Friday, January 4, 2019

USMLE Step 3 CCS sheet guide

Hey guys,

So I recently took my USMLE Step 3 and I gathered some of this from various resources. I think this may be of some help to the beginners.

Let's get started!

In relevant emergency cases (order the ones that are relevant):
ABC:
Airway
Breathing
Circulation

P.O. ICESS:
Pulse oximetry
Oxygen
Intravenous line and fluids (Please remember to type NSS/Normal Saline or Dextrose, etc. CCS software won't take orders that are less than 3 characters!)
Cardiac monitor
ECG
Sugar (fingerstick)
Suction

For chest pain add MONA:
Morphine
Oxygen
Nitrates
Aspirin
~~~
Then order relevant Physical Exam (In Office cases, you'd want to order most physical exams and in the Emergency Department cases, you'd want to order more symptom-based system specific exam)
~~~
Laboratory orders: CBC LFT ICU PAX
Complete Blood Count (CBC), ESR
Basic Metabolic Profile (BMP)
Cardiac enzymes (if not ordered earlier)

Liver Function Tests (LFT) or Lipid profile
FOBT
TFT

Imaging (CT/MRI/USG/etc) Iron profile Immunologic tests (HIV/HepB/HepC/Rubella/etc)
Cultures (Blood/urine/fluid/etc)
Urine (routine, microscopy, culture & sensitivity)

Pregnancy test (urine) & Pap test (if female) PT/INR PTT d-Dimer PFT
Amylase ABG
Xray
~~~
You can now forward the time to get some results or decide whether the location needs to be changed
~~~
CCC
Comfort: if the patient is in pain- give NSAIDs/Morphine based on the situation; vomiting- antiemetic; etc
Cure: if you suspect a particular infection-give antibiotic; if it's an MI- angiography v/s other management options; etc
Consult: you may want to order a Psych or Surgery or OBGYN or any other relevant consult based on the case
~~~
If the patient needs to get admitted on floors or ICU:  ADIC

Activity: Bed rest/ ambulation
Diet
Input/output charting
Compression stockings
~~~
If the patient is scheduled to undergo a procedure: ABC PIN
Antibiotics
Blood grouping and crossmatching
Consent

PT/ PTT
INR
NPO
~~~
When you get your 2-minute screen: Counsel and order follow-up labs!
You may want to counsel them on their diagnosis, lifestyle habits, medication adherence/ compliance/ side effects and so on.

Hope this helps!

Stay awesome :)
-Rippie

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