Table Of ContentCrush Step 3
CCS: The Ultimate
USMLE Step 3
CCS Review
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Crush Step 3
CCS: The Ultimate
USMLE Step 3
CCS Review
MAYUR K. MOVALIA, MD
Internship, Internal Medicine
University of Hawaii
Honolulu, Hawaii
Hematopathologist
Dahl-Chase Pathology Associates
Medical Director, Flow Cytometry Laboratory
Dahl-Chase Diagnostic Services
Medical Director, Affiliated Laboratories
Eastern Maine Medical Center
Bangor, Maine
Medical Director, Cancer Care of Maine Laboratory
Brewer, Maine
Medical Director, Mount Desert Island Hospital Laboratory
Bar Harbor, Maine
Faculty and Instructor
University of Maine
Orono, Maine
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
CRUSH STEP 3 CCS: THE ULTIMATE USMLE
STEP 3 CCS REVIEW ISBN: 978-1-4557-2374-4
Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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This book and the individual contributions contained in it are protected under copyright by the Pub-
lisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treat-
ment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evalu-
ating and using any information, methods, compounds, or experiments described herein. In using
such information or methods they should be mindful of their own safety and the safety of others,
including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
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product to be administered, to verify the recommended dose or formula, the method and duration
of administration, and contraindications. It is the responsibility of practitioners, relying on their
own experience and knowledge of their patients, to make diagnoses, to determine dosages and the
best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products, instruc-
tions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Movalia, Mayur.
Crush step 3 CCS: the ultimate USMLE step 3 CCS review / Mayur K. Movalia. -- 1st ed.
p. ; cm.
ISBN 978-1-4557-2374-4 (pbk.)
I. Title.
[DNLM: 1. Clinical Medicine--Examination Questions. WB 18.2]
616.0076--dc23 2012036370
Senior Content Strategist: James Merritt
Content Developmental Specialist: Christine Abshire
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Kamatchi Madhavan
Designer: Louis Forgione
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my wonderful wife, Neela, and to my kids, Raina, Ryan, and Renee, for their laughter, encouragement,
and unconditional support.
Mayur K. Movalia
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P H Y S I C I A N R E V I E W
B O A R D
Each of the following reviewers scored above the 90th percentile on USMLE Step 3 with most
scoring in the 99th percentile.
The author and publisher express sincere gratitude to these physicians for their many helpful
comments, suggestions, and recommendations for improving the text that appears in this book.
Whitney K. Bryant, MD, MPH
Simulation and Medical Education Fellow
Assistant Professor of Emergency Medicine
University of Cincinnati
Cincinnati, Ohio
Yewlin E. Chee, MD
Resident in Ophthalmology
Massachusetts Eye and Ear Infirmary
Harvard Medical School
Boston, Massachusetts
Linda Hall, MD
Family Physician
Beartooth Billings Clinic
Red Lodge, Montana
Capt. Jason M. Johnson, MD, USAFR
Clinical Fellow in Neuroradiology
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts
Jessica J. Kraeft, MD
Radiology Resident
Mount Auburn Hospital
Harvard Medical School
Cambridge, Massachusetts
Joseph T. Nezgoda, MD, MBA
Ophthalmology Resident
University Hospitals Case Medical Center
Cleveland, Ohio
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P R E F A C E
The Computer-based Case Simulation (CCS) portion of USMLE Step 3 comprises 12 inter-
active cases over 4 hours designed to evaluate your approach to patient management. This
book was created to provide a high-yield, rapid, comprehensive review for the CCS cases.
Studying for the CCS portion of Step 3 presents some unique challenges from study-
ing for the multiple-choice question (MCQ) portion. Most important, understanding the
USMLE CCS Primum® software is essential to performing well. As soon as you decide
to take Step 3, download the Primum® CCS software from the official www.usmle.org
website under “Practice Materials.” An in-depth review of the software is provided in
this book. Practice the six cases that are supplied by the USMLE and get a good feel for
how to place orders, what orders are available, how to manage the clock, how to transfer
patients, and all the various features of the software. Practice the sample cases multiple
times and see how the software responds to performing correct actions and perform-
ing incorrect actions. Once you are comfortable with the software, you can really start
using this book and studying for the exam.
This book incorporates the concept of bidirectional learning, which emphasizes
relationship building and associative memories. Each CCS case is presented on two
pages. The first page shows a brief sample case presentation with relevant information
presented in a format similar to the actual exam. The second page presents a review of
the disease entity with a focus on diagnosis, management, and important points in the
CCS matrix. Each case can be studied beginning from the first page or the second page.
How to Use This Book:
n Asaself-test
n To use as a self-test, begin with the first page of a case and read through the case
presentation. In most cases, the diagnosis should be suspected from the infor-
mation provided. On a blank sheet of paper or in your head, create a sequence
for how you would manage the patient. Compare your management with what
is presented on the second page.
n Asareviewbook
n To use as a review book, start backward with the second page of a case. At the top,
the final diagnosis is listed. Beginning with the final diagnosis, try to recall impor-
tant points in the diagnosis and management. In addition, create a CCS matrix with
the six domains and compare your results with those listed in the table provided.
n Asapracticeexam
n To use as a practice exam, open a CCS case in the USMLE Primum® software
(Case 1 begins in the emergency department and Case 2 begins in the office).
Begin with the first page of a case and read through the introduction. Using the
software, order the appropriate management (exam, labs, imaging, and treat-
ment). Compare what you did in the software with the management recom-
mended on the second page.
Preparing well for the CCS portion of Step 3 can have a dramatic impact on your overall
Step 3 score. If you learn the concepts, strategies, and cases in this book, you should
not just do well on the CCS cases, you should CRUSH them!
I wish you much success on your exam, residency, career, and future.
Mayur K. Movalia, MD
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