Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Berkowitz, 2023, Ch. 1: Left Heart Failure —
Symptoms and Signs of Heart Failure
Question stem: A 72-year-old man with long-standing
hypertension presents with progressive exertional dyspnea and
frothy pink sputum. On exam he has bibasilar crackles and
orthopnea. Which pathophysiologic mechanism best explains
his pulmonary edema?
A. Right ventricular failure leading to systemic venous
congestion
B. Left ventricular systolic failure causing increased left atrial
pressure and pulmonary capillary hydrostatic pressure
C. Decreased plasma oncotic pressure from hypoalbuminemia
D. Pulmonary embolism causing increased pulmonary vascular
resistance
,Correct answer: B
Rationales
Correct (B): Left ventricular systolic failure reduces cardiac
output and raises left ventricular end-diastolic and left atrial
pressures, increasing pulmonary capillary hydrostatic pressure
and causing transudation of fluid into alveoli (pulmonary
edema). This explains pink frothy sputum and crackles.
A: Right ventricular failure causes systemic venous congestion
(JVD, peripheral edema), not primary pulmonary edema.
C: Hypoalbuminemia causes transudative edema generally
systemic and gradual, not acute pulmonary edema with frothy
sputum in heart failure.
D: Pulmonary embolism can cause acute respiratory distress
but typically causes pleuritic chest pain and hypoxemia rather
than orthopnea with bilateral crackles and pink froth.
Teaching point: LV failure raises pulmonary capillary hydrostatic
pressure causing pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure — Symptoms
and Signs of Heart Failure
2
Reference: Berkowitz, 2023, Ch. 1: Right Heart Failure —
Symptoms and Signs of Heart Failure
Question stem: A patient with chronic left heart failure
develops increasing peripheral edema, jugular venous
,distention, and hepatic enlargement. Which best explains these
new findings?
A. Primary pulmonary disease causing right heart overload
B. Progression of left heart failure leading to right ventricular
failure from increased pulmonary venous pressure
C. Decompensated cirrhosis causing hypoalbuminemia and
ascites
D. Deep venous thrombosis with venous obstruction of the
lower limbs
Correct answer: B
Rationales
Correct (B): Chronic left heart failure elevates pulmonary
venous and arterial pressures; sustained pulmonary
hypertension increases right ventricular afterload, causing right-
sided failure with JVD, hepatomegaly, and peripheral edema.
A: Primary pulmonary disease can cause right heart strain but
the temporal progression from left-sided symptoms supports
secondary RV failure.
C: Cirrhosis causes ascites and low oncotic pressure; it does not
cause JVD or hepatic congestion with an acute cardiac picture.
D: DVT causes unilateral limb swelling, not generalized JVD and
hepatomegaly.
Teaching point: Left heart failure can progress to right heart
failure via pulmonary hypertension.
Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure
, 3
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question stem: A patient in acute decompensated heart failure
is started on intravenous nitroglycerin for symptomatic relief.
Which hemodynamic effect primarily explains the symptomatic
improvement?
A. Reduction of myocardial contractility (negative inotropy)
B. Decrease in systemic vascular resistance (afterload reduction)
C. Venodilation with decreased preload and left ventricular
filling pressure
D. Increased renal perfusion causing diuresis
Correct answer: C
Rationales
Correct (C): Nitroglycerin predominantly venodilates,
decreasing venous return (preload) and left ventricular end-
diastolic pressure, which reduces pulmonary congestion and
dyspnea in acute heart failure.
A: Nitroglycerin does not significantly reduce contractility as its
main action.
B: While high doses can modestly reduce afterload,
nitroglycerin’s primary acute effect is venodilation (preload
reduction).
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Berkowitz, 2023, Ch. 1: Left Heart Failure —
Symptoms and Signs of Heart Failure
Question stem: A 72-year-old man with long-standing
hypertension presents with progressive exertional dyspnea and
frothy pink sputum. On exam he has bibasilar crackles and
orthopnea. Which pathophysiologic mechanism best explains
his pulmonary edema?
A. Right ventricular failure leading to systemic venous
congestion
B. Left ventricular systolic failure causing increased left atrial
pressure and pulmonary capillary hydrostatic pressure
C. Decreased plasma oncotic pressure from hypoalbuminemia
D. Pulmonary embolism causing increased pulmonary vascular
resistance
,Correct answer: B
Rationales
Correct (B): Left ventricular systolic failure reduces cardiac
output and raises left ventricular end-diastolic and left atrial
pressures, increasing pulmonary capillary hydrostatic pressure
and causing transudation of fluid into alveoli (pulmonary
edema). This explains pink frothy sputum and crackles.
A: Right ventricular failure causes systemic venous congestion
(JVD, peripheral edema), not primary pulmonary edema.
C: Hypoalbuminemia causes transudative edema generally
systemic and gradual, not acute pulmonary edema with frothy
sputum in heart failure.
D: Pulmonary embolism can cause acute respiratory distress
but typically causes pleuritic chest pain and hypoxemia rather
than orthopnea with bilateral crackles and pink froth.
Teaching point: LV failure raises pulmonary capillary hydrostatic
pressure causing pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure — Symptoms
and Signs of Heart Failure
2
Reference: Berkowitz, 2023, Ch. 1: Right Heart Failure —
Symptoms and Signs of Heart Failure
Question stem: A patient with chronic left heart failure
develops increasing peripheral edema, jugular venous
,distention, and hepatic enlargement. Which best explains these
new findings?
A. Primary pulmonary disease causing right heart overload
B. Progression of left heart failure leading to right ventricular
failure from increased pulmonary venous pressure
C. Decompensated cirrhosis causing hypoalbuminemia and
ascites
D. Deep venous thrombosis with venous obstruction of the
lower limbs
Correct answer: B
Rationales
Correct (B): Chronic left heart failure elevates pulmonary
venous and arterial pressures; sustained pulmonary
hypertension increases right ventricular afterload, causing right-
sided failure with JVD, hepatomegaly, and peripheral edema.
A: Primary pulmonary disease can cause right heart strain but
the temporal progression from left-sided symptoms supports
secondary RV failure.
C: Cirrhosis causes ascites and low oncotic pressure; it does not
cause JVD or hepatic congestion with an acute cardiac picture.
D: DVT causes unilateral limb swelling, not generalized JVD and
hepatomegaly.
Teaching point: Left heart failure can progress to right heart
failure via pulmonary hypertension.
Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure
, 3
Reference: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure
Question stem: A patient in acute decompensated heart failure
is started on intravenous nitroglycerin for symptomatic relief.
Which hemodynamic effect primarily explains the symptomatic
improvement?
A. Reduction of myocardial contractility (negative inotropy)
B. Decrease in systemic vascular resistance (afterload reduction)
C. Venodilation with decreased preload and left ventricular
filling pressure
D. Increased renal perfusion causing diuresis
Correct answer: C
Rationales
Correct (C): Nitroglycerin predominantly venodilates,
decreasing venous return (preload) and left ventricular end-
diastolic pressure, which reduces pulmonary congestion and
dyspnea in acute heart failure.
A: Nitroglycerin does not significantly reduce contractility as its
main action.
B: While high doses can modestly reduce afterload,
nitroglycerin’s primary acute effect is venodilation (preload
reduction).
