NIHSS Language and Aphasia 2 — Questions and Answers
Question 1: A patient with stroke can name objects but cannot repeat phrases spoken to them. Which aphasia type does this best describe?
- Conduction aphasia (Correct answer)
- Broca's aphasia
- Wernicke's aphasia
- Global aphasia
Correct answer: Conduction aphasia
Conduction aphasia is characterized by intact naming and comprehension but severely impaired repetition due to damage to the arcuate fasciculus.
Question 2: On the NIHSS Item 9 (Language), a patient follows simple commands but cannot read a sentence aloud. What score is most appropriate?
- 1 — mild to moderate aphasia (Correct answer)
- 0 — no aphasia
- 2 — severe aphasia
- 3 — mute or global aphasia
Correct answer: 1 — mild to moderate aphasia
Partial language loss with some evident comprehension or expression difficulty scores a 1 on NIHSS Item 9.
Question 3: Which standardized picture scene is used in the NIHSS to assess language by having the patient describe what they see?
- The 'cookie theft' picture (Correct answer)
- A family dinner scene
- A street traffic scene
- A hospital room picture
Correct answer: The 'cookie theft' picture
The NIHSS uses the 'cookie theft' picture from the Boston Diagnostic Aphasia Examination to elicit spontaneous language.
Question 4: A patient scores 3 on NIHSS Item 9. Which clinical presentation matches this score?
- Mute, no usable speech or auditory comprehension (Correct answer)
- Fluent paraphasic speech with mild errors
- Reads sentences slowly but accurately
- Follows two-step commands but cannot name objects
Correct answer: Mute, no usable speech or auditory comprehension
A score of 3 on NIHSS Language indicates global aphasia: mute or with no useful communication ability.
Question 5: Which lobe of the brain, when infarcted, most commonly produces expressive (Broca's) aphasia?
- Left frontal lobe (Correct answer)
- Right parietal lobe
- Left temporal lobe
- Right occipital lobe
Correct answer: Left frontal lobe
Broca's area is located in the left inferior frontal gyrus (Brodmann areas 44 and 45), and its infarction causes expressive aphasia.
Question 6: When assessing language on the NIHSS, the examiner asks the patient to name items on a standard card. What does difficulty naming common objects indicate?
- Anomia, suggesting language pathway disruption (Correct answer)
- Agnosia, indicating perceptual failure only
- Neglect, suggesting right hemisphere stroke
- Dysarthria, indicating motor speech problem
Correct answer: Anomia, suggesting language pathway disruption
Anomia (word-finding difficulty) during naming tasks reflects disruption of language networks and contributes to an aphasia score on NIHSS Item 9.
Question 7: A patient produces fluent but nonsensical speech filled with paraphasias and does not understand questions. NIHSS Item 9 score should be:
- 2 — severe aphasia (Correct answer)
- 1 — mild aphasia
- 0 — no aphasia
- 3 — global aphasia/mute
Correct answer: 2 — severe aphasia
Severe aphasia with no intelligible exchange despite preserved speech fluency (as in Wernicke's) scores a 2 on NIHSS Item 9.
NIHSS Language and Aphasia 2
A patient with stroke can name objects but cannot repeat phrases spoken to them.
Which aphasia type does this best describe?