Step 1: The Glasgow Coma Scale is the sum of the best eye opening (E, score 1 to 4), best verbal response (V, score 1 to 5) and best motor response (M, score 1 to 6).
Step 2: Score each component. "Opens eyes in response to pain" gives E = 2. "Confused" speech corresponds to disoriented or confused conversation, which is V = 4. "Localises pain" is M = 5.
Step 3: Add them up.
\[\text{GCS} = E + V + M = 2 + 4 + 5 = 11\]
So the total is 11. The other options arise from mis-scoring a component, for example taking eye opening as 3 (to speech) or motor as 6 (obeys commands).