NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference: Ch. 1 — The Global Burden of Neurological Diseases
— Introduction
Stem: A 68-year-old man from a low-income country presents
with progressive gait impairment and cognitive decline over 2
years. Population data indicate rapidly ageing demographics
and rising noncommunicable disease prevalence in his region.
As a neurologist advising a national health plan, which
Page | 1
,interpretation best aligns with Queen Square–style
epidemiologic reasoning about future neurological service
needs?
Options:
A. The principal driver of future neurological service demand
will be infections; therefore invest in acute infectious disease
units.
B. Ageing and rise in noncommunicable diseases will increase
chronic neurodegenerative and stroke burden; prioritize long-
term care and stroke services.
C. Because population growth is static, neurological demand
will fall; focus on cost containment.
D. Environmental factors are negligible; therefore infrastructural
investments can be deferred.
Correct answer: B
Rationale (Correct): Ageing populations and rising
noncommunicable disease prevalence reliably predict increased
incidence and prevalence of stroke, dementia, and other
chronic neurological disorders; planning must prioritize stroke
Page | 2
,systems, memory services, rehabilitation, and long-term care —
consistent with Queen Square emphasis on population-based
clinical planning.
Rationale (Incorrect):
A. Infectious causes remain important in some regions, but
demographic transition shifts the dominant burden to
noncommunicable neurological disease.
C. Static growth does not reduce age-related disease burden;
absolute numbers and service needs often rise with ageing.
D. Climate and environment significantly influence neurological
disease patterns; they cannot be ignored.
Teaching point: Ageing drives chronic neurological service
demand — prioritize stroke, dementia, rehab.
Citation: Howard, R. (2021). Neurology: A Queen Square
Textbook (3rd ed.). Ch. 1.
2
Reference: Ch. 1 — The Global Burden of Neurological Diseases
— The Global Burden of Neurological Diseases
Page | 3
, Stem: In reviewing DALY (disability-adjusted life years) data for a
region, you note stroke contributes most to DALYs among
neurological disorders, while migraine causes substantial years
lived with disability (YLDs) in working-age adults. For health
policy prioritization, which conclusion best aligns with Queen
Square analytic approach?
Options:
A. Prioritize only stroke because it causes the most DALYs;
migraine can be deprioritized.
B. Prioritize interventions that reduce premature mortality and
severe disability (stroke) and targeted programs for high-YLD
disorders (migraine) for economic benefit.
C. Focus entirely on YLDs, because they reflect suffering, and
ignore mortality.
D. Use raw prevalence alone to set priorities — DALYs are
unnecessary.
Correct answer: B
Rationale (Correct): DALYs integrate mortality and disability;
Queen Square–style policy reasoning balances mortality
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference: Ch. 1 — The Global Burden of Neurological Diseases
— Introduction
Stem: A 68-year-old man from a low-income country presents
with progressive gait impairment and cognitive decline over 2
years. Population data indicate rapidly ageing demographics
and rising noncommunicable disease prevalence in his region.
As a neurologist advising a national health plan, which
Page | 1
,interpretation best aligns with Queen Square–style
epidemiologic reasoning about future neurological service
needs?
Options:
A. The principal driver of future neurological service demand
will be infections; therefore invest in acute infectious disease
units.
B. Ageing and rise in noncommunicable diseases will increase
chronic neurodegenerative and stroke burden; prioritize long-
term care and stroke services.
C. Because population growth is static, neurological demand
will fall; focus on cost containment.
D. Environmental factors are negligible; therefore infrastructural
investments can be deferred.
Correct answer: B
Rationale (Correct): Ageing populations and rising
noncommunicable disease prevalence reliably predict increased
incidence and prevalence of stroke, dementia, and other
chronic neurological disorders; planning must prioritize stroke
Page | 2
,systems, memory services, rehabilitation, and long-term care —
consistent with Queen Square emphasis on population-based
clinical planning.
Rationale (Incorrect):
A. Infectious causes remain important in some regions, but
demographic transition shifts the dominant burden to
noncommunicable neurological disease.
C. Static growth does not reduce age-related disease burden;
absolute numbers and service needs often rise with ageing.
D. Climate and environment significantly influence neurological
disease patterns; they cannot be ignored.
Teaching point: Ageing drives chronic neurological service
demand — prioritize stroke, dementia, rehab.
Citation: Howard, R. (2021). Neurology: A Queen Square
Textbook (3rd ed.). Ch. 1.
2
Reference: Ch. 1 — The Global Burden of Neurological Diseases
— The Global Burden of Neurological Diseases
Page | 3
, Stem: In reviewing DALY (disability-adjusted life years) data for a
region, you note stroke contributes most to DALYs among
neurological disorders, while migraine causes substantial years
lived with disability (YLDs) in working-age adults. For health
policy prioritization, which conclusion best aligns with Queen
Square analytic approach?
Options:
A. Prioritize only stroke because it causes the most DALYs;
migraine can be deprioritized.
B. Prioritize interventions that reduce premature mortality and
severe disability (stroke) and targeted programs for high-YLD
disorders (migraine) for economic benefit.
C. Focus entirely on YLDs, because they reflect suffering, and
ignore mortality.
D. Use raw prevalence alone to set priorities — DALYs are
unnecessary.
Correct answer: B
Rationale (Correct): DALYs integrate mortality and disability;
Queen Square–style policy reasoning balances mortality
Page | 4
