NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
Q1
Reference
Ch. 1 — Introduction — Global burden metrics
Stem
A national neurology service reports a 25% increase in reported
stroke cases over five years. The country’s elderly population
rose by 10% in the same period; MRI availability doubled and
stroke unit capacity increased. You are asked to advise whether
Page | 1
,this reflects a true incidence increase or other factors. Which
interpretation is most consistent with the provided data?
Options
A. True increase in stroke incidence due to population ageing.
B. Apparent increase driven primarily by improved diagnostic
capacity and reporting.
C. Artefactual decrease in incidence due to changes in case
definition.
D. Increase primarily due to environmental exposures unrelated
to diagnostic access.
Correct answer
B
Rationales
Correct (B): The doubling of MRI availability and increased
stroke unit capacity can markedly improve detection and
reporting, producing an apparent rise in cases even if true
incidence is stable. Queen Square epidemiologic principles
emphasise distinguishing changes in ascertainment from true
incidence.
Page | 2
,A: Partly plausible (ageing contributes) but the 25% rise exceeds
demographic shift (10%), pointing to detection/reporting
effects.
C: No evidence given of narrowing case definitions; this
contradicts the data showing increased capacity.
D: No specific environmental exposure data supplied;
attribution to such exposures is speculative without supporting
evidence.
Teaching point
Differentiate diagnostic/ascertainment effects from true
incidence increases.
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 interpretation
Stem
An epidemiologist presents DALY data showing rising YLD (years
lived with disability) but falling YLL (years of life lost) for
epilepsy over 20 years. As a clinician-advisor, which conclusion
best aligns with these metrics?
Options
A. Fewer people are living with epilepsy, but their seizures are
more fatal.
B. Epilepsy is becoming less disabling but more often fatal.
C. Case fatality has declined while morbidity and chronic
disability have increased.
D. Both incidence and prevalence of epilepsy have declined.
Correct answer
C
Rationales
Correct (C): Rising YLD with falling YLL indicates fewer deaths
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
Q1
Reference
Ch. 1 — Introduction — Global burden metrics
Stem
A national neurology service reports a 25% increase in reported
stroke cases over five years. The country’s elderly population
rose by 10% in the same period; MRI availability doubled and
stroke unit capacity increased. You are asked to advise whether
Page | 1
,this reflects a true incidence increase or other factors. Which
interpretation is most consistent with the provided data?
Options
A. True increase in stroke incidence due to population ageing.
B. Apparent increase driven primarily by improved diagnostic
capacity and reporting.
C. Artefactual decrease in incidence due to changes in case
definition.
D. Increase primarily due to environmental exposures unrelated
to diagnostic access.
Correct answer
B
Rationales
Correct (B): The doubling of MRI availability and increased
stroke unit capacity can markedly improve detection and
reporting, producing an apparent rise in cases even if true
incidence is stable. Queen Square epidemiologic principles
emphasise distinguishing changes in ascertainment from true
incidence.
Page | 2
,A: Partly plausible (ageing contributes) but the 25% rise exceeds
demographic shift (10%), pointing to detection/reporting
effects.
C: No evidence given of narrowing case definitions; this
contradicts the data showing increased capacity.
D: No specific environmental exposure data supplied;
attribution to such exposures is speculative without supporting
evidence.
Teaching point
Differentiate diagnostic/ascertainment effects from true
incidence increases.
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 interpretation
Stem
An epidemiologist presents DALY data showing rising YLD (years
lived with disability) but falling YLL (years of life lost) for
epilepsy over 20 years. As a clinician-advisor, which conclusion
best aligns with these metrics?
Options
A. Fewer people are living with epilepsy, but their seizures are
more fatal.
B. Epilepsy is becoming less disabling but more often fatal.
C. Case fatality has declined while morbidity and chronic
disability have increased.
D. Both incidence and prevalence of epilepsy have declined.
Correct answer
C
Rationales
Correct (C): Rising YLD with falling YLL indicates fewer deaths
Page | 4
