NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — The Global Burden of Neurological Diseases —
Epidemiology & DALYs
Stem
A 72-year-old woman with poorly controlled hypertension and
atrial fibrillation lives in a low-resource rural region where
access to emergency stroke care is limited. Over the past 20
Page | 1
,years the community has seen rising numbers of older adults
and diabetes. You are asked to advise health-system priorities
to reduce neurological DALYs in this region. Which single
intervention is likely to produce the largest short-term
reduction in stroke burden?
Options
A. Public health campaigns to reduce ambient air pollution
exposure
B. Expansion of thrombolysis and organized stroke units with
rapid transport pathways
C. Widespread screening for Parkinsonian features in primary
care
D. Community mental-health programs focusing on dementia
caregiver support
Correct answer
B
Rationales
Correct (B): Queen Square public-health reasoning emphasizes
that for acute vascular neurological disease in older adults,
Page | 2
,time-sensitive interventions (rapid triage, thrombolysis/
thrombectomy and stroke units) produce the largest immediate
reductions in mortality and DALYs. Organized stroke systems
address the dominant cause of neurological DALY in many
regions.
Incorrect (A): Reducing air pollution can lower long-term
neurodegenerative and vascular risk but achieves effects slowly
and is less likely to reduce immediate stroke DALYs rapidly.
Incorrect (C): Screening for Parkinsonism is low yield for short-
term DALY reduction; Parkinson’s contributes chronic morbidity
but not immediate, large DALY shifts.
Incorrect (D): Dementia caregiver support improves quality of
life but does not produce the same short-term DALY reduction
as acute stroke systems.
Teaching point
Time-sensitive stroke systems yield the largest near-term DALY
reductions in older populations.
Page | 3
, Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2
Reference
Ch. 1 — The Global Burden of Neurological Diseases — Stroke
epidemiology
Stem
During a prolonged heatwave, the emergency department in a
regional hospital reports a sudden increase in admissions with
focal weakness and confusion among older adults. CT is not
immediately available. Which initial bedside distinction best
prioritizes immediate management?
Options
A. Differentiate focal ischemic stroke from heat-related
encephalopathy by assessing for asymmetric focal neurological
signs and gaze deviation
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — The Global Burden of Neurological Diseases —
Epidemiology & DALYs
Stem
A 72-year-old woman with poorly controlled hypertension and
atrial fibrillation lives in a low-resource rural region where
access to emergency stroke care is limited. Over the past 20
Page | 1
,years the community has seen rising numbers of older adults
and diabetes. You are asked to advise health-system priorities
to reduce neurological DALYs in this region. Which single
intervention is likely to produce the largest short-term
reduction in stroke burden?
Options
A. Public health campaigns to reduce ambient air pollution
exposure
B. Expansion of thrombolysis and organized stroke units with
rapid transport pathways
C. Widespread screening for Parkinsonian features in primary
care
D. Community mental-health programs focusing on dementia
caregiver support
Correct answer
B
Rationales
Correct (B): Queen Square public-health reasoning emphasizes
that for acute vascular neurological disease in older adults,
Page | 2
,time-sensitive interventions (rapid triage, thrombolysis/
thrombectomy and stroke units) produce the largest immediate
reductions in mortality and DALYs. Organized stroke systems
address the dominant cause of neurological DALY in many
regions.
Incorrect (A): Reducing air pollution can lower long-term
neurodegenerative and vascular risk but achieves effects slowly
and is less likely to reduce immediate stroke DALYs rapidly.
Incorrect (C): Screening for Parkinsonism is low yield for short-
term DALY reduction; Parkinson’s contributes chronic morbidity
but not immediate, large DALY shifts.
Incorrect (D): Dementia caregiver support improves quality of
life but does not produce the same short-term DALY reduction
as acute stroke systems.
Teaching point
Time-sensitive stroke systems yield the largest near-term DALY
reductions in older populations.
Page | 3
, Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2
Reference
Ch. 1 — The Global Burden of Neurological Diseases — Stroke
epidemiology
Stem
During a prolonged heatwave, the emergency department in a
regional hospital reports a sudden increase in admissions with
focal weakness and confusion among older adults. CT is not
immediately available. Which initial bedside distinction best
prioritizes immediate management?
Options
A. Differentiate focal ischemic stroke from heat-related
encephalopathy by assessing for asymmetric focal neurological
signs and gaze deviation
Page | 4
