In the pathogenesis of atherosclerosis, which of the following is the earliest morphologic change visible in the arterial wall?

Question

Accepted Answer

A. Fatty streak formation with foam cells. ## Morphologic Progression of Atherosclerosis **Key Point:** The fatty streak is the earliest morphologically identifiable lesion in atherosclerosis, though endothelial dysfunction precedes it functionally. ### Stages of Atherosclerotic Lesion Development ```mermaid flowchart TD A[Endothelial Dysfunction
Increased LDL permeability]:::outcome --> B[Lipid Accumulation
in Intima]:::outcome B --> C[Fatty Streak
Foam cells + lipid]:::outcome C --> D[Intermediate Lesion
Smooth muscle migration]:::outcome D --> E[Fibrous Plaque
Thick fibrous cap]:::outcome E --> F[Complicated Lesion
Necrotic core, calcification]:::outcome ``` ### Characteristics of the Fatty Streak 1. **Composition:** - Macrophage-derived foam cells (lipid-laden macrophages) - Oxidized LDL (oxLDL) in intimal space - T lymphocytes - Minimal smooth muscle involvement 2. **Timing:** - Appears in childhood in susceptible individuals - Visible on gross examination as yellow streaks along coronary arteries - Reversible in early stages 3. **Microscopic appearance:** - Foamy macrophages with lipid droplets - Intimal thickening - No significant fibrous cap **High-Yield:** Fatty streaks are **reversible lesions** if risk factors are modified early; fibrous plaques are largely irreversible. This distinction is clinically important for primary prevention. **Clinical Pearl:** Fatty streaks can be found in the aortas of children as young as 5–10 years old in developed countries, reflecting early atherosclerotic disease. **Mnemonic:** **"FOAM = First Obvious Atherosclerotic Morphology"** — the fatty streak is the first morphologically visible stage.

Answer

B. Necrotic core with calcification

Answer

C. Endothelial dysfunction and increased permeability

Answer

D. Fibrous plaque with smooth muscle proliferation

In the pathogenesis of atherosclerosis, which of the following is the earliest morphologic change visible in the arterial wall?

Explanation

Morphologic Progression of Atherosclerosis

Stages of Atherosclerotic Lesion Development

Characteristics of the Fatty Streak

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