Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Reference: Berkowitz, 2023, Ch. 1: Left Heart Failure —
Symptoms and Signs of Heart Failure
Question Stem: A 68-year-old woman with ischemic
cardiomyopathy arrives with progressive dyspnea, orthopnea,
pink frothy sputum, and bibasilar crackles. Which
pathophysiologic explanation best accounts for her symptoms?
A. Right ventricular failure causing systemic venous congestion
and hepatic enlargement
B. Elevated left ventricular end-diastolic pressure causing
pulmonary capillary transudation and edema
C. Decreased oncotic pressure from hypoalbuminemia causing
,pulmonary interstitial fluid accumulation
D. Primary pulmonary pathology with alveolar capillary
destruction causing noncardiogenic pulmonary edema
Correct Answer: B
Rationales:
• Correct (B): Left ventricular systolic dysfunction raises left
ventricular end-diastolic pressure, which is transmitted to
pulmonary veins and capillaries, leading to increased
hydrostatic pressure, transudation of fluid into alveoli
(pulmonary edema), and the described symptoms.
• Incorrect (A): Right ventricular failure produces systemic
venous signs (JVD, hepatomegaly, peripheral edema), not
the pulmonary edema and frothy sputum seen here.
• Incorrect (C): Hypoalbuminemia lowers plasma oncotic
pressure globally and usually causes peripheral/anasarca
rather than acute pulmonary edema with pink frothy
sputum.
• Incorrect (D): Noncardiogenic pulmonary edema (e.g.,
ARDS) results from increased permeability; the
combination of orthopnea and known cardiomyopathy
favors cardiogenic mechanism.
Teaching Point: Left ventricular failure causes pulmonary
edema via increased pulmonary capillary hydrostatic pressure.
Citation: Berkowitz, A. (2023). Ch. 1: Left Heart Failure.
,2
Reference: Berkowitz, 2023, Ch. 1: Right Heart Failure — Signs
and Hemodynamics
Question Stem: A patient with chronic COPD presents with
increasing peripheral edema, jugular venous distention, and
hepatic congestion. Which mechanism most likely explains
these findings?
A. Left atrial pressure elevation causing pulmonary edema and
secondary systemic congestion
B. Chronic right ventricular pressure overload producing
systemic venous hypertension and organ congestion
C. Hypoalbuminemia from malnutrition producing low oncotic
pressure and generalized edema
D. Acute volume overload from renal failure causing isolated
pulmonary congestion
Correct Answer: B
Rationales:
• Correct (B): Chronic pulmonary disease can increase
pulmonary vascular resistance, producing right ventricular
pressure overload and dilation; right-sided failure raises
systemic venous pressure, causing JVD, hepatomegaly, and
peripheral edema.
, • Incorrect (A): Elevated left atrial pressure primarily causes
pulmonary congestion, not the prominent systemic venous
signs described.
• Incorrect (C): Hypoalbuminemia causes generalized edema
but does not explain JVD and hepatic congestion as
specifically as right-sided failure.
• Incorrect (D): Acute renal volume overload more
commonly produces pulmonary congestion first if left-
sided pressures rise; isolated systemic venous signs point
to RV dysfunction.
Teaching Point: Right ventricular failure produces systemic
venous hypertension with JVD, hepatomegaly, and peripheral
edema.
Citation: Berkowitz, A. (2023). Ch. 1: Right Heart Failure.
3
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question Stem: A patient with acute decompensated heart
failure (pulmonary edema) is started on intravenous
nitroprusside and loop diuretics. Which immediate
hemodynamic effect most contributes to improvement in
pulmonary congestion?
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Reference: Berkowitz, 2023, Ch. 1: Left Heart Failure —
Symptoms and Signs of Heart Failure
Question Stem: A 68-year-old woman with ischemic
cardiomyopathy arrives with progressive dyspnea, orthopnea,
pink frothy sputum, and bibasilar crackles. Which
pathophysiologic explanation best accounts for her symptoms?
A. Right ventricular failure causing systemic venous congestion
and hepatic enlargement
B. Elevated left ventricular end-diastolic pressure causing
pulmonary capillary transudation and edema
C. Decreased oncotic pressure from hypoalbuminemia causing
,pulmonary interstitial fluid accumulation
D. Primary pulmonary pathology with alveolar capillary
destruction causing noncardiogenic pulmonary edema
Correct Answer: B
Rationales:
• Correct (B): Left ventricular systolic dysfunction raises left
ventricular end-diastolic pressure, which is transmitted to
pulmonary veins and capillaries, leading to increased
hydrostatic pressure, transudation of fluid into alveoli
(pulmonary edema), and the described symptoms.
• Incorrect (A): Right ventricular failure produces systemic
venous signs (JVD, hepatomegaly, peripheral edema), not
the pulmonary edema and frothy sputum seen here.
• Incorrect (C): Hypoalbuminemia lowers plasma oncotic
pressure globally and usually causes peripheral/anasarca
rather than acute pulmonary edema with pink frothy
sputum.
• Incorrect (D): Noncardiogenic pulmonary edema (e.g.,
ARDS) results from increased permeability; the
combination of orthopnea and known cardiomyopathy
favors cardiogenic mechanism.
Teaching Point: Left ventricular failure causes pulmonary
edema via increased pulmonary capillary hydrostatic pressure.
Citation: Berkowitz, A. (2023). Ch. 1: Left Heart Failure.
,2
Reference: Berkowitz, 2023, Ch. 1: Right Heart Failure — Signs
and Hemodynamics
Question Stem: A patient with chronic COPD presents with
increasing peripheral edema, jugular venous distention, and
hepatic congestion. Which mechanism most likely explains
these findings?
A. Left atrial pressure elevation causing pulmonary edema and
secondary systemic congestion
B. Chronic right ventricular pressure overload producing
systemic venous hypertension and organ congestion
C. Hypoalbuminemia from malnutrition producing low oncotic
pressure and generalized edema
D. Acute volume overload from renal failure causing isolated
pulmonary congestion
Correct Answer: B
Rationales:
• Correct (B): Chronic pulmonary disease can increase
pulmonary vascular resistance, producing right ventricular
pressure overload and dilation; right-sided failure raises
systemic venous pressure, causing JVD, hepatomegaly, and
peripheral edema.
, • Incorrect (A): Elevated left atrial pressure primarily causes
pulmonary congestion, not the prominent systemic venous
signs described.
• Incorrect (C): Hypoalbuminemia causes generalized edema
but does not explain JVD and hepatic congestion as
specifically as right-sided failure.
• Incorrect (D): Acute renal volume overload more
commonly produces pulmonary congestion first if left-
sided pressures rise; isolated systemic venous signs point
to RV dysfunction.
Teaching Point: Right ventricular failure produces systemic
venous hypertension with JVD, hepatomegaly, and peripheral
edema.
Citation: Berkowitz, A. (2023). Ch. 1: Right Heart Failure.
3
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question Stem: A patient with acute decompensated heart
failure (pulmonary edema) is started on intravenous
nitroprusside and loop diuretics. Which immediate
hemodynamic effect most contributes to improvement in
pulmonary congestion?
