Cardiovascular: early atherosclerosis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Cardiovascular: early atherosclerosis

Sample item

An 18-year-old man dies in a road traffic accident. At autopsy the thoracic aorta shows flat, yellow, non-obstructing streaks on the intimal surface. Which histological finding underlies these lesions?

AA calcified, ulcerated plaque with overlying thrombusBLipid-laden macrophages beneath the endotheliumCFragmentation of medial elastic fibres with pools of mucoid materialDA fibrous cap over a necrotic lipid core with cholesterol clefts

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Lipid-laden macrophages beneath the endothelium

Fatty streaks are the earliest lesion of atherosclerosis, starting after endothelial injury and monocyte entry into the intima. Macrophages take up oxidised LDL through scavenger receptors and become foam cells. The lesions are flat and cause no flow obstruction, and they may regress or progress to fibrofatty plaques.

Option by option

A. A calcified, ulcerated plaque with overlying thrombus
Calcification, ulceration and thrombosis mark complicated advanced plaques.
B. Lipid-laden macrophages beneath the endothelium (correct)
Correct. Subendothelial foam cells give the yellow flat streak.
C. Fragmentation of medial elastic fibres with pools of mucoid material
Elastic fragmentation with mucoid pools is cystic medial degeneration seen in Marfan syndrome and aortic dissection.
D. A fibrous cap over a necrotic lipid core with cholesterol clefts
A fibrous cap over a necrotic core defines the established fibrofatty atheroma, a later lesion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Lipid-laden macrophages beneath the endothelium. Fatty streaks are the earliest lesion of atherosclerosis, starting after endothelial injury and monocyte entry into the intima.

Why is "A calcified, ulcerated plaque with overlying thrombus" not the answer?

Calcification, ulceration and thrombosis mark complicated advanced plaques.

Why is "Fragmentation of medial elastic fibres with pools of mucoid material" not the answer?

Elastic fragmentation with mucoid pools is cystic medial degeneration seen in Marfan syndrome and aortic dissection.

Why is "A fibrous cap over a necrotic lipid core with cholesterol clefts" not the answer?

A fibrous cap over a necrotic core defines the established fibrofatty atheroma, a later lesion.

What concept does this question test?

It tests Cardiovascular: early atherosclerosis in Pathology. Macrophages take up oxidised LDL through scavenger receptors and become foam cells. The lesions are flat and cause no flow obstruction, and they may regress or progress to fibrofatty plaques.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular: early atherosclerosis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.