19/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 12* - Portfolio: *CASE 1 - 49F, Housewife, Hypertension - 4 Years, Swelling Feet - 4 Years, SOB - 4 Years, CKD on Haemodialysis 3 Times / Week, Left Radiocephalic AV Fistula, Urine 200 ml / Day, BP 160/90*
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 / Female, Occupation: Housewife, chief complaints - HTN 4 years, Swelling of feet 4 years, SOB 4 years, HOPI - Asymptomatic 4 years ago, diagnosed with HTN, 4 years ago developed bilateral pedal edema, initially ankles progressing to legs, insidious, gradually progressive, bilateral, relieved by rest, 4 years ago had stomach pain, progressive, No hematuria, UTI, 4 years ago diagnosed with CKD on blood test, Since then taking hemodialysis 3 times/week, through left radiocephalic AV fistula, No fever, productive cough, chest pain, Past History - Known case HTN 4 years - Telmisartan, CKD 4 years - Haemodialysis, No TB, Asthma, COPD, No major surgery, Personal History - Appetite Decreased, Diet Mixed, Sleep Disturbed, Bowel Regular, Bladder Oliguria, Urine Output 200 ml/day, Addiction No, Family History - No significant, General Examination - Well oriented to TPP, PICCLE: No abnormality noted, Vitals - BP 160/90 mmHg, Pulse 74/min, RR 22/min, Temp 98°F, SpO2 94% on Room Air, Systemic Examination - CVS S1 S2 present (+), CNS NFND, RS NVBS BAE (+), P/A Soft, Non-Tender, AV Fistula Examination - Inspection: Surgical scar, No prominent veins, No redness, ulceration, discharge, Palpation: Palpable continuous thrill, Fistula not tender, Socratic questions - Pathophysiology & Clinical Presentation - started, truncated.
- Good details: Timeline - all 4 years ago - HTN, edema, SOB, stomach pain, CKD - together, edema pattern - ankles -> legs, insidious, progressive, bilateral, relieved rest, dialysis - 3 times/week, left radiocephalic AV fistula, urine - 200 ml/day - severe oliguria, drug - Telmisartan, vitals - all 5 - BP, Pulse, RR, Temp, SpO2 - complete, systemic exam - all 4 systems, AV fistula exam - Inspection + Palpation - scar, no redness / ulcer / discharge, thrill +, not tender.
- Gaps: *Contradiction - PICCLE: No abnormality noted* but chief complaint swelling feet + bilateral pedal edema 4 years - Edema must be Present. *No AV Fistula Auscultation - Bruit - missing.* *No Investigations - RFT, CBC, Hb, Electrolytes, eGFR.* *No SpO2 trend, No dry weight, No last dialysis date.* *Socratic questions truncated* - only heading "1. Pathophysiology & Clinical Presentation" - no questions listed.
*Score: 2 / 2*
- Full recall - timeline, dialysis, urine output, vitals, AV fistula exam - all present.
- *Next target:* Fix PICCLE - if pedal edema present, write E - Edema Present (+), Bilateral Pitting. Always add AV Fistula Auscultation - Bruit + / -. Always record Investigations - RFT - urea, creatinine, eGFR, CBC - Hb, Electrolytes - K, Ca, Phosphate, Chest X-ray. Always record Last dialysis, Dry weight, Interdialytic weight gain. Complete the Socratic questions - write them out, do not leave heading only.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- HTN + edema + SOB + CKD + oliguria + dialysis pattern described - bilateral pedal edema ankles -> legs, relieved rest, SOB 4 years, urine 200 ml/day.
- But no explanation in own words of why CKD causes edema, SOB, oliguria, HTN.
- No explanation of AV fistula - why radiocephalic, why thrill = working - not explained. No explanation of BP 160/90, SpO2 94%, RR 22 - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: CKD -> kidneys cannot clear water / salt / urea -> fluid overload -> bilateral pedal edema ankles -> legs, relieved rest, SOB, HTN 160/90. Explain: Urine 200 ml/day = severe oliguria, kidneys failing, dialysis needed to remove fluid / waste. Explain: Telmisartan = ARB for HTN, in CKD needs monitoring - K, creatinine. Explain: AV Fistula - Radial Artery to Cephalic Vein, Left - joins artery to vein for dialysis, Thrill + = vibration - fistula working, No redness / discharge = no infection. Explain: BP 160/90 = uncontrolled HTN, RR 22 = tachypnoea, SpO2 94% = low, due to fluid in lungs + anaemia. Explain: Sleep disturbed, appetite decreased = uremia.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Diagnosis - CKD on dialysis - given in HOPI, drug - Telmisartan - given.
- AV Fistula Examination done.
- But no student plan - no investigation plan, no management plan written by student - only what others did.
- No application of BP 160/90, SpO2 94%, RR 22, urine 200 ml/day to care.
*Score: 1 / 2*
- Partial application - dialysis + fistula exam applied, but no care plan.
- *Next target:* Add: CBC - Hb, RFT - urea, creatinine, eGFR, Electrolytes - K, Na, Ca, Phosphate, ABG, ECG, Chest X-ray, USG abdomen - kidney size. Add management - Continue dialysis 3 times/week, do not miss, fluid restriction, low salt, daily weight, check BP daily, check fistula daily - thrill / bruit, keep clean, no BP / blood draw on left arm, treat anaemia - iron, erythropoietin, treat HTN - Telmisartan - check K, creatinine, monitor SOB, edema, urine, sleep, appetite, refer - Nephrology. Add: If BP 160/90 + SOB + SpO2 94% + RR 22 - urgent - check lungs for crepitations, check for pulmonary edema, urgent dialysis.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Diagnosis - CKD on dialysis - given, but no differential list.
- No analysis of alternative causes: CKD vs Heart failure vs Liver failure vs Nephrotic syndrome.
- No analysis of SOB causes: Fluid overload vs Heart failure vs Anaemia vs Pulmonary edema.
- No analysis of edema causes: CKD vs Heart failure vs Liver vs Thyroid.
*Score: 1 / 2*
- Partial analysis - CKD pattern recognized, but not differentiated.
- *Next target:* Add differential table: CKD Stage 5 on Dialysis - supports 49F, HTN 4 years, edema ankles -> legs, SOB 4 years, oliguria 200 ml/day, dialysis 3 times/week, AV fistula, Telmisartan; against - no RFT, eGFR, USG kidney given, cause of CKD - HTN? - unknown. Heart Failure - supports SOB, edema, HTN; against - no chest pain, productive cough, S1 S2 normal, RS NVBS, no basal crepitations mentioned. Liver Failure - supports edema, appetite ↓; against - no jaundice, ascites, Icterus not present, P/A soft. Nephrotic Syndrome - supports edema, HTN; against - no frothy urine, no urine protein mentioned. Must analyze: Is SOB due to fluid overload from CKD, anaemia, or heart failure? Is edema due to CKD, HTN, or Telmisartan / other drug? Is stomach pain 4 years ago related to CKD - uremia?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Vitals - BP 160/90, SpO2 94%, RR 22 - recorded, but not flagged as abnormal.
- AV Fistula Examination - Thrill +, No redness / discharge - shows judgment - fistula working, not infected.
- Negatives - No fever, productive cough, chest pain, No hematuria, UTI - show judgment.
- But no judgment on BP 160/90 - uncontrolled HTN, SpO2 94% - low, RR 22 - tachypnoea - not evaluated as urgent.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - fistula + negatives show judgment, but vitals judgment missing.
- *Next target:* Add: Can I label CKD Stage 5 without eGFR / USG? What is most urgent - BP 160/90 + SOB + SpO2 94% + RR 22 + urine 200 ml/day - is she in fluid overload / pulmonary edema / hypertensive emergency? What is the risk if I miss pulmonary edema / hyperkalaemia / severe anaemia in a 49F on dialysis with SOB + edema? What would I do differently - re-check BP, check lungs for crepitations, check weight gain, check last dialysis, check fistula bruit, ask about orthopnoea / PND? Reflection on housewife - 4 years dialysis 3 times/week, sleep disturbed, appetite ↓ - impact on family, daily work, dialysis burden, diet - salt / fluid restriction compliance?
### 6. Create - Synthesis & New Learning Product
*Evidence in portfolio:*
- Socratic questions started - "1. Pathophysiology & Clinical Presentation" - heading only, truncated.
- No completed algorithm, concept map, patient education material.
*Score: 1 / 2*
- Partial - attempt at Socratic questions, but incomplete.
- *Next target:* Complete the Socratic questions - e.g. 1) Why does CKD cause edema, SOB, HTN? 2) Why is urine only 200 ml/day? 3) Why does AV fistula have thrill / bruit? 4) Why is BP 160/90 dangerous in CKD? 5) What would you do if SOB worsens + SpO2 falls? OR create 1-page algorithm: HTN + Edema + SOB + Oliguria -> CKD vs Heart Failure -> Examination -> RFT + Chest X-ray + AV Fistula Check -> Dialysis, OR patient education sheet for CKD on Dialysis - AV Fistula Care, fluid / salt, BP monitoring.
### Summary Sheet - Roll No. 12 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Timeline + dialysis + vitals + fistula exam complete, PICCLE contradiction
2. Understand | 1 | Edema + SOB + oliguria described, CKD mechanism not explained
3. Apply | 1 | Dialysis + fistula applied, no own RFT / management plan
4. Analyze | 1 | CKD pattern recognized, no differential table
5. Evaluate | 1 | Fistula + negatives show judgment, BP 160/90 / SpO2 94% missed
6. Create | 1 | Socratic questions started, truncated
**Total** | **7 / 12** | **Competent - Developing**
*Overall CBME Feedback for Roll 12 - Progression:*
- *This portfolio = 7 / 12* - First case for Roll 12, highest so far in this batch
- *Strength:* Best vitals + AV fistula exam in this batch - BP 160/90, Pulse 74, RR 22, Temp 98°F, SpO2 94% on Room Air - all five recorded, plus AV Fistula - Inspection Scar, No redness / ulcer / discharge, Palpation Thrill +, Not tender. Urine 200 ml/day is a powerful number, and you captured it. Telmisartan + dialysis 3 times/week + left radiocephalic fistula is a complete dialysis story.
- *Critical learning from this case:* You recorded dangerous numbers but did not flag them - BP 160/90 is uncontrolled HTN, SpO2 94% is low, RR 22 is tachypnoea, urine 200 ml/day is severe oliguria - in CKD, those are red flags for fluid overload / pulmonary edema. And PICCLE "No abnormality" contradicts your chief complaint - swelling feet + bilateral pedal edema - you must write Edema Present. Finish your Socratic questions - that is your Create product - and add eGFR + RFT + differential, and this case becomes 9-10/12.
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