Which set of changes defines conversion of an atheromatous plaque into a 'complicated' plaque?

• A Plaque hemorrhage, surface ulceration, overlying thrombus, calcification, or cholesterol embolization ✓
• B Smooth muscle proliferation with collagen deposition forming a thick fibrous cap
• C Foam cell accumulation beneath an intact endothelium
• D Reversible accumulation of extracellular lipid without a fibrous cap

Explanation

Robbins defines complicated plaques by superimposed structural events: calcification, intraplaque hemorrhage from fragile neovessels, ulceration of the fibrous cap, mural or occlusive thrombus, and cholesterol crystal embolization downstream. These changes underlie acute coronary syndromes and stroke. Foam cell accumulation and smooth muscle cap formation describe earlier benign stages of plaque growth, not complications.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.