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Review Question - QID 100592

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QID 100592 (Type "100592" in App Search)
A 14-year-old Caucasian female commits suicide by drug overdose. Her family decides to donate her organs, and her heart is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aorta. Which of the following cell types predominate in these yellow spots?
















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The "yellow spots" are actually fatty streaks that are seen in all persons over 10 years of age. Fatty streaks are mainly made up of macrophages.

In the pathogenesis of atherosclerosis, macrophages engulf LDL cholesterol within the intima, forming foam cells. These foam cells form the yellow fatty streaks described in the vignette above. Fatty streaks are considered a precursor lesion of atheromas which, with time, may evolve to plaques. Not all fatty streaks progress to atherosclerosis.

Safeer et al. report that hypercholesterolemia is one of the major contributors to atherosclerosis and coronary heart disease. Age, smoking status, hypertension, HDL levels, and family history are all risk factors are associated with target LDL goals. Regulation of LDL is important since studies have shown that LDL cholesterol is the primary lipoprotein mediating atherosclerosis.

Hansson discusses the activating effect of LDL infiltration on inflammation in the artery. He notes that patients with hypercholesterolemia, excess LDL tends to infiltrate arteries and is retained in the intima. This then initiates an inflammatory response, which ultimately modifies the LDL particles. The modified LDL particles are taken up by scavenger receptors of macrophages, which evolve into foam cells.

Illustration A is an overview image of the pathophysiology of fatty streak formation. Illustration B is a pathological specimen showing fatty streaks.

Incorrect Answers:
Answers 1,3-5: These cell types are not the predominant cells in a fatty streak.

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