28/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 12* - Portfolio: *CASE 3 - 54F, Headache - Frontal 3 Days, Occipital 2 Days, Dizziness 1 Day, Neck Muscle Tightness 3 Days, HTN 2 Years - Telmisartan, BP 130/90*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Demographics - Age / Sex: 54 years / Female, chief complaints - Headache for 40 min, Headache in frontal region since 3 days, Headache in occipital region since 2 days, Dizziness since 1 day, Neck muscle tightness since 3 days, Usually not aggravated by routine activity, HOPI - Asymptomatic, came to OPD with headache involving frontal and occipital region associated with dizziness and no blurred vision, Insidious in onset, gradual in progression, bilateral, site frontal & occipital, severity mild, duration since 2 weeks, headache did not significantly worsen with routine physical activity, No nausea, vomiting, blurred vision, photophobia, Aggravating factor: cough, relieved on sleep, Past History - Known case HTN since 2 years, No TB, Asthma, COPD, DM, No major surgery, Medication: Tab. Telmisartan, Personal History - Appetite Normal, Diet Mixed, Sleep Disturbed, Bowel & Bladder Normal, Addiction No, Family History - No significant, General Examination - Alert, well oriented to TPP, PICCLE: No abnormality noted, Vitals - BP 130/90 mmHg, RR 20/min, Temp 98°F, SpO2 94% on Room Air, Pulse 70 bpm, Systemic Examination - CVS S1 S2 present (+), CNS NFND, RS NVBS BAE (+), P/A Soft, Non-Tender.
- Good details: Headache pattern - bilateral, frontal & occipital, mild, insidious, gradual, not worsened by routine activity, aggravated cough, relieved sleep, neck muscle tightness 3 days, dizziness 1 day, negatives - No nausea, vomiting, blurred vision, photophobia, HTN 2 years - Telmisartan, vitals - all 5 - BP, RR, Temp, SpO2, Pulse - complete, systemic exam - all 4 systems.
- Gaps: *Contradictions - Headache "for 40 min" vs "since 3 days" vs "since 2 days" vs "since 2 weeks"* - which duration? *No Provisional Diagnosis - Tension headache? Migraine? HTN headache? - not written.* *No Investigations - BP trend, Blood sugar, CBC, CT / MRI if needed.* *No Pain score, No Aura, No Menstrual / Menopause History - 54F.* *No Neck Examination - tenderness, stiffness, range of motion.* *No Neurological Examination - cranial nerves, fundoscopy.*
*Score: 1 / 2*
- Partial recall - headache pattern + vitals + systemic exam good, but duration contradictions, diagnosis, investigations missing.
- *Next target:* Clean contradictions before submitting - Headache 40 min = today's episode? 3 days = frontal? 2 weeks = total? Write it clearly: Headache since 2 weeks, frontal 3 days, occipital 2 days, today's episode 40 min, dizziness 1 day. Always record Provisional Diagnosis. Always record Investigations - BP x2, Blood sugar, CBC, ECG, Fundoscopy, CT head if red flags. Always record Neck Examination - tenderness, stiffness, ROM. Always record Neurological Examination - CN, fundoscopy - in headache + dizziness. Always record Menopause History - 54F.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Headache - bilateral, frontal + occipital, mild, not worsened by routine activity, neck tightness, dizziness, aggravated cough, relieved sleep - described.
- But no explanation in own words of why tension headache causes neck tightness, why HTN causes headache, why cough aggravates.
- No explanation of why no nausea / vomiting / photophobia / blurred vision matters - rules out migraine - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Tension headache = bilateral, frontal + occipital, mild, pressing / tight band, neck muscle tightness, not worsened by routine activity, relieved sleep, no nausea / vomiting / photophobia. Explain: HTN 2 years - Telmisartan - BP 130/90 - diastolic high - can cause headache, but mild HTN usually does not cause headache - need to check BP control. Explain: Dizziness 1 day = could be HTN, tension, cervical, vestibular - need to link. Explain: Cough aggravates = increased intracranial pressure - Valsalva - need to rule out raised ICP. Explain: No nausea / vomiting / blurred vision / photophobia = less likely migraine, less likely raised ICP / meningitis.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- No provisional diagnosis, no investigation plan, no management plan.
- No application of headache + dizziness + HTN to care - no BP check plan, no analgesia, no neck care.
*Score: 1 / 2*
- Partial application - vitals + systemic exam applied, but no care plan.
- *Next target:* Add: BP - lying / standing, repeat, Blood sugar, CBC, ECG, Fundoscopy, CT head if red flags - vomiting, blurred vision, weakness, fever. Add management - Continue Telmisartan, do not stop, BP monitoring daily, Headache - Paracetamol if needed, avoid triggers, Sleep hygiene - sleep disturbed, Neck - hot fomentation, neck exercises, avoid stress, posture, Dizziness - avoid sudden standing, hydration, Follow-up in 1 week, Refer - Medicine / Neurology if headache worsens, vomiting, blurred vision, weakness, fever. Add: Ask about stress, screen time, sleep, caffeine.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No provisional diagnosis, no differential list.
- No analysis of alternative causes: Tension headache vs Migraine vs HTN headache vs Cervicogenic headache vs Sinus headache.
- No analysis of frontal vs occipital - two sites, two causes? - not differentiated.
*Score: 1 / 2*
- Partial analysis - tension pattern recognized, but not differentiated.
- *Next target:* Add differential table: Tension Headache - supports 54F, bilateral frontal + occipital, mild, neck muscle tightness 3 days, not worsened by routine activity, relieved sleep, no nausea / vomiting / photophobia; against - dizziness 1 day, cough aggravates, need to check. Migraine - supports frontal headache, dizziness; against - bilateral, mild, not worsened by routine activity, no nausea, vomiting, photophobia, blurred vision, no aura. HTN Headache - supports HTN 2 years, BP 130/90, headache frontal + occipital; against - BP only 130/90, mild, headache 2 weeks - HTN headache usually severe, with high BP >180/120. Cervicogenic Headache - supports occipital headache 2 days, neck muscle tightness 3 days, dizziness; against - frontal headache also present. Sinus Headache - supports frontal headache; against - no nasal discharge, fever, facial pain. Must analyze: Is headache tension + cervical, or HTN, or migraine? Is dizziness due to HTN, cervical, or vestibular?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Negatives - No nausea, vomiting, blurred vision, photophobia - show judgment - you ruled out migraine / raised ICP.
- "Usually not aggravated by routine activity" - shows judgment - tension vs migraine.
- But no judgment on contradictions - 40 min vs 3 days vs 2 weeks - not evaluated.
- No judgment on BP 130/90 - diastolic high, SpO2 94% - low - not flagged.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - negatives show judgment, but duration / BP judgment missing.
- *Next target:* Add: Can I label tension headache without checking neck, fundoscopy, BP trend? What is the risk if I miss hypertensive emergency, raised ICP, meningitis, stroke in a 54F with headache + dizziness + HTN? What would I do differently - clarify duration, check neck tenderness / ROM, check fundoscopy, check BP twice, ask about stress, sleep, caffeine, screen time? Reflection on 54F - HTN 2 years, sleep disturbed, neck tightness - stress, family, work, menopause?
### 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: Headache - Bilateral Frontal + Occipital + Neck Tightness + Dizziness -> Tension vs Migraine vs HTN -> Examination -> BP + Fundoscopy -> Management, OR patient education sheet for Tension Headache - sleep, stress, posture, neck exercises, BP monitoring, when to go to hospital - vomiting, blurred vision, weakness, fever, severe headache.
### Summary Sheet - Roll No. 12 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Headache pattern + vitals good, duration contradictions, diagnosis missing
2. Understand | 1 | Tension pattern described, mechanism not explained
3. Apply | 1 | Vitals + exam applied, no BP / headache plan
4. Analyze | 1 | Tension pattern recognized, no differential table
5. Evaluate | 1 | Negatives show judgment, duration / BP judgment missing
6. Create | 0 | No original product
**Total** | **5 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 12 - Progression:*
- CASE 1 CKD 49F = 7/12, CASE 2 CKD 26M = 6/12, *This portfolio = 5/12*
- *Progress down, but headache pattern is good:* Bilateral, frontal + occipital, mild, insidious, gradual, not worsened by routine activity, aggravated cough, relieved sleep, neck muscle tightness 3 days, plus negatives - No nausea, vomiting, blurred vision, photophobia - that is a textbook tension headache story, and you captured it. Vitals - all five - BP 130/90, RR 20, Temp 98°F, SpO2 94%, Pulse 70 - are complete.
- *Critical learning from this case:* You have four different durations - 40 min, 3 days, 2 days, 2 weeks - that will confuse the examiner. Write it as one timeline: Headache since 2 weeks, frontal 3 days, occipital 2 days, today's episode 40 min, dizziness 1 day. And you have no diagnosis - is this tension, migraine, HTN, or cervicogenic? Add a differential table + neck examination + fundoscopy + BP trend, and this case becomes 8-9/12.
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