The ULTIMATE GUIDE to CCS Cases | How to ACE the STEP 3 CCS Cases
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- เผยแพร่เมื่อ 23 พ.ค. 2022
- Hey Friends and welcome back! 😁
If you're preparing for the USMLE STEP 3 exam but feel intimidated when it comes to the CCS cases, then this is the video for you. I hope you find it beneficial!
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📝 Outline:
00:58 Approach
14:04 Case #1
22:31 Case #2
📝 Important links mentioned in the video:
CCS Cases Link: www.ccscases.com/
🙋🏻♂️ Who am I?
I'm Khaled, an internal medicine resident in the US, and I make videos on quite a few different topics within the scope of medicine. I hope that my videos help you in any way, shape, or form and that you enjoy them. Medicine is quite the challenging topic, but I don't see why we can't enjoy it together!
🎵 Music:
Outro music: Prod Riddiman - Autumn
Credits to my senior, Dr. Eiad Habib, for some of the mnemonics I later modified.
Key points:
1. Timing (1:01)
Real time = the actual time/real world time, which is 10-20 min.
Simulated time = hypothetical time, which can last from hours to days to weeks.
2. What to look for in case's introduction (2:18)
Age
Gender
Allergies
Main HPI points
Screening (vaccinations, pap smear, colonoscopy, etc)
3. Physical exam (3:45)
Complete physical exam --> if patient is stable or in the office
Focused physical exam --> if patient is unstable or in the ED; you can always do a complete PE later in the case after putting in emergency orders!
4. Disposition (4:35)
Where do you want the patient to be? Options: home, ED, admit to inpatient, admit to ICU.
5. Emergency orders (5:55)
MAVOCCF, which stands for:
Morphine
Acc (gives you IV access and glucose accucheck)
Vitals check
Oxygen/oximeter
Cardiac monitor
C-spine
Fluids (normal saline)
6. Routine orders (6:51)
CCCMP
CUAEH
LLUSCENT
stands for:
CBC, CMP, Creatine phosphokinase, Magnesium, Phosphate
Chest x-ray/other x-rays, Ultrasounds, Abg, Ecg/other cardiac tests, Hcg
Lactate, Lft/pt/ptt/inr, Urinalysis/culture/toxicology, Stool culture/pH/ova/etc, Culture (blood), Esr/crp, Neuro checks, Tsh
7. You should land on a diagnosis by this point and thus, a treament (9:09)
8. Case might finish early if you have managed the patient correctly (9:27)
9. Once the case finishes, you have 2 minutes at the end to put in last minute- orders (10:00).
These can be pap smears, colonoscopies, vaccinations, counseling the patient on various topics.
SITPM (vaccines)
CPM (screening tests)
ISSSAD (counseling)
Shingles
Influenza
Tetanus
Pneumococcal
Meningococcal
Colonoscopy (50-75 yrs, every 10 years)
Pap smear (21-65 yrs, every 3 years)
Mammography (50-75 yrs, every 2 years)
Instruct
Smoking cessation
Safe sex
Seatbelt
Alcohol abstention
Disease specific (diabetes, medication side effects, etc)
Here is a summary of the entire first part of the video (some of this is abbreviated so hopefully it makes sense, but you can watch and read along)
CCS Cases
Things to look for initially (brief skim of H&P) - write these on scratch sheet
1. Age
2. Gender
3. Allergies
4. Brief skim of hx
5. Screening/vaccines/social hx (smoke, drink, drugs, sexual hx)
**skimming hx - buzzwords (they don’t want to trick you, dx is sometimes very very obvious)
ex: RUQ pain exacerbated by fatty foods - gallstones
They want to see if you can put in orders correctly, in correct order, and rule out other scary things (i.e ACS, pancreatitis etc)
VS
Exam:
1. If pt stable (i.e. in clinic and HDS) - complete physical (especially hitting the things they present with)
2. If pt unstable - not doing complete PE, wastes “simulated” time, need to “act fast” and do a focused PE
Disposition - Where do you want the patient to be?
1. Home
2. ED
3. Admit
4. ICU
STAT orders - Do you want to place any emergency orders?
Mnemonic - MAVOCC + F (not all needed, but reminder of some HY examples)
1. Morphine
2. ACC (gives you IV access and glucose accuchecks)
3. Vitals check
4. Oxygen/oximeter
5. Cardiac monitor
6. C-spine
7. Fluids (NS)
Orders (mnemonic) - tailor these tests to your ddx, don’t order all every time for every patient
CCCMP
CUAEH
LLUSCENT
1. CBC
2. CMP
3. Creatine phosphokinase (CPK/CK)
4. Magnesium
5. Phosphate
1. CXR (or any XR)
2. US
3. ABG
4. ECG (other cardiac tests - echo, troponins)
5. B-HCG (repro age like case will end early and you have 2 minutes at the end to put in extra orders
**refer back to scratch paper for quick reference for these below
1. Screening tests - i.e. colonoscopy, Pap smear, mammography
2. Vaccines - shingles, tetanus, pneumococcal
3. Counseling patient - i.e. smoking/drinking/drug cessation, medications, compliance, side effects, safe sex (if STI case), seat belt
SITPM
CPM
ISSSAD
SITPM
Vax - based on case, age, gender etc
1. Shingles - zoster max - >50 yo, 2 dose series, now then in 2-6 mo
2. Influenza/COVID - fall/winter season (RSV >60 yo)
3. Tetanus - q10years
4. Pneumococcal >65 (or susceptible to encapsulated organisms)
5. Meningococcal - 2-dose at 11-12 yo and 16 yo
CPM
Screening
1. Colonoscopy - 45-75 yo (q10years if no abn)
2. Pap smear - (21-29 yo) q3yr w/ cervical cyto alone
- (30-65) q3yr w/ cervical cyto alone, q5yr w/ high-risk HPV testing alone, or q5yr w/ hrHPV w/ cyto (co-testing)
- Chlamydia/gonorrhea - all sexually active women 25 yo at increased risk for infection
3. Mammography - 50-74 yo - biennial screening
ISSSAD
Instructing patient - when you type “instruct” into order search, gives you lots of options
1. Instruct
2. Smoking
3. Safe sex
4. Seatbelt
5. Alcohol abstention
6. Disease specific instructions
Thank you, found this video the day before my exam, and it helped a ton!
This was extremely helpful. Thanks so much for putting this together.
By far the best video on this content. Thank you so much for taking the time to make this!
Very helpful. Makes CCS feel less overwhelming. Thank you!
my test is on Monday and this was great!!! you gave me some ideas on how to optimize my time. thanks doc!!
very helpful!! thank you!
You are an absolute legend.
This was a phenomenal video bro. I used all your ccs mnemonics and tips and passed with ease. Thank You !
Glad it helped you!
I really needed this video. Thank you so much
You are most welcome!
Thank you man that was helpful, God bless
Thank you!
excellent teaching thanks so much
Thank you so much!!
Thank you so much for the video. It's really helpful! I don't think you need prophylactic cefazolin on the cholecystitis case as you already started therapeutic piperacillin-tazobactam. Thanks again!
thank you!
Thanku so much 😊
Thank you😊😊
Thank you so much
You’re most welcome!
Thanks!!!
You bet!
Thank you
tytyty very helpful
THANK U
Where are u located?
That lemon tree looks stunning !
Thanks for your nice explanation. One thing, ct needs to be done before getting the lumber puncture fluid level, rt? But In the case, I do it simultaneously. How can we order them separately?
You can order the CT, advance time, then order the LP once the CT is clean.
I got 70 percentage in the 12th class.... does it cause any issues while doing pg in medicine (usmle, plab).....plz reply me plz ....
@@kookie-rd6pe NO
Hello doctor, quick question.. if the patient is unstable, do you put in the emergency orders first then assess the patient or do you assess first then put in the orders?
I usually first do a focused physical examination. This does not mean that my approach is necessarily correct because no one is sure how the CCS cases are scored. I personally preferred this and felt more comfortable about my performance with this approach.
This is important question of priority when it comes to emergency situation.
It depend on the emergency case.
If the patient is SOB and Hypoxemic then you should put them on O2 first then do your focused physical exam.
If the patient has low blood pressure you should put IV access and start fluid then do your focused physical exam.
If the patient has Seizure you should put IV access and give Ativan, O2 and check Glucometer then do focused physical exam.
I have an issue with the re-evaluate case, can you please explain how to use the "on" "in" and the others to really maximize time, I hope you see this, thank you for the video also!
I think you’re referring to when you click on the clock and run the time forward. If this is what you mean, I usually click “next available result” because it saves me time from typing exactly how far ahead I want to go.
On refers to a certain time you want to go forward to; for example, if it’s 10:15 and you want to skip to 10:45. You would just write “10:45”.
In refers to how much you want to skip ahead, using the same example, to skip ahead 30 minutes, you would write “30”.
I don’t like to use these because you have to check exactly how far you want to skip ahead and to check you have to click around a lot which will cost you some time (especially with input delay).
@Khalemedic Thank you so much, just saw this! Do you have any websites where I could purchase materials for you just to gain more knowledge? Really appreciate you!
Why are LFTs included in the pneumonic if CMP is already in there?
Great point! CMP’s include LFTs. You can just think of Lactate when it comes to L.
I noticed you keep choosing Intravenous. Is that better than choosing orals in the exams
It just depends on the case. In both of these cases, oral medications are not really going to act as quick as IV medications.
In other cases where they’ll likely be sent home (e.g. patient with GERD without red flags), oral meds (e.g omeprazole) could be given. Generally, one route is not better than the other. You instead must tailor your answer based on the knowledge you learned from medical school and studying for the STEP exams.
I hope this answered your question. Best of luck!
Thank you so much
Is it part of usmle exam??
Yes, there are 13 ccs cases at the end of day 2 of the USMLE STEP 3 exam.
@@Khalemedic I’ve heard , this time it’s only step 1,2 and OET. That’s y I asked.
@@niveditasingh6333 if you mean “is it required to apply for residency?” Then the answer is no, you don’t need to complete it. Most people complete the step 3 during their first year of residency but some choose to take it before then for various reasons. I go over all of this in my STEP 3 video: th-cam.com/video/NWJxOgbmHG0/w-d-xo.html
@@Khalemedic got it… Thankyou for responding 😊
Super Helpful. Instead of trying to memorize those terrible acronyms, I changed a few.
Emergent orders : FAV-MOCCA
Workup orders: LUNCHMEATS 4CLUE-P
Admit/Treatment orders: CICADA FLAB
Closing orders: STIMP shots and CP SADISMS
The admit/treatment one I made up: Consult, Insulin, Counsel meds, Abx, Diet, Acid, Fever/pain, Laxative, Activity, Blood (T/S/Transfuse)
Elaborate on your mnemonics please
Thank you !