop noted. Right arm and leg
weakness.
NIHSS Scoring:
1a. Level of Consciousness: 1 [CORRECT SCORE] – Alert but not fully oriented to time and
place; requires stimulation to attend but is not obtunded.
1b. LOC Questions (Month, Age): 1 [CORRECT SCORE] – Answers one question correctly
(knows age) but misses other (wrong month); partial credit for one correct answer.
1c. LOC Commands (Open/Close Eyes, Grip/Release): 0 [CORRECT SCORE] – Performs
both commands correctly despite slowed processing; no evidence of motor inability to follow
commands.
2. Best Gaze: 1 [CORRECT SCORE] – Gaze preference to the left but can be overcome
with oculocephalic maneuver; partial gaze palsy indicating right hemisphere
involvement.
3. Visual Fields: 0 [CORRECT SCORE] – No visual field cut identified on confrontation
testing; able to see fingers in all quadrants bilaterally.
4. Facial Palsy: 1 [CORRECT SCORE] – Minor right facial flattening with preserved
forehead movement; some weakness noted but not complete paralysis.
5. Motor Arm - Left: 0 [CORRECT SCORE] – Holds arm at 90 degrees (sitting) or 45
degrees (supine) for full 10 seconds without drift; no weakness detected.
6. Motor Arm - Right: 2 [CORRECT SCORE] – Arm falls immediately or cannot reach
position; no effort against gravity; severe right arm weakness consistent with left
hemisphere stroke.
, 2
7. Motor Leg - Left: 0 [CORRECT SCORE] – Holds leg at 30 degrees for full 5 seconds
without drift; no weakness detected.
8. Motor Leg - Right: 2 [CORRECT SCORE] – Leg falls immediately or cannot reach
position; no effort against gravity; severe right leg weakness.
9. Limb Ataxia: 0 [CORRECT SCORE] – No ataxia detected in finger-to-nose or heel-to-
shin testing; weakness is pyramidal, not cerebellar.
10. Sensory: 1 [CORRECT SCORE] – Diminished sensation to pinprick on right face, arm,
and leg compared to left; aware of being touched but asymmetry present.
11. Best Language: 2 [CORRECT SCORE] – Severe aphasia with fragmentary expression;
limited comprehension; able to identify only a few items or unable to follow commands
reliably.
12. Dysarthria: 1 [CORRECT SCORE] – Mild to moderate dysarthria; slurred speech but
some words intelligible; worse than baseline but able to communicate partially.
13. Extinction/Inattention: 1 [CORRECT SCORE] – Inattention to right side on double
simultaneous stimulation; extinguishes right-sided stimulus when both sides stimulated
simultaneously.
Total Score: 12 – Moderate Stroke (6-15 range)
Section 2: Patient 2
Patient Presentation: 54-year-old female, sudden onset left-sided weakness and numbness 45
minutes ago. Fully alert and oriented. Speech is clear. Unable to move left arm or leg. History of
migraine, no prior stroke.
NIHSS Scoring:
1a. Level of Consciousness: 0 [CORRECT SCORE] – Fully alert, spontaneously attends, and is
completely oriented to person, place, and time.
1b. LOC Questions (Month, Age): 0 [CORRECT SCORE] – Answers both questions correctly
with no errors; fully oriented.
1c. LOC Commands (Open/Close Eyes, Grip/Release): 0 [CORRECT SCORE] – Performs
both commands correctly and promptly; no hesitation or motor impairment in command
following.
2. Best Gaze: 0 [CORRECT SCORE] – Normal gaze with no deviation; eyes move
conjugately in all directions without forced deviation or nystagmus.
