USMLE Step 3 CCS Cases 2026

RecallsGuru’s Step 3 CCS cases are written practice cases for the computer-based case simulations on Day 2 of Step 3. Each case gives the orders to place in sequence, when to advance the clock, where to move the patient and why. The cases do not change, so you pay $60 once and keep them for life. For multiple-choice practice, see our Step 3 recalls.

What is inside

• Each case runs from the opening scene through history and examination, first orders, results, follow-up orders, change of location and counselling to the final orders, with the simulated time of each step.
• A note on each case listing the common mistakes, such as a missed pregnancy test or untreated pain.
• A checklist of orders that apply to most cases.

The presentations covered

Emergency department cases

• Chest pain: ST-elevation myocardial infarction, unstable angina, aortic dissection, pulmonary embolism
• Shortness of breath: asthma attack, COPD exacerbation, pneumonia, heart failure, tension pneumothorax
• Abdominal pain: appendicitis, cholecystitis, pancreatitis, bowel obstruction, ectopic pregnancy, ovarian torsion
• Altered mental status: DKA, hypoglycemia, meningitis, overdose, stroke, subarachnoid hemorrhage
• Sepsis, GI bleeding, anaphylaxis, status epilepticus
• Children: febrile infant, intussusception, croup, dehydration, suspected abuse

Office cases

• New type 2 diabetes, hypertension, hyperlipidemia, hypothyroidism
• Fatigue with iron deficiency anemia and the search for its cause
• Depression, anxiety, alcohol use disorder
• Prenatal first visit, well-child visit, adult health maintenance visit
• Joint pain, low back pain, chronic cough, urinary symptoms

Inpatient and intensive care cases

• Sepsis with organ failure, DKA after admission, acute kidney injury, alcohol withdrawal, postoperative fever

How CCS works on Step 3

According to usmle.org (checked October 2026), Day 2 includes 13 to 14 case simulations after the multiple-choice blocks, each allotted up to 10 or 20 minutes of real time, with a 6-minute tutorial beforehand. Day 1 has none.

You type orders, advance the clock to see results and move the patient between office, emergency department, ward, intensive care and home. The official description says indicated actions earn credit, unnecessary or risky ones lower the score, and timing and sequence count.

How to use the cases

Cover the model orders and write your own first, then compare line by line and note what you missed or ordered late. After five or six cases the opening orders repeat, and the first two minutes of most cases become routine.

Practise the screen itself with the free CCS software on usmle.org; use these cases to learn what to order, and when.

Tips that apply to almost every case

• Stabilise first: oxygen, IV access, monitor and pulse oximetry for any unstable patient.
• Match the examination to the case: focused when the problem is clear, full when it is vague.
• Advance the clock to the next result you need, not by a fixed amount.
• Move the patient when the case calls for it.
• Finish properly: counselling, vaccines and screening often belong before the case ends.

How the cases are written

A doctor builds each case on a presenting problem from the Step 3 content outline and sets out the orders a careful doctor would place, with timing. A second doctor works through the case and checks that the sequence is safe and complete. Unlike files shared on Reddit and Telegram, each case shows who wrote it, who reviewed it and when.

How access works

1. Pay $60 once and enter your email; your account is created at this step.
2. Pay by card or crypto and the cases open at once. Bank transfers open when we confirm them.
3. Keep the cases for life. Read online on a phone, tablet or computer, one case per page, on one device at a time. There is no PDF download, and each page carries your email and order number as a watermark.

All sales are final: see the Refund Policy.

Questions people ask

Can I type orders and get a score?

No. These are written cases: you compare your plan with the model orders. Use the official software on usmle.org to practise typing orders.

Do the cases include children and pregnant patients?

Yes, in the emergency and office cases.

What else is there for Step 3?

Step 3 recalls for Day 1 and Day 2 multiple-choice practice, updated every 15 days. The All Steps bundle includes these cases, with the Step 3 recalls, when they are released.