Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1.
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure / Preload & Afterload
Question Stem: A 72-year-old with chronic left-sided systolic
heart failure presents with acute orthopnea and pink, frothy
sputum. Which intervention most directly reduces pulmonary
capillary hydrostatic pressure and rapidly improves pulmonary
edema?
A. Start IV dobutamine infusion.
B. Give IV loop diuretic (furosemide).
,C. Initiate oral ACE inhibitor (lisinopril).
D. Give a bolus of IV normal saline.
Correct Answer: B
Rationales:
• Correct (B): IV loop diuretics rapidly reduce intravascular
volume and left ventricular preload, lowering pulmonary
capillary hydrostatic pressure and relieving pulmonary
edema — a primary acute management described by
Berkowitz.
• A: Dobutamine increases inotropy and may help perfusion
in cardiogenic shock but does not promptly reduce
pulmonary capillary hydrostatic pressure.
• C: ACE inhibitors reduce afterload and improve long-term
remodeling but act more slowly and are not first-line for
acute pulmonary edema relief.
• D: IV saline increases intravascular volume and worsens
pulmonary capillary hydrostatic pressure and edema.
Teaching Point: Reduce preload (diuretics) to relieve acute
pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure / Preload,
Afterload, and Treatment of Heart Failure
2.
,Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Right Heart
Failure / Signs and Symptoms
Question Stem: A patient with long-standing COPD develops
progressive peripheral edema, jugular venous distension, and
hepatomegaly. Which sign best differentiates right heart failure
from isolated left heart failure?
A. Pulmonary crackles on auscultation.
B. Elevated jugular venous pressure with hepatomegaly.
C. Orthopnea and paroxysmal nocturnal dyspnea.
D. Pink, frothy sputum.
Correct Answer: B
Rationales:
• Correct (B): Right heart failure causes systemic venous
congestion; elevated JVP and hepatic congestion
(hepatomegaly) are classic distinguishing features.
• A: Pulmonary crackles are more indicative of left-sided
failure and pulmonary edema.
• C: Orthopnea and PND are symptoms of left ventricular
failure causing pulmonary congestion.
• D: Pink, frothy sputum is a feature of acute pulmonary
edema from left heart failure.
Teaching Point: JVD and hepatomegaly indicate systemic
venous congestion from right heart failure.
, Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure / Symptoms
and Signs of Heart Failure
3.
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question Stem: A patient with chronic systolic heart failure
(reduced EF) requires therapy to decrease left ventricular
afterload and improve forward stroke volume. Which
medication class primarily reduces afterload?
A. Loop diuretics.
B. ACE inhibitors.
C. Beta-blockers.
D. Digitalis (digoxin).
Correct Answer: B
Rationales:
• Correct (B): ACE inhibitors lower systemic vascular
resistance (afterload), improving forward cardiac output
and reducing myocardial wall stress — a core mechanism
in HF therapy.
• A: Loop diuretics reduce preload by removing volume, but
have minimal direct effect on afterload.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1.
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure / Preload & Afterload
Question Stem: A 72-year-old with chronic left-sided systolic
heart failure presents with acute orthopnea and pink, frothy
sputum. Which intervention most directly reduces pulmonary
capillary hydrostatic pressure and rapidly improves pulmonary
edema?
A. Start IV dobutamine infusion.
B. Give IV loop diuretic (furosemide).
,C. Initiate oral ACE inhibitor (lisinopril).
D. Give a bolus of IV normal saline.
Correct Answer: B
Rationales:
• Correct (B): IV loop diuretics rapidly reduce intravascular
volume and left ventricular preload, lowering pulmonary
capillary hydrostatic pressure and relieving pulmonary
edema — a primary acute management described by
Berkowitz.
• A: Dobutamine increases inotropy and may help perfusion
in cardiogenic shock but does not promptly reduce
pulmonary capillary hydrostatic pressure.
• C: ACE inhibitors reduce afterload and improve long-term
remodeling but act more slowly and are not first-line for
acute pulmonary edema relief.
• D: IV saline increases intravascular volume and worsens
pulmonary capillary hydrostatic pressure and edema.
Teaching Point: Reduce preload (diuretics) to relieve acute
pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure / Preload,
Afterload, and Treatment of Heart Failure
2.
,Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Right Heart
Failure / Signs and Symptoms
Question Stem: A patient with long-standing COPD develops
progressive peripheral edema, jugular venous distension, and
hepatomegaly. Which sign best differentiates right heart failure
from isolated left heart failure?
A. Pulmonary crackles on auscultation.
B. Elevated jugular venous pressure with hepatomegaly.
C. Orthopnea and paroxysmal nocturnal dyspnea.
D. Pink, frothy sputum.
Correct Answer: B
Rationales:
• Correct (B): Right heart failure causes systemic venous
congestion; elevated JVP and hepatic congestion
(hepatomegaly) are classic distinguishing features.
• A: Pulmonary crackles are more indicative of left-sided
failure and pulmonary edema.
• C: Orthopnea and PND are symptoms of left ventricular
failure causing pulmonary congestion.
• D: Pink, frothy sputum is a feature of acute pulmonary
edema from left heart failure.
Teaching Point: JVD and hepatomegaly indicate systemic
venous congestion from right heart failure.
, Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure / Symptoms
and Signs of Heart Failure
3.
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question Stem: A patient with chronic systolic heart failure
(reduced EF) requires therapy to decrease left ventricular
afterload and improve forward stroke volume. Which
medication class primarily reduces afterload?
A. Loop diuretics.
B. ACE inhibitors.
C. Beta-blockers.
D. Digitalis (digoxin).
Correct Answer: B
Rationales:
• Correct (B): ACE inhibitors lower systemic vascular
resistance (afterload), improving forward cardiac output
and reducing myocardial wall stress — a core mechanism
in HF therapy.
• A: Loop diuretics reduce preload by removing volume, but
have minimal direct effect on afterload.
