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 low-middle income country (LMIC)
presents with progressive gait disturbance and cognitive decline
over 2 years. Local health planners report rising age-adjusted
stroke and dementia burdens, limited neurology workforce, and
Page | 1
,poor access to rehabilitation. As a consultant asked to prioritize
interventions at a national level, which strategy best reduces
the combined future burden of stroke and dementia?
A. Invest primarily in tertiary stroke units in urban centers.
B. Prioritize population-level vascular risk reduction
(hypertension/tobacco control).
C. Build specialized dementia care wards in regional hospitals.
D. Allocate funds to advanced neuroimaging for earlier
diagnosis.
Correct answer
B
Rationale — Correct
Population-level vascular risk reduction addresses root causes
shared by stroke and many dementias; Queen Square
epidemiology emphasizes prevention as highest yield for
reducing DALYs. Hypertension and smoking control lower
incident stroke and vascular contributions to cognitive decline
across populations.
Page | 2
,Rationale — Incorrect
A: Tertiary stroke units help severe cases but have limited
population impact where most events are preventable.
C: Dementia wards treat established disease but do little to
reduce incidence or disability-adjusted life years population-
wide.
D: Neuroimaging improves diagnosis but is resource-intensive
with small preventive effect compared to risk factor control.
Teaching Point
Primordial prevention of vascular risk yields the largest
population reduction in stroke/dementia 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 — DALYs &
metrics
Stem
A ministry of health official asks you to explain why DALYs
(disability-adjusted life years) are a better metric than mortality
alone for planning neurology services. Which explanation best
captures the advantage?
A. DALYs count only premature deaths, simplifying comparison.
B. DALYs combine years of life lost and years lived with
disability, reflecting chronic neurological morbidity.
C. DALYs primarily measure economic cost rather than health
outcomes.
D. DALYs are only useful for infectious disorders, not chronic
neurological disease.
Correct answer
B
Rationale — Correct
DALYs integrate mortality (YLL) and morbidity (YLD), which is
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 low-middle income country (LMIC)
presents with progressive gait disturbance and cognitive decline
over 2 years. Local health planners report rising age-adjusted
stroke and dementia burdens, limited neurology workforce, and
Page | 1
,poor access to rehabilitation. As a consultant asked to prioritize
interventions at a national level, which strategy best reduces
the combined future burden of stroke and dementia?
A. Invest primarily in tertiary stroke units in urban centers.
B. Prioritize population-level vascular risk reduction
(hypertension/tobacco control).
C. Build specialized dementia care wards in regional hospitals.
D. Allocate funds to advanced neuroimaging for earlier
diagnosis.
Correct answer
B
Rationale — Correct
Population-level vascular risk reduction addresses root causes
shared by stroke and many dementias; Queen Square
epidemiology emphasizes prevention as highest yield for
reducing DALYs. Hypertension and smoking control lower
incident stroke and vascular contributions to cognitive decline
across populations.
Page | 2
,Rationale — Incorrect
A: Tertiary stroke units help severe cases but have limited
population impact where most events are preventable.
C: Dementia wards treat established disease but do little to
reduce incidence or disability-adjusted life years population-
wide.
D: Neuroimaging improves diagnosis but is resource-intensive
with small preventive effect compared to risk factor control.
Teaching Point
Primordial prevention of vascular risk yields the largest
population reduction in stroke/dementia 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 — DALYs &
metrics
Stem
A ministry of health official asks you to explain why DALYs
(disability-adjusted life years) are a better metric than mortality
alone for planning neurology services. Which explanation best
captures the advantage?
A. DALYs count only premature deaths, simplifying comparison.
B. DALYs combine years of life lost and years lived with
disability, reflecting chronic neurological morbidity.
C. DALYs primarily measure economic cost rather than health
outcomes.
D. DALYs are only useful for infectious disorders, not chronic
neurological disease.
Correct answer
B
Rationale — Correct
DALYs integrate mortality (YLL) and morbidity (YLD), which is
Page | 4
