Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Q1
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure
Stem: A 68-year-old man with long-standing hypertension
presents with dyspnea on exertion, orthopnea, and bibasilar
crackles. His chest X-ray shows pulmonary vascular congestion.
Which pathophysiologic explanation best accounts for his
orthopnea and pulmonary crackles?
A. Right ventricular failure causing systemic venous congestion
and pulmonary interstitial edema
B. Left ventricular systolic or diastolic dysfunction causing
,elevated left atrial and pulmonary capillary hydrostatic pressure
C. Chronic bronchitis with mucus plugging causing localized
alveolar collapse and crackles
D. Pulmonary embolism causing acute pulmonary infarction and
basilar crackles
Correct Answer: B
Rationales:
• Correct (B): Left ventricular dysfunction elevates left
ventricular end-diastolic pressure; this transmits to the left
atrium and pulmonary veins, increasing pulmonary
capillary hydrostatic pressure → interstitial and alveolar
edema, causing orthopnea and crackles. This reflects
backward failure described by Berkowitz.
• A: Right ventricular failure primarily causes systemic
venous congestion (JVD, peripheral edema), not
pulmonary vascular congestion or orthopnea.
• C: Chronic bronchitis causes wheeze and productive cough
more than diffuse pulmonary vascular congestion; crackles
from cardiogenic edema are bilateral and associated with
orthopnea.
• D: Pulmonary embolism typically causes sudden pleuritic
pain and focal findings; chest X-ray more often normal or
focal; not progressive orthopnea.
Teaching Point: Left ventricular failure raises pulmonary
hydrostatic pressure causing cardiogenic pulmonary edema.
,Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure
Q2
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Right Heart
Failure
Stem: A 55-year-old woman with COPD develops progressive
peripheral edema, hepatomegaly, and jugular venous
distention. Which mechanism best explains her signs?
A. Left heart failure with pulmonary congestion only
B. Right heart failure from increased pulmonary vascular
resistance leading to systemic venous congestion
C. Hypoalbuminemia causing reduced plasma oncotic pressure
with dependent edema
D. Portal hypertension unrelated to cardiac function
Correct Answer: B
Rationales:
• Correct (B): Chronic lung disease raises pulmonary vascular
resistance (cor pulmonale), causing right ventricular strain
and failure. Right failure causes systemic venous
congestion → JVD, hepatomegaly, and dependent edema.
Berkowitz emphasizes the link between pulmonary
vascular load and right heart failure.
, • A: Left heart failure causes pulmonary symptoms primarily;
systemic venous congestion is a hallmark of right failure.
• C: Hypoalbuminemia can cause edema but would not
explain JVD and hepatomegaly as primary findings.
• D: Portal hypertension can cause hepatomegaly/ascites
but not the prominent JVD and peripheral venous
congestion pattern associated with right heart failure.
Teaching Point: Right ventricular failure causes systemic venous
congestion: JVD, hepatomegaly, peripheral edema.
Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Right Heart
Failure
Q3
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Stem: A patient with chronic heart failure is started on an ACE
inhibitor. Which hemodynamic effect most directly explains the
ACE inhibitor’s benefit in heart failure?
A. Increased preload via sodium and water retention
B. Reduced afterload by decreasing systemic vascular resistance
C. Increased heart rate by stimulating sympathetic tone
D. Direct increase in myocardial contractility (inotropy)
Correct Answer: B
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Q1
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure
Stem: A 68-year-old man with long-standing hypertension
presents with dyspnea on exertion, orthopnea, and bibasilar
crackles. His chest X-ray shows pulmonary vascular congestion.
Which pathophysiologic explanation best accounts for his
orthopnea and pulmonary crackles?
A. Right ventricular failure causing systemic venous congestion
and pulmonary interstitial edema
B. Left ventricular systolic or diastolic dysfunction causing
,elevated left atrial and pulmonary capillary hydrostatic pressure
C. Chronic bronchitis with mucus plugging causing localized
alveolar collapse and crackles
D. Pulmonary embolism causing acute pulmonary infarction and
basilar crackles
Correct Answer: B
Rationales:
• Correct (B): Left ventricular dysfunction elevates left
ventricular end-diastolic pressure; this transmits to the left
atrium and pulmonary veins, increasing pulmonary
capillary hydrostatic pressure → interstitial and alveolar
edema, causing orthopnea and crackles. This reflects
backward failure described by Berkowitz.
• A: Right ventricular failure primarily causes systemic
venous congestion (JVD, peripheral edema), not
pulmonary vascular congestion or orthopnea.
• C: Chronic bronchitis causes wheeze and productive cough
more than diffuse pulmonary vascular congestion; crackles
from cardiogenic edema are bilateral and associated with
orthopnea.
• D: Pulmonary embolism typically causes sudden pleuritic
pain and focal findings; chest X-ray more often normal or
focal; not progressive orthopnea.
Teaching Point: Left ventricular failure raises pulmonary
hydrostatic pressure causing cardiogenic pulmonary edema.
,Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure
Q2
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Right Heart
Failure
Stem: A 55-year-old woman with COPD develops progressive
peripheral edema, hepatomegaly, and jugular venous
distention. Which mechanism best explains her signs?
A. Left heart failure with pulmonary congestion only
B. Right heart failure from increased pulmonary vascular
resistance leading to systemic venous congestion
C. Hypoalbuminemia causing reduced plasma oncotic pressure
with dependent edema
D. Portal hypertension unrelated to cardiac function
Correct Answer: B
Rationales:
• Correct (B): Chronic lung disease raises pulmonary vascular
resistance (cor pulmonale), causing right ventricular strain
and failure. Right failure causes systemic venous
congestion → JVD, hepatomegaly, and dependent edema.
Berkowitz emphasizes the link between pulmonary
vascular load and right heart failure.
, • A: Left heart failure causes pulmonary symptoms primarily;
systemic venous congestion is a hallmark of right failure.
• C: Hypoalbuminemia can cause edema but would not
explain JVD and hepatomegaly as primary findings.
• D: Portal hypertension can cause hepatomegaly/ascites
but not the prominent JVD and peripheral venous
congestion pattern associated with right heart failure.
Teaching Point: Right ventricular failure causes systemic venous
congestion: JVD, hepatomegaly, peripheral edema.
Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Right Heart
Failure
Q3
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Stem: A patient with chronic heart failure is started on an ACE
inhibitor. Which hemodynamic effect most directly explains the
ACE inhibitor’s benefit in heart failure?
A. Increased preload via sodium and water retention
B. Reduced afterload by decreasing systemic vascular resistance
C. Increased heart rate by stimulating sympathetic tone
D. Direct increase in myocardial contractility (inotropy)
Correct Answer: B
