Friday, May 04, 2007

General Hints for USMLE Step 3 CCS exam

General Hints for CCS

The part that is problematic with most people is the case simulation part. Below I will list a few hints of how to succeed.

You will have plenty of time to complete each case. 25 minutes of testing time is available. In the end you have to write your diagnosis. Obviously this test will have more common diseases, so thing about those first. Second, think what you would do if it was a real patient. This helped me a lot during the exam. The test also wants to make sure you are practicing safe medicine, so stay away from anything dangerous, especially drugs with too much toxicity, surgery without confirmatory tests and such.


In order to decide where to best treat the patient (office, ICU, ward), you have to determine 2 aspects: how sick is the patient and how rapidly does it have to be treated.

  • Vital signs: watch for tachycardia, bradycardia and extremes in blood pressure. Also tachypnea should point to something more severe.
  • Complaint or symptoms: severe pain, shortness of breath should raise red-flags.
  • Age: very young and very old people tend to need to be hospitalized.
  • Instability: any unstable vital signs, fluctuating levels of consciousness, severe blood loss should prompt an ICU admission.


For most people that have not had medical training in the US this might be a problem. To order medications you do NOT have to know the dose. You can write common tradenames and generic names. Also, consultation can be obtained, and these take little time. Remember about vital signs / ECG monitors, oxygen.

Radiology and Laboratory tests

Know why you are ordering every test. It seems trivial, but do not order something unless it is going to help you with the diagnosis. All tests in Step 3 take considerable time, even days. The less common the test you order, the more you will wait for a result.

Follow-up and interim histories

The system will not penalize you for seeing your patients too often. If you do not know how often to see patients, in hospital usually once a day. The system will let you know of new test results and developments in the case.

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