1. The illustration shows a section of the heart from a 45-year-old African-American man with long-standing hypertension who died of a “stroke.” Which of the following adaptive changes is exemplified in the illustration?

2. A 16-year-old girl undergoes radiologic imaging of her abdomen and is found to have only one kidney. She had been entirely unaware of this problem. Which of the following terms is most descriptive of this finding?

3. A 45-year-old man with a long history of alcoholism presents with severe Epigastric pain, nausea, vomiting, fever, and an increase in serum amylase. During a previous hospitalization for a similar episode, computed tomography scanning demonstrated calcifications in the pancreas. A diagnosis of acute pancreatitis superimposed on chronic pancreatitis was made. In this condition, which of the following types of necrosis is most characteristic?

4. This figure (given below) illustrates the microscopic appearance of the heart of a 56-year-old man who died after a 24-hour hospitalization for severe “crushing” chest pain complicated by hypotension and pulmonary edema. The type of necrosis shown is best described as

5. A 56-year-old man dies 24 hours after the onset of substernal chest pain radiating down his left arm to the ulnar aspect of his fingertips. Which of the following morphologic myocardial findings is an indicator of irreversible injury?

6. Bone marrow cells from an organ donor are cultured in vitro at 37°C in the presence of recombinant erythropoietin. A photomicrograph of a typical “burst-forming unit” is shown in the image. This colony, committed to the erythrocyte pathway of differentiation, represents an example of which of the following physiologic adaptations to transmembrane signaling?

7. A 24-year-old woman contracts toxoplasmosis during her pregnancy and delivers a neonate at 37 weeks of gestation with a severe malformation of the central nervous system. MRI studies of the neonate reveal porencephaly and hydrocephalus. An X-ray fi lm of the head shows irregular densities in the basal ganglia. These X-ray findings are best explained by which of the following mechanisms of disease?

8. A 30-year-old woman suffers a tonic-clonic seizure and presents with delirium and hydrophobia. The patient states that she was bitten on the hand by a bat about 1 month ago. The patient subsequently dies of respiratory failure. Viral particles are found throughout the brainstem and cerebellum at autopsy. In addition to direct viral cytotoxicity, the necrosis of virally infected neurons in this patient was mediated primarily by which of the following mechanisms?

9. A 10-year-old girl presents with advanced features of progeria (patient shown in the image). This child has inherited mutations in the gene that encodes which of the following types of intracellular proteins?

10. A 16-year-old boy presents with a 24-hour history of severe abdominal pain, nausea, vomiting, and low-grade fever. The pain is initially periumbilical in location but has migrated to the right lower quadrant of the abdomen, with maximal tenderness elicited at a site one-third of the way between the crest of the ileum and the umbilicus (McBurney point). The leukocyte count is 14,000/mm3, with 74% segmented neutrophils and 12% bands. Surgery is performed. Which of the following describes the expected findings at the affected site?

11. A 2-year-old boy presents with recurrent infections involving multiple organ systems. Extensive investigation results in a diagnosis of chronic granulomatous disease of childhood. Which of the following most closely characterizes the abnormality in this patient’s phagocytic cells?

12. The accompanying figure is representative of the findings in a hilar lymph node from a 54-year-old man who sought medical care for low-grade fever, anorexia, fatigue, night sweats, weight loss, and persistent cough with bouts of hemoptysis. A chest x-ray had revealed a right apical infiltrate with beginning cavitation, and examination of the sputum had revealed acid-fast bacilli. This condition is typified by a form of inflammation that invariably includes which of the following?

13. Which of the following serum proteins activates the complement, coagulation, and fi brinolytic systems at the site of injury in the patient described in Question 5?

14. An 80-year-old woman presents with a 4-hour history of fever, shaking chills, and disorientation. Her blood pressure is 80/40 mm Hg. Physical examination shows diffuse purpura on her upper arms and chest. Blood cultures are positive for Gramnegative organisms. Which of the following cytokines is primarily involved in the pathogenesis of direct vascular injury in this patient with septic shock?

15. A 41-year-old woman complains of excessive menstrual bleeding and pelvic pain of 4 months. She uses an intrauterine device for contraception. Endometrial biopsy (shown in the image) reveals an excess of plasma cells (arrows) and macrophages within the stroma. The presence of these cells and scattered lymphoid follicles within the endometrial stroma is evidence of which of the following conditions?

16. A 60-year-old man with a history of multiple myocardial infarcts is hospitalized for shortness of breath. Physical examination reveals marked jugular distension, hepatomegaly, ascites, and pitting edema. A chest X-ray reveals cardiomegaly. The patient subsequently dies of cardiorespiratory failure. Examination of the lungs at autopsy would most likely disclose which of the following pathologic changes?

17. A 69-year-old retired man is brought to the emergency department because of the sudden onset of left-sided chest pain, which is exacerbated upon inspiration. Physical examination reveals dyspnea and hemoptysis. His temperature is 38°C (101°F), pulse 110 per minute, respirations 35 per minute, and blood pressure 158/100 mm Hg. A lateral chest wall friction rub is present on auscultation. The left leg is markedly edematous with a positive Homans’ sign. A chest X-ray reveals a left pleural effusion. What is the most likely cause of this patient’s pulmonary condition?

18. The body of a 28-year-old homeless man is brought to the coroner’s office. Histologic examination of the lungs under polarized light is shown. Which of the following is the most likely cause of the birefringence observed in this pulmonary lesion?

19. A 72-year-old man is dead on arrival after collapsing at home. Renal cortical infarcts are noted at autopsy. A section through the arcuate artery is shown. Which of the following is the most likely source of the atheroembolus occluding this artery?

20. A 28-year-old woman is evaluated for possible thrombophilia since she has had two episodes of deep vein thrombosis, as well as two pregnancies that terminated in spontaneous abortion. The activated partial thromboplastin time is prolonged, and she has a positive VDRL screening test for syphilis. This combination of findings is most suggestive of