Video summary: 01:00 Dr. Fisher tells us to get out into life and study while you enjoy life. 01:00 CCS: clinical cases simulator is the closest thing there is to flight simulator. It is UNIQUE because you won’t find this on any other exam. NBME has several practice cases: if you don’t go through the instructions before test day and know what you’re up to you’re plain stupid (it’s free). 01:45: You get 3 screens-> Chief complaint / HPI (history present illness) / Vitals. Cannot act upon the case until you see the 3 screens 02:00: After that you’ll have 4 box options: a) Ask for physical examination pieces b) write orders (tests/ treatments/ both), limiteless, can order anything/ everything you want c) move clock forward (most unique from CCS cases) 02:50: Moving clock forward has 3 different ways that are basically identical. If it’s 9am you could choose to advance X amount of minutes, or move to the exact time you want, or move to the moment when you get some result back. 3:15: 4th box is location: Moving the patient-> FIVE locations: ED, Hospital floor, Office, Home, ICU. That’s it, choose amongst the options given: no telemetry unit but you can order telemetry (make it fit) 4:27: Never change location first or moving the clock after the first 3 screens (CC/HPI/VS); DO SOMETHING FIRST (ask for physical exam piece or write an oder (test/ treatment))! 5:00: Physical exam -> Any piece you ask for is going to be 1 minute EXCEPT for rectal/ head and neck/ genital which are 2 minutes each (duration of the PE is independent of whatever the patient is presenting with). Neuro comes combined with psych (total 1 minute: 30 secs each). 7:08: You’ll always go for PE as first action EXCEPT IF PATIENT IS UNSTABLE. Remember Dr. Fisher’s song: Chest pain, SOB, hypotension, confusion… means low… per-fuu-ssion. IF UNSTABLE: emergency: WRITE ORDERS before physical exam. Ie. Hypotension-> fluids. 8:20: Writing orders-> they are all done at the same time once you hit enter for whatever exams you asked for (an idiosincracy of the test). 9:30 Moving location happens immediately, no time lost if you move from ED to ICU (or whichever place you move the patient). 10:30 Some procedures require consent. Just order the test and the CCS will let you know if you need consent. You don’t have to know what needs consent, just act upon it when prompted (ie. you need to consult urology… so, consult urology). 11:25: After moving clock forward you will get reports on what you asked for and patient status. Reports will give you the interpretation of the exams, ie. you won’t see the CT scan, you’ll see the interpretation/ report. After the clock is advanced on several occasions it will ask for diagnosis. DIAGNOSIS IS THE LEAST IMPORTANT CRITERIA FOR CCS, WHAT MATTERS IS THE PROCESS! Remember: Practice makes perfect. Follow my youtube channel for more USMLE/ step 3 videos IG: charlesclintonmd :)

@nabilaanika7844

10 ай бұрын

thank you.

I am going to be singing the chest pain, shortness of breath, hypotension, confusion song on test day

@annalisawilson7694

3 жыл бұрын

Same

Thank you so much doctor 🙏🏼

you are awesome Doctor, thank you very much !!!

This was very helpful... thank you.

🎶Chest pain, SOB, Hypotension, Confusion. 🎶🎤🎵 🎶🎤🎵

@jn-lucr.8387

3 жыл бұрын

Means you're not getting enough perfusion

i love this guy!!!

Phenomenal advice all around. One thing that is unnerving is that it does not tell you that you won when it shuts the cases off early. Just says " you have two minutes left." Got me panicked a bit.

Legend!

diagnosis of pneumothorax is clinical. It is ok giving oxy and order pulse ox before. But no CXR because you loose time. After clinical diagnosis of pneumothorax next is needle thoracocentesis

@LeNoLi.

4 жыл бұрын

in real life, but what does CCS want?

@HazyJay

3 жыл бұрын

That is only correct for a TENSION pneumothorax.

@monkiram

3 жыл бұрын

There is a tension pneumothorax in the practice examples on the USMLE website. They say this: "Timely diagnosis and management are essential in this case. An optimal, efficient diagnostic approach would include quickly performing a targeted physical examination that includes chest/lung and cardiovascular examination, cardiac monitoring, and assessing oxygen saturation by pulse oximetry. Treatment should be initiated immediately before the patient’s condition worsens. Ordering anything that might delay treatment (eg, a 12 lead ECG, arterial blood gases, or a portable chest x-ray) would be suboptimal in this case if ordered before the patient’s condition is stabilized." So no chest X-ray and no ABG in a case of tension pneumo. They would probably be alright in a stable patient with pneumothorax, but I believe the example he's giving is for an unstable patient

@charlesclintonmd

2 жыл бұрын

@@monkiram correct, you send exams to act on them. In an unstable patient with tension pneumo you got to act immediately or the cardiovascular collapse would make the patient code if you are waiting on ABG's and X rays. Well said, thanks for sharing

Superb!

wow. so perfect.

comlex 3 does not have CCS?

Amazing 🎉

Thanks, Dr. Fischer. Just checking if the diagnosis screen still there? I hear as of Jan 2019 the final diagnosis has been removed.

@fatmawafy4438

3 жыл бұрын

yes the diagnosis part is not present any more

@ILruffian

Жыл бұрын

Just took it last Friday (1st week in Dec 2022). Final diagnosis has definitely been removed.

7:10 I love Conrad Fischer. Always hilarious

there is a game on android called Full Code that sound similar to this. Puts you in an a and e scenario and you have to come up with reasonable treatments differentials. refer the patient or request consults oorder tests.

Chest pain, Shortness of breath, hypotension, confusion

This man is Hilarious, i wish he had a comprehensive video on CCS.

Can one take break of 2-3 years between step 2 Ck and Cs if he doesn't have the means to take tests consecutively? Secondly, step 1 and 2ck are mostly theory related and there are alot of resources available for them, but what to do for CS and step 3. I mean US system is very different. How can one gain clinical exposure (especially one who can't afford US rent)?

Dr. Fisch am a huge fan , no exaggeration there. But. Entire neuro exam 30 sec ?? 🤦🏻‍♀️Does *not * make sense. How can you do 5 *basic components 1. brain stem - 11 cranial nerves , 2)motor, 3)reflexes, 4) sensory, 5 ) gait… future brain doc here ☝️

@pimpnorris2097

2 жыл бұрын

It is not about what's real and what's not, it is literally a game you have to play, it is about mastering the test

@charlesclintonmd

2 жыл бұрын

In real life we all know a real neuro exam takes 15 minutes as stated in the literature but it's a game you got to play. You have to know that if you ask for the neuro exam your clock will add 1 minute (includes psych evaluation: 30 secs + neuro 30 sec). Such as Nicholas Arnold states next.

😂🤣

You look thinner