Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1: The Cardiovascular System — Heart Failure
(General)
Stem: A 68-year-old man with chronic ischemic heart disease
reports progressive dyspnea on exertion, orthopnea, and 2+
pitting edema. His BNP is elevated. Which finding most directly
explains his symptoms?
A. Decreased myocardial contractility leading to reduced stroke
volume.
B. Increased peripheral vascular resistance causing systolic
hypertension.
C. Enhanced renal perfusion leading to diuresis and low blood
volume.
D. Hyperdynamic circulation from anemia increasing metabolic
demand.
,Correct Answer: A
Rationales:
• Correct (A): Reduced myocardial contractility (systolic
dysfunction) lowers stroke volume and cardiac output,
causing pulmonary congestion (dyspnea, orthopnea) and
peripheral edema through increased venous pressures and
neurohormonal activation, consistent with Berkowitz’s
explanation of heart failure mechanisms.
• Incorrect (B): Elevated afterload can worsen heart failure,
but peripheral vascular resistance alone does not directly
produce orthopnea and elevated BNP as primary
mechanisms.
• Incorrect (C): Enhanced renal perfusion with diuresis
would reduce volume overload and improve symptoms,
not cause them.
• Incorrect (D): Hyperdynamic states can cause dyspnea but
do not explain elevated BNP and typical edema pattern in
chronic systolic heart failure.
Teaching Point: Systolic dysfunction reduces stroke volume and
causes congestion via neurohormonal volume retention.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology Made
Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1: Heart Failure.
2
,Reference: Ch. 1: The Cardiovascular System — Preload,
Afterload, and Treatment of Heart Failure
Stem: A patient with acute decompensated left heart failure is
short of breath and has pulmonary crackles. Which initial
nursing intervention best lowers pulmonary capillary
hydrostatic pressure and eases dyspnea?
A. Administer IV loop diuretic per order.
B. Give a beta-blocker bolus to slow heart rate.
C. Start IV norepinephrine to raise blood pressure.
D. Encourage fluid intake to improve preload.
Correct Answer: A
Rationales:
• Correct (A): Loop diuretics reduce intravascular volume
(preload) and pulmonary capillary hydrostatic pressure,
rapidly relieving pulmonary edema and dyspnea —
consistent with Berkowitz’s preload management.
• Incorrect (B): Beta-blockers are used chronically for
remodeling and rate control but acute boluses can depress
contractility and worsen acute decompensation.
• Incorrect (C): Norepinephrine raises afterload and venous
pressures, potentially worsening pulmonary edema.
• Incorrect (D): Adding fluid increases preload and capillary
hydrostatic pressure, aggravating pulmonary congestion.
, Teaching Point: Diuretics reduce preload and rapidly relieve
pulmonary congestion in acute left HF.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology Made
Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1: Preload,
Afterload, and Treatment.
3
Reference: Ch. 1: The Cardiovascular System — Left Heart
Failure vs. Right Heart Failure
Stem: A patient presents with ascites, hepatomegaly, and
jugular venous distension but minimal pulmonary symptoms.
Which best explains this pattern?
A. Isolated left ventricular failure causing systemic venous
congestion.
B. Right ventricular failure leading to systemic venous
hypertension.
C. Acute pulmonary edema from left-sided failure.
D. High-output heart failure from thyroid disease.
Correct Answer: B
Rationales:
• Correct (B): Right ventricular failure elevates systemic
venous pressures causing JVD, hepatic congestion, and
ascites; pulmonary symptoms are often absent or mild.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1: The Cardiovascular System — Heart Failure
(General)
Stem: A 68-year-old man with chronic ischemic heart disease
reports progressive dyspnea on exertion, orthopnea, and 2+
pitting edema. His BNP is elevated. Which finding most directly
explains his symptoms?
A. Decreased myocardial contractility leading to reduced stroke
volume.
B. Increased peripheral vascular resistance causing systolic
hypertension.
C. Enhanced renal perfusion leading to diuresis and low blood
volume.
D. Hyperdynamic circulation from anemia increasing metabolic
demand.
,Correct Answer: A
Rationales:
• Correct (A): Reduced myocardial contractility (systolic
dysfunction) lowers stroke volume and cardiac output,
causing pulmonary congestion (dyspnea, orthopnea) and
peripheral edema through increased venous pressures and
neurohormonal activation, consistent with Berkowitz’s
explanation of heart failure mechanisms.
• Incorrect (B): Elevated afterload can worsen heart failure,
but peripheral vascular resistance alone does not directly
produce orthopnea and elevated BNP as primary
mechanisms.
• Incorrect (C): Enhanced renal perfusion with diuresis
would reduce volume overload and improve symptoms,
not cause them.
• Incorrect (D): Hyperdynamic states can cause dyspnea but
do not explain elevated BNP and typical edema pattern in
chronic systolic heart failure.
Teaching Point: Systolic dysfunction reduces stroke volume and
causes congestion via neurohormonal volume retention.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology Made
Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1: Heart Failure.
2
,Reference: Ch. 1: The Cardiovascular System — Preload,
Afterload, and Treatment of Heart Failure
Stem: A patient with acute decompensated left heart failure is
short of breath and has pulmonary crackles. Which initial
nursing intervention best lowers pulmonary capillary
hydrostatic pressure and eases dyspnea?
A. Administer IV loop diuretic per order.
B. Give a beta-blocker bolus to slow heart rate.
C. Start IV norepinephrine to raise blood pressure.
D. Encourage fluid intake to improve preload.
Correct Answer: A
Rationales:
• Correct (A): Loop diuretics reduce intravascular volume
(preload) and pulmonary capillary hydrostatic pressure,
rapidly relieving pulmonary edema and dyspnea —
consistent with Berkowitz’s preload management.
• Incorrect (B): Beta-blockers are used chronically for
remodeling and rate control but acute boluses can depress
contractility and worsen acute decompensation.
• Incorrect (C): Norepinephrine raises afterload and venous
pressures, potentially worsening pulmonary edema.
• Incorrect (D): Adding fluid increases preload and capillary
hydrostatic pressure, aggravating pulmonary congestion.
, Teaching Point: Diuretics reduce preload and rapidly relieve
pulmonary congestion in acute left HF.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology Made
Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1: Preload,
Afterload, and Treatment.
3
Reference: Ch. 1: The Cardiovascular System — Left Heart
Failure vs. Right Heart Failure
Stem: A patient presents with ascites, hepatomegaly, and
jugular venous distension but minimal pulmonary symptoms.
Which best explains this pattern?
A. Isolated left ventricular failure causing systemic venous
congestion.
B. Right ventricular failure leading to systemic venous
hypertension.
C. Acute pulmonary edema from left-sided failure.
D. High-output heart failure from thyroid disease.
Correct Answer: B
Rationales:
• Correct (B): Right ventricular failure elevates systemic
venous pressures causing JVD, hepatic congestion, and
ascites; pulmonary symptoms are often absent or mild.
