23/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 14* - Portfolio: *CASE 2 - 27M, Delivery Boy, Fever - 6 Days, Headache - 6 Days, Retro-orbital Headache, Rash, Vomiting, Platelet 85k -> 1.0 Lakh, Dengue*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- History - Age / Sex: 27 years / Male, Occupation: Delivery boy, chief complaints - Fever since 6 days, Headache since 6 days, HOPI - Asymptomatic 6 days ago, then developed fever gradual in onset, intermittent, with rise and fall over 1 hr, Fever associated with headache retro-orbital, H/o rash on anterior side of hand, H/o vomiting 4 days ago, No H/o epistaxis, 5-6 episodes noted [as written], H/o cough, which was productive from gums, No H/o bleeding, No H/o seizures, Past History - No similar complaints, No H/o DM / HTN / Asthma / TB, Has got ... [illegible], Investigations - CBC Platelet Count Latest: 1.0 lakh / cumm, Reference Range: 1.5 - 4.0 lakh / cumm, Platelet Trend - Day 1: 85,000 / cumm, Day 2: 96,000 / cumm, Latest: 1.0 lakh / cumm, Provisional Diagnosis - Dengue, Personal History - Diet Mixed, Appetite Decreased, Sleep Adequate, Bowel / Bladder Normal, Addictions: Drinks alcohol occasionally, Smoking: Smokes cigarette once or twice, 3 times a day, Has not smoked since he was sick, Family History - No similar complaints, No H/o HTN / DM / TB / Epilepsy / Asthma, General Examination - Conscious, well oriented to TPP, Vitals: BP 125/60 mmHg, PR [illegible], Temp 98.8°F, Systemic Examination - Abdomen Soft, non-tender, CVS S1 S2 present, No murmur, RS Bilateral air entry present.
- Good details: Occupation - Delivery boy - mosquito exposure - relevant, fever pattern - gradual, intermittent, rise and fall over 1 hr, retro-orbital headache - classic dengue, rash anterior hand, vomiting 4 days ago, platelet trend - Day 1 85k, Day 2 96k, Latest 1.0 lakh - excellent trend, reference range given.
- Gaps: *Contradictions* - "No H/o epistaxis, 5-6 episodes noted", "No H/o bleeding" vs epistaxis episodes, "cough productive from gums" - meaningless, "PR illegible", "Has got ... illegible". *PICCLE - Not recorded.* *RR, SpO2 - Not recorded.* *CNS - Not recorded.* *No NS1 / Dengue IgM / IgG.* *No haematocrit, Hb, TLC.* *No rash details* - petechiae, macular, itchy? *No vomiting details* - how many times, blood? *No fever grade, no body pain / joint pain?* *No tourniquet test, no liver / spleen.*
*Score: 1 / 2*
- Partial recall - retro-orbital headache + platelet trend excellent, but contradictions, PICCLE, CNS, RR / SpO2, NS1 missing.
- *Next target:* Clean contradictions before submitting - epistaxis yes or no? Bleeding yes or no? If PR illegible, re-write it. Always record PICCLE - Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, Edema - in dengue with low platelets. Always record RR, SpO2, PR - all vitals. Always record CNS - NFD / orientation. Always record NS1 Antigen, Dengue IgM / IgG, Haematocrit, Hb, TLC. Always record rash - type, site, petechiae? Always record vomiting - frequency, blood, abdominal pain.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Fever + retro-orbital headache + rash + vomiting + low platelet pattern described.
- Diagnosis - Dengue given.
- But no explanation in own words of why retro-orbital headache + rash + low platelets = dengue.
- No explanation of platelet trend 85k -> 96k -> 1.0 lakh - rising - good - not explained. No explanation of BP 125/60 - wide pulse pressure 65 - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Dengue virus -> fever, retro-orbital headache, body pain, rash, low platelets -> bleeding risk. Explain: Platelet trend rising 85k -> 96k -> 1.0 lakh = recovery phase, platelets coming up, good sign - not falling. Explain: BP 125/60 - pulse pressure 65 - wide - need to check for plasma leakage, capillary leak. Explain: Vomiting 4 days ago = warning sign, needs monitoring. Explain: Rash on hand = dengue rash / petechiae due to low platelets. Explain: Delivery boy - outdoor, mosquito bites - exposure.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional Diagnosis - Dengue.
- Investigations given - Platelet trend only.
- No management plan, no fluid plan, no monitoring plan.
- No application of platelet 85k -> 1.0 lakh to care - no discharge / admission decision.
*Score: 1 / 2*
- Partial application - platelet trend applied, but no care plan.
- *Next target:* Add: CBC - Hb, Haematocrit, TLC, Platelet daily, Dengue NS1, Dengue IgM / IgG, RFT, LFT, Urine routine, Blood grouping. Add management - Admit / OPD, monitor vitals every 4-6 hours, BP, pulse pressure, urine output, oral fluids / ORS, paracetamol for fever - avoid aspirin / ibuprofen / NSAIDs - increases bleeding, avoid IM injections, check for warning signs - severe abdominal pain, persistent vomiting, bleeding, drowsiness, cold extremities, repeat platelet + haematocrit daily. Add: If platelet rising + no bleeding + no warning signs = can discharge with follow-up.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional Diagnosis - Dengue - single diagnosis, no differential list.
- No analysis of alternative causes: Dengue vs Malaria vs Typhoid vs Chikungunya vs Viral fever with thrombocytopenia.
- No analysis of why retro-orbital headache + rash + low platelets = dengue, not malaria / typhoid.
*Score: 1 / 2*
- Partial analysis - dengue pattern recognized, but not differentiated.
- *Next target:* Add differential table: Dengue - supports 27M, fever 6 days, retro-orbital headache, rash, vomiting, platelet 85k -> 1.0 lakh; against - no NS1, no body pain mentioned, no bleeding confirmed. Malaria - supports fever intermittent, rise and fall, headache, vomiting; against - no chills / rigors / sweating cycle, no splenomegaly mentioned. Typhoid - supports fever 6 days, headache, vomiting; against - no abdominal pain, constipation / diarrhoea, rose spots, platelet usually normal. Chikungunya - supports fever, headache, rash; against - no severe joint pain mentioned. Must analyze: Is platelet 1.0 lakh low enough to explain bleeding? Is trend rising good or bad? Is BP 125/60 wide pulse pressure a sign of leakage?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Platelet trend given - Day 1 85k, Day 2 96k, Latest 1.0 lakh - shows monitoring.
- But no justification for Dengue without NS1 / IgM.
- No judgment on contradictions - epistaxis vs no bleeding - not evaluated.
- No judgment on severity - platelet 1.0 lakh, no bleeding, vitals stable - mild / moderate? - not graded.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - platelet trend shows judgment, but NS1 justification missing.
- *Next target:* Add: Can I label Dengue without NS1 / IgM? Platelet low alone is not enough. What is the risk if I miss malaria / typhoid in a 27M with fever 6 days + vomiting? What is the risk if I miss bleeding because I wrote "No bleeding" and "epistaxis 5-6 episodes" in same case? What would I do differently - clarify bleeding history, check gums, nose, urine, stool for bleeding, check NS1, check haematocrit, check BP + pulse pressure trend? Reflection on delivery boy - outdoor work, mosquito exposure, family / co-workers with fever?
### 6. Create - Synthesis & New Learning Product
*Evidence in portfolio:*
- No original product - no algorithm, concept map, patient education material.
- Platelet trend table is a start, but not a full product.
*Score: 0 / 2*
- Not met.
- *Next target:* Create 1-page algorithm: Fever + Retro-orbital Headache + Rash -> Dengue vs Malaria vs Typhoid -> Examination -> NS1 + Platelet + Haematocrit -> Management, OR patient education sheet for Dengue - fluids, warning signs, avoid NSAIDs, mosquito prevention for delivery boy.
### Summary Sheet - Roll No. 14 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Retro-orbital headache + platelet trend excellent, contradictions / PICCLE missing
2. Understand | 1 | Fever + headache + rash described, platelet rising not explained
3. Apply | 1 | Dengue stated, no fluid / monitoring plan
4. Analyze | 1 | Dengue pattern recognized, no differential table
5. Evaluate | 1 | Platelet trend shows judgment, NS1 justification missing
6. Create | 0 | No original product
**Total** | **5 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 14 - Progression:*
- CASE 1 CKD Stage 5 on Dialysis = 6/12, *This portfolio = 5/12*
- *Progress flat, but platelet trend is your best work so far:* Day 1 85,000 -> Day 2 96,000 -> Latest 1.0 lakh, with reference range 1.5-4.0 lakh - that is exactly how dengue should be monitored, and you did it. Retro-orbital headache + rash + fever 6 days is a classic dengue triad, and you captured it.
- *Critical learning from this case:* Two traps - 1) Contradictions kill your case - you wrote "No H/o epistaxis, 5-6 episodes noted" and "No H/o bleeding" in the same HOPI, and "cough productive from gums" - fix bleeding history before submitting, check nose, gums, urine, stool. 2) Platelet trend rising is good, but you did not explain it - 85k -> 1.0 lakh = recovery, not deterioration. And BP 125/60 - pulse pressure 65 - wide - check for leakage. Add PICCLE + CNS + RR / SpO2 + NS1 + haematocrit, and this case becomes 8-9/12.
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