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* CCS cases (collected from another forum)
  ia - 01/05/12 06:24

The following are the new additional high-yield Step 3 CCS cases. The cases below are followed by an outline of the management are essential for obtaining high score on these CCS.

1. Hodgkins lymphoma : A 40 YEAR old man from india presenting with lymphadenopathy. TB work up comes negative. CXR and CT scan reveals mediastinal lymphadenopathy – biopsy supraclavicular node reveals Hodgkins disease – Proceed with the case – get HIV test, staging w/u involves CT CHEST/ ABDOMEN AND PELVIS, CT reveals Lymphnodes only in mediastinal and cervical area – proceed with getting a baseline Echo and PFTs since you need to start ABVD ( Adriamycin, bleomycin, vinblastine and dacarbazine) regimen , start abvd only after echo and pft comes back as you need them before starting adria and bleo respectively – call oncology consult, call radiation oncology consult for opinion.

2. GERD/ Hiatal Hernia : 40 YEAR OLD man with hx of hiatal hernia and long lasting GERD symptoms – Start PPI trial – comes back not responsive to PPI – now, do hiatal hernia surgery/ nissen fundoplication – patient improves.

3. New HIV/ With pharyntitis vs. Thrush/ lymphadenopathy : 30 year old African American woman with dry cough and white spots. Has night sweats and weightloss, has peripheral lymphadenopathy – supraclavicular and cervical. ΰ Rapid strep test, rx for strep pharyngitis with amoxi+clav if rapid strep +ve, if rapid strep –ve get throat cultures and empirical antibiotic, HIV test, if physical exam looks like thrush in oral cavity – start diflucan on day 1. Do additional routine w/u – CBC, CMP, U/A, UDS, CXR, LDH HIV test comes +ve, order viral load, cd4 panel, genotype. CD4 comes 50 – start MAC, PCP prophylaxis. Start HAART therapy and ID consult. CXR shows mediastinal widening – get CT scan and biopsy supraclavicular node – reveals non-hodgkin lymphoma – oncology consult, ct abdomen, ldh – case ends.

4. Acute diverticulitis

5. Femoral neck # in a 90 year old lady –90 y/o lasy after a fall and right hip pain – x-ray pelvis, hip – reveals right fem neck # - immobilization, do not forget DVT Prophylaxis, Orthopedic consult – says proceed with medical management in view of age . Continue DVT prophylaxis and physical therapy.

6. Bladder cancer: 40 year old man with history of smoking x 20 years, has not seen a doctor for 2 to 3 years comes for a general health wellness exam. All labs with urine analysis done. Showed 5 rbc/hpf with no casts. Urology consult. Since the patient has risk factor of smoking, both CT urogram + cystoscopy performed as a w/u for microscopic hematuria. Urine cytology sent for. Bladder wall biopsy +ve for transitional cell CA ΰ PROCEED WITH STAGING W/U

7. Ascites : 50 year old man with hx of known cirrhosis presenting with enlarging abdomen and caput medusae on physical examination. All routine labs – CBC, BMP, LFT, U/A, PT, PTT, CXR, U/A ABDOMEN, hep – c serology, hep b panel, ana ΰ Then, diagnostic paracentesis ΰ send for protein, albumin, cytology, cell count – follow. Rx if evidence of SBP. If no evidence of SBP, proceed with ascites management with sodium restricted diet, diuretics : furosemide and spironolactone. EGD to rule out varices. If varices, start bleeding prophylaxis with propranolol ( non selective beta blocker). If hepatitis C with cirrhosis, get a alpha-fetoprotein level.

8. Asthma exacerbation : 30 y/o woman with hx of childhood asthma presents with wheezing to the ER. Routine w/u normal. CXR negative. Given albuterol + ipratropium + steroids ΰ PEFR performed after nebulization , improved and clinically, also improved. Discharged in 1 day after improved and given oral steroids + albuterol MDI ΰ appointment in 4 weeks ΰ CASE ENDS ( If case proceeded, check for how many times she has used rescue inhaler in the last 2 weeks and classify her Asthma in to mild, moderate or severe so as to treat her Asthma appropriately).

9. Juvenile diabetes/ DKA : 8 year old male child with DKA

10. Adolescent Obesity – HTN 146/84 ΰ check for TSH, CUSHING FEATURES, CMP, U/A, CBC, lipid panel, check for clues of obstructive sleep apnea ΰ check for causes of secondary HTN ( plasma metanephrines, dexameth suppression test) – then, Sodium restricted diet, weight loss program, Exercise programΰ SEND HOME WITH APPOINTMENT IN 4 WEEKS TO RE-ASSESS PROGRESS.

11. Acute Lymphangitis : a 10 year old buy with low grade fever and abscess draining on his right forearm and a streak of redness radiating along the arm upwards ( a clue for acute lumphangitis) – admit, I and D if abcess, iv antibiotics, cultures.

Archer's List of 100 Cases
High Yield USMLE Step 3 CCS Case List :

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 cancer26. 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 know 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
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 makingthe 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 Arthritis65. 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 reheumatica
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)
83) hypothyroidism in a man
84) Post menopausal bleeding in a woman not on HRT/ benign endometrial hyperplasia85) 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)
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:CCS cases (collected from another forum)
  ia - 01/05/12 06:28
  I found those posted on another forum, where people were practicing some CCS cases  
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* Re:CCS cases (collected from another forum)
  zinetac - 01/05/12 08:06
  ia thanks a lot. You are always on the forum to help others. May god bless you and GL for your exam.  
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* Re:CCS cases (collected from another forum)
  gunny - 01/05/12 10:44
  thank u so much  
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* Re:CCS cases (collected from another forum)
  longtime - 01/05/12 12:09
  Thanks for helping out and keeping the same spirit since step 1. All the best for ur exam  
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* Re:CCS cases (collected from another forum)
  ia - 01/05/12 15:51
  Thanks guys! :) Best of luck to all of you :)  
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* Re:CCS cases (collected from another forum)
  gunny - 01/05/12 18:17
  any one help we have to do upper gi endoscopy before surgery for hiatal hernia case?  
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