NIHSS Language and Aphasia 3 — Questions and Answers
Question 1: Which NIHSS item directly tests the patient's ability to read and name objects from a standardized card set?
- Item 9 — Language (Correct answer)
- Item 10 — Dysarthria
- Item 8 — Sensory
- Item 11 — Extinction
Correct answer: Item 9 — Language
NIHSS Item 9 assesses language using a picture description task, object naming card, and reading sentences from a standardized card.
Question 2: A right-handed stroke patient has fluent speech, intact comprehension, but makes frequent sound substitution errors (e.g., 'spoot' for 'spoon'). This pattern most suggests:
- Phonemic paraphasia from conduction aphasia (Correct answer)
- Semantic paraphasia from Wernicke's aphasia
- Dysarthria from corticobulbar tract damage
- Apraxia of speech from supplementary motor area damage
Correct answer: Phonemic paraphasia from conduction aphasia
Sound-level substitution errors (phonemic paraphasias) with intact comprehension and fluency are hallmarks of conduction aphasia.
Question 3: In NIHSS training, which patient behavior during the language assessment would NOT be counted as aphasia?
- Slurred but intelligible speech when naming objects (Correct answer)
- Substituting a semantically related word (e.g., 'chair' for 'table')
- Unable to repeat the phrase 'no ifs, ands, or buts'
- Describing the cookie theft picture with only 2 words
Correct answer: Slurred but intelligible speech when naming objects
Slurred but intelligible speech reflects dysarthria (Item 10), not aphasia (Item 9), so it does not increase the language score.
Question 4: Global aphasia results from large infarcts typically involving which artery's territory?
- Left middle cerebral artery (Correct answer)
- Right posterior cerebral artery
- Basilar artery perforators
- Left anterior cerebral artery
Correct answer: Left middle cerebral artery
Large left MCA territory infarcts damage both Broca's and Wernicke's areas, causing global aphasia with severe expressive and receptive deficits.
Question 5: A stroke patient can write a sentence correctly but cannot speak. What aphasia type does this pattern suggest?
- Pure word mutism / aphemia (Correct answer)
- Global aphasia
- Transcortical sensory aphasia
- Wernicke's aphasia
Correct answer: Pure word mutism / aphemia
Aphemia (pure word mutism) spares written language while impairing speech output, suggesting damage to motor speech areas without broader language network involvement.
Question 6: On NIHSS Item 9, an intubated patient cannot speak. How should the examiner handle language scoring?
- Use written responses; score based on written language ability (Correct answer)
- Score 3 automatically because the patient cannot communicate
- Skip Item 9 entirely and mark as untestable
- Score 0 because the limitation is mechanical, not neurological
Correct answer: Use written responses; score based on written language ability
NIHSS guidelines allow written responses for intubated patients to assess language, and scoring reflects the written language ability observed.
Question 7: Which of the following best defines 'semantic paraphasia' as encountered in NIHSS language assessment?
- Substituting a related word (e.g., 'dog' for 'cat') (Correct answer)
- Substituting a similar sound (e.g., 'tat' for 'cat')
- Inventing a new nonsense word (e.g., 'blort')
- Repeating a word multiple times instead of answering
Correct answer: Substituting a related word (e.g., 'dog' for 'cat')
Semantic paraphasia involves replacing the target word with a semantically related word, commonly seen in Wernicke's and anomic aphasia.
NIHSS Language and Aphasia 3
Which NIHSS item directly tests the patient's ability to read and name objects from a standardized card set?