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* 100 CCS Cases on Exam, Let's Build this!
 #542961  
  jaiganesh - 10/24/10 16:34
 
  These are the cases you need to know how to manage inorder to make your CCS exam pass with no difficulties. Note that since the USMLE prohibits distribution of its CCS examination cases, I will not in any form tell you that these cases were obtained from previous people who examined nor I will tell you that you will face them in your exam. I will only advice you to master them as you know your name.

LET'S COME UP WITH FORMAT FOR ALL 100 CASES AND POST ON THIS THREAD SO WE CAN MAKE A MASTER LIST TO HAVE STUDY FROM I THINK THIS WILL BE USEFUL.

Sunday, February 28, 2010
USMLE STEP 3 FREQUENTLY ASKED CCS CASES

Common cases asked in CCS

1. DKA
2. Pulmonary embolism
3. Endometrial carcinoma
4. 1 day old Newborn Down’s baby presenting with vomiting/ Duodenal Atresia
5. Motor vehicle accident with splenic rupture
7. TIA
8. Acute Hepatitis A
9. Secondary Hypertension, Hypokalemia – adrenal mass
10. Minimal change disease: Child had scrotal swelling.
11. Constitutional growth delay in african american kid
12. Pericarditis
13. VSD
14. Acute MI
15. Osteoprosis with compression fractures
16. Gastritis secondary to NSAIDs use
17. New Onset DM type II
18. Pregnancy
19. Anaphylaxic reaction/ Shock
20. Adrenal Mass/ Hyperldosteronsim/ Hypokalemia/ Young woman presenting with leg cramps & weakness
21. Heat Stroke
22. Ovarian Teratoma
23. Inflammatory Bowel disease
24. Vaginal Bleeding secondary to Fibroids requiring hysterectomy. ( Woman 44 y/o)
25. cervical cancer
26. Turners syndrome
27. UTI/Sepsis – 76 Y/o woman sent from NH for evaluation of altered mental status
28. Hepatic encephalopathy
29. Acute Cholecystitis
30. G6PD deficiency
31. Constipation, hypercalcemia, primary hyperparathyroidism
32. Pregnancy with asymptomatic bactiriuria
33. Back pain due to osteoporotic fracture – compression fracture
34. Bipolar disorder
35. Plulmonary embolism
36. Abdominal Anuersym Rupture presenting with backpain/ No Hypotension at presentation – Vitals stable, so you can get CT scan and then surgery consult.
37. Chalymadia trochmatis (in a male)/ Non gonococcal urethritis
38. Erosive esophagitis/ GERD
39. Panic Attack
40. Acute Asthma Attack – 14 Y/O female with wheezing, Sob
41. Obesity in a teenager
42. Toxic Shock syndrome/ Tampon use
43. Hyperglycemia/ new onset DM Type
44. fracture neck of femurs – 75 y/o female fell and sustained right hip fracture – Ortho consult, ORIF, fall prevention, hip protection devices, Osteoporosis screening, DVT prophylaxis
45. HIV with pcp and lymphoma
46. child abuse with sub dural hemorrhage
47. Tylenol overdose
48. Heat Stroke
49. Acute PID
50. Tricyclic Overdose {40 y.o. Arab male with no history known brought in the ER by a neighbour with uncounciousness and unresponsive state – he had some depression as per neighbour (TCA TOXICITY)}
51. Acute pancreatitis
52. Child with intusussception
53. Woman with multiple sclerosis ( comes with weakness and has nystagmus on neuron exam)
54. Septic pulmonary emboli in IVD abuser.
55. Stable Angina
56. SLE
57. Pregnancy in a 44yr old women: CVS, amniocentesis for karyotyping
58. Bacterial Meningitis in an infant
59. Juvenile Rheumatoid Arthritis
60. Anemia secondary to colon cancer
61. Alzheimer’s Disease(had to rule out other causes of dementia before making the diagnosis)
62. 50 + y.o. M with epigastric pain (erosive gastritis, had h/o long term NSAID use) – Has age criteria for EGD.
63. 40 y.o. M with IVDA and SOB with fever (Infective Endocarditis)
64. 4 yo. F with ANA +ve Arthritis
65. 50 + y.o. F with high BP in office
66. 50 + y.o. F with Renal failure and family h/o ADAPKD, HIGH K+
67. Acute manic disorder
68. UTI with 12 week prenancy
69. chid abuse
70. acute diarrhea
71. Acute MI
72. CHILD ABUSE : 2 y/0 AA boy was brought with lethargy, CXR revealed multiple posterior rib fractures and CT head subdural hematoma —Child abuse, call child protection services and social work consult
73.) Eclampsia… presented with seizures and peripheral edema at 38 weeks pregnancy.( Magnesium sulfate, induce delivery, if still seizure – follow status protocol)
74) Uncontrolled DM type 2 – came with increased thirst and urination
75) HIV in a 25 y/o f with multiple partners – came with weightloss, fatigue and cough. Do HIV test, viral load, genotyping. Then cd4 count.
76) Acute pericarditis.
77). Right upper quadrant pain, cxr – pneumonia – right lower lobe – community acqd pneumonia
78) Dysfunctional uterine bleeding
79) Polymyalgia rheumatica
80) Trauma patient with cardiac tamponade
81) Pancreatic ca, old man with fatigue, weightloss – exam shows icterus – go ahead with CT
82) 9mos old baby with fever unknown cause all tests including cbc are negative ( Roseolum infantum)erythema infectiosum/fifth disease; exanthema subitum/sixth disease.
83) hypothyroidism in a man
84) Post menopausal bleeding in a woman not on HRT/ benign endometrial hyperplasia
85) cystitis
86) septic arthritis
87)gastric carcinoma
88)incomplete abortion
89)Atrial fibrillation
90) Diverticulitis
91) Dehydration/ Hypernatremia
92. 20 month old african american boy brought for fatigue and lethargy to office/ Fe deficiency
93. Acute Bacterial Prostatitis
94. ALL in a 5 year old/ 5 yr. old boy who came with weakness, disinterest in activity and lesion on leg.
95. Acute pericarditis – rx ( make sure to do echo, dont do unnecessary pericardiocentesis if there is mild to moderate pericarditis with out clinical or echocardiographic evidence of tamponade)
96. Osteoarthritis of the Knee ( if there is large joint effusion, always do arthrocentesis)
97. CIN III
98. Congestive heart failure in a post-op patient ( make sure they are not giving too much IV fluids in post op setting, I/O monitoring, daily weights, lasix, 2d echo, r/o MI, EKG, CXR, BNP – Lasix, if flash pulm edema, give morphine)
99. Hypercalcemia/ renal mass ( likely RCC) – Elderly man presenting with fatigue
100) Complete Heart Block - Woman coming with Motor Vehicle Accident/ only minor injuries on the arm , Vitals reveal Heart rate 38. - EKG shows complete Heart block


 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2248571
  jaiganesh - 10/24/10 16:36
 
  i will start first

#41. Obesity in child

obese girl in office


complete history and physical
note bmi
thorough review of systems in pe for any signs etc for any
secondary causes
waist and hip circumference
neck crcumference
cbc
bmp
lfts
tsh
ua
uhcg
fsh
lh
hepatic panel
24 hr urine free cortisol
Fasting glucose and insulin
Ekg
Cxr
Genetic testing
Echo if needbe
Send pt home
Counsel about diet
Nutrition consult
Weight loss program
Exercise and physical activity
Counselling/behavioral p,ans
Send pt home for f/u in 2 weeks
Mng depend son further esults
Childhood obesity


input needed
 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2248578
  medicine_king - 10/24/10 16:54
 
  Good work and good list..will help every one and everyone should also try atleast one case..

here from me..4. 1 day old Newborn Down’s baby presenting with vomiting/ Duodenal Atresia

Pulse oxy
IVA
NS
BP monitoring
Cardiac MONITOR
NPO
NGT
IV metoclopramide stat

Brief physical

CBC
BMP
CXR
EKG
AXR acute series
USG abd
UA
urin culture
LFTs
amylase
lipase

USG confirms the Diagnosis

Consult Pediatrics GI surgery

Transfer to ICU

vitals Q 1 hr
NPO
Urin out put
karyotyping
BP check
electrolytes

Karyotype confirms Down's

ECHO
audiometry
TSH
Psychiatry consult
Genetics consult

 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2248715
  sami2004 - 10/24/10 20:21
 
  hi everyone, why dont we narrow down the list and exlude the one done by Usmle world, and concentrate on ones that we dont have or new one. i will help doing some  
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* Re:100 CCS Cases on Exam, Let's Build this!
#2248876
  aceace2010 - 10/25/10 04:01
 
  89)1 day old afib ccs with sob BP stable

pulse ox
check o2 if more than 90%then give oxy cont
cardiac monitor
bp monitor
iva
cbc
bmp
pt/ptt
cardiac enzyme
ekg
focal exam
get ekg shows a fib
tachycardia but vitals otherwise stable
control heart rate
IV metoprolol
Iv heparin
(make sure occult blood neg, pt/ptt, cbc ok)
order TEE
TFT
tee result no thrombus
Synchronous cardioversion
cardic monito/ekg=sinus rythmn
change location to ward with telmontoring
cardiology consult
next day round
case ends
advise all appicable 5m inute screening stuff
diagnosis afib

 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2248878
  aceace2010 - 10/25/10 04:02
 
 
#1 DKA

uick P/E
pulse ox stat/continuous
oxygen
iv access
cardiac monitor
NS 0.9 % cont
finger stick gluc stat
u hcg
cbc
bmp
calcium
ekg
amylase
lipase
abg
ua
s.osmolality
s.ketones
regular insulin IV cont
phenargan iv one time

admit pt to ICU
NPO
bed rest
vitals per icu protocol
UOP
Kcl iv cont
hb A1c routine
phosporus stat
abg q2h times 2
bmp q2-4 hr
after 4 hrs stop iv ns 0.9 and then give 1/2 ns
consider anti-bioticsif infection cause of dka
get cxr, ucx, bcx
start oral fluids after nausea decreases
pt stable to floor

at discharge discontinue all lines
nph andregular insuling sc
diabetic diet
diabetic teaching
foot care
home glu monitor
no alcohol
no smoking
no illegal drugs
safe sex
regualr exercise
seat belt
f/u in 10 days




 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2248880
  aceace2010 - 10/25/10 04:05
 
  #80 CARDIAC TAMPONADE

Blood pressure monitor, cardiac monitor, oxygen, pulse oximetry, elevate foot of bed, intravenous access, normal saline 0.9% NaCl

General, heart, lungs

Pericardiocentesis, consult thoracic surgery, chest x-ray, ECG, echocardiography, morphine


Additional: skin, HEENT, abdomen, extremities + others

CBC, BMP, PT/PTT, cardiac enzymes, amylase, type & crossmatch blood, alcohol blood, cervical spine x-rays, pelvis x-ray, toxicology urine
Advance to pericardiocentesis
Chest x-ray, echocardiography, vital signs
Advance to vital signs
Transfer to ICU
Advance to additional results and case end
Advise patient drive with seat belt
 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2251013
  aceace2010 - 10/26/10 21:51
 
  all of you who are benifiting from sams qns plz make an effort to help us with ccs here and add
your contribution for cases

jaiganesh thanks, plz add more
 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2251371
  sami2004 - 10/27/10 10:14
 
  hiatal hernia

Patient will be older than 40 years, coming wth some sign of epigastric pain that is mild, heart burn,Nausea, hiccups

PE complete

Order:

cbc
bmp
chest xray
ekg
LFT
lipase---to make sure pt doesnt have pancreatitis, if he does , then u treat him and focus the case on pancreatitis which is separate case than this one.
amylase

send home with appt for next week and u can send him or her with maloox

pt come back with the same symptons and saying he isnt feeling well

Do focal exam then
consult GI


Order Upper Gi studies or barium swallow
consent for procedure
Order upper endoscopy
NPO
PT
ptt

fobt
type and cross
send the patient home with followup visit in one week based on the time of Endo


while patient at home you get the results saying

Upper GI series showing Hiatal hernia
Pt will arrive to his appt, we do focal exam

then we manage like GERD

Order
1. excercise, wt loss, avoid large meal, elevate head of bed, no alcohol, no smoking...etc
2. H2 blcoker, Zantac as initial or alternative give PPI like omeprazole (prilosec).
3.metoclopramide (reglan)
4.counsel patient

schedule appoint in 4 weeks:
Let us assume patient comes back again with pain and his medication isnt working

The we can do elective surgery Nissen fundoplication and order pre-op labs


if patient has paraesophageal hernia, then go straight to surgery to avoid complication.
 
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* Re:100 CCS Cases on Exam, Let's Build this!
#2251376
  aceace2010 - 10/27/10 10:17
 
  excellent  
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* Re:100 CCS Cases on Exam, Let's Build this!
#2251382
  sami2004 - 10/27/10 10:20
 
  ethylene glycol

ER

oxygen
oxi
iva
nss
ekg
vitb1
vitb6
naloxone
finger stick glucose
ethanol level
Theo level
salicy level
aceta level
urine toxicology
ABG
urinalysis
bmp
magnesium
cbc
osmolality serum
anion gap
lactic acid
cardiac and bp monitor

then focal exam
Read your results for focal exam
look at the results and history of ingestion
make sure u look at Osmolar Gap and Anion Gap, ABG
urine might show calcium oxalate, protien and RBC

IF TOXICATION IS PRESENT THEN GIVE iv fomepizole or iv ethanol, i think fomepizole is better


if low HCO3 or ABG showing PH < 7.2, then give NAHCO3
if agitation give benzo
if n &v...phenergran
order FOBT

Transfer to ICU

foley cather
NPO
penumatic stocking
urine output
vital Q 1 hr
Bun and creatinine
Repeat ABG
BMP every 6 hrs
cbc 12 hrs
repeat focal exam every 12 hrs for monitoring Cardio resp depression and cns depression

Keep the patient in icu till patient feel better

then you can counsel patient ...normal counseling

if anyone want to add anything please do, if u have a question, pls ask in a new subject so we dont have too many pages
 
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