NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — The Global Burden of Neurological Diseases —
Introduction
Stem
A national health ministry in a middle-income country asks you
to prioritise neurological conditions for a ten-year strategic
plan. Population ageing is progressing rapidly, stroke incidence
Page | 1
,has increased, and dementia referrals are rising. Based on
Queen Square public-health principles, which single approach
will most efficiently reduce population disability-adjusted life
years (DALYs) from neurological disease over the next decade?
Options
A. Invest in acute stroke thrombolysis centres in urban tertiary
hospitals.
B. Implement nationwide primary prevention targeting
hypertension and air pollution reduction.
C. Build long-term residential dementia care facilities in major
cities.
D. Expand neurosurgical capacity for traumatic brain injury
repair.
Correct answer
B
Rationales
Correct (B): Primary prevention of major modifiable risk factors
(notably hypertension and environmental contributors such as
air pollution) reduces incidence of stroke and vascular cognitive
Page | 2
,impairment at a population level; Queen Square public-health
reasoning prioritizes upstream interventions to reduce DALYs.
Reducing exposures affects incidence broadly and is cost-
effective in middle-income settings.
Incorrect (A): Acute thrombolysis reduces individual morbidity
but benefits fewer patients and doesn't reduce incidence; costly
to scale nationwide.
Incorrect (C): Residential care addresses downstream needs but
does not reduce incidence or DALYs at a population scale.
Incorrect (D): Expanding neurosurgery targets a smaller number
of injuries and doesn't address common chronic burdens such
as stroke and dementia.
Teaching point
Primary prevention (hypertension, pollution) yields the largest
DALY reductions population-wide.
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 — The
Global Burden of Neurological Diseases
Stem
You review epidemiologic data showing that in a region the age-
standardized mortality from neurological disorders is
decreasing, while total DALYs are increasing. What best explains
this paradox?
Options
A. Younger population with increased incidence of
neuroinfectious diseases.
B. Improved survival from acute neurological events with higher
chronic disability.
C. Misclassification of causes of death leading to
underreporting.
D. Rapid decrease in non-neurological mortality inflating
relative DALYs.
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — The Global Burden of Neurological Diseases —
Introduction
Stem
A national health ministry in a middle-income country asks you
to prioritise neurological conditions for a ten-year strategic
plan. Population ageing is progressing rapidly, stroke incidence
Page | 1
,has increased, and dementia referrals are rising. Based on
Queen Square public-health principles, which single approach
will most efficiently reduce population disability-adjusted life
years (DALYs) from neurological disease over the next decade?
Options
A. Invest in acute stroke thrombolysis centres in urban tertiary
hospitals.
B. Implement nationwide primary prevention targeting
hypertension and air pollution reduction.
C. Build long-term residential dementia care facilities in major
cities.
D. Expand neurosurgical capacity for traumatic brain injury
repair.
Correct answer
B
Rationales
Correct (B): Primary prevention of major modifiable risk factors
(notably hypertension and environmental contributors such as
air pollution) reduces incidence of stroke and vascular cognitive
Page | 2
,impairment at a population level; Queen Square public-health
reasoning prioritizes upstream interventions to reduce DALYs.
Reducing exposures affects incidence broadly and is cost-
effective in middle-income settings.
Incorrect (A): Acute thrombolysis reduces individual morbidity
but benefits fewer patients and doesn't reduce incidence; costly
to scale nationwide.
Incorrect (C): Residential care addresses downstream needs but
does not reduce incidence or DALYs at a population scale.
Incorrect (D): Expanding neurosurgery targets a smaller number
of injuries and doesn't address common chronic burdens such
as stroke and dementia.
Teaching point
Primary prevention (hypertension, pollution) yields the largest
DALY reductions population-wide.
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 — The
Global Burden of Neurological Diseases
Stem
You review epidemiologic data showing that in a region the age-
standardized mortality from neurological disorders is
decreasing, while total DALYs are increasing. What best explains
this paradox?
Options
A. Younger population with increased incidence of
neuroinfectious diseases.
B. Improved survival from acute neurological events with higher
chronic disability.
C. Misclassification of causes of death leading to
underreporting.
D. Rapid decrease in non-neurological mortality inflating
relative DALYs.
Page | 4
