Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Question 1
Reference: Ch. 1 — Heart Failure: Left Heart Failure (Anatomical
overview; Left vs. Right HF)
Question stem: A 68-year-old man with long-standing
hypertension reports progressive dyspnea on exertion and
orthopnea. Auscultation reveals bibasilar crackles and an S3
gallop. Which physiologic change best explains his orthopnea?
A. Decreased pulmonary capillary hydrostatic pressure when
supine
B. Increased venous return to the left heart while recumbent
C. Reduced left atrial preload while lying flat
D. Decreased pulmonary interstitial fluid due to improved
lymphatic drainage
,Correct answer: B
Rationales:
• Correct (B): Lying flat increases venous return to the left
heart, which in LV failure raises pulmonary capillary
hydrostatic pressure and promotes pulmonary edema,
causing orthopnea. (Mechanism: failing LV cannot
accommodate increased preload.)
• Incorrect (A): Pulmonary capillary hydrostatic pressure
increases — not decreases — when venous return rises in
LV dysfunction.
• Incorrect (C): Left atrial preload increases, not reduces,
when supine and venous return rises.
• Incorrect (D): Lymphatic drainage does not improve
enough to offset increased hydrostatic forces in LV failure.
Teaching point: Orthopnea arises from increased venous return
overwhelming a failing left ventricle.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure
Question 2
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
,Question stem: A patient with chronic systolic heart failure is
prescribed an ACE inhibitor. Which primary hemodynamic effect
explains the drug’s benefit in systolic HF?
A. Increased preload via sodium retention
B. Decreased afterload by reducing systemic vascular resistance
C. Increased heart rate through sympathetic activation
D. Direct increase in myocardial contractility
Correct answer: B
Rationales:
• Correct (B): ACE inhibitors reduce angiotensin II–mediated
vasoconstriction, lowering systemic vascular resistance and
afterload, which decreases LV work and improves forward
cardiac output in systolic HF.
• Incorrect (A): ACE inhibitors typically reduce aldosterone
effects over time and do not increase preload via sodium
retention.
• Incorrect (C): They usually blunt, not increase, maladaptive
neurohormonal activation; tachycardia is not the primary
mechanism.
• Incorrect (D): ACE inhibitors do not directly increase
myocardial contractility.
Teaching point: Lowering afterload reduces LV work and
improves forward flow in systolic heart failure.
, Citation: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question 3
Reference: Ch. 1 — Right Heart Failure; The Kidneys in Heart
Failure
Question stem: A patient with right-sided heart failure has
jugular venous distention, hepatomegaly, and dependent
edema. Which renal/perfusion change most directly contributes
to volume overload in right HF?
A. Increased renal perfusion pressure and natriuresis
B. Decreased renal venous pressure and enhanced GFR
C. Elevated renal venous pressure causing reduced effective
filtration
D. Reduced aldosterone secretion and diminished sodium
retention
Correct answer: C
Rationales:
• Correct (C): Right HF raises central and renal venous
pressures, which reduces effective glomerular filtration
and promotes sodium and water retention, worsening
systemic volume overload.
• Incorrect (A): Renal perfusion pressure is effectively
reduced and natriuresis decreases in HF.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Question 1
Reference: Ch. 1 — Heart Failure: Left Heart Failure (Anatomical
overview; Left vs. Right HF)
Question stem: A 68-year-old man with long-standing
hypertension reports progressive dyspnea on exertion and
orthopnea. Auscultation reveals bibasilar crackles and an S3
gallop. Which physiologic change best explains his orthopnea?
A. Decreased pulmonary capillary hydrostatic pressure when
supine
B. Increased venous return to the left heart while recumbent
C. Reduced left atrial preload while lying flat
D. Decreased pulmonary interstitial fluid due to improved
lymphatic drainage
,Correct answer: B
Rationales:
• Correct (B): Lying flat increases venous return to the left
heart, which in LV failure raises pulmonary capillary
hydrostatic pressure and promotes pulmonary edema,
causing orthopnea. (Mechanism: failing LV cannot
accommodate increased preload.)
• Incorrect (A): Pulmonary capillary hydrostatic pressure
increases — not decreases — when venous return rises in
LV dysfunction.
• Incorrect (C): Left atrial preload increases, not reduces,
when supine and venous return rises.
• Incorrect (D): Lymphatic drainage does not improve
enough to offset increased hydrostatic forces in LV failure.
Teaching point: Orthopnea arises from increased venous return
overwhelming a failing left ventricle.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure
Question 2
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
,Question stem: A patient with chronic systolic heart failure is
prescribed an ACE inhibitor. Which primary hemodynamic effect
explains the drug’s benefit in systolic HF?
A. Increased preload via sodium retention
B. Decreased afterload by reducing systemic vascular resistance
C. Increased heart rate through sympathetic activation
D. Direct increase in myocardial contractility
Correct answer: B
Rationales:
• Correct (B): ACE inhibitors reduce angiotensin II–mediated
vasoconstriction, lowering systemic vascular resistance and
afterload, which decreases LV work and improves forward
cardiac output in systolic HF.
• Incorrect (A): ACE inhibitors typically reduce aldosterone
effects over time and do not increase preload via sodium
retention.
• Incorrect (C): They usually blunt, not increase, maladaptive
neurohormonal activation; tachycardia is not the primary
mechanism.
• Incorrect (D): ACE inhibitors do not directly increase
myocardial contractility.
Teaching point: Lowering afterload reduces LV work and
improves forward flow in systolic heart failure.
, Citation: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question 3
Reference: Ch. 1 — Right Heart Failure; The Kidneys in Heart
Failure
Question stem: A patient with right-sided heart failure has
jugular venous distention, hepatomegaly, and dependent
edema. Which renal/perfusion change most directly contributes
to volume overload in right HF?
A. Increased renal perfusion pressure and natriuresis
B. Decreased renal venous pressure and enhanced GFR
C. Elevated renal venous pressure causing reduced effective
filtration
D. Reduced aldosterone secretion and diminished sodium
retention
Correct answer: C
Rationales:
• Correct (C): Right HF raises central and renal venous
pressures, which reduces effective glomerular filtration
and promotes sodium and water retention, worsening
systemic volume overload.
• Incorrect (A): Renal perfusion pressure is effectively
reduced and natriuresis decreases in HF.
