NIHSS Neurological 2 — Questions and Answers
Question 1: On the NIHSS, how is Item 1b (Level of Consciousness Questions) scored when the patient answers both questions correctly?
- 0 (Correct answer)
- 1
- 2
- 3
Correct answer: 0
A score of 0 is given when the patient correctly answers both the month and age questions.
Question 2: A patient with a right hemisphere stroke cannot move their left arm against gravity but shows some effort. What NIHSS motor arm score applies?
- 1 — Drift
- 2 — Some effort against gravity
- 3 — No effort against gravity (Correct answer)
- 4 — No movement
Correct answer: 3 — No effort against gravity
Score 3 means the limb falls immediately without resistance and there is no effort against gravity.
Question 3: Which NIHSS item specifically tests for extinction and inattention?
- Item 9
- Item 10
- Item 11 (Correct answer)
- Item 7
Correct answer: Item 11
Item 11 assesses extinction and inattention (neglect) using simultaneous bilateral stimulation.
Question 4: When scoring NIHSS Item 5 (Motor Arm), the patient's arm drifts to the bed before 10 seconds but does not fall immediately. What is the correct score?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Score 1 (drift) is assigned when the arm drifts before 10 seconds but does not fall to the bed immediately.
Question 5: The NIHSS visual fields item (Item 3) is scored as 2 when which finding is present?
- Monocular blindness
- Partial hemianopia
- Complete hemianopia (Correct answer)
- Bilateral blindness
Correct answer: Complete hemianopia
A score of 2 on Item 3 corresponds to complete hemianopia in one visual half-field.
Question 6: On NIHSS Item 8 (Sensory), how should the examiner test sensation in an aphasic patient?
- Skip the item and score 0
- Use verbal report only
- Observe grimace or withdrawal to noxious stimuli (Correct answer)
- Score based on motor responses alone
Correct answer: Observe grimace or withdrawal to noxious stimuli
In aphasic or unresponsive patients, grimace or withdrawal to pinprick is used to estimate sensory function.
Question 7: A patient follows simple commands but cannot name a pen or repeat a phrase. Which NIHSS aphasia 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
Score 1 reflects mild-to-moderate aphasia where communication is possible but clearly impaired.
NIHSS Neurological 2
On the NIHSS, how is Item 1b (Level of Consciousness Questions) scored when the patient answers both questions correctly?