NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
Q1
Reference
Ch. 1 — Introduction — Global burden overview
Stem
A 68-year-old man in a low-income country presents with
progressive gait instability, cognitive slowing, and new onset
episodic headaches over 6 months. Local clinic records show
rising regional stroke and dementia prevalence over the last
Page | 1
,decade. You must advise the regional health authority on the
likely drivers of increased neurodisability and immediate
priorities for neurologic services. Which single factor most
plausibly explains the observed rise in chronic neurological
disability?
Options
A. Aging population with increased life expectancy
B. Recent increase in neurotropic viral outbreaks
C. Improved diagnostic imaging availability
D. Increased prevalence of refractory epilepsy
Correct answer
A
Rationales
Correct (A): Global epidemiology in Ch. 1 emphasizes
demographic transition — population aging increases absolute
burden of chronic neurodegenerative disorders and stroke,
driving rising prevalence of gait instability and cognitive decline.
Queen Square reasoning links population structure to service
demand and disability-adjusted life years.
Page | 2
,Incorrect (B): Viral outbreaks increase acute neurological events
but are less likely to cause a steady, population-level rise in
chronic degenerative disability over years.
Incorrect (C): Improved diagnostics may increase detection but
would not alone produce the observed increase in disability
metrics and service strain described.
Incorrect (D): Refractory epilepsy contributes to morbidity but
is not the dominant driver of the broad, aging-related
neurodisability trend.
Teaching point
Population aging is the primary driver of rising chronic
neurological disability worldwide.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
Q2
Page | 3
, Reference
Ch. 1 — The Global Burden of Neurological Diseases — DALYs
and resource mismatch
Stem
A ministry of health requests advice after DALY estimates show
neurological disorders now account for a greater share of
disability than infectious diseases in their country. Neurology
services are scarce and concentrated in urban tertiary centres.
For equitable reduction of neurological DALYs, which health
system change should be prioritized?
Options
A. Centralize all neurology care in tertiary hospitals to
concentrate expertise
B. Invest in primary care training for early detection and
secondary prevention
C. Prioritize high-cost imaging equipment for district hospitals
D. Build specialized inpatient neuro-rehabilitation units only in
the capital
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
Q1
Reference
Ch. 1 — Introduction — Global burden overview
Stem
A 68-year-old man in a low-income country presents with
progressive gait instability, cognitive slowing, and new onset
episodic headaches over 6 months. Local clinic records show
rising regional stroke and dementia prevalence over the last
Page | 1
,decade. You must advise the regional health authority on the
likely drivers of increased neurodisability and immediate
priorities for neurologic services. Which single factor most
plausibly explains the observed rise in chronic neurological
disability?
Options
A. Aging population with increased life expectancy
B. Recent increase in neurotropic viral outbreaks
C. Improved diagnostic imaging availability
D. Increased prevalence of refractory epilepsy
Correct answer
A
Rationales
Correct (A): Global epidemiology in Ch. 1 emphasizes
demographic transition — population aging increases absolute
burden of chronic neurodegenerative disorders and stroke,
driving rising prevalence of gait instability and cognitive decline.
Queen Square reasoning links population structure to service
demand and disability-adjusted life years.
Page | 2
,Incorrect (B): Viral outbreaks increase acute neurological events
but are less likely to cause a steady, population-level rise in
chronic degenerative disability over years.
Incorrect (C): Improved diagnostics may increase detection but
would not alone produce the observed increase in disability
metrics and service strain described.
Incorrect (D): Refractory epilepsy contributes to morbidity but
is not the dominant driver of the broad, aging-related
neurodisability trend.
Teaching point
Population aging is the primary driver of rising chronic
neurological disability worldwide.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
Q2
Page | 3
, Reference
Ch. 1 — The Global Burden of Neurological Diseases — DALYs
and resource mismatch
Stem
A ministry of health requests advice after DALY estimates show
neurological disorders now account for a greater share of
disability than infectious diseases in their country. Neurology
services are scarce and concentrated in urban tertiary centres.
For equitable reduction of neurological DALYs, which health
system change should be prioritized?
Options
A. Centralize all neurology care in tertiary hospitals to
concentrate expertise
B. Invest in primary care training for early detection and
secondary prevention
C. Prioritize high-cost imaging equipment for district hospitals
D. Build specialized inpatient neuro-rehabilitation units only in
the capital
Page | 4
