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Atrial fibrillation rate control — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Atrial fibrillation rate controlUSMLE Step 3

A 78-year-old man with permanent atrial fibrillation reports palpitations with exertion. Resting heart rate is 112/min, blood pressure is 124/70 mm Hg, and ejection fraction is 60%. He takes apixaban and lisinopril. There is no heart failure decompensation. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start a beta blocker for rate control

Stable permanent atrial fibrillation with rapid ventricular response is managed with rate control and continued anticoagulation based on stroke risk.

Reference: ACC/AHA atrial fibrillation guideline: https://www.acc.org/