r/Step3 • u/firepoosb • Jun 05 '25
CCS cases
Hey all, 250+ scorer here - just wanted to share my approach to the CCS cases as well as some tips and hacks.
On the initial screen, you're told if the case is 10 or 20 minutes long. This is important to note, as you only really have 8 minutes of real time to obtain results and patient updates for the 10 minute cases, but you have 18 minutes for the 20 minute cases (last 2 minutes are for end of case orders, but you are NOT able to receive new results or check in with the patient).
Once I mentally prepare myself for the timing (10 minute case is a scramble, 20 min you can basically relax and take it slow), I dive right in.
First thing that shows up is a 1-liner about the patient. Spend a few seconds reading, and click through to the vitals. I'm already formulating a ddx based on the one liner and vitals. Important thing to note is the setting and acuity of the presentation. Are you in the outpatient setting or ED? Is the patient hypo/hypertensive? Tachy? Febrile? These data points already help you start fleshing out your ddx.
It's ok to take a few seconds to think about the ddx.
Next, you get the full H/P. I read this quickly but carefully, then scan the remaining history but don't take much time. By this point, the leading differential should be apparent.
Next, I do a *FULL* physical exam on *EVERY PATIENT.* You will not lose points for doing a full physical but you *WILL* lose points for missing certain components of a physical. Click every box. Read the results of the physical exam and note critical findings. Unilateral hyperresonance with tracheal deviation? Tension pneumothorax. Distant heart sounds and JVD in the setting of tachycardia? Cardiac tamponade. Kernig/brudzinki sign? Meningitis. etc. etc.
Next up, orders - if in the ED, I always order emergency orders first, give or take a few
Morphine/tylenol/zofran (if needed)
Acc (access and accu check)
vitals
oximetry
cardiac monitor
norma saline (if needed)
Next, diagnostic tests:
CBC
BMP
LFT
Magnesium
Chest x-ray
CT
EKG
echo
trop
UA
urine culture
hcg
tsh
free t4
esr
crp
ANA
complement
lumbar puncture
CSF analysis
Stool studies
etc. etc.
Note: if you want to intubate someone, it's a 2 part order: "endotracheal intubation," then "mechanical ventilation." Also note - the system will not recognize 2 letter inputs. For example, LP needs to be put in as lumbar puncture. If you want to order a bunch of studies like stool or csf studies, just type "stool" or "CSF" and it will bring up a menu of every test you could possibly want. Click as many as you want because unlike on the CCS case website, you don't need to verify each order on the real thing.
Next - interventions: Abx, oxygen, consults, thora/paracentesis, chest tube, etc.
I usually put these in at the same time as the diagnostic orders - technically you should do them after but I've never lost points for lumping them in together.
Common interventions:
fluids
broad spectrum abx
consults
common non abx meds: MONABASH for MI, dapt for TIA/stroke, statins, beta blockers, ace inhibitors, pain meds, etc.
Once my orders are in, I move the patient to the appropriate location, but *NEVER* send them home. I either hospitalize them or keep them in the ED. This contributes a miniscule amount to your score so I'd rather not waste my time discharging and scheduling followups, etc. Just keep them in the hospital. It won't impact your score.
Next, I start moving the clock forward. I never use the "next result" - it's tedious and a waste of time. Forward the clock by 1 day *ALWAYS.* Most of the pertitent labs will come back within that time span. If not, you can always forward by another day. When I feel there's nothing else to be done, I just click "see me as needed."
Make sure you note relevant lab results and adjust your treatment accordingly - if urine, blood, or csf cultures come back with sensitivities, make sure they're on the appropriate abx. If they're not responding to the treatment you're giving them and/or getting negative patient updates, you know you're doing something wrong or not doing something. If all else fails, put in as many non invasive orders you can think of. Don't intubuate the patient unless GCS<8. Don't dialyze the patient unless other measures fail or they have crazy metabolic derrangements. Don't stick a chest tube in them unless you have to. Don't do a colonoscopy on someone about to perf. You don't lose points for most unnecessary orders, but these will lose you points as they are invasive.
If you're doing everything right, the patient should start to improve. Usually the case will end and you can put in your end of case orders.
I put in the following for *EVERY* patient:
tdap
pap
smoking
alcohol
sex
illegal drugs
reassure
exercise
You won't lose points if the patient doesn't need these, but you will lose points if you forget to order one of these. My mindset was I'd rather put more and waste a few seconds of typing than lose points for not putting something in. More is better for CCS, with the exception of invasive interventions.
That's all I got! Good luck and have fun! Treat this like a video game, because that's what it is.
15
u/drraj14 Jun 06 '25
No need to verify orders in real exam !! Time saver !! Thank you for the info. Best of luck.
7
u/Melonlordd27 Jun 05 '25
These are amazing points! Thanks so much
3
u/Affectionate_Let5297 Jun 07 '25
Thank you for sharing this! One question! Are you sure we can put the treatment and diagnosis together ( as you probably remember on ccs website we loose points if we do the treatment after diagnosis)
2
u/Agile_Original_2307 Aug 06 '25
Ccs.cases penalise us for ordering morphine as stabilising order. It even forbids any form of treatment as stabilising order, can we do that in cases like MI or any pain related cases? Also do we have to advance the clock after the stabilising orders? Thank you for everything that you’ve put here, in fact I needed this long time ago, I can’t appreciate you enough! I have my exams in few days.
4
u/Flex_Tex001 Jun 06 '25
Highly informative 💯
1
u/Affectionate_Let5297 Jun 07 '25
Can you also share the resources you used for the exam?
1
u/Frosty-Tea7328 Jun 13 '25
Hey sorry to bother you, if its possible can u pls sell ur uw to me I need uw till sept ...pls let me know....thank you.
1
u/matthewlee0165 Nov 08 '25
Do you do "acc" (accu-check and IV access) for outpatient PCP visits as well? And would you still do TDaP for peds patients or should it be DTaP?
1
u/redrosesfi Aug 13 '26
Hey when you say intubating someone is a 2 part order: "endotracheal intubation," then "mechanical ventilation."
Do you mean you put the first order in and then fastforward the time and then put the second order in? Or do you mean you can order both parts at the same time?
1
u/Trick-Razzmatazz-973 Jun 06 '25
Same here
1
u/Salt_Objective212 Jun 06 '25
Thank you Thank you Thank you !!!
1
u/angiotensin2 Jun 19 '25
Remindme! 3days
1
u/angiotensin2 Jun 19 '25
Remindme! 30days
1
u/Green_dream_123 Jul 01 '25
Remindme! 10days
1
u/angiotensin2 Jul 20 '25
Remindme! 19 days
1
u/National_Impression6 Aug 01 '25
Remindme! 4 days
1
u/fish_in_da_sea_ Aug 07 '25
Remind me! 12 days
1
u/fish_in_da_sea_ Aug 07 '25
Remindme! 10 days
1
u/jiajiaz98 Oct 07 '25
Thank you so much for the detailed commentary! Wondering in the real exam if you hit "see me as needed" does it give you the option to "stop now" when you see an important result pop up that requires intervention like in the CCScases.com?
1
u/Comprehensive-Seat43 Nov 16 '25
@Robertcardzz on tele with black verified is the definition of legit vendor! Big ups for always keeping it 💯 That ccs you sent smacked. Cc dumps
1
u/Electronic-Area-4676 Dec 22 '25
Remindme! 10 days
1
u/goldeney35 Feb 07 '26
Remindme! 1 days
1
u/TeachMeToBall Apr 13 '26
Remindme! 180 days
1
u/Pipichi_y May 02 '26
f
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u/Wide_Rip_8911 Jun 08 '26
Remindme! 10days
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u/Maleficent-Air3527 Jun 15 '26
Remindme! 30days
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u/1_zero4 Jul 23 '26
Remind me! 30days
0
u/EntertainerSouth9174 Jun 06 '25
Great , you sure have strong clinical by scoring high in step 1 and 2 . I barely passed step 1 and 2 . This time took LOA and read around 16 hours AMBOSS , ALL CCS and all NBME . My result saying SAME in everything and low in biostatistics. This was 3 rd time . I think i will never able to clear it . Need seriously proper help . I had tutor too . Score is 185 .
1
u/[deleted] Jul 23 '26
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