CCS Cases Cheat Sheet: High-Yield Orders, Mnemonics & 5-Minute Case Templates (2026)

The 5 patterns every CCS case follows

Regardless of chief complaint, every CCS case follows one of these five patterns. Recognizing the pattern in the first 30 seconds determines your entire approach:

Pattern	Setting clues	First move
Emergent (unstable)	Abnormal vitals, acute distress, ER setting	ABCs → IV + monitor → focused exam → stat labs
Acute but stable	Normal vitals, ER or floor	Focused exam → initial workup → treat → monitor
Outpatient new complaint	Office setting, weeks–months history	Complete exam → workup → treat/counsel → follow-up
Outpatient chronic management	Office setting, known diagnosis	Review adherence → labs → adjust meds → preventive care
Inpatient complication	Post-op, floor patient deteriorating	Stat vitals → EKG/CXR/labs → narrow differential fast

The universal order sequence (works for every case)

Apply this sequence to any case. Skip steps that are clearly not applicable, but never skip them without a reason.

Step 1 — Stabilize (if needed): IV access · Cardiac monitor · Pulse oximetry · O2 if SpO2 < 94% · Fingerstick glucose (any AMS or emergency) · Transfer to appropriate location

Step 2 — Physical exam: Focused (emergent) or Complete (stable/outpatient) · Never skip entirely

Step 3 — Initial labs (always order unless clearly irrelevant): CBC · BMP · UA · Pregnancy test (any woman of childbearing age) · EKG (any cardiac/chest/AMS complaint)

Step 4 — Advance clock: 15–30 min for emergent; 1–2 hours for stable; longer for outpatient

Step 5 — Targeted workup: Based on differential after Step 4 results

Step 6 — Treat: Start obvious treatment early — don't wait for all results

Step 7 — Monitor: Recheck vitals · Repeat key labs · Interval history/exam · Adjust location if needed

Step 8 — 2-minute screen: Follow-up appointment · Preventive care (vaccines, cancer screening) · Counseling (diet, smoking, activity) · Future labs

Must-order labs by chief complaint

Chief complaint	Don't forget to order
Chest pain	EKG (stat) · Serial troponins · CXR · D-dimer if PE suspected · BNP if heart failure suspected
Shortness of breath	CXR · ABG (if severe) · BNP · Peak flow (asthma/COPD) · D-dimer if PE · Spirometry (outpatient)
Abdominal pain	LFTs · Lipase · UA · Pregnancy test · Upright CXR (free air) · RUQ ultrasound or CT abdomen
Altered mental status	Fingerstick glucose (first!) · Blood cultures · LP (if meningitis suspected) · CT head · TSH · Ammonia · Urine tox screen
Fever / sepsis	Blood cultures × 2 (before antibiotics) · UA + urine culture · CXR · Lactate · CBC + BMP
GI bleeding	Type and crossmatch · PT/INR · Liver function tests · Gastroenterology consult · NPO
Headache	CT head (rule out bleed first if thunderclap or focal neuro signs) · LP (if CT negative and meningitis/SAH suspected) · ESR (if > 50 y/o, rule out GCA)
Stroke / focal neuro	CT head (non-contrast, stat) · Finger stick glucose · EKG · Echo · CBC + coags · Neurology consult
Diabetic emergency (DKA)	ABG · Serum ketones · Phosphorus · Magnesium · IV fluids (NS) · Insulin drip · Monitor K+ every 1–2h
Well-child / prenatal visit	Age-appropriate vaccines · Developmental screening · Lead screening (12–24 months) · GBS culture (35–37 weeks) · Group B strep

CCS mnemonics

ABCDE (Stabilization sequence):

Airway — secure it · Breathing — O2, ventilate · Circulation — IV access, fluids, pressors · Disability — neuro check, glucose · Exposure — full exam, temperature

SMURF (2-minute screen memory cue):

Schedule follow-up · Medications — reconcile, add discharge meds · Updated preventive care (vaccines, cancer screening) · Refer (specialist follow-up) · Future labs (e.g., HbA1c in 3 months)

FAST (stroke recognition orders):

CT head non-contrast · FAST exam · Aspirin (only if hemorrhagic ruled out) · Stroke team / neurology consult · tPA window assessment (within 3–4.5 hours of symptom onset)

MOVE IT (sepsis bundle — first hour):

Measure lactate · Obtain blood cultures (×2 before antibiotics) · Volume — 30 mL/kg IV crystalloid bolus · Empathic antibiotics — broad spectrum IV · ICU transfer if hypotensive or lactate > 4 · Target MAP ≥ 65 with vasopressors if needed

20-minute CCS case time template

For a typical 20-minute case (most common on Step 3), distribute your real time like this:

Real time	Action	Sim clock advance
0:00–1:30	Read case, note vitals, place immediate orders	0 min
1:30–3:00	Physical exam + review first result batch	15–30 min
3:00–7:00	Interpret results, narrow diagnosis, initiate treatment	1–2 hrs
7:00–12:00	Monitor, recheck vitals, adjust treatment, move patient if improving	4–24 hrs
12:00–17:00	Disposition — discharge home or step down; discharge meds	1–3 days
17:00–20:00	2-minute screen — preventive care, follow-up, counseling	—

Top 10 things examinees forget to order

These are the most commonly missed orders that cost points — check every case against this list before advancing the clock for the last time:

1. Follow-up appointment — always schedule before ending the case
2. Age-appropriate cancer screening — colonoscopy (≥45), mammogram (≥40), Pap smear (21–65)
3. Vaccines — flu (annual), pneumococcal (≥65 or high-risk), Tdap, HPV (≤26)
4. Smoking cessation counseling — any smoker, every case
5. Repeat key labs — troponin at 3+6h, CBC after transfusion, K+ during insulin drip
6. Monitoring orders — vital signs q4–8h, telemetry, I&Os
7. Pregnancy test — every woman of childbearing age, every ER case
8. Discharge medications — all chronic meds plus new discharge prescriptions
9. Diet counseling — low-sodium (heart failure, HTN), diabetic diet, low-fat
10. Physical exam on first advance of the clock — skipping it costs points even with correct orders

High-yield CCS preventive care quick reference

Intervention	Who / when
Colonoscopy	Age ≥ 45, every 10 years
Mammogram	Women ≥ 40, every 1–2 years
Pap smear	Women 21–65; every 3 years alone or 5 years with HPV co-test
Lung cancer CT	50–80 y/o, ≥20 pack-year history, currently smoking or quit < 15 years ago
Influenza vaccine	Everyone ≥ 6 months, annually
Pneumococcal vaccine	Age ≥ 65, or < 65 with high-risk condition
Shingles (Shingrix)	Age ≥ 50 (2 doses)
Abdominal aortic aneurysm screen	Men 65–75 who have ever smoked — one-time abdominal ultrasound
Depression screening	All adults; PHQ-2 / PHQ-9

Related articles:

• CCS Cases for USMLE Step 3: The Complete 2026 Guide

• CCS Preventive Care & Discharge Cheat Sheet

• CCS First 60 Seconds Algorithms for Every Setting

• CCS Mistakes That Cost You Points