28/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 17* - Portfolio: *CASE 2 - 15F, Stomach Pain - 5 Months Ago, Severe Stomach Pain - 5 Days Back, Vomiting - 5 Days Back, Fever - 4 Days Back, Appendicitis Surgery - 24th Oct*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Date: 28/10/2026, Age / Sex: 15/F, chief complaints - Stomach pain 5 months ago, Severe stomach pain 5 days back, Vomiting 5 days back, Fever 4 days back, HOPI - Pt apparently asymptomatic 5 months ago, Later developed stomach pain dull around umbilical area, On 23rd Oct developed dull, vague pain around umbilicus and then became sharp and more severe and radiated to right iliac fossa, Pain aggravated with movement, Developed vomitings water as content, 4-5 episodes/day, Non-bilious, Non-Projectile, H/o Fever Low grade, not associated with chills, Underwent Appendicitis surgery on 24th Oct, Past H/O: N/K/C/O DM, HTN, Epilepsy, Asthma, Personal H/O: Diet Mixed, Low fiber diet, Appetite Decreased, Bowel Irregular, Once in 2 days, Bladder Regular, Sleep Sound, Addictions None.
- Good details: Timeline - pain 5 months ago, severe pain 5 days back, surgery 24th Oct, seen 28/10/2026 - chronology clear, pain migration - dull vague umbilicus -> sharp severe -> radiated to RIF - textbook appendicitis, pain aggravated with movement, vomiting - water content, 4-5 episodes/day, Non-bilious, Non-Projectile, fever - Low grade, not with chills, bowel - irregular, once in 2 days, low fiber diet, appetite decreased.
- Gaps: *No General Examination - PICCLE missing.* *No Vitals - BP, PR, RR, SpO2, Temp missing.* *No Systemic Examination - P/A, CVS, RS, CNS missing - critical in appendicitis.* *No Local Examination - RIF tenderness, rebound, guarding, Rovsing, McBurney point.* *No Investigations - CBC, TLC, USG abdomen.* *No Provisional Diagnosis - Appendicitis? - not written, only surgery mentioned.* *No Post-op details* - wound, pain, diet, bowel, fever after surgery? *No Family History.* *No Menstrual History - 15F - LMP?* *No Fever grade, no pain score.*
*Score: 1 / 2*
- Partial recall - pain migration + vomiting + fever pattern excellent, but examination, vitals, investigations, post-op details missing.
- *Next target:* Always record General Examination - PICCLE, Vitals - BP, PR, RR, SpO2, Temp - in a 15F with fever + vomiting + post-op. Always do Systemic Examination - P/A: Soft / Tender, RIF tenderness, rebound, guarding, bowel sounds, CVS, RS, CNS. Always record Investigations - CBC - TLC, Neutrophils, USG abdomen - appendix diameter, free fluid. Always record Menstrual History - LMP - in adolescent female with RIF pain. Always record Post-op - Day 4 after surgery 24th Oct -> 28th Oct: wound clean / discharge, pain, bowel, fever, diet, antibiotics. Always write Provisional Diagnosis - Acute Appendicitis - Post-op Day 4.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Pain migration - umbilicus -> RIF, sharp severe, aggravated movement, vomiting, fever - described.
- But no explanation in own words of why pain migrates, why vomiting + fever follow pain, why appendicitis needs surgery.
- No explanation of why pain 5 months ago matters - recurrent / chronic appendicitis? - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Appendix pain starts dull vague around umbilicus - T10 visceral pain - then becomes sharp severe in RIF - somatic pain when peritoneum inflamed. Explain: Pain aggravated with movement = peritoneal irritation. Explain: Vomiting follows pain - not before - in appendicitis, vomiting after pain, water content, non-bilious, 4-5 times/day. Explain: Low grade fever = inflammation, not with chills = not malaria / typhoid. Explain: Pain 5 months ago dull umbilical + low fiber + bowel once in 2 days = recurrent appendicitis / constipation / chronic appendicitis - need to link. Explain: Surgery 24th Oct = appendectomy - removes appendix, prevents rupture / peritonitis.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Surgery - Appendicitis surgery on 24th Oct - mentioned.
- But no student plan - no pre-op / post-op care, no investigation plan, no management plan written by student.
- No application of vomiting + fever + post-op to care - no wound check, no antibiotics, no diet.
*Score: 1 / 2*
- Partial application - surgery captured, but no care plan.
- *Next target:* Add: CBC - TLC, Neutrophils, CRP, USG abdomen - appendix, RFT, Urine routine, Blood grouping. Add management - Pre-op: NPO, IV fluids, antibiotics, pain relief. Post-op Day 4: Check wound - clean / red / discharge, check fever, check bowel - flatus / stool, check diet - liquids -> soft diet, check pain - RIF, check for complications - wound infection, abscess, ileus, advise - avoid heavy work, low fiber -> high fiber diet, bowel regular, follow-up in 1 week, suture removal. Add: Menstrual History - LMP, rule out ectopic / ovarian cyst in 15F with RIF pain - USG pelvis.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No provisional diagnosis, no differential list.
- No analysis of alternative causes: Acute Appendicitis vs Mesenteric lymphadenitis vs UTI vs Ovarian cyst / torsion vs Ectopic vs Constipation vs Right ureteric colic.
- No analysis of why pain 5 months ago + now = acute on chronic vs recurrent.
*Score: 1 / 2*
- Partial analysis - pain migration pattern recognized, but not differentiated.
- *Next target:* Add differential table: Acute Appendicitis - supports 15F, pain umbilicus -> RIF, sharp severe, aggravated movement, vomiting 4-5/day after pain, low grade fever, surgery 24th Oct; against - no TLC / USG given, no RIF tenderness recorded. Mesenteric Lymphadenitis - supports 15F, fever, umbilical pain, vomiting; against - pain not migrating to RIF, usually after URI, no surgery needed. UTI - supports fever, vomiting, abdominal pain; against - bladder regular, no dysuria, frequency, burning mentioned. Ovarian Cyst / Torsion - supports 15F, RIF pain, vomiting; against - no menstrual history, no USG pelvis mentioned. Constipation - supports low fiber, bowel once in 2 days, dull umbilical pain 5 months ago; against - pain sharp severe + fever + vomiting + surgery not explained by constipation alone. Right Ureteric Colic - supports RIF pain, vomiting; against - no loin to groin radiation, no hematuria, no dysuria mentioned. Must analyze: Is pain 5 months ago same disease - chronic / recurrent appendicitis - or constipation?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No diagnosis, no judgment on surgery, no judgment on post-op complications.
- No judgment on why surgery on 24th Oct was needed - rupture risk? - not evaluated.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - timeline + pain migration shows judgment, but post-op judgment missing.
- *Next target:* Add: Can I label Appendicitis with pain migration alone, without TLC / USG / RIF tenderness? What is the risk if I miss ectopic / ovarian torsion / UTI in a 15F with RIF pain + vomiting + fever? What is the risk if I miss post-op wound infection / abscess on Day 4 - 24th Oct -> 28th Oct - fever, vomiting, pain? What would I do differently - check wound, check bowel, check LMP, check USG, check TLC trend? Reflection on 15F - school, diet - low fiber, bowel irregular - constipation risk, family anxiety, post-op recovery.
### 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: Pain Umbilicus -> RIF + Vomiting + Fever -> Appendicitis vs Mesenteric Lymphadenitis vs Ovarian Cyst -> Examination -> TLC + USG -> Appendectomy, OR patient education sheet for Post-Appendectomy - wound care, diet - high fiber, bowel regular, when to go to hospital - fever, vomiting, wound discharge, severe pain.
### Summary Sheet - Roll No. 17 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Pain migration + vomiting excellent, exam / vitals / post-op missing
2. Understand | 1 | Pain migration described, mechanism not explained
3. Apply | 1 | Surgery captured, no pre-op / post-op plan
4. Analyze | 1 | Appendicitis pattern recognized, no differential table
5. Evaluate | 1 | Timeline shows judgment, post-op / LMP judgment missing
6. Create | 0 | No original product
**Total** | **5 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 17 - Progression:*
- CASE 1 HTN + Headache + Edema 53F = 5/12, *This portfolio = 5/12*
- *Progress flat, but history is textbook:* Pain - dull vague umbilicus -> sharp severe -> radiated to RIF, aggravated with movement, vomiting - water, 4-5/day, Non-bilious, Non-Projectile, fever - Low grade, no chills, surgery 24th Oct. That pain migration is exactly how appendicitis is taught, and you captured it. Low fiber + bowel once in 2 days + pain 5 months ago is also a good link for recurrent / chronic pain.
- *Critical learning from this case:* You have the history of appendicitis, but no examination, no investigations, no post-op details - and in a 15F, you must record LMP and rule out ovarian / ectopic causes. And this is Day 4 post-op - 24th Oct -> 28th Oct - you must check wound, fever, bowel, diet, pain. Add P/A - RIF tenderness, rebound, guarding, TLC + USG, LMP, post-op wound check, and this case becomes 8-9/12.
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