Best way is to practice the software as many times as you can.

Here's something to help

you on your approach for CCS exam.
LOGICAL APPROACH TO ANY CCS CASE :
First ------ Take a deep breath and select 'Start Case' button to begin.
You will see the case introduction.
Wait!
Note on the erasable board:
1. Setting
2. Age of the patient
3. Race of the Patient
4. Sex of the patient
Then click 'OK' and you will see the initial vital signs.
Wait!
Note on the erasable board: Stable or unstable?
Then click 'OK' and you will see the initial history.
Wait!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Think !!!!!!!!!!!!!!!!!!!!!!
and write on the erasable board: Differential Diagnosis : Allergies Habits smoking ,
alcohol , drugs , etc. Anything worrisome?
Then ask: Is the patient stable or is it an emergency? A clue to this would be in the
history - for emergency cases, you will see only the basic history of present illness and
not the detailed history (social, past, etc). All other history will be 'unobtainable'.
If unstable, do a EMERGENT physical exam. No emergency case should get a full
physical exam - it's an emergency!! For the EMERGENT physical, choose the 'general
appearance' and the relevant system. If needed, add one or two relevant systems.
After you note the results of the EMERGENT physical, stabilize patient immediately:
Airway Intubation? Breathing Oxygen mask? Chest tube? Circulation IV fluids?
Dopamine? Drugs Naloxone? Dextrose? Thiamine? IV Access?
Then ask: Does the patient's condition correlate to the setting? Emergency or unstable
patient in office needs to go to the ER immediately!! Change location if necessary. After

the patient is stable and in the right setting, proceed to 'Interval/follow-up history' and a
more detailed RELEVANT physical exam.
BUT If the patient is already a STABLE case in the right setting, proceed straight to the
RELEVANT physical exam. Then ask: Is the case limited to one particular system? Like
Asthma or MI? Choose the particular system and a few related systems, based on the
most likely diagnosis. Is the case not limited to one particular system?
Choose a COMPLETE physical exam. This option is available on the top of the physical
exam choices. Examples of such cases include Case for Annual Physical Exam, Child
Abuse, Depression, Asymptomatic Hypertensive for Office Management, etc. Note the
significant findings on the physical exam and go back to your erasable paper and revise
your Differential Diagnosis. Strike out those which are less likely and add those are
more likely.
Then -- keeping the Differential Diagnosis in mind, consider the labs to be done. When
considering labs use this mnemonic:
IBUOP
I Imaging > X-Rays, CT, USG, MRI, Echo, Scopy, VQ Scan, etc.
B Blood > CBC, Basic Metabolic Panel, Lipid Profile, LFT, Smears, Cultures, etc.
U Urine > Urinalysis, Toxicology Screen, Ketones, etc.
O Others > Other tests which do not fall under IBU, like EKG, PEFR for Asthma,
Pulse oximetry, Biopsies, etc.
P Pregnancy test > For any female of reproductive age presenting with abdominal or
pelvic symptoms, or trauma.
When ordering labs, consider:
Is this test time-effective/time-consuming? Choose time-effective.
Is this test initial screening/confirmatory? Choose initial screening.
Is this test cheap/expensive? Choose cheap.
Is this test non-invasive/invasive? Choose non-invasive.
Then ask:
Will this test tell me anything useful? Tests like CBC, ESR, Chem 7, etc might satisfy the
above criteria but will not tell you anything useful.
Are there any specific tests for this condition? Examples are Cardiac Enzymes for MI,
Sweat Chloride test for Cystic Fibrosis, etc.

Are the tests in the right order? Example Pulse Oximetry before ABG, CT before
Spinal Tap, etc. Order the labs using the Order button.
Then advance clock to the 'Next Available Result'. Understand the results.
Ask: Is the diagnosis clear or do I need any confirmatory tests? If diagnosis is clear, start
treatment. If confirmation is needed, order confirmatory tests and then start treatment.
Treatment :
Determine if the patient is in the right setting. If patient is in office and needs to be
admitted, change location to ward. If patient is in ward and is in a serious condition,
change location to ICU. If case is admitted, order: IV access (unless IV drugs are not
indicated) Type 'IV Access'. Vital Signs Type Vitals and click on 'Every 1,2, 4 or 6
hours' depending on the condition of patient. Activity Type 'Bed Rest' and choose
'Complete bed rest' or 'Bed rest with bathroom privileges' or type restrain and choose
'Restrain patient in bed'. Diet Normal, liquid, NPO, 2 gram Sodium, ADA, etc. Order
'Diet' and you will see the list of options, choose which is the best for this case. Tubes
NG Tube? Foley's catheter? Fluids Saline, Ringer, etc. Type 'Fluids' and choose which
is the best for this case. Urine output Type 'Urine Output' and choose frequency. There
is no option for Input/output chart. Medications : Stop! Check for allergies on erasable
board! Order standard drugs for this case. Decide IV or Oral. Decide bolus or
continuous. Decide frequency. Labs : Additional labs to confirm diagnosis? Labs to
monitor? Cardiac Monitor? Pulse Oximetry? Consults : Order consults if necessary. GI,
Ophthalmology, Psychiatry, Genetics, Social worker, etc.
Then move clock!
Depending on severity of case, move by 30 minutes/1 hour/2 hours/3 hours/6 hours/12
hours/1 day/2 days/1 week.
Do Interval/follow-up history. Understand the results of the labs. Then ask: Has the
patient's condition changed significantly? If yes, change locations.
If the condition has improved, move the patient to the next location in the order ER -->
ICU --> Ward --> Office/Home.
If the condition has worsened, move the patient to the next location in the order
Home/Office --> Ward/ER or Ward/ER --> ICU.
If you are changing location from inpatient (ER/ICU/Ward) to outpatient
(Office/Home): Stop unnecessary medications and change IV medications to oral.
Discontinue IV fluids. Remove tubes. Remove IV access.

Schedule followup visit in 1 or 2 weeks as relevant. Patient education or counseling or

diet specific and vital to this case.
Type 'patient education' and 'counsel' and see if anything is relevant to this specific case.
Type 'Diet' and see if anything is relevant to this specific case. By this time, the 5 minute
screen will appear!
Then type 'counsel' and choose the relevant things. You can choose multiple things at a
time. See your erasable board for any worrisome habits like alcohol or smoking!
Type 'patient education' and choose the relevant things. You can choose multiple things
at a time .