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NIHSS Group A Version 5
NIHSS Group A Version 5 - Questions and Answers with Rationales Based on available study resources, here are the verified answers for the NIH Stroke Scale (NIHSS) Group A - Version 5. This certification assessment evaluates 15 neurological functions across 6 patient scenarios. Scoring Guidelines Reference Category Score 0 Score 1 Score 2 Score 3 1a. LOC Alert Not alert but arousable Not alert, obtunded Unresponsive 1b. LOC Questions Both correct One correct Neither correct
1c. LOC Commands Both correct One correct Neither correct
- Best Gaze Normal Partial gaze palsy Forced deviation
Category Score 0 Score 1 Score 2 Score 3
- Visual No visual loss Partial hemianopia Complete hemianopia Bilateral hemianopia
- Facial Palsy Normal Minor paralysis Partial paralysis Complete paralysis 5a/5b. Motor Arm No drift Drift before 10 sec Falls before 10 sec No effort against gravity 6a/6b. Motor Leg No drift Drift before 5 sec Falls before 5 sec No effort against gravity
- Limb Ataxia No ataxia Ataxia in one limb Ataxia in two limbs
- Sensory Normal Mild loss Severe loss –
- Best Language Normal Mild aphasia Severe aphasia Global aphasia
Dysarthria Normal Mild dysarthria Severe dysarthria
Rationale: The patient is alert (1a: 0) but cannot answer orientation questions correctly (1b: 2), suggesting aphasia. Commands are performed correctly (1c: 0). Minor facial palsy (4: 1) is present. Sensory testing reveals mild loss (8: 1). Language shows severe aphasia (9: 2), indicating dominant hemisphere (typically left) involvement affecting Broca's or Wernicke's areas. Mild dysarthria (10: 1) is also noted. Motor function is intact bilaterally. *Note: Some sources score Item 2 as 1 (partial gaze palsy) and Item 7 as 1 , while others score both as 0. Patient 3 Answers: 1a: 0, 1b: 0, 1c: 0, 2: 0/1 , 3: 0/1 , 4: 0/1 , 5a: 0/1 , 5b: 0, 6a: 0/2/3 , 6b: 0/2 , 7: 0, 8: 1, 9: 0, 10: 1, 11: 0 Total Score: Varies (4-5) Rationale: The patient is fully alert and oriented. Motor findings are asymmetrical with some arm drift on the left side, suggesting right hemisphere involvement. Mild sensory loss (8: 1) is present. Dysarthria (10: 1) indicates speech articulation difficulty. *Note: This patient shows the most significant scoring discrepancies across sources. Item 2 (Gaze) varies between 0 and 1; Item 3 (Visual) varies between 0 and 1; Item 4 (Facial Palsy) varies between 0 and 1; Item 5a (Left Arm) varies between 0 and 1; Item 6a (Left Leg) ranges from 0 to 3; Item 6b (Right Leg) ranges from 0 to 2. Patient 4
Answers: 1a: 0, 1b: 0, 1c: 0, 2: 0, 3: 0, 4: 0/1 , 5a: 0, 5b: 0, 6a: 0, 6b: 0/1 , 7: 0, 8: 0/1*, 9: 0, 10: 0, 11: 0 Total Score: 0 - 1 Rationale: This is the mildest stroke scenario in the group. The patient is fully alert, oriented, and has normal language function. A single motor deficit (isolated right leg drift) indicates minimal stroke severity. This pattern suggests a small lacunar infarct affecting the corticospinal tract. *Note: Some sources show slight variations in Items 4, 6b, and 8 scoring. Patient 5 Answers: 1a: 0, 1b: 1, 1c: 0, 2: 0, 3: 0/2 , 4: 1/2 , 5a: 0/3/4 , 5b: 0, 6a: 0/1 , 6b: 0/3 , 7: 0/1 , 8: 1, 9: 0/1 , 10: 0/1 , 11: 1 Total Score: 8 Rationale: The patient answers one orientation question correctly (1b: 1), suggesting mild confusion or subtle aphasia. Facial palsy (4: 1) indicates motor involvement. The left arm shows no effort against gravity (5a: 3), and the left leg shows significant weakness (6b: 3), demonstrating dense right-sided hemiparesis. This pattern indicates severe left hemisphere involvement in the middle cerebral artery territory. *Note: Significant variation exists in Items 3, 4, 5a, 6a, 6b, 7, 9, and 10 across sources.
Patient Total Score Key Findings Patient 5 8 Severe left-sided weakness, facial palsy, aphasia Patient 6 0 Normal examination - no deficits Important Notes
- Verify with your specific patient video: These answers are compiled from multiple study resources, but significant variations exist between sources. Always confirm scoring by watching the actual patient videos, as subtle differences in assessment can affect scoring.
- Patient 3 shows the greatest discrepancies: This patient has the most inconsistent scoring across sources, requiring careful video observation.
- Scoring principles: Lower scores indicate better outcomes (0 = normal, higher = more severe deficit). The NIHSS is a standardized tool used to quantify stroke severity and guide treatment decisions.
- The 11 categories assessed are: Level of Consciousness (1a-1c), Best Gaze, Visual, Facial Palsy, Motor Arm (left/right), Motor Leg
(left/right), Limb Ataxia, Sensory, Best Language, Dysarthria, and Extinction/Inattention. NIHSS Group A Version 5.....give me questions and answers 1-100 with rationals Read 10 web pages NIHSS Group A Version 5 - Complete Answer Key with Rationales (Patients 1-6) Based on a review of multiple study resources for the BlueCloud NIHSS certification, the examination consists of 6 patient scenarios (Patients 1- 6). The answers and rationales reflect the 2025/ updates. Discrepancies exist across sources , so verification with your specific patient videos is crucial. Scoring Guidelines Reference Category Score 0 Score 1 Score 2 Score 3 1a. LOC Alert Not alert but arousable Not alert, obtunded Unresponsive 1b. LOC Questions Both correct One correct Neither correct
1c. LOC Commands Both correct One correct Neither correct
Category Score 0 Score 1 Score 2 Score 3 10. Dysarthria Normal Mild dysarthria Severe dysarthria
Extinction Normal Mild neglect Severe neglect
Patient 1 Answers: 1a: 0, 1b: 0, 1c: 0, 2: 0, 3: 0, 4: 1, 5a: 3, 5b: 0, 6a: 1, 6b: 0, 7: 0, 8: 0 or 2 , 9: 0, 10: 0, 11: 0 or 1 Total Score: 4 - 5 Rationales:
- 1a-c (Score 0): The patient is fully alert, oriented, and follows commands, indicating intact consciousness and comprehension.
- Item 4 (Score 1): Minor facial paralysis (asymmetry on smiling) indicates mild dysfunction of the seventh cranial nerve.
- Item 5a (Score 3): The left arm shows no effort against gravity, representing significant motor weakness suggesting right hemispheric cortical involvement.
- Item 6a (Score 1): The left leg drifts but does not hit the bed, indicating milder weakness than the arm.
- Item 8 (Score 2 in some resources): One source indicates severe sensory loss on the left side , while others show normal sensation.
Patient 2 Answers: 1a: 0, 1b: 2, 1c: 0, 2: 0 or 1 , 3: 0, 4: 1, 5a: 0, 5b: 0, 6a: 0, 6b: 0, 7: 0 or 1 , 8: 1, 9: 2, 10: 1, 11: 0 Total Score: 4 - 6 Rationales:
- 1a (Score 0): The patient is alert.
- 1b (Score 2): Inability to answer orientation questions correctly suggests aphasia or cognitive impairment.
- Item 4 (Score 1): Minor facial palsy is present.
- Item 8 (Score 1): Mild sensory loss indicates a sensory pathway deficit.
- Item 9 (Score 2): Severe aphasia indicates dominant hemisphere (typically left) involvement affecting Broca's or Wernicke's areas.
- Item 10 (Score 1): Mild dysarthria suggests articulation difficulty.
- Discrepancy Note: Some sources score Item 2 as 1 (partial gaze palsy) and Item 7 as 1 , while others score both as 0. Patient 3 Answers: 1a: 0, 1b: 0, 1c: 0, 2: 0 or 1 , 3: 0 or 1 , 4: 0 or 1 , 5a: 0 or 1 , 5b: 0, 6a: 0- 3 , 6b: 0- 2 , 7: 0 or 1 , 8: 0 or 1 , 9: 0, 10: 1, 11: 0 Total Score: Varies significantly Rationales:
Rationales:
- 1b (Score 1): Answers one orientation question correctly, suggesting subtle cognitive or language difficulty.
- Item 4 (Score 1-2): Facial palsy indicates motor involvement.
- Item 5a (Score 3-4): Significant left arm weakness suggests right hemisphere involvement. One source scores this as 4 (no movement).
- Item 6b (Score 3 in some resources): Significant left leg weakness further supports contralateral hemisphere damage.
- Discrepancy Note: This patient shows the widest variation in scoring for Visual (3), Facial Palsy (4), Motor Arm Left (5a), Motor Leg Right (6b), Ataxia (7), Language (9), Dysarthria (10), and Extinction (11). Patient 6 Answers: 1a: 0, 1b: 0, 1c: 0, 2: 0, 3: 0, 4: 0, 5a: 0, 5b: 0, 6a: 0, 6b: 0 or 1 , 7: 0, 8: 0 or 1 , 9: 0, 10: 0, 11: 0 Total Score: 0 Rationales:
- Demonstrates a completely normal neurological examination with all categories scoring 0.
- A total NIHSS score of 0 indicates no detectable stroke-related deficits.
- Discrepancy Note: Some sources score Item 6b (Right Leg) as 1 or Item 8 (Sensory) as 1 , while others score both as 0.
