Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1: The Cardiovascular System — Anatomical
Overview
Question Stem: A 68-year-old man with long-standing
hypertension presents with exertional dyspnea. On assessment
you note a displaced PMI (point of maximal impulse) laterally
and an S3 gallop. Which pathophysiologic change best explains
these findings?
A. Concentric hypertrophy causing decreased chamber
compliance
,B. Left ventricular dilation with systolic dysfunction
C. Isolated right ventricular hypertrophy from pulmonary
hypertension
D. Restrictive cardiomyopathy with preserved ejection fraction
Correct Answer: B
Rationales:
• Correct (B): Left ventricular dilation (cardiac dilatation)
leads to systolic dysfunction, a displaced PMI, and an S3
due to increased end-systolic volume and poor contractility
— consistent with dilated cardiomyopathy mechanisms
described by Berkowitz.
• A: Concentric hypertrophy (from pressure overload) causes
a thickened wall and preserved chamber size and more
commonly diastolic dysfunction; it usually does not
produce a lateral PMI displacement.
• C: Right ventricular hypertrophy affects right-sided findings
(e.g., right-sided PMI shift) and is less likely to cause an S3
from left-sided dilation.
• D: Restrictive cardiomyopathy causes diastolic filling
impairment with preserved size and often normal PMI; it
does not typically produce the displaced PMI seen here.
Teaching Point: Dilated ventricles produce lateral PMI
displacement and S3 from systolic failure.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Cardiac Dilatation
,2
Reference: Ch. 1: The Cardiovascular System — Left Heart
Failure
Question Stem: A patient with chronic ischemic heart disease
develops acute pulmonary edema. Which immediate nursing
priority addresses the primary pathophysiologic mechanism
causing dyspnea?
A. Raise the HOB and administer oxygen to decrease work of
breathing
B. Administer IV furosemide to reduce preload and pulmonary
congestion
C. Start IV norepinephrine to increase systemic vascular
resistance
D. Give a beta-blocker to decrease myocardial oxygen demand
Correct Answer: B
Rationales:
• Correct (B): In left heart failure, elevated left-sided end-
diastolic pressure increases pulmonary capillary
hydrostatic pressure causing edema; IV loop diuretics
rapidly reduce preload and pulmonary congestion — a
pathophysiologic, evidence-based priority.
, • A: Raising HOB and oxygen are appropriate supportive
measures but do not address the core mechanism of fluid
overload in pulmonary edema.
• C: Increasing afterload with norepinephrine would worsen
left ventricular filling pressures and pulmonary edema.
• D: Beta-blockers may be indicated chronically but are not
first-line acute therapy for pulmonary edema and can
depress contractility acutely.
Teaching Point: Acute pulmonary edema requires rapid preload
reduction (loop diuretics) to relieve pulmonary hydrostatic
pressure.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Left Heart Failure; Preload, Afterload, and Treatment
3
Reference: Ch. 1: The Cardiovascular System — Right Heart
Failure
Question Stem: A 55-year-old woman with COPD develops
progressive peripheral edema, hepatomegaly, and elevated JVP.
Which physiologic explanation best links her pulmonary disease
to these signs?
A. COPD causes left ventricular failure, leading to systemic
venous congestion
B. Chronic hypoxic pulmonary vasoconstriction increases
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1: The Cardiovascular System — Anatomical
Overview
Question Stem: A 68-year-old man with long-standing
hypertension presents with exertional dyspnea. On assessment
you note a displaced PMI (point of maximal impulse) laterally
and an S3 gallop. Which pathophysiologic change best explains
these findings?
A. Concentric hypertrophy causing decreased chamber
compliance
,B. Left ventricular dilation with systolic dysfunction
C. Isolated right ventricular hypertrophy from pulmonary
hypertension
D. Restrictive cardiomyopathy with preserved ejection fraction
Correct Answer: B
Rationales:
• Correct (B): Left ventricular dilation (cardiac dilatation)
leads to systolic dysfunction, a displaced PMI, and an S3
due to increased end-systolic volume and poor contractility
— consistent with dilated cardiomyopathy mechanisms
described by Berkowitz.
• A: Concentric hypertrophy (from pressure overload) causes
a thickened wall and preserved chamber size and more
commonly diastolic dysfunction; it usually does not
produce a lateral PMI displacement.
• C: Right ventricular hypertrophy affects right-sided findings
(e.g., right-sided PMI shift) and is less likely to cause an S3
from left-sided dilation.
• D: Restrictive cardiomyopathy causes diastolic filling
impairment with preserved size and often normal PMI; it
does not typically produce the displaced PMI seen here.
Teaching Point: Dilated ventricles produce lateral PMI
displacement and S3 from systolic failure.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Cardiac Dilatation
,2
Reference: Ch. 1: The Cardiovascular System — Left Heart
Failure
Question Stem: A patient with chronic ischemic heart disease
develops acute pulmonary edema. Which immediate nursing
priority addresses the primary pathophysiologic mechanism
causing dyspnea?
A. Raise the HOB and administer oxygen to decrease work of
breathing
B. Administer IV furosemide to reduce preload and pulmonary
congestion
C. Start IV norepinephrine to increase systemic vascular
resistance
D. Give a beta-blocker to decrease myocardial oxygen demand
Correct Answer: B
Rationales:
• Correct (B): In left heart failure, elevated left-sided end-
diastolic pressure increases pulmonary capillary
hydrostatic pressure causing edema; IV loop diuretics
rapidly reduce preload and pulmonary congestion — a
pathophysiologic, evidence-based priority.
, • A: Raising HOB and oxygen are appropriate supportive
measures but do not address the core mechanism of fluid
overload in pulmonary edema.
• C: Increasing afterload with norepinephrine would worsen
left ventricular filling pressures and pulmonary edema.
• D: Beta-blockers may be indicated chronically but are not
first-line acute therapy for pulmonary edema and can
depress contractility acutely.
Teaching Point: Acute pulmonary edema requires rapid preload
reduction (loop diuretics) to relieve pulmonary hydrostatic
pressure.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Left Heart Failure; Preload, Afterload, and Treatment
3
Reference: Ch. 1: The Cardiovascular System — Right Heart
Failure
Question Stem: A 55-year-old woman with COPD develops
progressive peripheral edema, hepatomegaly, and elevated JVP.
Which physiologic explanation best links her pulmonary disease
to these signs?
A. COPD causes left ventricular failure, leading to systemic
venous congestion
B. Chronic hypoxic pulmonary vasoconstriction increases
