STOOL Tests : A Mnemonic for Step 3 CCS

I've listed this mnemonic under Step 3 instead of the SmartMD blog, since that's where it might be most useful for USMLEtoMD.com readers . On the CCS, what will save you time is quick fact-finding about what case you are dealing with, a big part of that is ordering the right tests on your digital patients - here's a quick way of remembering what tests need to be ordered when dealing with a case that needs stool examination

S - Staining ! for Fat (qualitative/quantitative) + bacteria
T - Toxin Testing (e.g. C-Diff)
O - Occult Blood Testing (Cancers, GI Bleed), Ova & Parasites testing
O - Osmolality (Diff. b/w Osmotic/Malaborptive v/s Secretory Diarrhea)
L - Leukocytes (inflammatory diarrheas)

Additions / Suggestions r welcome :) And of course, the mnemonic does not mean that you have order ALL the tests - you will need to stay within the domain of relevance ..so, I would not do C.Difficile testing in a case of an old patient presenting with progressive constipation, but would certainly test of occult blood - coz remember that on the Step 3 CCS you are also testing for how efficiently you use resources...

CCS Mnemonic: Pancreatitis Case

Management Options in the Treatment for Pancreatitis (Especially Useful for CCS cases)


"PANCREAS"

P - Pain Control
A - Aspiration by Naso-Gastric Tube
N - NPO
C - Calcium for Hypocalcemia
R - Replenish Fluids
E - Enteric Feeds or TPN depending on the case
A - Antibiotics (Imipenem)
S - Surgery in case of Abscess or Pseudocyst development

And of course, For any acute Abdominal Emergency - remember the 4 "N"s to be done at first :

Nil By Mouth (NPO)
Naso-Gastric Tube
Needle Infusion of IV Fluids
Narcotics for the pain (Meperidine preferred)

CCS MNEMONIC : Basic Orders on patient admission

Don't forget these basic orders if you admit a patient on a CCS case. For that matter, first of all, do not forget to have the patient sent to the inpatient floor after you are done stabilizing the patient who showed up with an emergency and needs continuing observation or Intravenous fluids / Drugs. This is important - you will tend to forget and is a common error.



"ADMIT"

A - Activity (Bed rest ? , restricted movements ?, etc)
D - Diet (NPO, Diabetic Diet ? , etc)
M - Medications (Switch to oral if possible)
I - Investigations (Labs) + Input/Output Monitoring + IV Fluids (with frequency)
T - TPR (Temp. Pulse.pressure.Resp.) i.e. Vitals ...with frequency

:-)

CCS Mnemonic: Orders for a Case of Trauma

A Case of Trauma can often be a TRAUMATIC EXPerience - not only to the patient but also to the doc since so many different orders need to be taken care in pretty less time.

Lets use the phrase "TRAUMATIC EXPerience" to help us remember the orders to keep in mind on the USMLE Step 3 CCS , once you have done the basic Stabilization (ABC):

Note:
1. These orders are not necessarily in the right order, you can change the sequence on the CCS screen after you type them out...
2. Not all orders will be applicable to some cases - this mnemonic is to be used as a guideline

"TRAUMATIC EXP"

T - Typing + Cross Matching of Blood
R - Routine Labs [CBC, BMP, LFTs]
A - Alcohol levels, blood + ABG (trauma can result in lactic acidosis)
U - Urine Analysis + Urine Drug Screen if Pt. known drug abuser
M - Morphine for pain (Meperidine if biliary / pancreatic system injury suspected)
A - Amylase for Abdominal Injuries
T - Transfer to ICU / Ward
I - IV Fluids
C - Consult Surgery, Orthopedics, etc ; CT-scans if Pt. Stable OR bedside USG if not

E - EKG 12 Lead
X - Xray Relevant
P - PT / PTT



Again, these orders are AFTER the basic first orders like Oxygen, Endotracheal tube if needed, Continuous BP Monitoring, Pulse Oxy, IV access + Cervical Spine Immobilization + Physical Examination.

Additions, Suggestions and Modifications are welcome - leave us a comment !