USMLE Step 3: CCS Case-Specific Bundles

Expanded Master List of 30+ High-Yield Scenarios

🚀 Key Strategy: Master these bundles to be ready for 90% of Step 3 CCS cases.

Total Bundles

30+

Cases Covered

90%

Specialties

Exam Impact

High

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Cardiology

ACS / NSTEMI / STEMI

O2, IV access, monitor, pulse ox

EKG, troponins × serial, CXR

Aspirin, nitrates, heparin, statin, beta-blocker (unless contraindicated)

Admit to CCU, cardiology consult

CHF Exacerbation

O2, IV access, monitor, pulse ox

IV loop diuretic (furosemide), strict I&O, daily weights

CXR, EKG, BMP, BNP

Low-salt diet, fluid restriction, admit

Hypertensive Emergency

O2, IV access, monitor, pulse ox

IV antihypertensive (labetalol, nitroprusside, nicardipine)

CBC, CMP, UA, EKG, CXR, troponins

Admit ICU, neuro checks

Atrial Fibrillation (new, unstable)

O2, monitor, IV access

EKG, BMP, TSH, Mg

If unstable → synchronized cardioversion

If stable → rate control (diltiazem, beta-blocker) + anticoagulation

Pulmonary

Asthma Exacerbation

O2, monitor, pulse ox

Nebulized albuterol/ipratropium, systemic steroids

CXR, peak flow, ABG if severe

Admit if severe, counsel on inhaler use

COPD Exacerbation

O2 (88–92%), monitor, pulse ox

Nebulized albuterol/ipratropium, systemic steroids

Antibiotics if increased sputum or fever

CXR, ABG, admit if severe

Pulmonary Embolism

O2, monitor, pulse ox

EKG, CXR, ABG, D-dimer (if low probability)

CT angio chest (or V/Q if contraindicated)

Anticoagulation (heparin) immediately if high suspicion, admit

Pneumonia (CAP)

O2, monitor, pulse ox

CXR, CBC, BMP, blood cultures, sputum culture

Empiric IV antibiotics (ceftriaxone + azithro or levofloxacin)

Admit if severe, otherwise outpatient + oral antibiotics

Neurology

Ischemic Stroke

O2, monitor, pulse ox, IV access

CT head non-contrast STAT

Neuro checks q1h, NPO until swallow eval

tPA if within window, ASA if not, admit ICU/stroke unit

TIA

O2, monitor, pulse ox

EKG, CT/MRI brain, carotid doppler, echo

ASA, statin, risk factor control, admit for workup

Meningitis

O2, monitor, IV access

Blood cultures, CBC, CMP

Empiric IV antibiotics + dexamethasone immediately

CT before LP if ↑ICP signs, then LP, admit, neuro checks

Seizure / Status Epilepticus

O2, monitor, pulse ox, IV access

IV lorazepam → phenytoin/fosphenytoin

CBC, CMP, glucose, tox screen

Head CT, EEG, neuro consult, admit

GI / Hepatic

Upper GI Bleed

O2, monitor, IV access ×2, pulse ox

IV fluids, type & cross, NPO

CBC, CMP, coags, CXR

IV PPI, GI consult for urgent EGD, octreotide + ceftriaxone if variceal suspected

Lower GI Bleed

Same as upper (fluids, type & cross, NPO, admit), colonoscopy once stable

Acute Pancreatitis

NPO, IV fluids, pain control

CBC, CMP, lipase/amylase, LFTs, triglycerides

RUQ US if gallstones suspected, admit, monitor for complications

Cholecystitis

NPO, IV fluids, pain control, IV antibiotics

CBC, CMP, RUQ US

Surgery consult for cholecystectomy

Appendicitis

NPO, IV fluids, pain control, IV antibiotics

CBC, CMP, abdominal CT (or US if pregnant)

Surgery consult for appendectomy

Diverticulitis

NPO, IV fluids, pain control

CBC, CMP, abdominal CT

IV antibiotics, admit if complicated

Infectious

Sepsis

O2, monitor, IV access ×2, pulse ox

IV fluids (30 mL/kg bolus), blood cultures

CBC, CMP, lactate, UA/culture, CXR

Broad-spectrum IV antibiotics within 1 hour, admit ICU if unstable

Cellulitis / Abscess

CBC, blood cultures if severe

IV antibiotics, I&D if abscess

Elevate limb, mark margins, outpatient if mild, admit if severe

Endocarditis

O2, monitor, IV access

Blood cultures ×3 before antibiotics

IV antibiotics empiric

EKG, TTE/TEE, admit, ID consult

OB / GYN

Ectopic Pregnancy

O2, monitor, IV access, pulse ox

β-hCG, type & cross, TVUS

OB consult STAT, laparotomy if unstable, methotrexate if stable & criteria met

Preeclampsia/Eclampsia

O2, monitor, IV access, pulse ox

CBC, CMP, urine protein, LFTs

Magnesium sulfate, IV labetalol/hydralazine, OB consult, deliver if severe/term

Preterm Labor

O2, monitor, IV access

CBC, UA, vaginal cultures, fetal monitoring

Tocolytics (if no contraindication), betamethasone, GBS prophylaxis, OB consult

Pediatrics

Febrile Infant (<28 days)

O2, monitor, IV access

CBC, CMP, blood/urine/CSF cultures, LP

Empiric IV antibiotics, admit

Croup

O2, monitor, pulse ox

Nebulized racemic epi if severe, steroids, cool mist, admit if severe

Epiglottitis

O2, monitor, intubation precautions

ENT/anesthesia consult STAT

Blood cultures, IV antibiotics, admit ICU

Otitis Media

Outpatient oral antibiotics, pain control, f/u in 1–2 weeks

Trauma / MSK

Blunt Abdominal Trauma

O2, monitor, IV access ×2, pulse ox

FAST exam, CBC, CMP, type & cross

IV fluids, surgical consult, admit

Fracture (open/closed)

O2, monitor, IV access if unstable

X-ray of injured site

Pain control, splint, ortho consult, tetanus prophylaxis, IV antibiotics if open

Spinal Cord Compression

O2, monitor, IV access

High-dose IV steroids

MRI spine

Neuro/ortho consult, admit

Why This Expanded List Helps

Step 3 "Greatest Hits"

These bundles are tested repeatedly because they mimic real emergencies and bread-and-butter medicine.

Mental Efficiency

Having 30+ memorized means you won't waste brainpower recalling orders on exam day.

Comprehensive Coverage

This CCS Case Bundle Bank covers 30+ of the most common scenarios with the core orders you must fire off.

Exam Readiness

If you master these, you'll be ready for 90% of Step 3 CCS cases.