PEX NIH STROKE SCALE
A
GROUP A 2025 | Patient 1-6 Answers
| Complete Certification | 90 Scored
Items | NIHSS Version 2.0 | Pass
Guaranteed - A+ Graded
Instructions:** Each patient case presents a clinical scenario based on APEX Group A video
patients. Select the appropriate NIHSS score (0-4 or 0-2 as applicable) for each item based on
the patient presentation described. Remember that "untestable" (UN) is only used for specific
circumstances defined in the NIHSS administration manual.
---
[PATIENT 1: Mr. Johnson - 68-year-old male, right MCA stroke, 4 hours post onset]
* *Clinical Presentation:** Patient is drowsy but opens eyes when called loudly. Speaks in short
phrases. Follows commands on the unaffected side. Right-sided weakness evident.
---
* *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
D. 3 - Responds only with reflex motor or autonomic effects
**Correct Answer: B**
* *Rationale:** Patient 1 demonstrates the classic "1" score presentation seen in APEX Patient
1. The patient is not fully alert (not 0) but is arousable with minor stimulation - specifically, the
examiner must speak loudly or shake the patient gently to get eye opening. The patient does
not require repeated stimulation (which would be 2) and is not unresponsive (3). The key
distinction is that the patient cannot maintain attention spontaneously but responds
, ppropriately once aroused. Score 0 would require the patient to be fully alert without
a
stimulation. Score 2 would require multiple attempts to arouse the patient.
---
* *1b. LOC Questions (Month and Age)**
A. 0 - Answers both questions correctly
B. 1 - Answers one question correctly [CORRECT]
C. 2 - Answers neither question correctly
**Correct Answer: B**
* *Rationale:** APEX Patient 1 typically answers one question correctly (usually knows the
month) but fails the second (age) due to mild confusion and aphasia. The patient is not aphasic
enough to score 2 (which would be inability to answer either due to severe aphasia, stupor, or
disorientation). The examiner must ask both questions and document the response. If the
patient answers one correctly, the score is 1 regardless of which question is answered. Score 0
requires both correct. Score 2 would indicate the patient cannot answer either question
appropriately.
---
* *1c. LOC Commands (Open and Close Eyes, Grip and Release)**
A. 0 - Performs both tasks correctly
B. 1 - Performs one task correctly [CORRECT]
C. 2 - Performs neither task correctly
**Correct Answer: B**
* *Rationale:** Patient 1 can typically perform one command correctly (usually the grip/release
on the unaffected left hand) but fails the other due to right-sided weakness and mild
comprehension issues. The patient is not severely aphasic or plegic (which would be 2). The
commands must be given without gestural cues. Score 0 requires both commands performed
correctly. Score 2 would indicate the patient cannot perform either command, which would
suggest severe impairment, coma, or global aphasia not present in this patient.
---
* *2. Best Gaze**
A. 0 - Normal
B. 1 - Partial gaze palsy [CORRECT]
C. 2 - Forced deviation or total gaze paresis
**Correct Answer: B**
, * *Rationale:** APEX Patient 1 demonstrates partial gaze palsy with eyes deviated toward the
right (toward the lesion in a right MCA stroke) but can be brought to midline with the
oculocephalic maneuver. The patient does not have forced deviation that cannot be overcome
(which would be 2). The gaze preference is evident but not absolute. Score 0 would require no
gaze deviation. Score 2 would indicate the eyes are forced toward one side and cannot be
brought to midline even with manipulation.
---
* *3. Visual Fields**
A. 0 - No visual loss
B. 1 - Partial hemianopia
C. 2 - Complete hemianopia [CORRECT]
D. 3 - Bilateral hemianopia or blindness
**Correct Answer: C**
* *Rationale:** Patient 1 has a complete right homonymous hemianopia due to right MCA stroke
affecting the optic radiations. The patient does not see fingers on the left side in both temporal
fields. This is not partial (1) because there is no vision in the affected field. Score 0 would
indicate normal visual fields. Score 1 would indicate partial or quadrantanopia. Score 3 would
require bilateral involvement (cortical blindness) not present here.
---
* *4. Facial Palsy**
A. 0 - Normal symmetrical movements
B. 1 - Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 - Partial paralysis (total or near-total paralysis of lower face) [CORRECT]
D. 3 - Complete paralysis of one or both sides
**Correct Answer: C**
* *Rationale:** APEX Patient 1 shows clear right lower facial weakness with drooping of the right
corner of the mouth and inability to fully smile on the right, but some forehead movement is
preserved. This is classic central facial palsy from upper motor neuron lesion. Score 1 would be
too mild for this presentation. Score 0 is normal. Score 3 would indicate complete paralysis
including forehead (lower motor neuron lesion) or bilateral involvement.
---
* *5a. Motor Arm - Left**
A. 0 - No drift; holds 90 degrees (or 45) for full 10 seconds
A
GROUP A 2025 | Patient 1-6 Answers
| Complete Certification | 90 Scored
Items | NIHSS Version 2.0 | Pass
Guaranteed - A+ Graded
Instructions:** Each patient case presents a clinical scenario based on APEX Group A video
patients. Select the appropriate NIHSS score (0-4 or 0-2 as applicable) for each item based on
the patient presentation described. Remember that "untestable" (UN) is only used for specific
circumstances defined in the NIHSS administration manual.
---
[PATIENT 1: Mr. Johnson - 68-year-old male, right MCA stroke, 4 hours post onset]
* *Clinical Presentation:** Patient is drowsy but opens eyes when called loudly. Speaks in short
phrases. Follows commands on the unaffected side. Right-sided weakness evident.
---
* *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
D. 3 - Responds only with reflex motor or autonomic effects
**Correct Answer: B**
* *Rationale:** Patient 1 demonstrates the classic "1" score presentation seen in APEX Patient
1. The patient is not fully alert (not 0) but is arousable with minor stimulation - specifically, the
examiner must speak loudly or shake the patient gently to get eye opening. The patient does
not require repeated stimulation (which would be 2) and is not unresponsive (3). The key
distinction is that the patient cannot maintain attention spontaneously but responds
, ppropriately once aroused. Score 0 would require the patient to be fully alert without
a
stimulation. Score 2 would require multiple attempts to arouse the patient.
---
* *1b. LOC Questions (Month and Age)**
A. 0 - Answers both questions correctly
B. 1 - Answers one question correctly [CORRECT]
C. 2 - Answers neither question correctly
**Correct Answer: B**
* *Rationale:** APEX Patient 1 typically answers one question correctly (usually knows the
month) but fails the second (age) due to mild confusion and aphasia. The patient is not aphasic
enough to score 2 (which would be inability to answer either due to severe aphasia, stupor, or
disorientation). The examiner must ask both questions and document the response. If the
patient answers one correctly, the score is 1 regardless of which question is answered. Score 0
requires both correct. Score 2 would indicate the patient cannot answer either question
appropriately.
---
* *1c. LOC Commands (Open and Close Eyes, Grip and Release)**
A. 0 - Performs both tasks correctly
B. 1 - Performs one task correctly [CORRECT]
C. 2 - Performs neither task correctly
**Correct Answer: B**
* *Rationale:** Patient 1 can typically perform one command correctly (usually the grip/release
on the unaffected left hand) but fails the other due to right-sided weakness and mild
comprehension issues. The patient is not severely aphasic or plegic (which would be 2). The
commands must be given without gestural cues. Score 0 requires both commands performed
correctly. Score 2 would indicate the patient cannot perform either command, which would
suggest severe impairment, coma, or global aphasia not present in this patient.
---
* *2. Best Gaze**
A. 0 - Normal
B. 1 - Partial gaze palsy [CORRECT]
C. 2 - Forced deviation or total gaze paresis
**Correct Answer: B**
, * *Rationale:** APEX Patient 1 demonstrates partial gaze palsy with eyes deviated toward the
right (toward the lesion in a right MCA stroke) but can be brought to midline with the
oculocephalic maneuver. The patient does not have forced deviation that cannot be overcome
(which would be 2). The gaze preference is evident but not absolute. Score 0 would require no
gaze deviation. Score 2 would indicate the eyes are forced toward one side and cannot be
brought to midline even with manipulation.
---
* *3. Visual Fields**
A. 0 - No visual loss
B. 1 - Partial hemianopia
C. 2 - Complete hemianopia [CORRECT]
D. 3 - Bilateral hemianopia or blindness
**Correct Answer: C**
* *Rationale:** Patient 1 has a complete right homonymous hemianopia due to right MCA stroke
affecting the optic radiations. The patient does not see fingers on the left side in both temporal
fields. This is not partial (1) because there is no vision in the affected field. Score 0 would
indicate normal visual fields. Score 1 would indicate partial or quadrantanopia. Score 3 would
require bilateral involvement (cortical blindness) not present here.
---
* *4. Facial Palsy**
A. 0 - Normal symmetrical movements
B. 1 - Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
C. 2 - Partial paralysis (total or near-total paralysis of lower face) [CORRECT]
D. 3 - Complete paralysis of one or both sides
**Correct Answer: C**
* *Rationale:** APEX Patient 1 shows clear right lower facial weakness with drooping of the right
corner of the mouth and inability to fully smile on the right, but some forehead movement is
preserved. This is classic central facial palsy from upper motor neuron lesion. Score 1 would be
too mild for this presentation. Score 0 is normal. Score 3 would indicate complete paralysis
including forehead (lower motor neuron lesion) or bilateral involvement.
---
* *5a. Motor Arm - Left**
A. 0 - No drift; holds 90 degrees (or 45) for full 10 seconds
