For this exam you need to be able to manage a patient as the sole responsible for its care. All diagnostic and therapeutic procedures must be ordered on the appropriate time and sequence. You will have approximately 25 minutes to complete all expected steps in management, and for that an organized approach is recommended. The following is an example of how to perform during the exam but you may make your own approach with which you feel more comfortable.

    1.  Read the case presentation

    2.  Order all emergent procedures if required (ABCD's)

    3.  Write down the differential diagnosis

    4. Write Orders (Look for the definitive diagnosis)

    a.  Monitoring

    b.  Laboratory tests

    c.  Medications

    d.  Procedures (diagnostic and therapeutic)

    e.  Consultations

    5. Physical Examination

    a.  Always perform a general, pulmonary, cardiovascular, abdominal, and extremities examination

    b.  Select any other system as suggested by the presentation

    6.  Change Patient's Location if required

    7.  Continuous Management (screen for risk factors and complications)

    a.  Monitoring

    b.  Laboratory tests

    c.  Medications

    d.  Procedures

    e.  Consultations

    8.  End Case

    a.  If patient improves, discharge or change to an appropriate location

    b.  Make an appointment and continuously follow the patient

    c.  Order appropriate counseling

In the USMLE CD you will find information about the structure of the exam and a simulator with 5 patients for you to practice. One of the most efficient ways to prepare for the CCS is to practice the cases in the simulator and know how to use the program. The CCS simulator has several keys and features, and you need to know them very well.

Have in mind that the outcome of the patient is not always relevant to your score. You may find during the CSS that some patients doesn't improve or can even complicate while standard management is being used. Also, the case may finish before the time ran out and when such occurs it has nothing to do with your performance. Your score will depend not only on you knowing what to order, but to do it in the adequate sequence and timing as well.

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