View source for WBR0362

 {{WBRQuestion
|QuestionAuthor=Neeraja Danda M.B.B.S
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|Prompt=A 56 year old male presented to his physician’s office for his regular physical check up.He was discharged from the hospital one month  prior after undergoing angioplasty for Unstable angina. Now he is on Clopidogrel, atenolol, Lipitor , Lisinopril and Nitrates.Today he asks whether he can resume his sexual activity and how long he should wait between taking his Nitrates and Sildenafil.  What is your response?

|Explanation=Patient can participate in sexual activity immediately post myocardial infarction if he is totally symptom free. Sildenafil and nitrates should never be combined as the risk of hypotension is greater because both are vasodilators.

'''Educational Objective:''' Patients post myocardial infarction can resume sexual activity immediately if they are symptom free. Sildenafil and Nitrates should not be combined as the risk of hypotension is increased with the combination

'''References:''' Page 74 Master the boards Step 2 CK Second edition
|AnswerA=He can resume his sexual activity but should stop both nitrates and Sildenafil.


|AnswerAExp='''Incorrect''' There is no need to stop both Nitrates and Sildenafil.

|AnswerB=He can only resume sexual activity after 3 months of angioplasty
|AnswerBExp='''Incorrect''' He can resume sexual activity immediately if he does not have any symptoms now
|AnswerC=He can resume his sexual activity , and can take Sildenafil after 4 hours of taking nitrates
|AnswerCExp='''Incorrect''' Sildenafil and Nitrates should never be combined
|AnswerD=He has to undergo Exercise stress testing again to check if he can resume his sexual activity
|AnswerDExp='''incorrect''' Exercise stress testing is not needed at this point of time to resume sexual activity

|AnswerE=He can resume his sexual activity and should not combine Sildenafil and Nitrates
|AnswerEExp=Patient can participate in sexual activity immediately post myocardial infarction if he is totally symptom free. Sildenafil and nitrates should never be combined as the risk of hypotension is greater.
|RightAnswer=E
|Approved=Yes
}}