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In cases where a CT scan reveals an aneurysmal lumen larger than 5 cm, the appropriate next step is to refer the patient for surgery. This is based on established medical guidelines, which indicate that aneurysms of this size carry a significant risk of rupture, making surgical intervention critical to prevent potentially life-threatening complications.

Aneurysms larger than 5 cm often require surgical correction, either through open surgery or endovascular techniques, to reduce the risk of rupture. Monitoring or observation is generally reserved for smaller aneurysms or those that are asymptomatic, where the risks of surgery may outweigh the benefits. While medications may help manage associated conditions such as hypertension, they do not address the structural issue of the aneurysm itself. Additionally, performing more imaging tests would delay necessary treatment and may not provide any new information that would change the immediate need for surgical intervention. Thus, referring for surgery is the most appropriate course of action in this scenario.