USMLE Step 3 CCS Case Categories

The CCS (Computer-based Case Simulations) section tests your ability to manage patients in real time — ordering labs, imaging, medications, and consults with time-sensitive decision-making. These 10 categories cover the highest-yield CCS case types on Step 3.

Acute Coronary Syndrome

ACS is the single highest-yield CCS case type on USMLE Step 3.

Order 12-lead ECG immediatelyAspirin 325 mg PO chewed, not swallowed …
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Pneumonia

Community-acquired pneumonia is a bread-and-butter CCS case.

Supplemental O2 to maintain SpO2 ≥92%Chest X-ray PA and lateral
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COPD Exacerbation

COPD exacerbation CCS cases test your ability to layer bronchodilators, systemic steroids, antibiotics, and non-invasive ventilation in the correct sequence.

Controlled oxygen via Venturi maskAlbuterol 2.5 mg + ipratropium 0.5 mg ne…
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Diabetic Ketoacidosis

DKA is a CCS classic that tests meticulous fluid and electrolyte management over simulated hours.

Normal saline 1 L/hr IV bolusBMP
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GI Bleeding

GI bleeding CCS cases test your ability to resuscitate aggressively, risk-stratify using validated scores, and coordinate endoscopy timing.

Two large-boreType and crossmatch 4 units pRBCs, CBC, …
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Stroke

Stroke CCS cases are time-critical from the first second.

STAT non-contrast CT headFingerstick glucose
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Heart Failure

Acute decompensated heart failure CCS cases require you to simultaneously manage volume overload, optimize hemodynamics, and identify the precipitating cause.

IV furosemide 40-80 mgSupplemental O2 to SpO2 ≥92%, BiPAP if r…
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Sepsis

Sepsis CCS cases demand immediate, protocolized action within the first simulated hour.

Blood cultures x2 from separate peripher…Lactate level, CBC, BMP, hepatic functio…
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Pulmonary Embolism

Pulmonary embolism CCS cases test your ability to rapidly risk-stratify, anticoagulate, and identify massive PE requiring thrombolytics.

Supplemental O2 to SpO2 ≥92%, hemodynami…If high clinical suspicion: start hepari…
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Acute Abdomen

Acute abdomen CCS cases test your ability to differentiate surgical from medical emergencies under time pressure.

NPOTwo large-bore IVs, normal saline bolus …
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