CCS cases are an integral part of the USMLE Step 3 examination. This article will outline a proven strategy to approach the cases during your preparation and during your exam. This strategy has been used by many students and has been proven to be highly effective.
IDRCP is the mnemonic you can use for each of the approaching CCS cases.
The mnemonic stands for:
I: Identification (age, sex, smoking, alcohol, drug, vaccine)
D: Diagnosis
R: Rx (treatment)
C: Consultation/counselling
P: Preventive (vaccine, colonoscopy, mammogram, pap smear, etc)
This is the best strategy you can use while dealing with all the ccs cases. This is true for both 10-minute and 20-minute cases.
Whenever you start a case, write this mnemonic ID RCP on a page.
We will give an example to simplify how to use this mnemonic:
Case: A 65-year-old male patient who smokes 30 cigarettes per day and consumes alcohol regularly presented with a history of yellowish discoloration of the eyes and abdominal distention for the last 15 days. He has not received any vaccines recently. He occasionally uses heroin and marijuana.
After reading the case, quickly write the age, sex of the patient, and risk factors requiring preventive care.
Identification: 65, M, smoker, alcohol, vaccine, illegal drugs
Then, next step is ordering the diagnostic tests.
Diagnosis: Make a list of tests which you will order for every patient and then add on it as required
Eg.
Mandatory List:
Pulse oximetry
CMP/BMPCBC
Urinalysis
Additional Important:
Beta Hcg: always order for reproductive age female
PT/PTT/INR, Abo and Rh: order for all cases that possibly require surgery
Rest diagnostic test you need to decide based on the patient’s presentation.
R: Rx ( Treatment)
Always keep in mind that stabilization is more important in emergency cases. Once the patient is stabilized, you can proceed to the other aspects of management.
Stabilization: Stabilization is the first priority if the patient is sick. E.g. For tension pneumothorax, needle thoracostomy is more important than diagnostic tests and other treatments. Don’t delay treatment in acute cases.
Remember following for most of the cases:
IVF: need or not needed?
Cardiac monitor: needed or not
Location: where should patient be? Office, home, floor, ICU
C: Consultation and counselling
-Always think about whether you need to consult other specialists.
-Always counsel the patient appropriately. If you note down the points in identification properly, you can decide on what counselling patient needs based on that.
These are the points we need to address based on our I (Identification)
“I: 65, M, smoker, alcohol, vaccine, illegal drugs”
65/M: this will be useful for prevention
Smoker: counsel, quit smoking
Alcohol: counsel, abstain from alcohol
Vaccine: this will be used in prevention
Illegal drugs: advice on avoiding illegal drugs
P: Prevention
Again, use the information obtained from identification for the purpose of prevention
Our case: I: 65, M, smoker, alcohol, vaccine, illegal drugs
65 Male: Colonoscopy
Smoker: low-dose CT chest annually
Vaccine: tdap every 10 years, pneumococcal, varicella, influenza (tailored according to the need, age of the patient and vaccination status of the patient)
If you use this method using the mnemonic IDRCP you will save a lot of time and make the exam easier. Initially, you might find it difficult to use this mnemonic but once you use it to practice, you will identify the benefit. Once you do about 20 practice cases, you won’t even need to write the mnemonic for each case. You can just use the mnemonic in your brain and it will definitely improve your effectiveness in dealing with CCS cases.
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MBBS, MD (Internal Medicine)
