Step 3 CCS Cheat Sheet: All 5 Mnemonics on One Page

This is the HTML home for the Step 3 CCS cheat sheet. For the fuller explanation, read USMLE Step 3 CCS Cases: Quick Framework with 5 Mnemonics.

Download the PDF here

Fast facts

• CCS cases are on Day 2 of Step 3.
• There are 13 cases, usually 10 to 20 minutes each.
• CCS is commonly estimated at about 25% to 30% of the total Step 3 score.
• The goal is not to show off. The goal is to be safe, organized, and timely.
• Practice the software before test day. The interface itself is part of the game.

The six scoring pillars

Use these as the mental checklist for every case:

1. Physical exam and monitoring
2. Diagnostic orders
3. Treatment and monitoring
4. Location and timing
5. Procedures, when indicated
6. Preventive care

HAVOCC

In acute presentations, stabilize first:

• H: Hurting. Treat pain.
• A: Access. IV access, fluids when appropriate, and accu-check.
• V: Vitals. Repeat vitals frequently if unstable.
• O: Oxygen. Oxygen and pulse oximetry; consider naloxone when indicated.
• C: Cardiac monitor. Add telemetry and EKG.
• C: C-spine. Immobilize in trauma when appropriate.

I-BOUP plus micro and toxins

Use I-BOUP as the first diagnostic sweep:

• I: Imaging. CXR, CT, ultrasound, echo, or other targeted imaging.
• B: Blood. Use the blood lab mnemonic below.
• O: Other. Stool tests, rheum panels, and case-specific studies.
• U: Urine. UA, urine culture, ketones, protein, and other urine studies.
• P: Pregnancy test. In women of childbearing age.

Then remember two extra buckets:

• Micro. Blood, urine, sputum, and CSF cultures when indicated.
• Toxins. Utox, ethanol, acetaminophen, salicylates, and relevant toxicology panels.

Blood panel mnemonic

Cool Cats Crush Mice, Playing Cleverly Under Angry Lamps.

• Cool: CBC
• Cats: CK
• Crush: Cardiac enzymes
• Mice: CMP
• Playing: Pancreatic enzymes
• Cleverly: Coags
• Under: Urinalysis
• Angry: ABG
• Lamps: Lactate

P-MiST

Vaccines:

• P: Pneumococcal
• M: Meningococcal
• I: Influenza
• S: Shingles
• T: Tdap

PMC CREA4S

Screening and counseling:

• P: Pap smear
• M: Mammogram
• C: Colonoscopy
• C: Counseling on diagnosis, medications, and lifestyle
• R: Reassurance
• E: Exercise and diet
• A: Alcohol cessation
• S: Safe sex
• S: Seatbelt
• S: Smoking cessation
• S: Social work

Scoring rules

• Sequence matters. Stabilize first when the patient is unstable.
• Timing matters. Delayed orders may get little or no credit.
• Harmful orders can hurt you.
• Over-ordering is not the goal; safe, logical management is.
• Preventive care counts, but it belongs after the acute problem is handled.

Minimal prep plan

• Do enough cases to understand the rhythm of the software.
• Practice entering orders quickly.
• Use the mnemonics until the common orders become automatic.
• Review missed cases for sequencing errors, not just knowledge gaps.
• Keep the printable PDF nearby while practicing, then try to run cases without looking.

Related White Coat guides

• USMLE Step 3 CCS Cases: Quick Framework with 5 Mnemonics
• Resident's Guide to Step 3: Minimal Time, Maximum Results
• How to Study for USMLE Step 2 CK: Aim for a 260 in 4 Weeks