NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global burden overview
Stem
A 68-year-old man from a rural region presents with progressive
gait instability and cognitive decline over 18 months.
Community data show an increase in stroke survivors and rising
prevalence of dementia in the last decade. As a neurologist
Page | 1
,advising the regional health authority you must prioritize
interventions. Which single program would most efficiently
reduce overall neurological DALYs (disability-adjusted life years)
in this population?
Options
A. Expand tertiary memory clinics for early Alzheimer diagnosis.
B. Implement a primary prevention cardiovascular risk program
(HTN, smoking, diabetes control).
C. Build a regional neurorehabilitation centre for post-stroke
disability.
D. Increase MRI access for earlier detection of structural brain
disease.
Correct answer
B
Rationales
Correct (B): Primary prevention targeting hypertension,
diabetes and smoking reduces incidence of stroke and vascular
dementia — the largest contributors to neurological DALYs
globally. Queen Square public-health reasoning emphasises
Page | 2
,upstream risk modification to reduce population-level burden.
Population interventions are higher yield than diagnostic or
tertiary services when incidence drives DALYs.
A: Memory clinics improve diagnosis but have limited impact on
incidence or DALYs compared with prevention.
C: Rehabilitation reduces disability but does not prevent initial
events; prevention averts more DALYs per resource.
D: Diagnostic imaging improves case ascertainment but has
minimal effect on incidence or population DALYs.
Teaching point
Primary prevention of vascular risk factors most reduces
neurological DALYs at population level.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2
Page | 3
, Reference
Ch. 1 — The Global Burden of Neurological Diseases — Stroke
epidemiology
Stem
A 55-year-old woman in a low-income country suffers sudden
right hemiparesis and expressive dysphasia. Local registries
report rising stroke incidence in young adults linked to obesity
and diabetes. You are designing an early-warning surveillance
system. Which indicator will best identify populations at
imminent increased stroke risk due to climate-linked changes?
Options
A. Incidence of heatwave-related dehydration admissions.
B. Prevalence of untreated hypertension in adults 30–60 years.
C. Number of CT scanners per 100,000 population.
D. Annual admissions for neuroinfections.
Correct answer
B
Rationales
Correct (B): Untreated hypertension is the strongest modifiable
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global burden overview
Stem
A 68-year-old man from a rural region presents with progressive
gait instability and cognitive decline over 18 months.
Community data show an increase in stroke survivors and rising
prevalence of dementia in the last decade. As a neurologist
Page | 1
,advising the regional health authority you must prioritize
interventions. Which single program would most efficiently
reduce overall neurological DALYs (disability-adjusted life years)
in this population?
Options
A. Expand tertiary memory clinics for early Alzheimer diagnosis.
B. Implement a primary prevention cardiovascular risk program
(HTN, smoking, diabetes control).
C. Build a regional neurorehabilitation centre for post-stroke
disability.
D. Increase MRI access for earlier detection of structural brain
disease.
Correct answer
B
Rationales
Correct (B): Primary prevention targeting hypertension,
diabetes and smoking reduces incidence of stroke and vascular
dementia — the largest contributors to neurological DALYs
globally. Queen Square public-health reasoning emphasises
Page | 2
,upstream risk modification to reduce population-level burden.
Population interventions are higher yield than diagnostic or
tertiary services when incidence drives DALYs.
A: Memory clinics improve diagnosis but have limited impact on
incidence or DALYs compared with prevention.
C: Rehabilitation reduces disability but does not prevent initial
events; prevention averts more DALYs per resource.
D: Diagnostic imaging improves case ascertainment but has
minimal effect on incidence or population DALYs.
Teaching point
Primary prevention of vascular risk factors most reduces
neurological DALYs at population level.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2
Page | 3
, Reference
Ch. 1 — The Global Burden of Neurological Diseases — Stroke
epidemiology
Stem
A 55-year-old woman in a low-income country suffers sudden
right hemiparesis and expressive dysphasia. Local registries
report rising stroke incidence in young adults linked to obesity
and diabetes. You are designing an early-warning surveillance
system. Which indicator will best identify populations at
imminent increased stroke risk due to climate-linked changes?
Options
A. Incidence of heatwave-related dehydration admissions.
B. Prevalence of untreated hypertension in adults 30–60 years.
C. Number of CT scanners per 100,000 population.
D. Annual admissions for neuroinfections.
Correct answer
B
Rationales
Correct (B): Untreated hypertension is the strongest modifiable
Page | 4
