30/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 14* - Portfolio: *CASE 3 - 26F, Construction Worker, G2 P1 A0 L1, 2 Months Pregnant, Fever - 2 Days, Bleeding Nose & Gums - 1 Day, Platelet 72k -> 1.1 Lakh*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Demographics - Age / Sex: 26 years / Female, Occupation: Construction worker, chief complaints - Fever since 2 days, Bleeding from nose & gums since 1 day, HOPI - Patient is G2 P1 A0 L1, 2 months pregnant, She has pain in legs since 16 years, Asymptomatic 2 days ago, then developed fever during evening, Fever intermittent, decreases with Paracetamol, associated with headache frontal, increases with chills & rigors, associated with pain in legs, History of epistaxis & gingival bleeding since 1 day, HOPI Continued - History of pain in head 3 days ago, History of vomiting 3 episodes, Bleeding occurs when brushing teeth, Avoiding spicy food, Negative History - No blood in urine, No hematemesis, No hemoptysis, No SOB, No seizures, No blood in stool, No pain in joints, No diarrhea, No constipation, Past History - History of open sewage system near home, Family History - Daughter has fever since yesterday afternoon, gradually progressive, high grade, with chills & rigors, No vomiting, loose stools, pain abdomen, No DM in father, No HTN / TB / Epilepsy / Asthma in family, No bleeding disorders in family, General Examination - Conscious, coherent, cooperative, well oriented to TPP, Moderately nourished, PICCLE: P - Pallor Absent, I - Icterus Absent, C - Cyanosis Absent, C - Clubbing Absent, L - Lymphadenopathy Absent, E - Edema Absent, Vitals - Temp Febrile, BP 120/60 mmHg, RR 20 bpm, PR 80 bpm, Systemic Examination - CVS S1 S2 present (+), No murmur, RS NVBS, No added breath sounds, CNS NAD, CBC - General Medicine: Hb 12.5 g/dL, TRBC 3.9, WBC 5,100, Neutrophils 85%, Lymphocytes 10%, Eosinophils 02%, Monocytes 03%, Basophils 00%, PCV 38.0%, MCV 96.1, MCH 31.7, MCHC 33.0, Platelet 72,000, CBC - Obstetrics / Unit-III: Hb 12.9, TRBC 4.0, WBC 6,500, Neutrophils 87%, Lymphocytes 09%, Eosinophils 01%, Monocytes 03%, Basophils 00%, PCV 39.0%, MCV 95.6, MCH 31.6, MCHC 33.1, Platelet 1.1 Lakhs.
- Good details: Obstetric history - G2 P1 A0 L1, 2 months pregnant - critical, Occupation - Construction worker - mosquito / sewage exposure, Negative History - 9 negatives - excellent, Family History - Daughter fever since yesterday - contact / outbreak - excellent, Past History - Open sewage near home - excellent, CBC x2 with full differential + reference intervals - best labs in batch, Platelet trend 72k -> 1.1 lakh, Neutrophilia 85-87% + Lymphopenia 9-10% - abnormal pattern captured.
- Gaps: *SpO2 - Not recorded.* *P/A - Not recorded - Systemic Examination incomplete - CVS, RS, CNS only.* *No NS1 / Dengue IgM, No Malaria smear, No Widal, No Urine routine.* *No provisional diagnosis written* - Dengue? Malaria? - not stated. *No management plan.* *"Pain in legs since 16 years"* - since age 10? - not explained, likely error. *No bleeding details* - amount, frequency. *No antenatal details* - LMP, USG, folic acid?
*Score: 2 / 2*
- Full recall - obstetric + negative + family + sewage + 2 CBCs - all present.
- *Next target:* Always record SpO2, P/A - Soft, Non-tender, Uterus size in pregnancy. Always write Provisional Diagnosis - even if suspected. Always record NS1, Malaria smear, Widal, Urine routine in fever + bleeding in pregnancy. Always clarify "pain legs since 16 years" - is it since 16 years of age, or for 16 years? Always record LMP, USG, antenatal visits, folic acid.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Fever + epistaxis + gingival bleeding + low platelet pattern described - intermittent fever, frontal headache, chills / rigors, vomiting 3 episodes, bleeding on brushing.
- But no explanation in own words of why fever + bleeding + low platelets = dengue / malaria / typhoid, why pregnancy makes it high-risk.
- No explanation of CBC - Neutrophilia 85-87% + Lymphopenia 9-10% + Platelet 72k -> 1.1 lakh - not explained. No explanation of BP 120/60 - wide pulse pressure - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Fever 2 days + bleeding nose / gums + platelet 72k = thrombocytopenia with bleeding - dengue / malaria / leptospirosis. Explain: Neutrophilia 85% + Lymphopenia 10% = bacterial / acute infection pattern, not typical dengue - dengue usually lymphocytosis / leucopenia - this pattern needs explanation. Explain: Platelet rising 72k -> 1.1 lakh = recovery, good. Explain: Pregnancy 2 months + fever + bleeding = high-risk - risk to mother + fetus, needs obstetric + medicine joint care, avoid drugs harmful in pregnancy. Explain: Open sewage + daughter fever + construction worker = outbreak / mosquito / water-borne exposure. Explain: BP 120/60 - pulse pressure 60 - wide - check for leakage.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- No provisional diagnosis, no investigation plan beyond CBC, no management plan.
- No application of pregnancy 2 months + bleeding to care - no obstetric referral, no drug safety.
- No application of platelet 72k to care - no monitoring, no bleeding control.
*Score: 1 / 2*
- Partial application - CBCs + negative history applied, but no care plan.
- *Next target:* Add: Dengue NS1, Dengue IgM, Malaria smear / RDT, Widal, Leptospirosis IgM, Urine routine, RFT, LFT, Blood grouping, USG abdomen / pelvis - pregnancy viability, Obstetric referral. Add management - Admit, Medicine + Obstetrics joint care, monitor vitals, BP, urine output, platelet + haematocrit daily, oral fluids / ORS, paracetamol - safe in pregnancy, avoid aspirin / ibuprofen / NSAIDs - increases bleeding, avoid drugs harmful in pregnancy, check for warning signs - severe abdominal pain, persistent vomiting, bleeding, drowsiness, check fetal - USG, counsel - mosquito prevention, avoid sewage exposure, follow-up daughter - also check for fever.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No provisional diagnosis, no differential list.
- No analysis of alternative causes: Dengue vs Malaria vs Typhoid vs Leptospirosis vs Viral fever with thrombocytopenia.
- No analysis of why daughter fever + open sewage + construction worker matters - outbreak vs isolated.
- No analysis of CBC - Neutrophilia vs Lymphopenia - not interpreted.
*Score: 1 / 2*
- Partial analysis - fever + bleeding + low platelet pattern recognized, but not differentiated.
- *Next target:* Add differential table: Dengue - supports 26F, fever 2 days, frontal headache, chills / rigors, epistaxis + gingival bleeding, platelet 72k, construction worker - mosquito; against - no NS1, Neutrophilia 85% - dengue usually leucopenia, no body pain mentioned. Malaria - supports fever intermittent, chills / rigors, headache, vomiting, open sewage / mosquito, daughter fever; against - no rigors cycle, no splenomegaly mentioned, platelet low but can be in malaria. Typhoid - supports fever, headache, vomiting; against - no abdominal pain, diarrhoea / constipation, rose spots, platelet usually normal. Leptospirosis - supports fever, chills, bleeding, open sewage, construction worker, leg pain; against - no jaundice, conjunctival suffusion, muscle pain, Icterus absent. Must analyze: Is Neutrophilia 85% + Lymphopenia 10% more for bacterial / leptospirosis than dengue? Is daughter fever same illness - outbreak?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Negative History - 9 negatives - shows judgment - you ruled out hematuria, hematemesis, hemoptysis, SOB, seizures, blood in stool, joint pain, diarrhea, constipation.
- Family History - Daughter fever - shows judgment - outbreak thinking.
- But no provisional diagnosis, no judgment on pregnancy risk, no judgment on drug safety in pregnancy.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - negative + family history shows judgment, but diagnosis / pregnancy risk missing.
- *Next target:* Add: Can I leave provisional diagnosis blank with fever + bleeding + platelet 72k in pregnancy? What is most urgent - mother bleeding, fetus risk, or infection? What is the risk if I miss dengue / malaria / leptospirosis in a 2-month pregnant woman with bleeding? What drugs are safe in pregnancy - paracetamol yes, NSAIDs no, doxycycline - avoid in pregnancy for leptospirosis? What would I do differently - NS1 + malaria smear urgently, obstetric USG, check BP + pulse pressure, check for petechiae / rash, ask about daughter - same exposure? Reflection on construction worker + open sewage + pregnancy - social determinants, mosquito prevention, family screening.
### 6. Create - Synthesis & New Learning Product
*Evidence in portfolio:*
- No original product - no algorithm, concept map, patient education material.
- Two CBC tables are good data, but not synthesized.
*Score: 0 / 2*
- Not met.
- *Next target:* Create 1-page algorithm: Fever + Bleeding in Pregnancy -> Dengue vs Malaria vs Leptospirosis -> Examination -> NS1 + Smear + CBC -> Medicine + Obstetrics Management, OR patient education sheet for Fever + Bleeding in Pregnancy - warning signs, mosquito prevention, sewage avoidance, when to go to hospital, family screening.
### Summary Sheet - Roll No. 14 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Obstetric + negative + family + 2 CBCs complete, P/A / SpO2 / diagnosis missing
2. Understand | 1 | Fever + bleeding described, pregnancy risk / CBC pattern not explained
3. Apply | 1 | CBCs done, no NS1 / smear / obstetric plan
4. Analyze | 1 | Fever + bleeding pattern recognized, no differential table
5. Evaluate | 1 | Negative + family history shows judgment, pregnancy risk missing
6. Create | 0 | No original product
**Total** | **6 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 14 - Progression:*
- CASE 1 CKD Stage 5 on Dialysis = 6/12, CASE 2 Dengue 27M = 5/12, *This portfolio = 6/12*
- *Progress stable, but history is your strongest skill:* Negative History - 9 negatives - is the best in this batch, and Family History - Daughter fever since yesterday - plus Past History - Open sewage near home - plus Occupation - Construction worker - together make an outbreak story, and you captured all three. Two CBCs with full differential + reference intervals is the best lab work in this batch.
- *Critical learning from this case:* You did everything except the two most important things - 1) Write a provisional diagnosis - fever + bleeding + platelet 72k in a 2-month pregnant woman cannot be left blank, you must commit to Dengue / Malaria / Leptospirosis and test for it. 2) Pregnancy changes everything - drug safety, fetal risk, joint Medicine + Obstetrics care, USG - you did not mention any of it. And your CBC shows Neutrophilia 85% + Lymphopenia 10% - that is not typical dengue, it needs explanation. Add diagnosis + NS1 + malaria smear + obstetric plan, and this case becomes 9-10/12.
No comments:
Post a Comment