USMLE Step 3 CCS Orders Guide
High-Yield Orders to Know Cold for CCS Cases
π© Key Principle: These orders rarely hurt your score, but missing them loses big points!
CBC (Complete Blood Count)
Checks for anemia, leukocytosis (infection), thrombocytopenia.
π Nearly universal in ER/inpatient; drives antibiotics, transfusion, bleeding eval.
CMP/BMP (Metabolic Panel)
Electrolytes (Na, K, Cl, HCOβ), renal function, liver function.
π Guides fluids, insulin/potassium protocols, medication dosing.
UA (Urinalysis Β± culture)
Infection (UTI/pyelo), hematuria, proteinuria.
π Cheap, noninvasive, high diagnostic yield.
Fingerstick/Serum glucose
Any AMS, weakness, diaphoresis, seizure.
π Rules out hypoglycemia immediately.
EKG (Electrocardiogram)
Chest pain, SOB, syncope, palpitations, AMS, sepsis.
π Rapidly rules in/out arrhythmia, ischemia, electrolyte issues.
Cardiac enzymes (Troponin Β± CK-MB)
Chest pain, SOB, syncope.
π Guides NSTEMI/ACS management.
Telemetry / Cardiac monitor
If unstable, chest pain, arrhythmia risk, ACS, sepsis.
Chest X-Ray
SOB, chest pain, cough, fever, trauma.
π Screens for pneumonia, CHF, PTX, effusion.
Abdominal US/CT
Abdominal pain, trauma, suspected gallstones, appendicitis, AAA.
π Use targeted imaging, not shotgun.
Pregnancy test (Ξ²-hCG)
Always in women 12β55 unless post-hysterectomy/menopause.
π Changes management: no radiation, medication restrictions, OB involvement.
Type & Screen / Crossmatch
GI bleed, trauma, ectopic pregnancy, any possible surgical bleed.
π Prepares for transfusion or OR.
Blood cultures Γ2
Fever, sepsis, endocarditis suspicion.
π Always before starting antibiotics.
Urine culture
Suspected UTI/pyelo.
Sputum culture
Pneumonia/severe respiratory infection.
CSF studies (LP)
Meningitis, encephalitis suspicion (after CT if βICP signs).
Oxygen (nasal cannula or mask)
If hypoxic, tachypneic, or in distress.
IV access (large-bore or central line)
For fluids, meds, transfusions.
IV fluids (NS or LR)
Dehydration, sepsis, DKA, hypotension.
Vital signs monitoring
ICU/unstable patients (q1h-q4h checks).
Pulse oximetry
Any respiratory/cardiac case.
Why These Orders Matter
Safety Net
These orders rarely hurt your score, but missing them loses big points.
Scoring System
CCS rewards you for catching life-threatening diagnoses early.
Efficiency
You don't need 100 tests β just these 15β20 high-yield ones.
CCS Case Strategy
Start with these orders in almost every case, then branch out based on findings.
Order time-sensitive interventions first (oxygen, IV access, glucose check).
Never forget pregnancy test in women of childbearing age.
Get cultures before antibiotics when infection is suspected.