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Atrial fibrillation stroke prevention — MCCQE Part 1 MCQ

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ModeratePalpitationsAtrial fibrillation stroke preventionMCCQE Part 1

A 77-year-old woman has ECG-confirmed atrial fibrillation, hypertension and a previous transient ischaemic attack, with no major bleeding contraindication. Which of the following is the most appropriate next step?

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Correct answer: A — Start oral anticoagulation after shared decision-making

Start oral anticoagulation after shared decision-making is the single best answer because the age, timing, examination findings and investigations in the vignette fit Atrial fibrillation stroke prevention better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to CCS atrial fibrillation guidelines, with attention to acuity, safety-netting and local provincial pathways.

Reference: CCS atrial fibrillation guidelines