Cardiology: atrial fibrillation: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: atrial fibrillation

Sample item

A 72-year-old woman with hypertension and type 2 diabetes has newly diagnosed non-valvular atrial fibrillation. What is her CHA2DS2-VASc score, and what does it imply?

A2, so aspirin alone is enoughB4, so oral anticoagulation is recommendedC1, so no therapy is neededD6, so surgical closure of the left atrial appendage is mandatory

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. 4, so oral anticoagulation is recommended

CHA2DS2-VASc assigns 1 point each for heart failure, hypertension, diabetes, vascular disease, age 65 to 74 and female sex, and 2 points each for age 75 or more and prior stroke or TIA. Here hypertension (1), diabetes (1), age 65 to 74 (1) and female sex (1) give 4. Oral anticoagulation, preferably a direct oral anticoagulant, is recommended for scores of 2 or more in men and 3 or more in women.

Option by option

A. 2, so aspirin alone is enough
The score is higher than 2, and aspirin alone does not provide adequate stroke prevention in atrial fibrillation.
B. 4, so oral anticoagulation is recommended (correct)
Correct. Four points indicate a high stroke risk and warrant anticoagulation.
C. 1, so no therapy is needed
This undercounts the risk factors; the score is not 1.
D. 6, so surgical closure of the left atrial appendage is mandatory
The score is 4, not 6, and appendage closure is reserved for patients who cannot take anticoagulants.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, 4, so oral anticoagulation is recommended. CHA2DS2-VASc assigns 1 point each for heart failure, hypertension, diabetes, vascular disease, age 65 to 74 and female sex, and 2 points each for age 75 or more and prior stroke or TIA.

Why is "2, so aspirin alone is enough" not the answer?

The score is higher than 2, and aspirin alone does not provide adequate stroke prevention in atrial fibrillation.

Why is "1, so no therapy is needed" not the answer?

This undercounts the risk factors; the score is not 1.

Why is "6, so surgical closure of the left atrial appendage is mandatory" not the answer?

The score is 4, not 6, and appendage closure is reserved for patients who cannot take anticoagulants.

What concept does this question test?

It tests Cardiology: atrial fibrillation in General Medicine. Here hypertension (1), diabetes (1), age 65 to 74 (1) and female sex (1) give 4. Oral anticoagulation, preferably a direct oral anticoagulant, is recommended for scores of 2 or more in men and 3 or more in women.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: atrial fibrillation?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.