NIHSS Group A Patient 5 — Questions and Answers
Question 1: In Group A patient testing, the patient reads from a standardized card but makes several literal paraphasic errors. Under Item 9 (Best Language), what score is most appropriate?
- 0 — no aphasia
- 1 — mild to moderate aphasia (Correct answer)
- 2 — severe aphasia
- 3 — mute or global aphasia
Correct answer: 1 — mild to moderate aphasia
Literal paraphasic errors with preserved ability to communicate represent mild to moderate aphasia, scored as 1.
Question 2: The Group A patient is sitting up for the motor arm test. The examiner should hold the arm at what angle for Item 5?
- 45 degrees
- 90 degrees (Correct answer)
- 120 degrees
- 180 degrees (straight up)
Correct answer: 90 degrees
When the patient is sitting, the arm is held at 90 degrees for the motor arm test in Items 5a and 5b.
Question 3: In a Group A patient scenario, bilateral visual field loss is confirmed. What is the Item 3 (Visual Fields) score, and what additional consequence does this have?
- Score 3; Item 11 extinction testing becomes invalid (Correct answer)
- Score 2; no other consequences
- Score 3; Item 2 gaze testing is also affected
- Score 1; only partial loss is present
Correct answer: Score 3; Item 11 extinction testing becomes invalid
Bilateral hemianopia is scored as 3, and when bilateral blindness is present, Item 11 visual extinction testing cannot be validly performed.
Question 4: When testing Item 8 (Sensory) in the Group A patient who is aphasic, how should the examiner assess sensory function?
- Skip and score NT
- Use facial grimacing or withdrawal to determine response (Correct answer)
- Automatically score 2
- Only test the face
Correct answer: Use facial grimacing or withdrawal to determine response
In aphasic patients, sensory scoring should rely on observable reactions such as facial grimacing or limb withdrawal to pin stimuli.
Question 5: The Group A patient has right arm drift to the bed at 8 seconds with clear effort against gravity during the first few seconds. Which Item 5b score is correct?
- 1 — arm drifts but stays above bed
- 2 — arm falls to bed but some effort against gravity (Correct answer)
- 3 — no effort against gravity
- 0 — no drift
Correct answer: 2 — arm falls to bed but some effort against gravity
Score 2 applies when the arm falls to the bed within 10 seconds but some initial effort against gravity was demonstrated.
Question 6: For Item 10 (Dysarthria) in the Group A patient, the patient's speech is completely unintelligible even in short phrases. What is the correct score?
- 0 — normal
- 1 — mild to moderate dysarthria
- 2 — severe dysarthria, nearly unintelligible or mute (Correct answer)
- NT — intubated or has a physical barrier
Correct answer: 2 — severe dysarthria, nearly unintelligible or mute
Severe dysarthria (score 2) applies when speech is so slurred it is nearly unintelligible or the patient is mute due to motor speech impairment.
Question 7: During Group A patient assessment, the examiner simultaneously touches both hands. The patient reports only feeling the right hand touched every time. What is Item 11 score?
- 0 — no abnormality detected
- 1 — visual, tactile, or other extinction in one modality (Correct answer)
- 2 — profound hemi-inattention or extinction in more than one modality
- NT — cannot be tested
Correct answer: 1 — visual, tactile, or other extinction in one modality
Consistent tactile extinction on one side during bilateral simultaneous stimulation is scored as 1 on Item 11.
NIHSS Group A Patient 5
In Group A patient testing, the patient reads from a standardized card but makes several literal paraphasic errors.
Under Item 9 (Best Language), what score is most appropriate?