NIH GROUP E QUESTIONS AND ANSWERS 2026/2027 |
Verified Edition with Complete Solutions | NIHSS Group E
Certification | Pass Guaranteed - A+ Graded
Patient E1: Anterior Cerebral Artery (ACA) Stroke - Right Leg Weakness > Arm,
Abulia, Grasp Reflex, Incontinence
Patient E1 - Item 1a: Level of Consciousness (LOC):
Patient is drowsy but arousable by minor stimulation. Opens eyes to voice, responds to
questions but slow to answer. Falls asleep if not stimulated.
A. 0 - Alert, keenly responsive
B. 2 - Not alert, requires repeated stimulation to attend
C. 3 - Unresponsive or responds only with reflex motor effects
D. 1 - Not alert but arousable by minor stimulation [CORRECT]
Correct Answer: D
Rationale: Patient is drowsy but arousable by minor stimulation (voice), meeting
definition of 1. Score 0 requires alert, score 2 requires repeated/tactile stimulation, score
3 requires coma. ACA stroke causes abulia and decreased arousal due to frontal lobe
involvement.
Patient E1 - Item 1b: LOC Questions (Month and Age):
Patient is slow to respond. When asked "What month is it?" patient pauses then
correctly says "April." When asked "How old are you?" patient says "I think... 68?"
(correct answer is 68). Both answers correct but hesitant.
A. 2 - Answers neither correctly
B. NT - Not testable (intubated/aphasic)
C. 1 - Answers one correctly
D. 0 - Answers both correctly [CORRECT]
Correct Answer: D
Rationale: Patient answered both month and age correctly despite hesitancy, scoring 0.
Abulia (lack of initiative) causes delayed responses but accuracy determines score.
Score 1 if only one correct, score 2 if neither correct, NT only for intubation or aphasia.
Patient E1 - Item 1c: LOC Commands (Open/Close Eyes, Grip/Release):
Patient is slow to initiate but follows commands. When asked to open and close eyes,
patient performs correctly after a delay. When asked to grip and release non-paretic
hand (left hand), patient performs correctly after a delay.
A. 2 - Performs neither
B. 1 - Performs one correctly
C. 0 - Performs both correctly [CORRECT]
,D. NT - Not testable (amputation/joint fusion)
Correct Answer: C
Rationale: Patient performed both commands correctly (despite delayed initiation due to
abulia), scoring 0. Score 1 if only one correct, score 2 if neither, NT only for
amputation/joint fusion.
Patient E1 - Item 2: Best Gaze (Horizontal Eye Movement):
Patient has conjugate horizontal eye movement. Eyes move fully to left and right without
deviation. No gaze preference or partial gaze palsy noted.
A. 2 - Forced deviation
B. 1 - Partial gaze palsy
C. 0 - Normal [CORRECT]
D. NT - Not testable
Correct Answer: C
Rationale: Patient has full conjugate eye movements without gaze deviation or palsy,
scoring 0. ACA strokes typically spare gaze centers (frontal eye fields in MCA territory).
Score 1 for partial gaze palsy, score 2 for forced deviation.
Patient E1 - Item 3: Visual Fields (Confrontation Testing):
On confrontation testing, patient sees fingers in all four quadrants bilaterally. No visual
field cut detected. Visual threat response present on both sides.
A. 3 - Bilateral hemianopia
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia
D. 0 - No visual loss [CORRECT]
Correct Answer: D
Rationale: Patient has intact visual fields in all quadrants, scoring 0. ACA strokes spare
visual pathways (occipital lobe, optic radiations in MCA/PCA territories). Score 1 for
quadrantanopia, score 2 for complete hemianopia, score 3 for bilateral blindness.
Patient E1 - Item 4: Facial Palsy:
Patient has mild right lower face weakness. When asked to show teeth, right side of
mouth moves but not fully. Right nasolabial fold flattened. Upper face symmetric.
A. 3 - Complete paralysis (upper and lower face)
B. 2 - Partial paralysis (lower face)
C. 0 - Normal symmetric movement
D. 1 - Minor paralysis (flattened nasolabial fold, asymmetric smile) [CORRECT]
Correct Answer: D
Rationale: Patient has minor right lower face weakness with flattened nasolabial fold
and asymmetric smile but movement present, scoring 1. ACA strokes may have mild
, facial weakness but less than MCA strokes. Score 0 for normal, score 2 for partial (no
movement), score 3 for complete.
Patient E1 - Item 5: Motor Arm - Left (Non-paretic):
Patient extends left arm 90 degrees (sitting position). Arm maintains position for full 10
seconds without drift.
A. 3 - No effort against gravity
B. 1 - Drift
C. 2 - Some effort against gravity
D. 0 - No drift [CORRECT]
Correct Answer: D
Rationale: Patient has normal strength in left arm, maintaining position for 10 seconds,
scoring 0. ACA stroke causes contralateral leg > arm weakness, arm less affected.
Score 1 for drift, score 2 for some effort but cannot maintain, score 3 for no effort, score
4 for no movement.
Patient E1 - Item 5: Motor Arm - Right (Paretic):
Patient extends right arm 90 degrees (sitting position). Arm maintains position for 10
seconds but demonstrates subtle drift (approximately 10 degrees) without hitting
support.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 3 - No effort against gravity (arm falls)
D. 1 - Drift (arm drifts down but does not hit bed) [CORRECT]
Correct Answer: D
Rationale: Patient has mild right arm weakness with drift but maintains above support,
scoring 1. ACA stroke causes leg weakness greater than arm weakness. Score 0 for no
drift, score 2 for some effort but cannot maintain, score 3 for arm falls, score 4 for no
movement.
Patient E1 - Item 6: Motor Leg - Left (Non-paretic):
Patient is supine. Left leg is raised 30 degrees. Leg maintains position for full 5 seconds
without drift.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 0 - No drift [CORRECT]
D. 1 - Drift
Correct Answer: C
Rationale: Patient has normal strength in left leg, maintaining position for 5 seconds,
scoring 0. Score 1 for drift, score 2 for some effort but cannot maintain, score 3 for leg
falls, score 4 for no movement.
Verified Edition with Complete Solutions | NIHSS Group E
Certification | Pass Guaranteed - A+ Graded
Patient E1: Anterior Cerebral Artery (ACA) Stroke - Right Leg Weakness > Arm,
Abulia, Grasp Reflex, Incontinence
Patient E1 - Item 1a: Level of Consciousness (LOC):
Patient is drowsy but arousable by minor stimulation. Opens eyes to voice, responds to
questions but slow to answer. Falls asleep if not stimulated.
A. 0 - Alert, keenly responsive
B. 2 - Not alert, requires repeated stimulation to attend
C. 3 - Unresponsive or responds only with reflex motor effects
D. 1 - Not alert but arousable by minor stimulation [CORRECT]
Correct Answer: D
Rationale: Patient is drowsy but arousable by minor stimulation (voice), meeting
definition of 1. Score 0 requires alert, score 2 requires repeated/tactile stimulation, score
3 requires coma. ACA stroke causes abulia and decreased arousal due to frontal lobe
involvement.
Patient E1 - Item 1b: LOC Questions (Month and Age):
Patient is slow to respond. When asked "What month is it?" patient pauses then
correctly says "April." When asked "How old are you?" patient says "I think... 68?"
(correct answer is 68). Both answers correct but hesitant.
A. 2 - Answers neither correctly
B. NT - Not testable (intubated/aphasic)
C. 1 - Answers one correctly
D. 0 - Answers both correctly [CORRECT]
Correct Answer: D
Rationale: Patient answered both month and age correctly despite hesitancy, scoring 0.
Abulia (lack of initiative) causes delayed responses but accuracy determines score.
Score 1 if only one correct, score 2 if neither correct, NT only for intubation or aphasia.
Patient E1 - Item 1c: LOC Commands (Open/Close Eyes, Grip/Release):
Patient is slow to initiate but follows commands. When asked to open and close eyes,
patient performs correctly after a delay. When asked to grip and release non-paretic
hand (left hand), patient performs correctly after a delay.
A. 2 - Performs neither
B. 1 - Performs one correctly
C. 0 - Performs both correctly [CORRECT]
,D. NT - Not testable (amputation/joint fusion)
Correct Answer: C
Rationale: Patient performed both commands correctly (despite delayed initiation due to
abulia), scoring 0. Score 1 if only one correct, score 2 if neither, NT only for
amputation/joint fusion.
Patient E1 - Item 2: Best Gaze (Horizontal Eye Movement):
Patient has conjugate horizontal eye movement. Eyes move fully to left and right without
deviation. No gaze preference or partial gaze palsy noted.
A. 2 - Forced deviation
B. 1 - Partial gaze palsy
C. 0 - Normal [CORRECT]
D. NT - Not testable
Correct Answer: C
Rationale: Patient has full conjugate eye movements without gaze deviation or palsy,
scoring 0. ACA strokes typically spare gaze centers (frontal eye fields in MCA territory).
Score 1 for partial gaze palsy, score 2 for forced deviation.
Patient E1 - Item 3: Visual Fields (Confrontation Testing):
On confrontation testing, patient sees fingers in all four quadrants bilaterally. No visual
field cut detected. Visual threat response present on both sides.
A. 3 - Bilateral hemianopia
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia
D. 0 - No visual loss [CORRECT]
Correct Answer: D
Rationale: Patient has intact visual fields in all quadrants, scoring 0. ACA strokes spare
visual pathways (occipital lobe, optic radiations in MCA/PCA territories). Score 1 for
quadrantanopia, score 2 for complete hemianopia, score 3 for bilateral blindness.
Patient E1 - Item 4: Facial Palsy:
Patient has mild right lower face weakness. When asked to show teeth, right side of
mouth moves but not fully. Right nasolabial fold flattened. Upper face symmetric.
A. 3 - Complete paralysis (upper and lower face)
B. 2 - Partial paralysis (lower face)
C. 0 - Normal symmetric movement
D. 1 - Minor paralysis (flattened nasolabial fold, asymmetric smile) [CORRECT]
Correct Answer: D
Rationale: Patient has minor right lower face weakness with flattened nasolabial fold
and asymmetric smile but movement present, scoring 1. ACA strokes may have mild
, facial weakness but less than MCA strokes. Score 0 for normal, score 2 for partial (no
movement), score 3 for complete.
Patient E1 - Item 5: Motor Arm - Left (Non-paretic):
Patient extends left arm 90 degrees (sitting position). Arm maintains position for full 10
seconds without drift.
A. 3 - No effort against gravity
B. 1 - Drift
C. 2 - Some effort against gravity
D. 0 - No drift [CORRECT]
Correct Answer: D
Rationale: Patient has normal strength in left arm, maintaining position for 10 seconds,
scoring 0. ACA stroke causes contralateral leg > arm weakness, arm less affected.
Score 1 for drift, score 2 for some effort but cannot maintain, score 3 for no effort, score
4 for no movement.
Patient E1 - Item 5: Motor Arm - Right (Paretic):
Patient extends right arm 90 degrees (sitting position). Arm maintains position for 10
seconds but demonstrates subtle drift (approximately 10 degrees) without hitting
support.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 3 - No effort against gravity (arm falls)
D. 1 - Drift (arm drifts down but does not hit bed) [CORRECT]
Correct Answer: D
Rationale: Patient has mild right arm weakness with drift but maintains above support,
scoring 1. ACA stroke causes leg weakness greater than arm weakness. Score 0 for no
drift, score 2 for some effort but cannot maintain, score 3 for arm falls, score 4 for no
movement.
Patient E1 - Item 6: Motor Leg - Left (Non-paretic):
Patient is supine. Left leg is raised 30 degrees. Leg maintains position for full 5 seconds
without drift.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 0 - No drift [CORRECT]
D. 1 - Drift
Correct Answer: C
Rationale: Patient has normal strength in left leg, maintaining position for 5 seconds,
scoring 0. Score 1 for drift, score 2 for some effort but cannot maintain, score 3 for leg
falls, score 4 for no movement.
