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NBME 24 Answers

nbme24/Block 3/Question#49

A 20-year-old woman with asthma comes to the ...

Ask the roommate not to smoke in the apartment

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

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +  

 +5  upvote downvote
submitted by yotsubato(543),

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

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. +2  
medguru2295  Stress makes asthma worse. Therefore, keep doggo for stress relief! +  

 +2  upvote downvote
submitted by dragon3(8),

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)

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. +1  
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." +18  

 +2  upvote downvote
submitted by lilmonkey(15),

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

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 :) https://blog.homesalive.ca/dogs-that-dont-shed-23-hypoallergenic-dog-breeds +  

 +1  upvote downvote
submitted by whoissaad(40),

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

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. +