Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Berkowitz, 2023, Ch. 1: Anatomical Overview —
Cardiac size and point of maximal impulse (PMI)
Question Stem: A 68-year-old man with progressive dyspnea
has his PMI palpated 2.5 cm lateral to the midclavicular line in
the 6th intercostal space. Which is the best interpretation of
this finding?
A. Right ventricular dilation from pulmonary hypertension
B. Left ventricular enlargement (cardiomegaly) with lateral
displacement of the PMI
C. Isolated left atrial enlargement causing PMI displacement
D. Normal variant — no clinical significance
Correct Answer: B
Rationales:
, • Correct (B): Lateral and inferior displacement of the PMI
indicates left ventricular enlargement or dilation
(cardiomegaly), consistent with increased LV chamber size
or hypertrophy.
• A: RV dilation typically shifts the PMI medially or upward
and does not usually move the PMI laterally into the 6th
interspace.
• C: Left atrial enlargement enlarges the left atrial silhouette
on imaging but does not commonly produce a lateral PMI
shift.
• D: A PMI displaced >1–2 cm from the midclavicular line is
abnormal and suggests ventricular enlargement.
Teaching Point: PMI lateral displacement indicates left
ventricular enlargement.
Citation: Berkowitz, 2023, Ch. 1: Anatomical Overview
2
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure & Preload/Afterload
Question Stem: A patient presents with acute pulmonary
edema, severe dyspnea, crackles to the mid-lung fields, and an
S3 gallop. Which immediate intervention most directly reduces
pulmonary venous congestion?
A. Intravenous loop diuretic (e.g., furosemide)
,B. Immediate IV beta-blocker infusion
C. High-dose IV corticosteroids
D. Oral angiotensin-converting enzyme (ACE) inhibitor at home
dose
Correct Answer: A
Rationales:
• Correct (A): IV loop diuretics rapidly reduce intravascular
volume and preload, decreasing left atrial pressure and
pulmonary venous congestion — a first-line acute measure
for pulmonary edema.
• B: Beta-blockers worsen acute decompensated heart
failure if started or escalated during acute pulmonary
edema because they can depress contractility.
• C: Steroids are not indicated for cardiogenic pulmonary
edema.
• D: Oral ACE inhibitors act slower and are not adequate as
an immediate measure in acute pulmonary edema.
Teaching Point: IV loop diuretics quickly reduce preload and
relieve pulmonary congestion.
Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure; Preload and Treatment
3
, Reference: Berkowitz, 2023, Ch. 1: Right Heart Failure — RV
infarction and hemodynamics
Question Stem: A 59-year-old man with an inferior MI becomes
hypotensive and develops prominent jugular venous distension
with clear lung fields. What is the most appropriate immediate
hemodynamic intervention?
A. IV nitroprusside to reduce afterload
B. Rapid infusion of IV fluids to augment preload
C. Immediate high-dose loop diuretics
D. Start IV beta-blocker to reduce myocardial oxygen demand
Correct Answer: B
Rationales:
• Correct (B): Inferior MI can involve the right ventricle
causing RV failure; RV depends on adequate preload —
cautious IV fluid bolus improves RV filling and cardiac
output.
• A: Vasodilators reduce preload and can worsen
hypotension in RV infarction.
• C: Diuresis would decrease preload further and worsen RV
output.
• D: Beta-blockers can depress RV function and are risky in
acute RV infarction with hypotension.
Teaching Point: RV infarction often requires preload
augmentation (IV fluids) to maintain output.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Berkowitz, 2023, Ch. 1: Anatomical Overview —
Cardiac size and point of maximal impulse (PMI)
Question Stem: A 68-year-old man with progressive dyspnea
has his PMI palpated 2.5 cm lateral to the midclavicular line in
the 6th intercostal space. Which is the best interpretation of
this finding?
A. Right ventricular dilation from pulmonary hypertension
B. Left ventricular enlargement (cardiomegaly) with lateral
displacement of the PMI
C. Isolated left atrial enlargement causing PMI displacement
D. Normal variant — no clinical significance
Correct Answer: B
Rationales:
, • Correct (B): Lateral and inferior displacement of the PMI
indicates left ventricular enlargement or dilation
(cardiomegaly), consistent with increased LV chamber size
or hypertrophy.
• A: RV dilation typically shifts the PMI medially or upward
and does not usually move the PMI laterally into the 6th
interspace.
• C: Left atrial enlargement enlarges the left atrial silhouette
on imaging but does not commonly produce a lateral PMI
shift.
• D: A PMI displaced >1–2 cm from the midclavicular line is
abnormal and suggests ventricular enlargement.
Teaching Point: PMI lateral displacement indicates left
ventricular enlargement.
Citation: Berkowitz, 2023, Ch. 1: Anatomical Overview
2
Reference: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure & Preload/Afterload
Question Stem: A patient presents with acute pulmonary
edema, severe dyspnea, crackles to the mid-lung fields, and an
S3 gallop. Which immediate intervention most directly reduces
pulmonary venous congestion?
A. Intravenous loop diuretic (e.g., furosemide)
,B. Immediate IV beta-blocker infusion
C. High-dose IV corticosteroids
D. Oral angiotensin-converting enzyme (ACE) inhibitor at home
dose
Correct Answer: A
Rationales:
• Correct (A): IV loop diuretics rapidly reduce intravascular
volume and preload, decreasing left atrial pressure and
pulmonary venous congestion — a first-line acute measure
for pulmonary edema.
• B: Beta-blockers worsen acute decompensated heart
failure if started or escalated during acute pulmonary
edema because they can depress contractility.
• C: Steroids are not indicated for cardiogenic pulmonary
edema.
• D: Oral ACE inhibitors act slower and are not adequate as
an immediate measure in acute pulmonary edema.
Teaching Point: IV loop diuretics quickly reduce preload and
relieve pulmonary congestion.
Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure; Preload and Treatment
3
, Reference: Berkowitz, 2023, Ch. 1: Right Heart Failure — RV
infarction and hemodynamics
Question Stem: A 59-year-old man with an inferior MI becomes
hypotensive and develops prominent jugular venous distension
with clear lung fields. What is the most appropriate immediate
hemodynamic intervention?
A. IV nitroprusside to reduce afterload
B. Rapid infusion of IV fluids to augment preload
C. Immediate high-dose loop diuretics
D. Start IV beta-blocker to reduce myocardial oxygen demand
Correct Answer: B
Rationales:
• Correct (B): Inferior MI can involve the right ventricle
causing RV failure; RV depends on adequate preload —
cautious IV fluid bolus improves RV filling and cardiac
output.
• A: Vasodilators reduce preload and can worsen
hypotension in RV infarction.
• C: Diuresis would decrease preload further and worsen RV
output.
• D: Beta-blockers can depress RV function and are risky in
acute RV infarction with hypotension.
Teaching Point: RV infarction often requires preload
augmentation (IV fluids) to maintain output.
