ADVANCED PATHOPHYSIOLOGY UTMB 5355
EXAM 4 2026 PRACTICE QUESTIONS WITH
DETAILED RATIONALES A+
◉ Right to left shunt. Answer: Tetralogy of Fallot is most common
cyanotic congenital heart defect.
*Impaired gas exchanged r/t decreased pulmonary blood flow*
Right side of heart = Deoxygenated
Left side = Oxygenated
1. Deoxygenated blood is mixed with oxygenated blood.
2. Blood on left side has oxygen saturation decrease from 95% to
80% or lower.
3. Cyanosis may or may not develop depending on how low the
oxygen saturation on the left side drops.
-Left side oxygen saturation 85% or high, cyanosis is not likely to
occur.
-Left side oxygen saturation below 80% is indicative of a large
amount of blood being shunted and will result in cyanosis.
◉ Tetralogy of Fallot. Answer: Most common cyanotic congenital
heart defect
,Tetralogy of Fallot involves four heart defects:
1. A large ventricular septal defect
2. Pulmonary stenosis
3. Right ventricular hypertrophy
4. An overriding aorta
◉ Heart Failure Risk Factors. Answer: -Age (most common over 65
y/o)
-Ischemic heart disease
-Obesity
-Diabetes
-Hypertension
-Excessive ETOH use
-Congenital heart disease
-Valvular heart disease
-Myocarditis
-Cardiomyopathy (stiffening of heart muscle)
-Renal failure
◉ Heart Failure Clinical Manifestations. Answer: -Volume overload
-Poor perfusion secondary to pump failure
,◉ Heart Failure with REDUCED Ejection Fraction, SYSTOLIC Heart
Failure, LEFT-SIDED heart failure. Answer: -LEFT-SIDED HEART
FAILURE, SYSTOLIC HEART FAILURE, but right ventricular systolic
dysfunction can happen too
-IMPAIRMENT in LEFT VENTRICULAR CONTRACTION (SYSTOLE)
-Most common CAUSE is MYOCARDIAL INFARCTION. Other causes
are myocarditis and cardiomyopathies.
1. Decrease in contractility in left ventricle will decrease stroke
volume (volume of blood pumped from left ventricle with each
beat).
2. Cardiac output (amount of blood pumped from heart per minute)
decreases.
3. Left ventricular end diastolic (relaxation of heart) volume
(preload) increases - not enough blood got pumped out of left
ventricle during systole (contraction), so more is hanging around
during diastole (relaxation).
4. Ventricular remodeling occurs.
5. Preload (amount of blood in ventricle during relaxation) further
increases over time, causing causing a dilation of the ventricle and
further compromises contraction and cardiac output.
6. Myocytes deteroriate.
The systolic dysfunction (low cardiac output) results in 2 processes
being triggered:
, -Baroreceptor activation: Baroreceptors notify the medulla to turn
on sympathetic nervous system because heart is not pumping out
enough blood. The catecholamines epinephrine and norepinephrine
cause vasoconstriction, increased afterload, increased blood
pressure, increased heart rate. This increases work loard of heart,
causes hypertrophy & dilation of left ventricle, and further impairs
contractility.
-Renin Angiotensin Aldosterone System (RAAS): Activated by
decreased renal blood flow. Causes vasoconstriction, which
increases afterload and blood pressure, but contributes to
worsening of left ventricular hypertrophy/dilation and worsens
contractility.
Medications: BETA BLOCKERS to block the effects of
chatecholamines in the heart. ACE INHIBITORS and ARBS
(angiotensin II receptor blockers) to block effects o
◉ Heart Failure with PRESERVED Ejection Fraction (HFpEF),
LEFT-SIDED heart failure. Answer: -Diastolic heart failure (heart
can't relax)
-Characterized by pulmonary congestion in the presence of normal
left systolic ejection fraction, stoke volume, and cardiac output.
-More common in WOMEN
-Most commonly caused by hypertension-induced hypertrophy or
myocardial ischemia resulting in remodeling
EXAM 4 2026 PRACTICE QUESTIONS WITH
DETAILED RATIONALES A+
◉ Right to left shunt. Answer: Tetralogy of Fallot is most common
cyanotic congenital heart defect.
*Impaired gas exchanged r/t decreased pulmonary blood flow*
Right side of heart = Deoxygenated
Left side = Oxygenated
1. Deoxygenated blood is mixed with oxygenated blood.
2. Blood on left side has oxygen saturation decrease from 95% to
80% or lower.
3. Cyanosis may or may not develop depending on how low the
oxygen saturation on the left side drops.
-Left side oxygen saturation 85% or high, cyanosis is not likely to
occur.
-Left side oxygen saturation below 80% is indicative of a large
amount of blood being shunted and will result in cyanosis.
◉ Tetralogy of Fallot. Answer: Most common cyanotic congenital
heart defect
,Tetralogy of Fallot involves four heart defects:
1. A large ventricular septal defect
2. Pulmonary stenosis
3. Right ventricular hypertrophy
4. An overriding aorta
◉ Heart Failure Risk Factors. Answer: -Age (most common over 65
y/o)
-Ischemic heart disease
-Obesity
-Diabetes
-Hypertension
-Excessive ETOH use
-Congenital heart disease
-Valvular heart disease
-Myocarditis
-Cardiomyopathy (stiffening of heart muscle)
-Renal failure
◉ Heart Failure Clinical Manifestations. Answer: -Volume overload
-Poor perfusion secondary to pump failure
,◉ Heart Failure with REDUCED Ejection Fraction, SYSTOLIC Heart
Failure, LEFT-SIDED heart failure. Answer: -LEFT-SIDED HEART
FAILURE, SYSTOLIC HEART FAILURE, but right ventricular systolic
dysfunction can happen too
-IMPAIRMENT in LEFT VENTRICULAR CONTRACTION (SYSTOLE)
-Most common CAUSE is MYOCARDIAL INFARCTION. Other causes
are myocarditis and cardiomyopathies.
1. Decrease in contractility in left ventricle will decrease stroke
volume (volume of blood pumped from left ventricle with each
beat).
2. Cardiac output (amount of blood pumped from heart per minute)
decreases.
3. Left ventricular end diastolic (relaxation of heart) volume
(preload) increases - not enough blood got pumped out of left
ventricle during systole (contraction), so more is hanging around
during diastole (relaxation).
4. Ventricular remodeling occurs.
5. Preload (amount of blood in ventricle during relaxation) further
increases over time, causing causing a dilation of the ventricle and
further compromises contraction and cardiac output.
6. Myocytes deteroriate.
The systolic dysfunction (low cardiac output) results in 2 processes
being triggered:
, -Baroreceptor activation: Baroreceptors notify the medulla to turn
on sympathetic nervous system because heart is not pumping out
enough blood. The catecholamines epinephrine and norepinephrine
cause vasoconstriction, increased afterload, increased blood
pressure, increased heart rate. This increases work loard of heart,
causes hypertrophy & dilation of left ventricle, and further impairs
contractility.
-Renin Angiotensin Aldosterone System (RAAS): Activated by
decreased renal blood flow. Causes vasoconstriction, which
increases afterload and blood pressure, but contributes to
worsening of left ventricular hypertrophy/dilation and worsens
contractility.
Medications: BETA BLOCKERS to block the effects of
chatecholamines in the heart. ACE INHIBITORS and ARBS
(angiotensin II receptor blockers) to block effects o
◉ Heart Failure with PRESERVED Ejection Fraction (HFpEF),
LEFT-SIDED heart failure. Answer: -Diastolic heart failure (heart
can't relax)
-Characterized by pulmonary congestion in the presence of normal
left systolic ejection fraction, stoke volume, and cardiac output.
-More common in WOMEN
-Most commonly caused by hypertension-induced hypertrophy or
myocardial ischemia resulting in remodeling
