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NBME 24 Answers

nbme24/Block 3/Question#49 (38.7 difficulty score)
A 20-year-old woman with asthma comes to the ...
Ask the roommate not to smoke in the apartmentπŸ”

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submitted by tissue creep(101),
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heT pldooe is enlpoiyralce,gh dna a 0101/ oodg y.ob

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +  
mynamejeff  The poodle is hypoallergenic, and a 10/10 good boy. +  

submitted by yotsubato(954),
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loCd iar scendui asmaht atcka.ts

necsergDia secruo odal nowt hepl

kTngia sotrdsie is too chmu fro own

nivMog akcb ot het msrdo is not abelvi

iAr cansreel ntod rokw honeug

nDot teg ird of the ooGd oyeB

kioSnmg disoonr si tgngusisdi

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. +7  
medguru2295  Stress makes asthma worse. Therefore, keep doggo for stress relief! +  
qiss  Also her symptoms started 3 months ago and she moved in with a roommate who smokes indoors 3 months ago. +1  
jrish  But wouldn't the smoke on the roommates clothes still cause significant asthma problems? +  

submitted by lilmonkey(18),
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wasyAl soceh nmsgiok fi yuo ese .ti nI nya teyp of outqines. n'Dot enev reda :)

submitted by dragon3(11),
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I satlom cdkpei knsaig eth mmaoetor ont ot omeks ni hte m,ttepraan btu nhte I gedirfu a'stht eydnbo the ocesp fo het ...odcotr oartenh osrpen disa ktagni estodsri ouwdl be too muhc orf now, adn I uespspo ta'tsh uebcsea hte thamas si rc-wndlollolete thiw hre iaehnrl n?r h'stt(a htwa I had ce)idkp

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." +39  
peqmd  Depends who's dickier the doctor telling the patient she shouldn't live in smoke or some guy smoking in the house +  

submitted by saturdaynightpalsy(4),

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."


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 :) +1  
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 +  

submitted by whoissaad(72),
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Whta aterneuag do we hvae taht hte tmrmaoeo is niggo ot stop osgmnki in eth tptrmanae by ignks""a imh ot do ?.o.s

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  

submitted by therealslimshady(18),

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?

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. +  
123ojm  Also her roommate is the one that makes it warm, so the apartment is not cold +