NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1.
Reference
Ch. 1 — Introduction — Global Burden overview
Stem
A 72-year-old man in a low-income country presents with
sudden right-sided weakness and expressive dysphasia. His
family reports prolonged delays reaching care because the
nearest stroke unit is 150 km away. As a neurology consultant
Page | 1
,advising health policy planners, which systemic factor most
likely explains why stroke causes disproportionately higher
disability-adjusted life years (DALYs) in low-income settings
compared with high-income settings?
Options
A. Higher stroke incidence due to genetic differences.
B. Greater case fatality and disability because of limited acute
stroke services and rehabilitation.
C. Overdiagnosis of stroke due to misclassification of functional
disorders.
D. Lower prevalence of vascular risk factors leading to later
presentation.
Correct answer
B
Rationales
Correct (B): Queen Square–style reasoning: DALYs combine
years of life lost and years lived with disability; in low-income
settings, limited acute reperfusion, delayed presentation, and
sparse rehabilitation drive higher case fatality and long-term
Page | 2
,disability, increasing DALYs. This matches the textbook emphasis
on health-system determinants.
Incorrect (A): Genetic differences do not account for the
observed large health-system driven DALY gap.
Incorrect (C): Misclassification would not explain consistent
higher burden and worse outcomes documented across
populations.
Incorrect (D): Lower prevalence of risk factors would reduce,
not increase, DALYs.
Teaching point
Access to timely acute care and rehabilitation drives stroke
DALYs more than incidence differences.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2.
Page | 3
, Reference
Ch. 1 — Global Burden of Neurological Diseases — Metrics
Stem
You are asked to advise a ministry of health on monitoring
neurological disease burden. They ask whether Years Lived with
Disability (YLD) or Years of Life Lost (YLL) better captures the
long-term societal impact of dementia. Which measure should
you emphasize and why?
Options
A. YLL — dementia reduces life expectancy more than disability.
B. YLD — dementia primarily contributes via prolonged
disability and care needs.
C. Neither — incidence rate is sufficient for policy planning.
D. Use only DALYs — because it excludes YLD or YLL individually.
Correct answer
B
Rationales
Correct (B): Dementia contributes large long-term care and
disability burdens; YLD quantifies non-fatal health loss — Queen
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1.
Reference
Ch. 1 — Introduction — Global Burden overview
Stem
A 72-year-old man in a low-income country presents with
sudden right-sided weakness and expressive dysphasia. His
family reports prolonged delays reaching care because the
nearest stroke unit is 150 km away. As a neurology consultant
Page | 1
,advising health policy planners, which systemic factor most
likely explains why stroke causes disproportionately higher
disability-adjusted life years (DALYs) in low-income settings
compared with high-income settings?
Options
A. Higher stroke incidence due to genetic differences.
B. Greater case fatality and disability because of limited acute
stroke services and rehabilitation.
C. Overdiagnosis of stroke due to misclassification of functional
disorders.
D. Lower prevalence of vascular risk factors leading to later
presentation.
Correct answer
B
Rationales
Correct (B): Queen Square–style reasoning: DALYs combine
years of life lost and years lived with disability; in low-income
settings, limited acute reperfusion, delayed presentation, and
sparse rehabilitation drive higher case fatality and long-term
Page | 2
,disability, increasing DALYs. This matches the textbook emphasis
on health-system determinants.
Incorrect (A): Genetic differences do not account for the
observed large health-system driven DALY gap.
Incorrect (C): Misclassification would not explain consistent
higher burden and worse outcomes documented across
populations.
Incorrect (D): Lower prevalence of risk factors would reduce,
not increase, DALYs.
Teaching point
Access to timely acute care and rehabilitation drives stroke
DALYs more than incidence differences.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2.
Page | 3
, Reference
Ch. 1 — Global Burden of Neurological Diseases — Metrics
Stem
You are asked to advise a ministry of health on monitoring
neurological disease burden. They ask whether Years Lived with
Disability (YLD) or Years of Life Lost (YLL) better captures the
long-term societal impact of dementia. Which measure should
you emphasize and why?
Options
A. YLL — dementia reduces life expectancy more than disability.
B. YLD — dementia primarily contributes via prolonged
disability and care needs.
C. Neither — incidence rate is sufficient for policy planning.
D. Use only DALYs — because it excludes YLD or YLL individually.
Correct answer
B
Rationales
Correct (B): Dementia contributes large long-term care and
disability burdens; YLD quantifies non-fatal health loss — Queen
Page | 4
