IvyMed · USMLE Step 3 (Day 2 ACM & CCS)
CCS & Clinical Cases
Day 2 of USMLE Step 3 features 13 Computer-based Case Simulations (CCS) alongside Advanced Clinical Medicine (ACM) blocks. Run rapid 2-phase CCS stabilization scenarios with live vitals or work through full longitudinal patient encounters.
Rapid-Fire CCS Case Manager
Practice the highest-yield Step 3 CCS emergencies with a live bedside vitals monitor. Choose the right first-line stabilization order, avoid classic “do-no-harm” traps, and transition the patient to definitive care.
Tension Pneumothorax
Hypotensive emphysema patient with absent unilateral breath sounds and tracheal deviation.
Eclampsia at 37 Weeks
Witnessed generalized tonic-clonic seizure at 37 weeks gestation with BP 172/112.
Type A Aortic Dissection
Tearing interscapular chest pain, BP 196/110, and unequal radial pulses.
DKA Precipitated by Sepsis
Febrile, obtunded patient with Kussmaul respirations and high-anion-gap metabolic acidosis.
Ruptured Abdominal Aortic Aneurysm
Older smoker with sudden flank/abdominal pain, pulsatile mass, and hypotension (BP 78/48).
Traumatic Cardiac Tamponade
Post-chest trauma hypotension, JVD, and muffled heart sounds (Beck triad).
Full Patient Encounters
History, physical exam, differential diagnosis, diagnostic orders, and management plan graded on a 4-criterion rubric.
Derya Arslan
3-year-old female
Fever and leg pain in a 3-year-old girl
Chief complaint: Fever and leg pain
Emergency Department
Larry Sanosyan
63-year-old male
Tremor in a 63-year-old man
Chief complaint: Tremor
Outpatient Clinic
Mateo Alvarez
15-year-old male
Hip pain in a 15-year-old boy
Chief complaint: Right hip and knee pain
Pediatric Emergency Department
Jordan Vance
17-year-old male
Adolescent wellness visit in a 17-year-old boy
Chief complaint: Annual wellness visit and varsity basketball physical
Outpatient Pediatrics & Adolescent Medicine Clinic
Dana Whitfield
41-year-old female
Agitation and tremor in a 41-year-old woman
Chief complaint: Agitation
Emergency Department
Priya Raman
23-year-old female
Mood swings in a 23-year-old woman
Chief complaint: Mood swings
Outpatient Psychiatry
Walter Osei
78-year-old male
Confusion in a 78-year-old man
Chief complaint: Confusion
Inpatient Medicine — Psychiatry Consult
Jessica Wiley
32-year-old female
Intrusive thoughts in a 32-year-old woman
Chief complaint: Intrusive thoughts about harming the baby
Outpatient Perinatal Psychiatry & OB/GYN Clinic
Sarah Langer
62-year-old female
Shortness of breath in a 62-year-old woman
Chief complaint: Shortness of breath
Emergency Department
Maya Lin
24-year-old female
Lower abdominal pain in a 24-year-old woman
Chief complaint: Right lower abdominal pain and dizziness
Emergency Department
Arthur Pendelton
58-year-old male
Crushing chest pain in a 58-year-old man
Chief complaint: Crushing chest pressure and sweating
Emergency Department Resuscitation Bay
Carmen Delgado
46-year-old female
Right upper abdominal pain and fever in a 46-year-old woman
Chief complaint: Right upper abdominal pain, fever, and yellow eyes
Emergency Department
Stabilize before imaging
In unstable CCS patients (tension pneumothorax, tamponade, ruptured AAA), bedside stabilization or OR precedes confirmatory CT.
Avoid harmful orders
Step 3 CCS deducts heavily for invasive or contraindicated orders (e.g., nitroprusside before beta-blockade in aortic dissection).
Complete the disposition
Move stabilized patients to the right level of care (ICU, ward, or home) and add counseling, vaccines, and follow-up.