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NBME 24 Answers

nbme24/Block 3/Question#49 (reveal difficulty score)
A 20-year-old woman with asthma comes to the ...
Ask the roommate not to smoke in the apartment ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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 +105  upvote downvote
submitted by โˆ—tissue creep(133)

The poodle is hypoallergenic, and a 10/10 good boy.

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medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +1
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +
unknown001  no man, smoking is life :-P +

 +17  upvote downvote
submitted by โˆ—yotsubato(1208)

Cold air induces asthma attacks.

Decreasing course load wont help

Taking steroids is too much for now

Moving back to the dorms is not viable

Air cleaners dont work enough

Dont get rid of the Good Boye

Smoking indoors is disgusting

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sherry  Stress can actually be a trigger for asthma. I think the problem here is that she has alwasys carried a heavy course, while the disease just started recently. +8
medguru2295  Stress makes asthma worse. Therefore, keep doggo for stress relief! +1
qiss  Also her symptoms started 3 months ago and she moved in with a roommate who smokes indoors 3 months ago. +2
jrish  But wouldn't the smoke on the roommates clothes still cause significant asthma problems? +

 +7  upvote downvote
submitted by saturdaynightpalsy(10)

So we are just supposed to know that poodles are hypoallergenic...

I put "get an air cleaner" because I thought asking the roommate to stop smoking would be beyond the scope of the physician and since I didnt know poodles were hypoallergenic, I thought "well, even if the roommate stopped smoking, she'll still have issues because of the pet dander."


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luciana  Same here, I got confused because it seemed that the smoke AND the dog were the triggers, so I picked "Move back to the dormitories" so all the triggers would be gone. Who would imagine poodles were hypoallergenic +
luciana  For those like me who didn't know there was 1 hypoallergenic dog, there are 23 to you memorize :) +2
jamaicabliz  The way I thought about it was that she's had the poodle for longer than 3 months, since she brought it with her, and didn't seem to have problems beforehand +1

 +4  upvote downvote
submitted by โˆ—lilmonkey(63)

Always chose smoking if you see it. In any type of question. Don't even read :)

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 +2  upvote downvote
submitted by dragon3(15)

I almost picked asking the roommate not to smoke in the apartment, but then I figured that's beyond the scope of the doctor... another person said taking steroids would be too much for now, and I suppose that's because the asthma is well-controlled with her inhaler rn? (that's what I had picked)

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sherry  I would say the patient's asthma only got worse after her moving out. So its more allergen-related. Getting rid of the allergen is always better than upgrading medications. +2
et-tu-bromocriptine  Rippp the "don't be a dick" strategy definitely failed me on this one. For some reason, I thought requesting the patient to ask someone else to change their smoking habits would be a tad too much. I can just picture UWorld smacking me with a "Although it is likely that the roommate's cessation of smoking could alleviate the patient's asthma exacerbations, this request would be out of the physician's scope....etc." +47
peqmd  Depends who's dickier the doctor telling the patient she shouldn't live in smoke or some guy smoking in the house +

 +1  upvote downvote
submitted by โˆ—whoissaad(102)

What guarantee do we have that the roommate is going to stop smoking in the apartment by "asking" him to do so..?

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krewfoo99  There is no guarentee. They are basically asking what a trigger is for her asthma recurrence. Smoking in this scenario can be the cause of this patients symptoms. Dont dwell to deep into the question. +1

 +0  upvote downvote
submitted by โˆ—therealslimshady(42)

I honestly don't understand why A is the correct answer. I picked "move back to the dorm" because there are three asthma triggers in her dorm: (1) the smoker, (2) the fact that her roommate doesn't like it when it's too warm (she doesn't want to be cold, and cold is a trigger for asthma), and (3) the stress of people who don't clean their dishes. Stress, cold, and smoke. Those are triggers for asthma that are present in her apartment. Is anyone else not seeing this?

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123ojm  Because presumably she's already signed a lease and cannot afford to pay a second rent by moving back into the dorms. I think this goes back to making suggestions for our patients that are reasonable for them to achieve. +1
123ojm  Also her roommate is the one that makes it warm, so the apartment is not cold +1

 +0  upvote downvote
submitted by โˆ—freemanpeng(7)

No such thing as hypoallergenic dogs!!

The major dog allergen, Can f 1, is responsible for allergies in most people who are allergic to dogs. Hypoallergenic breeds of dogs were promoted because it was thought they would produce lower concentrations of Can f 1, and therefore cause less (or even no) allergic symptoms in people with a dog allergy. Examples of dog breeds that have previously been labeled as hypoallergenic include Poodles, Labradoodles, and Yorkshire terriers. There is no scientific proof these breeds truly produce lower amounts of Can f 1; these dogs were simply labeled as hypoallergenic because of the false assumption that dog breeds that do not shed hair must release less allergen.

(Nicholas CE, Wegienka GR, Havstad SL, Zoratti EM, Ownby DR, Johnson CC. Dog allergen levels in homes with hypoallergenic compared with nonhypoallergenic dogs. Am J Rhinol Allergy. 2011;25(4):252โ€“256. doi:10.2500/ajra.2011.25.3606)

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freemanpeng  Surprisingly, the amount of Can f 1 found in hair and coat samples was actually highest in the "hypoallergenic" breeds of dogs, with Poodles having the highest amount of the dog allergen, and Labrador Retrievers having the lowest amount. (Vredegoor DW, Willemse T, Chapman MD, Heederik DJ, Krop EJ. Can f 1 levels in hair and homes of different dog breeds: Lack of evidence to describe any dog breed as hypoallergenic. Journal of Allergy and Clinical Immunology. 2012;130(4). doi:10.1016/j.jaci.2012.05.013) +

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