NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global trends in neurological disease
Stem
A 68-year-old man from a rapidly urbanising low-middle income
country (LMIC) presents with an acute right-sided weakness and
dysarthria. Local hospital data show rising numbers of similar
strokes over the last decade; CT head is being rationed. As a
Page | 1
,policy adviser, you must prioritise a single population-level
intervention that most directly reduces stroke DALYs in this
setting.
Options
A. Expand tertiary stroke units with endovascular capability.
B. Implement community-based hypertension detection and
treatment programs.
C. Establish a national MRI network for diagnostic precision.
D. Fund advanced genetic research into stroke susceptibility.
Correct answer
B
Rationales
Correct (B): Queen Square–style public health reasoning
focuses on dominant, modifiable risk factors. Hypertension
prevention/treatment reduces stroke incidence and disability
across populations and is the highest-yield, cost-effective
intervention to reduce stroke DALYs in LMICs. Population-level
risk reduction addresses burden more reliably than
concentrating scarce tertiary resources.
Page | 2
,Incorrect (A): Endovascular therapies benefit a minority of
ischaemic strokes and are resource-intensive; they are not the
highest-impact population strategy in resource-limited settings.
Incorrect (C): MRI improves diagnostic precision but does not
prevent strokes or substantially reduce population DALYs
compared with risk-factor control.
Incorrect (D): Genetic research has long-term value but does
not provide immediate, high-yield reduction in stroke burden.
Teaching Point
Population hypertension control yields the largest immediate
reduction in stroke burden.
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 —
Measuring burden
Stem
You are interpreting country-level metrics showing high
prevalence but relatively low years-of-life-lost (YLL) for a chronic
neurological condition. Case mix data reveal long survival with
disability. Which burden metric most directly explains why
prevalence is high while YLL remains low?
Options
A. Incidence rate
B. Disability-Adjusted Life Years (DALYs) driven by Years Lived
with Disability (YLD)
C. Case fatality ratio
D. Years of Productive Life Lost (YPLL)
Correct answer
B
Rationales
Correct (B): DALYs comprise YLL + YLD; a condition with long
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global trends in neurological disease
Stem
A 68-year-old man from a rapidly urbanising low-middle income
country (LMIC) presents with an acute right-sided weakness and
dysarthria. Local hospital data show rising numbers of similar
strokes over the last decade; CT head is being rationed. As a
Page | 1
,policy adviser, you must prioritise a single population-level
intervention that most directly reduces stroke DALYs in this
setting.
Options
A. Expand tertiary stroke units with endovascular capability.
B. Implement community-based hypertension detection and
treatment programs.
C. Establish a national MRI network for diagnostic precision.
D. Fund advanced genetic research into stroke susceptibility.
Correct answer
B
Rationales
Correct (B): Queen Square–style public health reasoning
focuses on dominant, modifiable risk factors. Hypertension
prevention/treatment reduces stroke incidence and disability
across populations and is the highest-yield, cost-effective
intervention to reduce stroke DALYs in LMICs. Population-level
risk reduction addresses burden more reliably than
concentrating scarce tertiary resources.
Page | 2
,Incorrect (A): Endovascular therapies benefit a minority of
ischaemic strokes and are resource-intensive; they are not the
highest-impact population strategy in resource-limited settings.
Incorrect (C): MRI improves diagnostic precision but does not
prevent strokes or substantially reduce population DALYs
compared with risk-factor control.
Incorrect (D): Genetic research has long-term value but does
not provide immediate, high-yield reduction in stroke burden.
Teaching Point
Population hypertension control yields the largest immediate
reduction in stroke burden.
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 —
Measuring burden
Stem
You are interpreting country-level metrics showing high
prevalence but relatively low years-of-life-lost (YLL) for a chronic
neurological condition. Case mix data reveal long survival with
disability. Which burden metric most directly explains why
prevalence is high while YLL remains low?
Options
A. Incidence rate
B. Disability-Adjusted Life Years (DALYs) driven by Years Lived
with Disability (YLD)
C. Case fatality ratio
D. Years of Productive Life Lost (YPLL)
Correct answer
B
Rationales
Correct (B): DALYs comprise YLL + YLD; a condition with long
Page | 4
