Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1)
Reference: Ch. 1 — Anatomical Overview: Cardiac Chambers
and Circulation
Question stem: A 68-year-old man with chronic hypertension
reports progressive exertional dyspnea and orthopnea. On
exam he has an S3 gallop and bibasilar crackles. Which
structural change best explains these symptoms?
A. Thickened left ventricular wall with decreased chamber size
B. Dilation of the left ventricle with thin wall and increased
chamber size
C. Right ventricular hypertrophy producing septal shift into left
ventricle
D. Isolated mitral valve stenosis with left atrial enlargement
Correct answer: A
,Rationales:
Correct (A): Longstanding pressure overload (hypertension)
leads to concentric left ventricular hypertrophy — thicker wall,
reduced compliance, elevated LV end-diastolic pressure →
pulmonary congestion, S3/S4, dyspnea (Berkowitz: hypertrophy
physiology).
Incorrect (B): Dilation with thin wall arises from volume
overload or dilated cardiomyopathy, not chronic pressure
overload; presentation would favor forward failure.
Incorrect (C): RV hypertrophy causing septal shift is typical of
pulmonary hypertension and produces different symptoms
(right-sided signs).
Incorrect (D): Mitral stenosis causes exertional dyspnea and LA
enlargement but is less consistent with hypertension history
and LV hypertrophy signs.
Teaching point: Chronic pressure overload → concentric LV
hypertrophy, diastolic dysfunction, pulmonary congestion.
Citation: Berkowitz, 2023, Ch. 1: Anatomical Overview &
Cardiac Hypertrophy
2)
Reference: Ch. 1 — Heart Failure: Left Heart Failure →
Symptoms & Signs
Question stem: A patient with left-sided heart failure has rising
pulmonary capillary wedge pressure and pink, frothy sputum.
,Which immediate nursing intervention most directly reduces
pulmonary capillary hydrostatic pressure?
A. Administer oral ACE inhibitor per schedule
B. Place patient upright with legs dependent
C. Give IV loop diuretic (e.g., furosemide) and monitor urine
output
D. Begin low-flow supplemental oxygen by nasal cannula
Correct answer: C
Rationales:
Correct (C): IV loop diuretics reduce intravascular volume,
lowering left atrial and pulmonary capillary hydrostatic
pressures and rapidly improving pulmonary edema; monitoring
urine output ensures efficacy and safety.
Incorrect (A): ACE inhibitors reduce afterload and remodeling
but act slower and are not the immediate treatment for acute
pulmonary edema.
Incorrect (B): Legs dependent increases venous return and
preload, potentially worsening pulmonary edema; upright
position with feet down may be used for dyspnea but not for
reducing hydrostatic pressure.
Incorrect (D): Oxygen treats hypoxia but does not reduce
pulmonary capillary hydrostatic pressure causing edema.
Teaching point: IV loop diuretics rapidly lower preload and
pulmonary hydrostatic pressure in acute pulmonary edema.
, Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure — Symptoms
and Treatment
3)
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
Question stem: An older adult with chronic heart failure
becomes hypotensive after starting an ACE inhibitor. Which
physiologic effect of ACE inhibitors most likely caused the drop
in blood pressure?
A. Reduction of venous capacitance reducing preload
B. Vasodilation from decreased angiotensin II lowering systemic
vascular resistance
C. Increased heart rate due to reflex sympathetic activation
D. Increased sodium retention increasing intravascular volume
Correct answer: B
Rationales:
Correct (B): ACE inhibitors reduce angiotensin II production
causing arterial vasodilation and decreased systemic vascular
resistance (afterload), which can acutely lower blood pressure.
Incorrect (A): ACE inhibitors primarily reduce arterial resistance;
effects on venous capacitance are less pronounced than arterial
vasodilation.
Incorrect (C): Reflex tachycardia may occur but does not explain
the primary hypotension mechanism.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1)
Reference: Ch. 1 — Anatomical Overview: Cardiac Chambers
and Circulation
Question stem: A 68-year-old man with chronic hypertension
reports progressive exertional dyspnea and orthopnea. On
exam he has an S3 gallop and bibasilar crackles. Which
structural change best explains these symptoms?
A. Thickened left ventricular wall with decreased chamber size
B. Dilation of the left ventricle with thin wall and increased
chamber size
C. Right ventricular hypertrophy producing septal shift into left
ventricle
D. Isolated mitral valve stenosis with left atrial enlargement
Correct answer: A
,Rationales:
Correct (A): Longstanding pressure overload (hypertension)
leads to concentric left ventricular hypertrophy — thicker wall,
reduced compliance, elevated LV end-diastolic pressure →
pulmonary congestion, S3/S4, dyspnea (Berkowitz: hypertrophy
physiology).
Incorrect (B): Dilation with thin wall arises from volume
overload or dilated cardiomyopathy, not chronic pressure
overload; presentation would favor forward failure.
Incorrect (C): RV hypertrophy causing septal shift is typical of
pulmonary hypertension and produces different symptoms
(right-sided signs).
Incorrect (D): Mitral stenosis causes exertional dyspnea and LA
enlargement but is less consistent with hypertension history
and LV hypertrophy signs.
Teaching point: Chronic pressure overload → concentric LV
hypertrophy, diastolic dysfunction, pulmonary congestion.
Citation: Berkowitz, 2023, Ch. 1: Anatomical Overview &
Cardiac Hypertrophy
2)
Reference: Ch. 1 — Heart Failure: Left Heart Failure →
Symptoms & Signs
Question stem: A patient with left-sided heart failure has rising
pulmonary capillary wedge pressure and pink, frothy sputum.
,Which immediate nursing intervention most directly reduces
pulmonary capillary hydrostatic pressure?
A. Administer oral ACE inhibitor per schedule
B. Place patient upright with legs dependent
C. Give IV loop diuretic (e.g., furosemide) and monitor urine
output
D. Begin low-flow supplemental oxygen by nasal cannula
Correct answer: C
Rationales:
Correct (C): IV loop diuretics reduce intravascular volume,
lowering left atrial and pulmonary capillary hydrostatic
pressures and rapidly improving pulmonary edema; monitoring
urine output ensures efficacy and safety.
Incorrect (A): ACE inhibitors reduce afterload and remodeling
but act slower and are not the immediate treatment for acute
pulmonary edema.
Incorrect (B): Legs dependent increases venous return and
preload, potentially worsening pulmonary edema; upright
position with feet down may be used for dyspnea but not for
reducing hydrostatic pressure.
Incorrect (D): Oxygen treats hypoxia but does not reduce
pulmonary capillary hydrostatic pressure causing edema.
Teaching point: IV loop diuretics rapidly lower preload and
pulmonary hydrostatic pressure in acute pulmonary edema.
, Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure — Symptoms
and Treatment
3)
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
Question stem: An older adult with chronic heart failure
becomes hypotensive after starting an ACE inhibitor. Which
physiologic effect of ACE inhibitors most likely caused the drop
in blood pressure?
A. Reduction of venous capacitance reducing preload
B. Vasodilation from decreased angiotensin II lowering systemic
vascular resistance
C. Increased heart rate due to reflex sympathetic activation
D. Increased sodium retention increasing intravascular volume
Correct answer: B
Rationales:
Correct (B): ACE inhibitors reduce angiotensin II production
causing arterial vasodilation and decreased systemic vascular
resistance (afterload), which can acutely lower blood pressure.
Incorrect (A): ACE inhibitors primarily reduce arterial resistance;
effects on venous capacitance are less pronounced than arterial
vasodilation.
Incorrect (C): Reflex tachycardia may occur but does not explain
the primary hypotension mechanism.
