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
and Signs of Heart Failure
Question Stem: A 72-year-old with longstanding hypertension
presents with exertional dyspnea and orthopnea. Chest exam
reveals crackles and an S3 gallop; CXR shows pulmonary
congestion. Which physiologic mechanism best explains his
symptoms?
A. Decreased myocardial contractility causing reduced forward
stroke volume and pulmonary venous congestion.
B. Increased systemic venous pressure causing peripheral
edema and hepatic congestion.
C. Isolated right ventricular failure increasing pulmonary artery
pressures and causing hemoptysis.
D. Increased cardiac output causing fluid transudation into
alveoli.
,Correct Answer: A
Rationales:
• Correct (A): Left heart failure reduces left ventricular
ejection (contractility or increased afterload), causing
elevated left atrial and pulmonary venous pressures →
pulmonary congestion/edema, explaining orthopnea,
dyspnea, crackles and S3 (Berkowitz: pathophysiology of
left-sided failure).
• Incorrect (B): Systemic venous pressure rises primarily in
right-sided failure causing peripheral edema/hepatic
congestion, not pulmonary crackles.
• Incorrect (C): Right ventricular failure causes systemic
venous signs; hemoptysis from RV failure is uncommon
and does not explain pulmonary congestion from LV
failure.
• Incorrect (D): Increased cardiac output (high-output
failure) is rare and would not cause pulmonary
transudation in the setting described; findings point to
failing forward flow.
Teaching Point: Left ventricular dysfunction raises
pulmonary venous pressure, producing pulmonary edema
and orthopnea.
Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure
,2.
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure / Kidneys in Heart Failure
Question Stem: A patient with acute decompensated heart
failure is started on intravenous loop diuretics. Which
immediate physiologic effect most directly reduces pulmonary
congestion?
A. Decreased systemic vascular resistance (afterload) lowering
LV wall stress.
B. Reduced intravascular volume lowering left ventricular
preload and pulmonary venous pressure.
C. Increased renal retention of sodium raising circulating
volume.
D. Improved myocardial contractility increasing stroke volume.
Correct Answer: B
Rationales:
• Correct (B): Loop diuretics decrease intravascular volume,
reducing venous return and left ventricular preload,
thereby lowering pulmonary venous pressure and relieving
congestion (Berkowitz: preload reduction as treatment).
• Incorrect (A): Afterload reduction helps forward flow but is
not the immediate primary effect of diuretics; vasodilators
produce afterload reduction.
• Incorrect (C): Diuretics cause natriuresis and reduce, not
increase, circulating volume.
, • Incorrect (D): Diuretics do not directly increase
contractility; inotropes do.
Teaching Point: Diuretics relieve pulmonary congestion
primarily by lowering preload via intravascular volume
reduction.
Citation: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure; The Kidneys in Heart Failure
3.
Reference: Ch. 1 — Right Heart Failure / Symptoms and Signs of
Heart Failure
Question Stem: A patient with chronic COPD develops
progressive peripheral edema, JVD, and hepatomegaly with
pulsatile liver. Which explanation best links pulmonary disease
to these findings?
A. Hypoxic pulmonary vasoconstriction increases pulmonary
vascular resistance, causing right ventricular hypertrophy and
failure.
B. Destruction of alveoli increases systemic vascular resistance
causing left ventricular failure.
C. Chronic hypercapnia causes volume overload of the left
atrium only.
D. Asthma-like bronchospasm causes mitral valve regurgitation
leading to peripheral edema.
Correct Answer: A
Rationales:
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1.
Reference: Ch. 1 — Heart Failure: Left Heart Failure / Symptoms
and Signs of Heart Failure
Question Stem: A 72-year-old with longstanding hypertension
presents with exertional dyspnea and orthopnea. Chest exam
reveals crackles and an S3 gallop; CXR shows pulmonary
congestion. Which physiologic mechanism best explains his
symptoms?
A. Decreased myocardial contractility causing reduced forward
stroke volume and pulmonary venous congestion.
B. Increased systemic venous pressure causing peripheral
edema and hepatic congestion.
C. Isolated right ventricular failure increasing pulmonary artery
pressures and causing hemoptysis.
D. Increased cardiac output causing fluid transudation into
alveoli.
,Correct Answer: A
Rationales:
• Correct (A): Left heart failure reduces left ventricular
ejection (contractility or increased afterload), causing
elevated left atrial and pulmonary venous pressures →
pulmonary congestion/edema, explaining orthopnea,
dyspnea, crackles and S3 (Berkowitz: pathophysiology of
left-sided failure).
• Incorrect (B): Systemic venous pressure rises primarily in
right-sided failure causing peripheral edema/hepatic
congestion, not pulmonary crackles.
• Incorrect (C): Right ventricular failure causes systemic
venous signs; hemoptysis from RV failure is uncommon
and does not explain pulmonary congestion from LV
failure.
• Incorrect (D): Increased cardiac output (high-output
failure) is rare and would not cause pulmonary
transudation in the setting described; findings point to
failing forward flow.
Teaching Point: Left ventricular dysfunction raises
pulmonary venous pressure, producing pulmonary edema
and orthopnea.
Citation: Berkowitz, 2023, Ch. 1: Heart Failure — Left Heart
Failure
,2.
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure / Kidneys in Heart Failure
Question Stem: A patient with acute decompensated heart
failure is started on intravenous loop diuretics. Which
immediate physiologic effect most directly reduces pulmonary
congestion?
A. Decreased systemic vascular resistance (afterload) lowering
LV wall stress.
B. Reduced intravascular volume lowering left ventricular
preload and pulmonary venous pressure.
C. Increased renal retention of sodium raising circulating
volume.
D. Improved myocardial contractility increasing stroke volume.
Correct Answer: B
Rationales:
• Correct (B): Loop diuretics decrease intravascular volume,
reducing venous return and left ventricular preload,
thereby lowering pulmonary venous pressure and relieving
congestion (Berkowitz: preload reduction as treatment).
• Incorrect (A): Afterload reduction helps forward flow but is
not the immediate primary effect of diuretics; vasodilators
produce afterload reduction.
• Incorrect (C): Diuretics cause natriuresis and reduce, not
increase, circulating volume.
, • Incorrect (D): Diuretics do not directly increase
contractility; inotropes do.
Teaching Point: Diuretics relieve pulmonary congestion
primarily by lowering preload via intravascular volume
reduction.
Citation: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure; The Kidneys in Heart Failure
3.
Reference: Ch. 1 — Right Heart Failure / Symptoms and Signs of
Heart Failure
Question Stem: A patient with chronic COPD develops
progressive peripheral edema, JVD, and hepatomegaly with
pulsatile liver. Which explanation best links pulmonary disease
to these findings?
A. Hypoxic pulmonary vasoconstriction increases pulmonary
vascular resistance, causing right ventricular hypertrophy and
failure.
B. Destruction of alveoli increases systemic vascular resistance
causing left ventricular failure.
C. Chronic hypercapnia causes volume overload of the left
atrium only.
D. Asthma-like bronchospasm causes mitral valve regurgitation
leading to peripheral edema.
Correct Answer: A
Rationales:
