A 45-year-old man developed severe abdominal pain and was transported to the emergency room where he was found to be hypotensive and in shock. He was unresponsive to therapy and died 2 days later. Based upon this history and the accompanying image in Figure 5-17, which of the following most likely initiated this sequence of events?

(A) acute pancreatitis

(B) esophageal varices

(C) gastric ulcer

(D) liver cirrhosis

(E) splenic infarct

Over the past few months, a 5-year-old boy has developed changes suggestive of puberty. Physical examination reveals the presence of secondary sex characteristics including pubic hair and penile enlargement. Laboratory studies reveal increased levels of ACTH. If you were able to examine his adrenals, which of the following would you most likely find?

(A) bilateral atrophy of the cortex

(B) bilateral atrophy of the medulla

(C) bilateral cortical hyperplasia

(D) bilateral medullary hyperplasia

(E) nodule in the cortex

(F) nodule in the medulla

A 5-year-old boy is brought to a pediatrician by his mother for progressive abdominal girth and poor appetite. His mother is concerned over a “growing lump” she has felt in his abdomen, and physical examination confirms the presence of a large palpable mass in the left upper quadrant. Abdominal ultrasound demonstrates an 18-cm solid mass in the upper pole of the left kidney. A renal biopsy is taken. Which of the following is the pathologist most likely to see on microscopic examination of the biopsy?

(A) a mixture of proliferating smooth muscle cells, mature fat cells, and abnormal blood vessels

(B) numerous fusiform cysts lined by uniform cuboidal cells and no normal parenchyma

(C) primitive mesenchymal tissue with minimal tubular and glomerular differentiation

(D) sheets of large cells with abundant clear cytoplasm and small uniform nuclei

(E) well-formed papillary frond structures lined by cytologically normal, thickened epithelium

A 64-year-old man with long-standing hypertension experiences severe abdominal pain and loses consciousness. He dies en route to the hospital. Significant autopsy findings include dilation of the aorta just above the iliac bifurcation and massive abdominal hemorrhage. Which of the following was most likely the initiating event that resulted in his fatal lesion?

(A) antibody-mediated endothelial damage

(B) autosomal dominant inheritance of an abnormal gene on chromosome 15

(C) intimal proliferation with fibrous cap formation

(D) luminal narrowing of the vasa vasorum leading to medial degeneration and fibrosis

(E) ossification of calcific deposits in the tunica media

A 19-year-old freshman football player collapses during preseason workouts on a very hot afternoon. He has no significant prior medical history other than a recent upper respiratory infection. He is taken to the emergency room but cannot be revived. An autopsy reveals an enlarged heart that, on microscopic examination, shows myocyte disarray. Which of the following was the most likely cause of death?

(A) alcoholism

(B) cardiac amyloidosis

(C) heat stroke

(D) hypertrophic cardiomyopathy

(E) viral myocarditis