17. The answer is C. This describes the clinical manifestations of malignant hypertension. This is an accelerated phase of hypertension that occurs for unknown reasons, and it can be in patients with primary or secondary causes of hypertension. Gross findings of the kidneys include petechial hemorrhages, giving the parenchyma a “flea-bitten” appearance. Microscopically, there would be fibrinoid necrosis of the blood vessel walls and hyperplastic arteriolosclerosis. Immune complex vasculitis of the glomeruli is typical of polyarteritis nodosa. Longitudinal intraluminal tears of the ascending aorta is describing a dissection, these patients typically present with “tearing” chest pain. “Tree-bark” appearance of the ascending aorta is a classic description of the ascending aorta in tertiary syphilis. Unilateral renal artery stenosis can occur via atherosclerosis, fibromuscular dysplasia, or other more rare entities.