NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global burden framing
Stem
A 68-year-old man from a low-income region presents with
progressive gait instability, memory decline over 2 years, and
poorly controlled hypertension. Community data show rising
prevalence of vascular risk factors and limited access to
Page | 1
,secondary prevention. You must advise public-health priorities
to reduce future burden of similar cases. Which single public-
health intervention is most likely to yield the largest population-
level reduction in this cohort’s incidence of disabling
neurological disease?
Options
A. Expand MRI availability in district hospitals to improve
diagnostic precision.
B. Implement community-wide blood-pressure screening and
affordable antihypertensive therapy.
C. Build tertiary stroke units in capital hospitals.
D. Launch memory-screening clinics to detect dementia early.
Correct answer
B
Rationale — Correct (3–5 sentences)
Queen Square–based reasoning emphasizes primary prevention
of common, modifiable risks. Hypertension is the leading global
contributor to stroke and vascular cognitive impairment;
community screening plus affordable treatment reduces
Page | 2
,incidence at population scale. In low-resource settings,
addressing the dominant risk factor is higher yield than
increasing advanced diagnostics or tertiary services, which
benefit fewer patients. This aligns with the chapter’s message
that prevention of risk factors is the most powerful lever to
reduce neurological burden.
Rationale — Incorrect
A. MRI improves diagnosis but does not prevent disease;
benefit is limited by access and cost.
C. Tertiary stroke units help acute care but have less effect on
population incidence where prevention is weak.
D. Memory clinics aid diagnosis but don’t reduce incidence; late
detection often comes after irreversible decline.
Teaching point
Primary prevention of hypertension yields the greatest
population reduction in stroke and vascular dementia.
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 —
Epidemiologic transitions
Stem
A national health report documents a shift from infectious to
non-communicable neurological disease over 20 years, with
rising stroke and neurodegenerative disorders. As a neurologist
advising ministers, which structural health-system change best
addresses this epidemiologic transition?
Options
A. Redirect funding exclusively to infectious neurology units.
B. Invest in chronic disease management integrated into
primary care (risk factor control, rehab).
C. Prioritize building high-cost neurosurgical centres.
D. Focus solely on expanding acute critical care beds.
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global burden framing
Stem
A 68-year-old man from a low-income region presents with
progressive gait instability, memory decline over 2 years, and
poorly controlled hypertension. Community data show rising
prevalence of vascular risk factors and limited access to
Page | 1
,secondary prevention. You must advise public-health priorities
to reduce future burden of similar cases. Which single public-
health intervention is most likely to yield the largest population-
level reduction in this cohort’s incidence of disabling
neurological disease?
Options
A. Expand MRI availability in district hospitals to improve
diagnostic precision.
B. Implement community-wide blood-pressure screening and
affordable antihypertensive therapy.
C. Build tertiary stroke units in capital hospitals.
D. Launch memory-screening clinics to detect dementia early.
Correct answer
B
Rationale — Correct (3–5 sentences)
Queen Square–based reasoning emphasizes primary prevention
of common, modifiable risks. Hypertension is the leading global
contributor to stroke and vascular cognitive impairment;
community screening plus affordable treatment reduces
Page | 2
,incidence at population scale. In low-resource settings,
addressing the dominant risk factor is higher yield than
increasing advanced diagnostics or tertiary services, which
benefit fewer patients. This aligns with the chapter’s message
that prevention of risk factors is the most powerful lever to
reduce neurological burden.
Rationale — Incorrect
A. MRI improves diagnosis but does not prevent disease;
benefit is limited by access and cost.
C. Tertiary stroke units help acute care but have less effect on
population incidence where prevention is weak.
D. Memory clinics aid diagnosis but don’t reduce incidence; late
detection often comes after irreversible decline.
Teaching point
Primary prevention of hypertension yields the greatest
population reduction in stroke and vascular dementia.
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 —
Epidemiologic transitions
Stem
A national health report documents a shift from infectious to
non-communicable neurological disease over 20 years, with
rising stroke and neurodegenerative disorders. As a neurologist
advising ministers, which structural health-system change best
addresses this epidemiologic transition?
Options
A. Redirect funding exclusively to infectious neurology units.
B. Invest in chronic disease management integrated into
primary care (risk factor control, rehab).
C. Prioritize building high-cost neurosurgical centres.
D. Focus solely on expanding acute critical care beds.
Page | 4
