Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1.
Reference: Ch. 1 — Heart Failure: Left Heart Failure
Question Stem: A 72-year-old man with a history of long-
standing hypertension presents with exertional dyspnea,
orthopnea, and bibasilar crackles. Which hemodynamic change
most directly explains his pulmonary edema?
A. Increased right ventricular afterload
B. Decreased left ventricular preload
C. Increased left ventricular end-diastolic pressure
D. Decreased pulmonary capillary hydrostatic pressure
Correct Answer: C
Rationales
• Correct (C): Elevated left ventricular end-diastolic pressure
raises left atrial and pulmonary venous pressures,
, increasing pulmonary capillary hydrostatic pressure and
causing transudation of fluid—mechanism underlying
pulmonary edema in left-sided failure (Berkowitz).
• A: Increased RV afterload causes right-sided strain and
systemic venous congestion, not primary pulmonary
edema from LV failure.
• B: Decreased LV preload would lower filling pressures and
reduce, not increase, pulmonary congestion.
• D: Decreased pulmonary capillary hydrostatic pressure
would reduce edema; the patient has increased pressure.
Teaching Point: Left ventricular failure raises pulmonary venous
pressure, producing pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Left Heart Failure
2.
Reference: Ch. 1 — Heart Failure: Right Heart Failure
Question Stem: A patient with chronic COPD develops
progressive peripheral edema, JVD, and hepatomegaly. Which
physiologic mechanism best explains his symptoms?
A. Left ventricular systolic dysfunction causing increased
pulmonary capillary wedge pressure
B. Elevated right atrial pressure leading to systemic venous
congestion
,C. Decreased systemic vascular resistance producing capillary
leakage
D. Increased lymphatic drainage preventing interstitial fluid
accumulation
Correct Answer: B
Rationales
• Correct (B): Right ventricular dysfunction or failure
elevates right atrial pressure, transmitting back to systemic
veins and causing peripheral edema, jugular venous
distention, and congestive hepatomegaly.
• A: LV systolic dysfunction causes pulmonary symptoms and
may secondarily affect the right heart, but the primary
mechanism for systemic edema is elevated right-sided
pressures.
• C: Decreased systemic vascular resistance does not
primarily cause the cohesive systemic venous congestion
seen here.
• D: Increased lymphatic drainage would reduce edema,
opposite to this patient’s presentation.
Teaching Point: Right-sided failure causes systemic venous
congestion and peripheral edema.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Right Heart Failure
, 3.
Reference: Ch. 1 — Symptoms and Signs of Heart Failure
Question Stem: A nurse assessing a patient with new-onset
heart failure documents orthopnea and paroxysmal nocturnal
dyspnea (PND). What physiologic change best explains PND in
heart failure?
A. Increased sympathetic activity during sleep
B. Redistribution of peripheral edema into the pulmonary
circulation when supine
C. Nocturnal bronchoconstriction unrelated to cardiac function
D. Decreased renal perfusion causing nocturnal polyuria
Correct Answer: B
Rationales
• Correct (B): When the patient lies flat, dependent edema
redistributes centrally, increasing venous return and
pulmonary capillary pressure, provoking PND and
orthopnea.
• A: Sympathetic activity may change but does not directly
explain orthopnea/PND due to fluid redistribution.
• C: Bronchoconstriction is pulmonary/airway etiologies
(e.g., asthma) and unlikely the primary cause in heart
failure.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1.
Reference: Ch. 1 — Heart Failure: Left Heart Failure
Question Stem: A 72-year-old man with a history of long-
standing hypertension presents with exertional dyspnea,
orthopnea, and bibasilar crackles. Which hemodynamic change
most directly explains his pulmonary edema?
A. Increased right ventricular afterload
B. Decreased left ventricular preload
C. Increased left ventricular end-diastolic pressure
D. Decreased pulmonary capillary hydrostatic pressure
Correct Answer: C
Rationales
• Correct (C): Elevated left ventricular end-diastolic pressure
raises left atrial and pulmonary venous pressures,
, increasing pulmonary capillary hydrostatic pressure and
causing transudation of fluid—mechanism underlying
pulmonary edema in left-sided failure (Berkowitz).
• A: Increased RV afterload causes right-sided strain and
systemic venous congestion, not primary pulmonary
edema from LV failure.
• B: Decreased LV preload would lower filling pressures and
reduce, not increase, pulmonary congestion.
• D: Decreased pulmonary capillary hydrostatic pressure
would reduce edema; the patient has increased pressure.
Teaching Point: Left ventricular failure raises pulmonary venous
pressure, producing pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Left Heart Failure
2.
Reference: Ch. 1 — Heart Failure: Right Heart Failure
Question Stem: A patient with chronic COPD develops
progressive peripheral edema, JVD, and hepatomegaly. Which
physiologic mechanism best explains his symptoms?
A. Left ventricular systolic dysfunction causing increased
pulmonary capillary wedge pressure
B. Elevated right atrial pressure leading to systemic venous
congestion
,C. Decreased systemic vascular resistance producing capillary
leakage
D. Increased lymphatic drainage preventing interstitial fluid
accumulation
Correct Answer: B
Rationales
• Correct (B): Right ventricular dysfunction or failure
elevates right atrial pressure, transmitting back to systemic
veins and causing peripheral edema, jugular venous
distention, and congestive hepatomegaly.
• A: LV systolic dysfunction causes pulmonary symptoms and
may secondarily affect the right heart, but the primary
mechanism for systemic edema is elevated right-sided
pressures.
• C: Decreased systemic vascular resistance does not
primarily cause the cohesive systemic venous congestion
seen here.
• D: Increased lymphatic drainage would reduce edema,
opposite to this patient’s presentation.
Teaching Point: Right-sided failure causes systemic venous
congestion and peripheral edema.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Right Heart Failure
, 3.
Reference: Ch. 1 — Symptoms and Signs of Heart Failure
Question Stem: A nurse assessing a patient with new-onset
heart failure documents orthopnea and paroxysmal nocturnal
dyspnea (PND). What physiologic change best explains PND in
heart failure?
A. Increased sympathetic activity during sleep
B. Redistribution of peripheral edema into the pulmonary
circulation when supine
C. Nocturnal bronchoconstriction unrelated to cardiac function
D. Decreased renal perfusion causing nocturnal polyuria
Correct Answer: B
Rationales
• Correct (B): When the patient lies flat, dependent edema
redistributes centrally, increasing venous return and
pulmonary capillary pressure, provoking PND and
orthopnea.
• A: Sympathetic activity may change but does not directly
explain orthopnea/PND due to fluid redistribution.
• C: Bronchoconstriction is pulmonary/airway etiologies
(e.g., asthma) and unlikely the primary cause in heart
failure.
