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Lumbar radiculopathy — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareLumbar radiculopathyUSMLE Step 3

A 45-year-old with hypertrophic cardiomyopathy has a 6-hour episode of ECG-documented atrial fibrillation. CHA₂DS₂-VASc score is 0 and kidney function is normal. What is the best stroke-prevention strategy?

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Correct answer: A — Start a direct-acting oral anticoagulant independent of the CHA2DS2-VASc score

The best answer is “Start a direct-acting oral anticoagulant independent of the CHA2DS2-VASc score”. Hypertrophic cardiomyopathy confers substantial thromboembolic risk with clinical AF, so anticoagulation is recommended independent of CHA₂DS₂-VASc. A DOAC is generally preferred unless a contraindication exists. Aspirin or waiting for recurrent/prolonged AF leaves avoidable stroke risk.

Reference: 2024 AHA/ACC Guideline for the Management of Hypertrophic Cardiomyopathy: https://professional.heart.org/en/science-news/2024-guideline-for-the-management-of-hypertrophic-cardiomyopathy