Step 3 (251) Writeup

 STEP 3 251 WRITE UP 

Duration: 3 months ( on and off ) 

Resources : 

U-world step 3 

CCS cases 

Uworld step 3: 

Only resource that is enough for step 3. There are about 1900 questions. It is more useful for developing stamina and test taking skills than learning actual content, as the content is already covered mostly by step 1 and step 2. 

CCS cases: 

CCScases.com is much better than the ccs cases provided by uworld, as it gives you feedback on the cases which uworld lacks. CCS cases are the only new thing in step 3 and need some practice, but are easy marks if you get a hold of them. There are 176 cases in ccscases. I started it late so I was only able to do 120 of the high yield ones. I’d recommend to do them all atleast once. 

THE TEST: 

Day 1:

DAY 1 consist of 6 blocks  of 38-39 questions with 1 hour time for each block. Total questions 232. 

It is most similar to step 1 with micro and pharma mixed in. if you have time I would recommend going through first aid for micro and antibiotics. Day 1 also has biostats which is the most annoying part about it. There are drug ads in almost every block. Leave them to the end. Do revise stats from first aid before the test. 

Day 2: 

Day 2 is most similar to step2ck. There are 6 blocks of 30 questions with 45 mins for each block. It is less tiring than Day 1, and almost everyone find it easier. 

End of day 2 comes the ccs cases. There are 13 cases in total with some being 10 mins and some being 20 mins. The cases may end before time if you do everything correct, which is a good thing and means the management was correct. So don’t panic when that happens. 

Practice tests:

There are uwsa 1,2, free 137, nbmes for step3 as well. Uwsas are underpredictive for step 3. I got 233 on uwsa 1 and didn’t do any other test due to lack of time. I would suggest doing uwsa 2 as well. 

CCSCASES tips:

1: order everything as over ordering does not deduct marks, unless you order something invasive. 

2: Don’t forget your end of case preventive medicine orders.

3: Even if you suspect a clear diagnosis, do order tests for your differentials!

4: shift the patient according to severity of case. 

A general Pattern: 

My general pattern for any ccscase : 

Step 1: 

Hx and physical exam >  must for all cases.

Step 2: 

Emergency orders (can be used in non ER cases)

Mnemonic: VOMICAA

Vitals

Oximetry

Morphine (if in pain) 

Metoclopramide (if nausea or vomiting pt) 

Iv fluids ( almost always)

Cardiac monitor (should be attached)

Acetaminophen ( if fever)

Acute glucose ( means RBS) 

Step 3: 

Stabilizing orders 

Mnemonic : CUBE T3 

Cbc

Cmp

Chest Xray/ CT head/ Ct chest etc

Urinalysis, Urine culture

Beta hcg (in all women), blood culture ( if infective) 

Ecg, Echo 

Tsh

Troponin

Toxicology screen (Blood, urine) 

Step 4: If Surgical Pt

 Mnemonic: TPN A CSF 

Type and cross match

Pt/ Aptt

Npo

Activity limitation 

Consent

Subcutaneous Heparin 

Fluids 

Step 5: 

End of case orders:

Depends on the patient age, gender, history etc.

Tetanus vaccine, pneumococcal vaccine, meningococcal vaccine, STI screening in sexually active, STD pt, seat belt use, smoking, alcohol cessation, suicide screen etc etc. 

ALL of the cases can be solved with this basic pattern, just add extra orders to the above according to the case. Credit for these mnemonics goes to reddit. Best of luck to everyone preparing for step 3, you have made it to the last step. Don’t get lazy now!!