End-Organ Damage Mechanisms · USMLE Step 1

Which mechanism best explains how a stable atherosclerotic plaque can suddenly cause an acute myocardial infarction?

  1. Slow progressive narrowing of the arterial lumen over several decades
  2. Rupture of the plaque cap exposing thrombogenic core, causing thrombosis
  3. Sudden spasm of the coronary artery provoked by cold exposure
  4. Autoimmune destruction of the vascular smooth muscle cells
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Correct answer: Rupture of the plaque cap exposing thrombogenic core, causing thrombosis

Plaque rupture or erosion exposes thrombogenic material (lipid core, collagen) to blood, leading to platelet aggregation and thrombus formation — the common cause of acute MI.

Difficulty: Medium Question 5 of 20

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