5/11/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 11* - Portfolio: *49M, Dialysis - 3 Times / Week for 2.5 Years, Loss of Appetite, Weakness, Cloudy Urine, Burning Micturition, Vomiting, Itching, Severe Back Pain*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Demographics - Age / Sex: 49 years / Male, History - Admit 2.5 years ago, weekly 3 times, chief complaints, present illness, past illness - Suspecting Gout, HTN, No DM / Asthma / Seizures, personal history - Sleep Decreased, Appetite Decreased, Alcohol - Addiction, Bowel & Bladder Regular, Diet Mixed, Medications - BP tabs Telmisartan, Paracetamol, Furosemide, Aspirin / Rosuvastatin, Levocarnitine & B12 inj - Before coming or End of dialysis, General Examination - Pitting edema, Vitals - BP 103/67 after taking BP, HR 93, SpO2 93, Temp Normal, Differential Diagnosis - Hypertensive Nephropathy, Chronic gout has maybe appeared as due to CKD stage.
- Good details: Dialysis 3 times / week, 2 failed fistula, chest on present [as written], loss of appetite, weakness, chills, anuria, burning micturition, vomiting, itching, severe back pain, cloudy urine.
- Gaps: *Occupation - Not recorded.* *Systemic Examination - Not recorded.* *PICCLE - Not recorded.* *No dialysis details* - dialysis centre, duration of each session, dry weight, last dialysis date, urine output per day. *Contradictions not clarified* - "Cloudy urine" + "Anuria" together, "Admit - 2.5 years ago, weekly 3 times" - does this mean dialysis started 2.5 years ago? *"Chest on present"* - likely chest catheter / Permcath? - not explained. *"Due to burns, tendons contracted"* - when? where? why in medications list?
*Score: 1 / 2*
- Partial recall - dialysis history is the core, but occupation, systemic exam, PICCLE missing.
- *Next target:* Always record Occupation, PICCLE - P/I/C/C/L/E each as + / -, Systemic Examination - CVS, RS, CNS, P/A. Always clarify: Dialysis since when? Where? How many hours? Last session when? Urine output - anuria vs oliguria vs cloudy urine? Access - fistula / Permcath / chest catheter? Always write full medication name + dose.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Symptoms listed - loss of appetite, weakness, chills, anuria, burning micturition, vomiting, itching, severe back pain.
- Differential - Hypertensive Nephropathy, Chronic gout maybe due to CKD stage.
- But no explanation in own words of why CKD causes itching, vomiting, loss of appetite, weakness, cloudy urine.
- No explanation of burning micturition + chills - UTI in dialysis patient - not explained.
- No explanation of severe back pain in dialysis patient - renal osteodystrophy / gout / infection - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: CKD -> urea builds up -> vomiting, loss of appetite, weakness, itching, anuria. Explain: Burning micturition + chills + cloudy urine = UTI - common in CKD, needs urine culture. Explain: Itching in CKD = uraemia + high phosphate + dry skin. Explain: Severe back pain in CKD = renal osteodystrophy, gout, or infection - need to separate. Explain: 2 failed fistula = vascular access failure - important for dialysis. Explain: Alcohol addiction - worsens HTN, liver, nutrition.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Differential given - Hypertensive Nephropathy, Chronic gout maybe due to CKD stage.
- No investigation plan, no management plan.
- No application of dialysis to care - no dialysis adequacy, no Kt/V, no Hb, calcium, phosphate, PTH.
- No application of BP 103/67 after BP tablet to care - hypotension on dialysis day - not addressed.
- No application of SpO2 93 - low - not addressed.
*Score: 1 / 2*
- Partial application.
- *Next target:* Add: CBC - anaemia, Hb, RFT - urea, creatinine, eGFR, Electrolytes - K, Na, Ca, Phosphate, PTH, Vitamin D, Uric acid - gout, Urine routine + culture - burning micturition, ECG, Chest X-ray - SpO2 93, fluid overload, Dialysis adequacy. Add management - Continue dialysis 3 times / week, do not miss sessions, low salt, fluid restriction, avoid nephrotoxins, alcohol cessation, treat UTI if culture positive, gout diet, check fistula / catheter infection. Add: Check BP before and after dialysis - 103/67 after BP tablet = risk of intradialytic hypotension, check with doctor if Telmisartan to hold on dialysis day. Add: Check pitting edema - fluid overload, weight gain between sessions.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Differential list given - Hypertensive Nephropathy, Chronic gout maybe due to CKD stage.
- But no supports / against reasoning.
- No analysis of alternative causes: Hypertensive nephropathy vs Diabetic nephropathy vs Chronic glomerulonephritis vs Obstructive uropathy.
- No analysis of itching - uraemia vs allergy vs liver disease.
- No analysis of severe back pain - gout vs renal osteodystrophy vs spondylosis vs infection.
*Score: 1 / 2*
- Partial analysis - two diagnoses listed, but not analyzed.
- *Next target:* Add differential table: Hypertensive Nephropathy - supports HTN, CKD on dialysis 2.5 yrs, pitting edema; against - no BP history duration, no fundus, no urine protein. Chronic Gout due to CKD - supports taking tablets for chronic gout, CKD, severe back pain, uric acid high in CKD; against - no joint swelling / tophi mentioned, no uric acid level. UTI - supports burning micturition, cloudy urine, chills, vomiting; against - anuria - how to get urine sample? Dialysis Access Infection - supports 2 failed fistula, chest catheter, chills, fever; against - no catheter site redness mentioned. Must analyze: Is severe back pain due to gout, or due to renal bone disease, or due to infection? Is itching due to uraemia or due to high phosphate?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Hypertensive Nephropathy without BP duration, fundus, urine protein, kidney size on USG.
- No judgment on most urgent problem - burning micturition + chills + vomiting + SpO2 93 + BP 103/67 in a dialysis patient = possible sepsis / fluid overload - not prioritized.
- No judgment on alcohol addiction - modifiable factor, not evaluated.
- No reflection.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Which is most urgent - itching / back pain or burning micturition + chills + SpO2 93 + low BP? What is the risk if I miss catheter / fistula infection or UTI sepsis in a dialysis patient? What would I do differently - ask about catheter site pain, redness, discharge, ask about last dialysis, weight gain, urine output in ml, ask about alcohol amount, check SpO2 on room air vs oxygen? Reflection on dialysis patient - impact on daily life, 3 times / week dialysis, 2 failed fistula - access is life.
### 6. Create - Synthesis & New Learning Product
*Evidence in portfolio:*
- No original product - no algorithm, concept map, patient education material.
*Score: 0 / 2*
- Not met.
- *Next target:* Create 1-page algorithm: Dialysis Patient with Fever / Burning Micturition / Itching -> UTI vs Access Infection vs Uraemia -> Examination -> Urine Culture + Blood Culture + Access Site Check -> Management, OR patient education sheet for CKD on Dialysis - diet, fluid, salt, dialysis regularity, fistula care, alcohol cessation.
### Summary Sheet - Roll No. 11 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Dialysis history core, occupation / systemic exam / PICCLE missing
2. Understand | 1 | Symptoms listed, uraemia / itching / UTI not explained
3. Apply | 1 | 2 differentials listed, no investigations / dialysis plan
4. Analyze | 1 | Differential list present, no supports / against reasoning
5. Evaluate | 0 | No justification, sepsis / hypotension / SpO2 93 missed
6. Create | 0 | No original product
**Total** | **4 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 11 - Progression:*
- *This portfolio = 4 / 12* - First case for Roll 11
- *Strength:* You captured the dialysis story that matters - 3 times / week for 2.5 years, 2 failed fistula, chest catheter, anuria, itching, burning micturition. That is a difficult case to take history for.
- *Critical learning from this case:* In a dialysis patient, burning micturition + chills + vomiting + BP 103/67 + SpO2 93 is not routine CKD - think infection / sepsis / fluid overload first. And "cloudy urine" + "anuria" cannot both be true without explanation - always ask urine output in ml / day, last dialysis date, and check catheter / fistula site for redness, discharge, pain. "Chest on present" and "burns, tendons contracted" - if you don't understand your own note, clarify it before submitting. Also, gout in CKD is common because uric acid is not cleared - but you need uric acid level, joint exam, tophi, to prove it. Fix the urgent triage + clarify contradictions, and this case becomes 7-8/12.
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