30/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 16* - Portfolio: *CASE SUMMARY - 36F, Bilateral Lower-Limb Swelling - 4 Years, Abdominal Pain - 4 Years, Known CKD on Maintenance Haemodialysis - 2 Times/Week, Bilateral Pedal Edema +, Abdomen Distended +, Provisional Diagnosis: CKD on Maintenance Haemodialysis with Bilateral Pedal Edema + Abdominal Distension + Abdominal Pain*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Age/Sex: 36-year-old female, Chief Complaints: 1. Bilateral lower-limb swelling for 4 years. 2. Abdominal pain for 4 years, History of Present Illness: A 36-year-old female, a known case of chronic kidney disease (CKD) on maintenance hemodialysis two times per week (as reported), presented with bilateral lower-limb swelling and abdominal pain for 4 years, Past History: Known case of CKD on maintenance hemodialysis, General Examination: Bilateral pedal edema present. Other findings and vital signs examined and documented, Systemic Examination: CVS: S1 and S2 heard; murmurs assessed, RS: Bilateral air entry assessed; added sounds assessed, Per Abdomen: Abdomen distended; tenderness, organomegaly, and shifting dullness assessed, CNS: Consciousness, orientation, and neurological status assessed, Provisional Diagnosis: Chronic kidney disease on maintenance hemodialysis with bilateral pedal edema and abdominal distension, with abdominal pain.
- Good details: Age / Sex - 36F, C/C - bilateral lower-limb swelling 4 years, abdominal pain 4 years - duration given, Past History - CKD on maintenance haemodialysis 2 times/week - mentioned, General Examination - Bilateral pedal edema present, P/A - Abdomen distended, Provisional Diagnosis - given.
- Gaps: *This is a summary, not a case history.* *No Occupation.* *No HOPI - onset, progression, character of swelling / pain - missing.* Swelling - pitting / non-pitting? Up to ankle / leg? More evening / morning? Relieved by rest? Pain - site, onset, character, radiation, aggravating / relieving, associated - fever, vomiting, dysuria, oliguria, breathlessness - all missing. *No Personal History - Appetite, Diet, Sleep, Bowel & Bladder, Addictions - missing.* *No Family History.* *No Cause of CKD - DM? HTN? Glomerulonephritis? - missing.* *No Dialysis details - since when? AV fistula? Last dialysis? Missed dialysis?* *No Vitals RESULTS - "examined and documented" - not given - BP, PR, RR, Temp, SpO2 missing.* *No PICCLE RESULTS - Pallor? Icterus? Clubbing? Lymphadenopathy? Edema grading? - "bilateral pedal edema present" only.* *No Systemic Examination RESULTS - CVS: "S1 S2 heard; murmurs assessed" - murmur present or absent? RS: "air entry assessed; added sounds assessed" - NVBS? Crepitations? Wheeze? P/A: "tenderness, organomegaly, shifting dullness assessed" - tender or not? Organomegaly present or not? Shifting dullness present or not? CNS: "consciousness, orientation, neurological status assessed" - oriented? NFND? - all missing.* *No Investigations - RFT, CBC, Hb, Electrolytes, USG, Urine.*
*Score: 1 / 2*
- Partial recall - age / sex + C/C + CKD + dialysis + edema + distension present, but almost all findings are "assessed" not reported.
- *Next target:* Never write "assessed" / "examined and documented" - write the RESULT. E.g. CVS - S1 S2 (+), no murmur. RS - NVBS (+), BAE (+), no crepitations / wheeze. P/A - soft, NT, no organomegaly, shifting dullness (+) / (-). CNS - conscious, oriented to TPP, NFND. Vitals - BP 140/90, PR 80, RR 18, Temp Afebrile, SpO2 98% on RA. PICCLE - P (+) mild, E (+) Gr II pitting up to ankle. Always record HOPI - swelling - onset, progression, pitting, diurnal, pain - site, character, radiation, aggravating / relieving, associated symptoms. Always record Personal + Family History, Cause of CKD, Dialysis - since when, AV fistula, last dialysis, missed dialysis?, Investigations - RFT - urea, creatinine, eGFR, CBC - Hb, Electrolytes - K, USG.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- CKD on dialysis + bilateral pedal edema + abdomen distended + abdominal pain - listed.
- But no explanation in own words of why CKD causes edema, distension, pain, why dialysis 2 times/week matters.
- No explanation of CKD - not explained.
*Score: 0 / 2*
- Not met - no comprehension shown, only listing.
- *Next target:* Explain: CKD = kidneys lose function, cannot clear water / salt -> bilateral pedal edema, cannot clear urea -> abdominal pain, nausea, appetite ↓. Explain: Abdomen distended = ascites? Gas? Fluid overload? - need shifting dullness (+) / (-) to decide. Explain: Dialysis 2 times/week = removes water, urea, creatinine, electrolytes - if missed, fluid overload -> edema + distension + breathlessness. Explain: Bilateral lower-limb swelling 4 years + abdominal pain 4 years = chronic, progressive, not acute. Explain: 36F on dialysis - young for CKD - need cause - DM, HTN, glomerulonephritis, polycystic kidney, autoimmune?
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Dialysis 2 times/week - mentioned.
- Provisional Diagnosis - given.
- But no student plan - no investigation plan, no management plan.
- No application of swelling 4 years + pain 4 years + distension to care - no urgent dialysis, no ascites check.
*Score: 0 / 2*
- Not met - no care plan.
- *Next target:* Add: RFT - urea, creatinine, eGFR, CBC - Hb, Electrolytes - K, Na, Ca, Phosphate, Urine protein, USG abdomen - kidney size, ascites, ECG, Chest X-ray. Add management - Continue dialysis - clarify times/week, do not miss, Fluid restriction, low salt, daily weight, check BP, Check AV fistula - thrill / bruit, no BP / blood draw on fistula arm, Treat anaemia, Diet - low salt, low potassium, Follow-up, Refer - Nephrology. Add: If abdomen distended + shifting dullness (+) + pain - urgent - check ascites, infection, USG, paracentesis if indicated.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional Diagnosis: CKD on maintenance haemodialysis with bilateral pedal edema and abdominal distension, with abdominal pain - this is a restatement of C/C, not a diagnosis.
- No differential list.
- No analysis of alternative causes: CKD cause, edema cause, abdominal pain cause, distension cause.
*Score: 0 / 2*
- Not met - diagnosis is restatement, no differentiation.
- *Next target:* Add differential table: Cause of CKD - Diabetic Nephropathy - supports? Need DM history, against? No DM given. Hypertensive Nephrosclerosis - supports? Need HTN history, against? No HTN given. Chronic Glomerulonephritis - supports young 36F, edema, CKD, against? No haematuria, proteinuria given. Polycystic Kidney Disease - supports young, CKD, abdominal pain / distension - palpable kidneys, against? No family history given. Cause of Edema - CKD / fluid overload - supports CKD on dialysis, bilateral pedal edema; against - need pitting, grading. Cardiac - supports edema, distension - ascites; against - no SOB, orthopnoea given. Hepatic - supports edema, distension - ascites, pain; against - no jaundice, alcohol history given. Cause of Abdominal Pain - Ascites / stretching - supports distension; against - no tenderness given. Peritonitis - supports pain + distension + dialysis; against - no fever given. Must analyze: Is pain due to ascites, gastritis from uraemia, or peritonitis? Is distension due to ascites, gas, or fluid overload?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- "As reported" for dialysis 2 times/week - shows some caution - you noted it is reported, not verified.
- But no judgment on 4 years swelling + pain - chronic, not acute - not flagged.
- No judgment on missing vitals / examination results - not evaluated.
- No judgment on dialysis adequacy - 2 times/week - is it enough? - not flagged.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - "as reported" shows caution, but rest is missing.
- *Next target:* Add: Can I label CKD cause without RFT, USG, urine protein, DM / HTN history? What is most urgent - 36F, 4 years swelling + pain, abdomen distended - is she in fluid overload, ascites, peritonitis, hyperkalaemia? What is the risk if I miss peritonitis / ascites infection in a dialysis patient? What would I do differently - ask cause of CKD, ask dialysis - since when, last dialysis, missed dialysis?, ask pain - site, character, fever, vomiting, ask urine - oliguria?, check vitals, check fistula, check shifting dullness, check tenderness? Reflection on 36F - young, 4 years swelling + pain, on dialysis - impact on work, family, marriage, fertility, mental health, need for counselling, transplant?
### 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: 36F + CKD on Dialysis + Bilateral Pedal Edema + Abdomen Distended + Abdominal Pain -> Cause of CKD -> Examination -> RFT + USG + Shifting Dullness -> Management, OR patient education sheet for CKD on Dialysis - Fluid / Salt, Daily Weight, AV Fistula Care, when to go to hospital - breathlessness, swelling, pain, fever.
### Summary Sheet - Roll No. 16 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Age / C/C / CKD / dialysis present, all exam results "assessed" not reported
2. Understand | 0 | Listing only, no mechanism explained
3. Apply | 0 | No investigation / management plan
4. Analyze | 0 | Diagnosis is restatement, no differential
5. Evaluate | 1 | "As reported" shows caution, urgency / missing data missed
6. Create | 0 | No original product
**Total** | **2 / 12** | **Beginning - Emerging**
*Overall CBME Feedback for Roll 16 - Progression:*
- *This portfolio = 2 / 12* - First case for Roll 16
- *Strength:* You gave Age / Sex + C/C with duration + CKD on dialysis 2 times/week + Provisional Diagnosis - that is a clean case summary header. And "as reported" for dialysis is good caution.
- *Critical learning from this case:* A case summary must report RESULTS, not that something was "assessed" / "examined and documented". CVS - murmur present or absent? RS - crepitations present or absent? P/A - tender or not? Organomegaly present or not? Shifting dullness present or not? CNS - oriented or not? Vitals - BP, PR, RR, Temp, SpO2 - what are they? Without results, this is a template, not a patient. Add HOPI + Personal / Family History + Cause of CKD + Dialysis Details + PICCLE + Vitals RESULTS + Systemic RESULTS + RFT / USG RESULTS + Differential, and this case becomes 7-8/12.
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