NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — The Global Burden of Neurological
Diseases
Stem
A 68-year-old man in a low-resource region presents with
sudden right-sided weakness and dysarthria for 2 hours. Family
report long-standing untreated hypertension and recent
Page | 1
,prolonged exposure to indoor biomass smoke during cooking.
Given the local health infrastructure constraints and Queen
Square bedside localisation, which public-health priority most
directly reduces the region’s burden of similar neurological
emergencies?
Options
A. Increase availability of advanced neuroimaging (MRI) at
tertiary centres.
B. Implement community-level hypertension screening and
control programs.
C. Train paramedics in advanced neurocritical care ventilation
strategies.
D. Build national stroke rehabilitation hospitals in the capital.
Correct Answer
B
Rationales
Correct (B): Community blood-pressure detection and control
prevent the majority of ischaemic and haemorrhagic strokes;
Queen Square principles emphasise prevention through
Page | 2
,identifying modifiable vascular risks at population level. In low-
resource settings, primary prevention reduces incidence and
DALYs more effectively than tertiary expansion alone.
Incorrect (A): MRI is diagnostically useful but does not
significantly reduce population stroke incidence where risk
factors are uncontrolled and access is limited.
Incorrect (C): Advanced neurocritical care improves outcomes
for selected patients but does not address the principal burden
driver—uncontrolled vascular risk—at a population level.
Incorrect (D): Rehabilitation capacity is important for disability
reduction but secondary to primary prevention in reducing
overall burden.
Teaching Point
Population hypertension control yields the greatest reduction in
stroke burden.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
Page | 3
, 2
Reference
Ch. 1 — The Global Burden of Neurological Diseases — Metrics
and Distribution
Stem
A minister of health asks why disability-adjusted life years
(DALYs) are prioritized when planning neurology services. Using
Queen Square reasoning, which argument best explains why
DALYs—not prevalence alone—should guide resource allocation
for neurological disorders?
Options
A. DALYs combine mortality and morbidity indicating both years
lost and years lived with disability.
B. Prevalence overestimates the societal impact because it
ignores mortality.
C. DALYs primarily reflect economic cost rather than clinical
burden.
D. Prevalence is more useful; DALYs are too theoretical for
service planning.
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — The Global Burden of Neurological
Diseases
Stem
A 68-year-old man in a low-resource region presents with
sudden right-sided weakness and dysarthria for 2 hours. Family
report long-standing untreated hypertension and recent
Page | 1
,prolonged exposure to indoor biomass smoke during cooking.
Given the local health infrastructure constraints and Queen
Square bedside localisation, which public-health priority most
directly reduces the region’s burden of similar neurological
emergencies?
Options
A. Increase availability of advanced neuroimaging (MRI) at
tertiary centres.
B. Implement community-level hypertension screening and
control programs.
C. Train paramedics in advanced neurocritical care ventilation
strategies.
D. Build national stroke rehabilitation hospitals in the capital.
Correct Answer
B
Rationales
Correct (B): Community blood-pressure detection and control
prevent the majority of ischaemic and haemorrhagic strokes;
Queen Square principles emphasise prevention through
Page | 2
,identifying modifiable vascular risks at population level. In low-
resource settings, primary prevention reduces incidence and
DALYs more effectively than tertiary expansion alone.
Incorrect (A): MRI is diagnostically useful but does not
significantly reduce population stroke incidence where risk
factors are uncontrolled and access is limited.
Incorrect (C): Advanced neurocritical care improves outcomes
for selected patients but does not address the principal burden
driver—uncontrolled vascular risk—at a population level.
Incorrect (D): Rehabilitation capacity is important for disability
reduction but secondary to primary prevention in reducing
overall burden.
Teaching Point
Population hypertension control yields the greatest reduction in
stroke burden.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
Page | 3
, 2
Reference
Ch. 1 — The Global Burden of Neurological Diseases — Metrics
and Distribution
Stem
A minister of health asks why disability-adjusted life years
(DALYs) are prioritized when planning neurology services. Using
Queen Square reasoning, which argument best explains why
DALYs—not prevalence alone—should guide resource allocation
for neurological disorders?
Options
A. DALYs combine mortality and morbidity indicating both years
lost and years lived with disability.
B. Prevalence overestimates the societal impact because it
ignores mortality.
C. DALYs primarily reflect economic cost rather than clinical
burden.
D. Prevalence is more useful; DALYs are too theoretical for
service planning.
Page | 4
