26/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 18* - Portfolio: *70M, Unemployed, Pain Over Right Hip & Right Thigh - 5 Days, Intertrochanteric Fracture, History of Fall*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Diagnosis - Intertrochanteric Fracture, Demographics - Age / Sex: 70 years / Male, Occupation: Unemployed, chief complaints - Pain over right hip & right thigh since 5 days, HOPI - asymptomatic 5 days ago, then pain over right hip & right thigh, Pain dragging type, increased during night time, decreased when he took medication since 4 days, History of trauma - he fell, Past History - No history of consumption of bore water, No similar complaints in past, Known case of DM since 2 months, No known history of BP / Asthma / Fits, History of DM medications since 2 months - Discontinued after a day, History of surgery 6 months ago, Personal History - Diet Mixed, Appetite No appetite since past 1 day, Sleep Disturbed, Bowel / Bladder Normal, Family / Addictions - Occasionally drinks alcohol, Used to smoke earlier, General Examination - Conscious, coherent, cooperative, well oriented to time, place, person, PICCLE: P - Pallor Absent, I - Icterus Absent, C - Cyanosis Absent, C - Clubbing Absent, L - Lymphadenopathy Absent, E - Edema Absent, Vitals - BP 140/90 mmHg, PR 94 bpm, RR 20 cpm, SpO2 97%, Temp 97.8 °F, Systemic Examination - CVS: S1 S2 present (+), CNS: NAD, RS: Bilateral Air Entry present, P/A: Soft, Non-tender, Investigations Advised - CBP, CRP, ESR, CUE, Provisional Diagnosis - Intertrochanteric Fracture, Follow-up - Fever after surgery - types [to be assessed], C/o pain at surgical site, No passage of stools, Soft diet, Physiotherapy - Quadriceps strengthening, Prevent contractures, Keep moving.
- Good details: Most complete portfolio so far - Occupation, PICCLE, Vitals, Systemic Examination - all four systems - all present. Trauma history - fall - captured, pain character - dragging, night pain, relieved by medication, DM history + drug discontinued after a day - important compliance detail, surgery 6 months ago, alcohol + smoking history, follow-up + physiotherapy plan given.
- Gaps: *No hip / limb examination* - swelling, deformity, shortening, external rotation, tenderness over greater trochanter, ability to bear weight, ROM? *No X-ray mentioned* - diagnosis Intertrochanteric Fracture without X-ray - not recorded. *No fall details* - how did he fall, from height, loss of consciousness, other injuries? *No DM details* - blood sugar, HbA1c? *Surgery 6 months ago - what surgery?* *"No history of consumption of bore water"* - why asked? Not explained. *No blood grouping, ECG, pre-anaesthetic workup for surgery.*
*Score: 2 / 2*
- Full recall - occupation, PICCLE, vitals, systemic exam, trauma, DM compliance, follow-up, physio - all present.
- *Next target:* Always add Local Examination of Hip / Limb - Inspection: swelling, deformity, shortening, external rotation. Palpation: tenderness, crepitus. Movement: ROM, can he bear weight? Always record X-ray pelvis with both hips - AP / Lateral - to prove intertrochanteric fracture. Always record fall details - mechanism, height, LOC, other injuries. Always record what surgery 6 months ago - was it related to hip? Always record blood sugar, HbA1c, ECG for surgery fitness.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Pain pattern - dragging type, increased at night, decreased with medication, after fall - described.
- Diagnosis - Intertrochanteric Fracture given.
- But no explanation in own words of why fall in 70M causes intertrochanteric fracture - osteoporosis, weak bone - not explained.
- No explanation of why DM discontinued drug matters for fracture healing / surgery infection - not explained.
- No explanation of why no appetite, disturbed sleep - pain, stress - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Intertrochanteric fracture = fracture between greater and lesser trochanter of femur, common in elderly after trivial fall due to osteoporosis. Explain: Fall + pain hip / thigh + inability to bear weight + shortening + external rotation = hip fracture until proven otherwise. Explain: DM + drug stopped after 1 day = uncontrolled sugar -> poor wound healing, infection risk after surgery, delayed union. Explain: Alcohol + smoking earlier = osteoporosis risk, poor bone healing. Explain: Night pain = fracture pain, inflammation.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Investigations Advised - CBP, CRP, ESR, CUE.
- Follow-up - Fever after surgery, pain at surgical site, No passage of stools, Soft diet.
- Physiotherapy - Quadriceps strengthening, Prevent contractures, Keep moving.
- Provisional Diagnosis - Intertrochanteric Fracture.
- But no X-ray, no surgical plan - DHS / PFN / replacement? No blood sugar control plan. No analgesia plan - which medication relieved pain? No DVT prophylaxis, no fall prevention.
*Score: 1 / 2*
- Partial application - investigations + follow-up + physio given, but incomplete.
- *Next target:* Add: X-ray pelvis with both hips - AP / Lateral, CBC, Blood sugar - FBS / PPBS / HbA1c, RFT, Electrolytes, Calcium, Vitamin D, ECG, Chest X-ray, Blood grouping + cross-match, Coagulation profile for surgery. Add management - Admit, bed rest, traction if advised, analgesics, control blood sugar, antibiotics prophylaxis for surgery, DVT prophylaxis - stockings / LMWH, surgery - DHS / PFN - as per orthopaedics, post-op - early mobilization, physiotherapy, fall prevention, calcium + Vitamin D. Add: Check for fever after surgery - infection vs atelectasis vs UTI vs DVT - types to be assessed - good that you noted it, now list them.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional Diagnosis - Intertrochanteric Fracture - single diagnosis, no differential list.
- No analysis of alternative causes: Intertrochanteric vs Femoral neck fracture vs Subtrochanteric fracture vs Soft tissue injury / contusion vs Pathological fracture.
- No analysis of why dragging pain + night pain + fall = fracture, not muscle pain.
*Score: 1 / 2*
- Partial analysis - trauma + hip pain pattern recognized, but not differentiated.
- *Next target:* Add differential table: Intertrochanteric Fracture - supports 70M, fall, pain hip + thigh, dragging, night pain; against - no X-ray, no shortening / external rotation mentioned. Femoral Neck Fracture - supports 70M, fall, hip pain; against - usually groin pain, shortening, external rotation - need exam. Subtrochanteric Fracture - supports fall, thigh pain; against - usually high-energy trauma in young, or pathological. Soft Tissue Injury / Contusion - supports fall, pain; against - 5 days persistent, night pain, dragging - less likely. Pathological Fracture - supports 70M, trivial fall; against - no bore water / fluoride? No malignancy history mentioned - need to rule out. Must analyze: Is this intertrochanteric or femoral neck? X-ray decides - management is different.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Intertrochanteric Fracture without X-ray / limb examination.
- Some judgment - Follow-up: Fever after surgery, No passage of stools, Soft diet - post-op complications considered.
- But no judgment on DM drug stopped - risk for surgery, no judgment on BP 140/90 - HTN for surgery fitness, no judgment on age 70M + fall - osteoporosis / fall risk.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - post-op follow-up shows judgment, but diagnosis justification missing.
- *Next target:* Add: Can I label Intertrochanteric Fracture without X-ray and without limb examination? What is the risk if I miss femoral neck fracture or pathological fracture? What is the risk of surgery with uncontrolled DM - drug stopped after 1 day - and BP 140/90 in 70M? What would I do differently - check limb for shortening / external rotation, check blood sugar, HbA1c, check X-ray urgently, ask about previous surgery 6 months ago - was it hip? Reflection on elderly fall - impact on mobility, independence, family care, fall prevention at home.
### 6. Create - Synthesis & New Learning Product
*Evidence in portfolio:*
- Follow-up plan + Physiotherapy plan given - Quadriceps strengthening, Prevent contractures, Keep moving, Soft diet, Fever after surgery - types, Pain at surgical site, No passage of stools.
- This is a start of a post-op care plan, but not a full original product - no algorithm, concept map, patient education sheet.
- No synthesis of pre-op + surgery + post-op + rehab into one pathway.
*Score: 1 / 2*
- Partial creation - follow-up + physio plan is a care product, but not fully developed.
- *Next target:* Create 1-page algorithm: Elderly Fall + Hip Pain -> Intertrochanteric vs Femoral Neck -> Examination -> X-ray -> Surgery Fitness -> DHS / PFN -> Post-op Fever / DVT / Constipation -> Physiotherapy, OR patient education sheet for Hip Fracture in Elderly - surgery, physio, fall prevention, calcium / Vitamin D, DM control.
### Summary Sheet - Roll No. 18 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Occupation / PICCLE / Vitals / Systemic exam complete
2. Understand | 1 | Fall + pain described, osteoporosis / DM healing not explained
3. Apply | 1 | CBP / CRP / ESR / CUE + physio given, no X-ray / surgery plan
4. Analyze | 1 | Fracture pattern recognized, no differential table
5. Evaluate | 1 | Post-op follow-up shows judgment, X-ray justification missing
6. Create | 1 | Follow-up + physio plan, not a full algorithm / education sheet
**Total** | **7 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 18 - Progression:*
- *This portfolio = 7 / 12* - First case for Roll 18, and the highest score so far in this batch
- *Strength:* This is the first portfolio in this batch that is complete on basics - Occupation, PICCLE, Vitals - BP 140/90, PR 94, RR 20, SpO2 97%, Temp 97.8 °F - Systemic Examination - CVS, CNS, RS, P/A - all present. You captured DM drug discontinued after a day - a small detail that changes surgery risk - and you added follow-up + physiotherapy, which no one else in this batch has done. That is real clinical thinking.
- *Critical learning from this case:* You diagnosed Intertrochanteric Fracture without the two things that prove it - limb examination - shortening, external rotation, tenderness - and X-ray pelvis with both hips. In hip fracture, X-ray decides intertrochanteric vs femoral neck, and that decides surgery - DHS / PFN vs replacement. And with DM drug stopped + BP 140/90 + age 70, you must check blood sugar, HbA1c, ECG before surgery. Add X-ray + limb exam + surgery fitness workup, and this case becomes 9-10/12.
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