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 presents after sudden onset right
hemiparesis and expressive aphasia. He has hypertension and
long smoking history; CT shows left MCA territory infarct. In
planning regional stroke services, which population-level metric
best captures both mortality and long-term disability burden
relevant to service planning?
Page | 1
,Options:
A. Crude mortality rate from stroke
B. Years of life lost (YLL) only
C. Disability-adjusted life years (DALYs)
D. Incidence rate of transient ischemic attack (TIA)
Correct answer: C
Rationale — Correct: DALYs combine years of life lost and years
lived with disability, offering a single metric for mortality plus
long-term functional burden — key for planning stroke services
and rehabilitation allocation (Queen Square principles on
burden metrics).
Rationale — Incorrect:
A. Mortality alone ignores long-term disability.
B. YLL ignores chronic disability contribution.
D. TIA incidence is useful but doesn’t quantify lifelong disability.
Teaching point: Use DALYs to capture combined mortality and
disability burden for service planning.
Citation: Howard, R. (2021). Neurology: A Queen Square
Textbook (3rd ed.). Ch. 1. Wiley Online Library
Page | 2
,2
Reference: Ch. 1 — The Global Burden of Neurological Diseases
— Epidemiology principles
Stem: A health minister asks which neurological disorders
contribute most to global disability-adjusted life years (DALYs).
According to global burden analyses, which disorder category is
typically the largest contributor to neurological DALYs
worldwide?
Options:
A. Migraine and other headache disorders
B. Neurodegenerative dementias (e.g., Alzheimer disease)
C. Stroke and cerebrovascular disease
D. Epilepsy
Correct answer: C
Rationale — Correct: Stroke ranks as the leading cause of
neurological DALYs globally, driven by high incidence, mortality
and residual disability, making it the largest component in most
GBD analyses referenced in the chapter.
Page | 3
, Rationale — Incorrect:
A. Headache disorders cause high YLDs but less mortality and
combined DALYs than stroke.
B. Dementias are significant and rising but generally contribute
fewer DALYs than stroke currently.
D. Epilepsy contributes meaningfully to YLDs but not at stroke’s
scale.
Teaching point: Stroke is the dominant contributor to
neurological DALYs worldwide.
Citation: Howard, R. (2021). Neurology: A Queen Square
Textbook (3rd ed.). Ch. 1. Open Access LMU
3
Reference: Ch. 1 — The Global Burden — Risk factors overview
Stem: A population health report highlights top modifiable risk
factors underlying neurological DALYs. Which of the following
risk factors is repeatedly identified as a leading preventable
contributor to neurological disease burden (including stroke
and dementia)?
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 presents after sudden onset right
hemiparesis and expressive aphasia. He has hypertension and
long smoking history; CT shows left MCA territory infarct. In
planning regional stroke services, which population-level metric
best captures both mortality and long-term disability burden
relevant to service planning?
Page | 1
,Options:
A. Crude mortality rate from stroke
B. Years of life lost (YLL) only
C. Disability-adjusted life years (DALYs)
D. Incidence rate of transient ischemic attack (TIA)
Correct answer: C
Rationale — Correct: DALYs combine years of life lost and years
lived with disability, offering a single metric for mortality plus
long-term functional burden — key for planning stroke services
and rehabilitation allocation (Queen Square principles on
burden metrics).
Rationale — Incorrect:
A. Mortality alone ignores long-term disability.
B. YLL ignores chronic disability contribution.
D. TIA incidence is useful but doesn’t quantify lifelong disability.
Teaching point: Use DALYs to capture combined mortality and
disability burden for service planning.
Citation: Howard, R. (2021). Neurology: A Queen Square
Textbook (3rd ed.). Ch. 1. Wiley Online Library
Page | 2
,2
Reference: Ch. 1 — The Global Burden of Neurological Diseases
— Epidemiology principles
Stem: A health minister asks which neurological disorders
contribute most to global disability-adjusted life years (DALYs).
According to global burden analyses, which disorder category is
typically the largest contributor to neurological DALYs
worldwide?
Options:
A. Migraine and other headache disorders
B. Neurodegenerative dementias (e.g., Alzheimer disease)
C. Stroke and cerebrovascular disease
D. Epilepsy
Correct answer: C
Rationale — Correct: Stroke ranks as the leading cause of
neurological DALYs globally, driven by high incidence, mortality
and residual disability, making it the largest component in most
GBD analyses referenced in the chapter.
Page | 3
, Rationale — Incorrect:
A. Headache disorders cause high YLDs but less mortality and
combined DALYs than stroke.
B. Dementias are significant and rising but generally contribute
fewer DALYs than stroke currently.
D. Epilepsy contributes meaningfully to YLDs but not at stroke’s
scale.
Teaching point: Stroke is the dominant contributor to
neurological DALYs worldwide.
Citation: Howard, R. (2021). Neurology: A Queen Square
Textbook (3rd ed.). Ch. 1. Open Access LMU
3
Reference: Ch. 1 — The Global Burden — Risk factors overview
Stem: A population health report highlights top modifiable risk
factors underlying neurological DALYs. Which of the following
risk factors is repeatedly identified as a leading preventable
contributor to neurological disease burden (including stroke
and dementia)?
Page | 4
