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 / Symptoms
& Signs
Stem: A 72-year-old man with chronic ischemic cardiomyopathy
presents with increasing dyspnea, orthopnea, bibasilar crackles,
and an S3 gallop. Which pathophysiologic change best explains
his pulmonary edema?
A. Elevated right atrial pressure causing systemic venous
congestion
B. Increased left ventricular end-diastolic pressure leading to
pulmonary venous congestion
C. Decreased pulmonary vascular resistance causing increased
pulmonary capillary pressure
D. Primary pulmonary capillary leak from infection
,Correct Answer: B
Rationale (correct): In left heart failure the failing left ventricle
cannot pump forward, raising left ventricular end-diastolic
pressure (LVEDP). Elevated LVEDP transmits back into
pulmonary veins and capillaries, causing pulmonary congestion
and edema. Berkowitz emphasizes backward failure of the left
heart as the driver of pulmonary signs.
Option A (incorrect): Right atrial pressure elevation causes
systemic venous congestion (peripheral edema, liver
congestion), not pulmonary edema.
Option C (incorrect): Decreased pulmonary vascular resistance
would lower pulmonary capillary pressure, not increase it.
Option D (incorrect): Primary capillary leak from infection
(ARDS) is a different mechanism and typically presents with
inflammatory signs and bilateral infiltrates unrelated to LV
dysfunction.
Teaching point: Left ventricular failure raises LVEDP →
pulmonary venous congestion → pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure & Symptoms.
2
Reference: Ch. 1 — Heart Failure: Right Heart Failure / Signs
Stem: A patient with known chronic obstructive pulmonary
disease (COPD) develops progressive peripheral edema, jugular
,venous distention, and hepatomegaly. Which statement best
describes the mechanism of his findings?
A. Left ventricular failure is causing backwards transmission into
the systemic veins
B. Right ventricular failure raises systemic venous pressure
producing peripheral edema and hepatic congestion
C. Decreased oncotic pressure from hypoalbuminemia explains
the swelling
D. Pulmonary embolism decreases right ventricular afterload
causing edema
Correct Answer: B
Rationale (correct): Right ventricular failure increases systemic
venous (right-sided) pressures; raised venous pressure leads to
peripheral edema and hepatic congestion. In COPD, chronic
pulmonary hypertension (cor pulmonale) commonly causes
right HF.
Option A (incorrect): Left ventricular failure affects pulmonary,
not systemic venous, pressures primarily.
Option C (incorrect): Hypoalbuminemia causes generalized
edema but would not explain JVD and hepatomegaly
specifically.
Option D (incorrect): Pulmonary embolism increases RV
afterload (not decreases it) and can precipitate RV failure but
the described chronic picture fits cor pulmonale more closely.
, Teaching point: Right HF produces systemic venous congestion:
JVD, hepatomegaly, peripheral edema.
Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure.
3
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
Stem: A 65-year-old patient with chronic systolic heart failure
and hypertension is started on an agent to reduce afterload and
improve forward cardiac output. Which medication class most
directly reduces afterload?
A. Loop diuretics (e.g., furosemide)
B. ACE inhibitors (e.g., lisinopril)
C. Digoxin
D. Inotropic beta-agonists (e.g., dobutamine)
Correct Answer: B
Rationale (correct): ACE inhibitors reduce systemic vascular
resistance by blocking angiotensin II–mediated
vasoconstriction, thereby lowering afterload and improving
forward stroke volume in systolic HF. Berkowitz discusses ACE
inhibitors as afterload-reducing agents that improve cardiac
output and remodeling.
Option A (incorrect): Loop diuretics primarily reduce preload by
decreasing intravascular volume, not systemic vascular
resistance.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1 — Heart Failure: Left Heart Failure / Symptoms
& Signs
Stem: A 72-year-old man with chronic ischemic cardiomyopathy
presents with increasing dyspnea, orthopnea, bibasilar crackles,
and an S3 gallop. Which pathophysiologic change best explains
his pulmonary edema?
A. Elevated right atrial pressure causing systemic venous
congestion
B. Increased left ventricular end-diastolic pressure leading to
pulmonary venous congestion
C. Decreased pulmonary vascular resistance causing increased
pulmonary capillary pressure
D. Primary pulmonary capillary leak from infection
,Correct Answer: B
Rationale (correct): In left heart failure the failing left ventricle
cannot pump forward, raising left ventricular end-diastolic
pressure (LVEDP). Elevated LVEDP transmits back into
pulmonary veins and capillaries, causing pulmonary congestion
and edema. Berkowitz emphasizes backward failure of the left
heart as the driver of pulmonary signs.
Option A (incorrect): Right atrial pressure elevation causes
systemic venous congestion (peripheral edema, liver
congestion), not pulmonary edema.
Option C (incorrect): Decreased pulmonary vascular resistance
would lower pulmonary capillary pressure, not increase it.
Option D (incorrect): Primary capillary leak from infection
(ARDS) is a different mechanism and typically presents with
inflammatory signs and bilateral infiltrates unrelated to LV
dysfunction.
Teaching point: Left ventricular failure raises LVEDP →
pulmonary venous congestion → pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure & Symptoms.
2
Reference: Ch. 1 — Heart Failure: Right Heart Failure / Signs
Stem: A patient with known chronic obstructive pulmonary
disease (COPD) develops progressive peripheral edema, jugular
,venous distention, and hepatomegaly. Which statement best
describes the mechanism of his findings?
A. Left ventricular failure is causing backwards transmission into
the systemic veins
B. Right ventricular failure raises systemic venous pressure
producing peripheral edema and hepatic congestion
C. Decreased oncotic pressure from hypoalbuminemia explains
the swelling
D. Pulmonary embolism decreases right ventricular afterload
causing edema
Correct Answer: B
Rationale (correct): Right ventricular failure increases systemic
venous (right-sided) pressures; raised venous pressure leads to
peripheral edema and hepatic congestion. In COPD, chronic
pulmonary hypertension (cor pulmonale) commonly causes
right HF.
Option A (incorrect): Left ventricular failure affects pulmonary,
not systemic venous, pressures primarily.
Option C (incorrect): Hypoalbuminemia causes generalized
edema but would not explain JVD and hepatomegaly
specifically.
Option D (incorrect): Pulmonary embolism increases RV
afterload (not decreases it) and can precipitate RV failure but
the described chronic picture fits cor pulmonale more closely.
, Teaching point: Right HF produces systemic venous congestion:
JVD, hepatomegaly, peripheral edema.
Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure.
3
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
Stem: A 65-year-old patient with chronic systolic heart failure
and hypertension is started on an agent to reduce afterload and
improve forward cardiac output. Which medication class most
directly reduces afterload?
A. Loop diuretics (e.g., furosemide)
B. ACE inhibitors (e.g., lisinopril)
C. Digoxin
D. Inotropic beta-agonists (e.g., dobutamine)
Correct Answer: B
Rationale (correct): ACE inhibitors reduce systemic vascular
resistance by blocking angiotensin II–mediated
vasoconstriction, thereby lowering afterload and improving
forward stroke volume in systolic HF. Berkowitz discusses ACE
inhibitors as afterload-reducing agents that improve cardiac
output and remodeling.
Option A (incorrect): Loop diuretics primarily reduce preload by
decreasing intravascular volume, not systemic vascular
resistance.
