24/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 14* - Portfolio: *CASE 4 - 11M, Student, Informant Mother, Swelling Left Side Neck & Head - 12 Days, Seizure-like Episode - 18 Days Ago, Vomiting + Abdominal Pain - 1 Month Ago, Fever*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Demographics - Age / Sex: 11 years / Male, Occupation: Student, Informant: Mother, chief complaints - Swelling on left side of neck and on head - 12 days, HOPI - Patient had vomiting and pain in abdomen since 1 month ago, Patient was asymptomatic 18 days ago, then had seizure-like episode while playing on road, lasted 2 minutes, after which he fainted, Taken to hospital, bandage applied on head, discharged, Next day, he had pain and developed fever, which was high during evening and did not reduce after taking medications, Fever associated with swelling on left side of neck, due to which patient had pain and was unable to move head, History of Medication - Levetiracetam, Note: Some words partially illegible due to overlapping pages.
- Good details: Informant - Mother - correct for child, timeline - vomiting + abdominal pain 1 month ago, seizure 18 days ago, swelling 12 days ago, fever next day after seizure - chronology clear, seizure details - while playing, 2 minutes, fainted, bandage on head - trauma? - captured, fever pattern - high evening, not reducing after medications, swelling - left neck, pain, unable to move head - torticollis, drug - Levetiracetam - antiepileptic - captured.
- Gaps: *No General Examination - PICCLE missing.* *No Vitals - BP, PR, RR, SpO2, Temp missing.* *No Systemic Examination - CVS, RS, CNS, P/A missing.* *No Local Examination of neck swelling* - size, tenderness, warm, fluctuant, lymph nodes, head swelling? *No Past History - DM / HTN / TB / Epilepsy.* *No Personal History - Diet, Appetite, Sleep, Bowel / Bladder.* *No Family History.* *No Investigations.* *No Provisional Diagnosis.* *Illegible parts - need to rewrite, not leave as "illegible".*
*Score: 1 / 2*
- Partial recall - timeline + seizure + swelling + informant good, but examination, vitals, investigations, diagnosis all missing.
- *Next target:* Always record General Examination - PICCLE, Vitals - BP, PR, RR, SpO2, Temp - in a child with fever + seizure + neck swelling. Always do Local Examination - Neck swelling: size, site, tenderness, warmth, fluctuation, lymph nodes, head swelling: size, wound, discharge? Always do Systemic Examination - CVS, RS, CNS - GCS, neck stiffness, Kernig / Brudzinski, P/A. Always record Past History - TB contact, epilepsy, head injury, immunization. Always record Personal History - Diet, Appetite, Sleep, Bowel / Bladder, School. Always record Investigations - CBC, CRP, USG neck, CT head if needed. Always write Provisional Diagnosis.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Seizure + fainting + fever + neck swelling + unable to move head pattern described.
- But no explanation in own words of why seizure + neck swelling + fever could be linked, why vomiting + abdominal pain 1 month ago matters.
- No explanation of Levetiracetam - why given, for seizure - not explained. No explanation of bandage on head - head injury? - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Seizure-like episode 2 minutes + fainting while playing = seizure / syncope / head injury - need to separate. Explain: Fever high evening + neck swelling + pain + unable to move head = neck abscess / lymphadenitis / cellulitis / TB lymphadenitis - infection. Explain: Vomiting + abdominal pain 1 month ago = could be TB, typhoid, or increased intracranial pressure - need to link. Explain: Levetiracetam = antiepileptic, given after seizure to prevent recurrence, need dose, compliance. Explain: Bandage on head = head injury after fall during seizure / fainting - need to check for wound, bleeding, loss of consciousness.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- No provisional diagnosis, no investigation plan, no management plan.
- No application of fever + neck swelling + unable to move head to care - no urgent referral, no antibiotics, no imaging.
- No application of seizure + Levetiracetam to care - no seizure precautions, no EEG / CT.
*Score: 0 / 2*
- Not met - diagnosis + plan missing.
- *Next target:* Add: CBC, CRP, ESR, Blood culture, USG neck - abscess vs lymph node, Chest X-ray, Mantoux / TB test, CT head if seizure / head injury, EEG. Add management - Urgent admission, monitor vitals, GCS, temperature, seizure precautions, antipyretics, antibiotics if bacterial abscess / lymphadenitis, refer - Paediatrics / ENT / Neurology, do not delay - neck swelling + fever + unable to move head + seizure = red flag. Add: Check for meningitis signs - neck stiffness, headache, photophobia, vomiting, check for TB contact, check immunization, check Levetiracetam dose + compliance, counsel mother - seizure first aid, do not put anything in mouth.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No provisional diagnosis, no differential list.
- But timeline suggests analysis - vomiting + abdominal pain 1 month ago, seizure 18 days ago, swelling 12 days ago, fever - could be linked.
- No analysis of alternative causes: Neck abscess vs Tubercular lymphadenitis vs Bacterial lymphadenitis vs Cellulitis vs Meningitis vs Brain abscess vs Epilepsy.
*Score: 1 / 2*
- Partial analysis - timeline pattern recognized, but not differentiated.
- *Next target:* Add differential table: Bacterial Neck Abscess / Lymphadenitis - supports 11M, fever high evening, neck swelling left, pain, unable to move head; against - no size / tenderness / warmth mentioned. Tubercular Lymphadenitis - supports 11M, swelling neck 12 days, fever evening, vomiting + abdominal pain 1 month ago; against - no weight loss, night sweats, TB contact mentioned, no nodes described. Cellulitis - supports swelling, fever, pain; against - no redness / warmth mentioned. Meningitis - supports fever, vomiting, seizure, neck pain / unable to move head; against - no headache, neck stiffness, photophobia mentioned - need to check. Brain Abscess / Head Injury - supports seizure, fainting, bandage on head; against - no details of head injury, no focal deficit mentioned. Epilepsy - supports seizure 2 min, Levetiracetam; against - fever + neck swelling not explained by epilepsy. Must analyze: Is seizure cause or effect of fever / infection? Is neck swelling cause of inability to move head, or is it neck stiffness from meningitis?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No diagnosis, no judgment on urgency.
- But informant Mother + timeline + Levetiracetam shows some judgment.
- No judgment on red flags - seizure + fever + neck swelling + unable to move head in 11M = emergency - not prioritized.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - timeline shows judgment, but urgency missing.
- *Next target:* Add: Can I leave a child with seizure + fever + neck swelling + unable to move head without diagnosis / urgent plan? What is most urgent - seizure, meningitis, neck abscess, or head injury? What is the risk if I miss meningitis / brain abscess / neck abscess in an 11M? What would I do differently - check GCS, neck stiffness, Kernig / Brudzinski, check head wound, check neck swelling size / fluctuation, check vitals, ask about TB contact, immunization, previous seizures, ask mother about seizure - tongue bite, frothing, uprolling eyes, post-ictal confusion? Reflection on child - school, play, mother anxiety, need for urgent paediatric referral.
### 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: Child with Fever + Neck Swelling + Seizure -> Meningitis vs Neck Abscess vs TB Lymphadenitis -> Examination -> CBC + USG Neck + CT Head -> Urgent Management, OR patient education sheet for Mother - Seizure First Aid, Fever + Neck Swelling Warning Signs, When to Go to Hospital.
### Summary Sheet - Roll No. 14 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Timeline + seizure + informant good, exam / vitals / diagnosis missing
2. Understand | 1 | Seizure + swelling described, link not explained
3. Apply | 0 | No diagnosis / investigations / management
4. Analyze | 1 | Timeline pattern recognized, no differential table
5. Evaluate | 1 | Timeline shows judgment, urgency not prioritized
6. Create | 0 | No original product
**Total** | **4 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 14 - Progression:*
- CASE 1 CKD Stage 5 = 6/12, CASE 2 Dengue 27M = 5/12, CASE 3 Fever + Bleeding in Pregnancy 26F = 6/12, *This portfolio = 4/12*
- *Progress down - this is an incomplete case:* Your timeline is good - vomiting + abdominal pain 1 month ago, seizure 18 days ago, swelling 12 days ago, fever next day - and you correctly recorded Informant - Mother - and drug - Levetiracetam. But you stopped at history. No PICCLE, no vitals, no local neck examination, no systemic examination, no investigations, no diagnosis.
- *Critical learning from this case:* This is a red-flag child - 11M, seizure + fainting + fever + neck swelling + unable to move head. That combination is meningitis / neck abscess / brain abscess until proven otherwise, it cannot wait. You must check GCS, neck stiffness, Kernig / Brudzinski, head wound, neck swelling - size, tenderness, warmth, fluctuation - and vitals, and refer urgently. And "illegible" is not acceptable in a portfolio - rewrite the history clearly. Add examination + diagnosis + urgent plan, and this case becomes 8-9/12.
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