NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global neurology framing
Stem
A national neurology service reviews 10 years of data showing
rising years lived with disability (YLDs) from neurological
disorders while age-standardised mortality falls. A health
minister asks whether investment should prioritise acute stroke
Page | 1
,units or community neurorehabilitation. Which inference best
reflects the epidemiologic pattern and its policy implication?
A. Rising YLDs with falling mortality indicate predominantly
more disabling chronic neurological disorders — prioritize
community rehabilitation.
B. Falling mortality means fewer strokes — invest in acute
stroke units over rehabilitation.
C. YLD rise with lower mortality suggests better diagnostics
only; focus on imaging infrastructure.
D. The pattern implies an ageing population only; invest in
geriatric general medicine rather than neurology.
Correct Answer
A
Rationale — Correct
Rising YLDs with falling age-standardised mortality typically
reflect improved survival from acute neurological events (e.g.,
stroke) leading to greater long-term disability. Queen Square–
style population reasoning prioritizes services that reduce
disability burden; therefore community neurorehabilitation and
Page | 2
,long-term support align with the epidemiology. The textbook
emphasises disability-adjusted planning when YLDs dominate
disease burden.
Rationale — Incorrect
B. Falling mortality does not necessarily mean fewer strokes; it
often means improved survival with disability, so deprioritizing
rehab would worsen YLDs.
C. Improved diagnostics alone would not explain large YLD
increases without concurrent survival changes.
D. While ageing contributes, the specific YLD/mortality pattern
requires neurologic rehabilitation focus rather than broad
geriatric generalism.
Teaching Point
Rising YLDs with lower mortality → prioritise rehabilitation and
long-term neurological care.
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 — Metrics
and interpretation
Stem
In a low-income country, DALYs from epilepsy are
disproportionately high compared with high-income settings
despite similar incidence. A neurologist asks why DALYs differ.
Which epidemiologic factor best explains higher DALYs locally?
A. Higher case fatality and untreated chronicity due to limited
access to care.
B. Genetic predisposition to more severe epilepsy phenotypes.
C. Over-reporting of disability in community surveys.
D. Lower incidence but higher prevalence due to demographic
differences.
Correct Answer
A
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Introduction — Global neurology framing
Stem
A national neurology service reviews 10 years of data showing
rising years lived with disability (YLDs) from neurological
disorders while age-standardised mortality falls. A health
minister asks whether investment should prioritise acute stroke
Page | 1
,units or community neurorehabilitation. Which inference best
reflects the epidemiologic pattern and its policy implication?
A. Rising YLDs with falling mortality indicate predominantly
more disabling chronic neurological disorders — prioritize
community rehabilitation.
B. Falling mortality means fewer strokes — invest in acute
stroke units over rehabilitation.
C. YLD rise with lower mortality suggests better diagnostics
only; focus on imaging infrastructure.
D. The pattern implies an ageing population only; invest in
geriatric general medicine rather than neurology.
Correct Answer
A
Rationale — Correct
Rising YLDs with falling age-standardised mortality typically
reflect improved survival from acute neurological events (e.g.,
stroke) leading to greater long-term disability. Queen Square–
style population reasoning prioritizes services that reduce
disability burden; therefore community neurorehabilitation and
Page | 2
,long-term support align with the epidemiology. The textbook
emphasises disability-adjusted planning when YLDs dominate
disease burden.
Rationale — Incorrect
B. Falling mortality does not necessarily mean fewer strokes; it
often means improved survival with disability, so deprioritizing
rehab would worsen YLDs.
C. Improved diagnostics alone would not explain large YLD
increases without concurrent survival changes.
D. While ageing contributes, the specific YLD/mortality pattern
requires neurologic rehabilitation focus rather than broad
geriatric generalism.
Teaching Point
Rising YLDs with lower mortality → prioritise rehabilitation and
long-term neurological care.
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 — Metrics
and interpretation
Stem
In a low-income country, DALYs from epilepsy are
disproportionately high compared with high-income settings
despite similar incidence. A neurologist asks why DALYs differ.
Which epidemiologic factor best explains higher DALYs locally?
A. Higher case fatality and untreated chronicity due to limited
access to care.
B. Genetic predisposition to more severe epilepsy phenotypes.
C. Over-reporting of disability in community surveys.
D. Lower incidence but higher prevalence due to demographic
differences.
Correct Answer
A
Page | 4
