11-09-2010, 05:32 AM
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-- Great CCS help from --- - meti
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11-25-2010, 07:42 PM
if anybody wants to share experiences and idea about CCS, could post here --
12-11-2010, 12:48 PM
here is another appraoch for CCS:
from link: http://www.usmleforum.com/showthread.php?tid=553686 also, copy and pasting------------ drstethoscope - 12/09/10 13:26 I am pasting what I used and made for myself but of course it is not perfect since it is tailored to me and what I had to remember and not mess up Read intro Note/write (My Sheet that I made on exam center scratch pad is in the end) Age Sex Race CC Duration Location Appearance or any special note like breath smell etc Time/person/place orientation if mentioned Click OK Read Hx of present Illness Note BP Pulse RR Temp BMI Note/Write CC, duration, Intensity, character, associated symptoms Note relieving aggravating factors Past History Medications/vaccination hx (children not if due) Herbs Allergies Fam Hx Drugs/alcohol/smoking Sexual/home life Excer/Diet Female Check LMP, Preg hx, OCP/birth control/last pap/last mammo…make note if due Male note age appropriate screenings done or not…. If not make note if due Children note birth hx, sibling hx, daycare, develop milestones ROS on all pts note anything abnormal Make D/D at least 3 Click OK Now decide based on where patient presented and VS Do Triage here in your mind If pt in ER and unstable with low BP, Chest pain, high pulse etc Before doing anything Start IV Fluids Oxy Pulse Oxi BP moniter (q 2 or 4 hr depends on case) Cardiac Monitor EKG Any specifics needed based on hx like Epinephrine, PEFR can be done here but unless life threatening cases can be deferred till focus exam results Now do Focal exam Notice any abn or +ve findings Just do Heent, Chest, and related system Move clock Note PE abnormalities (narrow your D/D) if possible now Order more investigations based on PE and ER orders All cases check your orders CBC BMP ESR (if suggestive hx and PE) Xray needed for anything PT/PTT INR Blood group and type (esp trauma and expecting surgery or interventional diagnostics) ABG if pulse ox suggestive UA Blood and Urine cultures if suggestive Hx and PE Amylase Lipase LFT Alk PO Lipid TSH Stool culture or Ova/FOBT case dependent Cardiac enzymes (if presentation or EKG suggestive) x 3 /8 hr Females: Pregnancy test U/S if ectopic suspected Imaging : Case dependant Don’t forget to send relevant consult Check on patient after all of this and relevant ER measures If pt needed to be admitted Do Activity Diet Meds Comp stocking Out put Forward case and treat as your D/D narrows Last 5 min D/C IV. Switch to oral meds if needed at this time Take care of NPO or diet orders Counsel following and do screening recs for later date Smoking Alco Seat belt Etc Write Dx Office cases non emergent Complete exam Order basic CBC BMP UA Preg test (if needed) when preg test is ordered you can advance clock to get results before doing further management Order Chief complaint and associated complaint relevant orders Change location if needed Make follow up appt if sending home Recommend/do due screenings Forward clock as needed and treat as case unfolds This is what I Made and used for cases when I had to do the case....use the sheet they give you, write this before you start CCS and than for each case erase the info not the headings and refill with next case's headings Age Sex Location race CC Appearance of patient Vital Signs what is abnormal? Hx of CC Relevant –ve and +ve findings PMH and surgeries Med/Alle Any herbs Fam Hx Social Hx Sexual Hx Any screenings done Screenings that should be done ROS Female LMP/Ob gyn Hx D/D make it now !!!!!!!!!!!!!!!!! Start case and Triage from here onward by hemodynamic status i.e. are there any ER orders??? Counsel pt about dx do followup/interval with focus exam Before ending case DC IV and switch to oral, counsel smoking, sex, drugs, alc, med compliance, s/e, seat belt, order relevant screenings, exercise and diet On 5 min screen treat patient as “stuck in that time” don’t assume he/she is going home. You can order more stuff for later dates on this screen even if it is for 2 hours later or s days later or 2 months later.
12-22-2010, 11:50 PM
Practice
Practice and Practice Once one of my friend (already in resdiency) told me that when he prepared for step 3, there were 43 UW-CCS practice cases and he passed with good scores. So, It is not essential to know many cases like 100 star cases. Jist, You need to make format and practice on that. during reading theory time, for specific case/disease/topic (those are impotant) know diafferentials know initial tests know confirmatory test treatment
12-22-2010, 11:54 PM
01-01-2011, 06:38 PM
musa's 100 rules at the end of neeraj notes.
I wouls sugest again to DO 5 cases from usmle website. That would be a great help to know about how they mark in real exam. Please try to do it whatever knowledge you have. I have corrected orders (according to exam software), I need to find out where it is hiding in PC, then I will post it 
01-01-2011, 06:40 PM
HAppy New Year.
Wishing all best for studying and exam. Enjoy your study and ace it
01-01-2011, 08:06 PM
great post Meti,
Thanx a bunch....Happy New Year and best wishes to you as well. |
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