29/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 19* - Portfolio: *CASE 3 - 50F, Housewife, Headache - 1 Month, Dizziness - 1 Month, SOB - 2 Years, Fall - Hit Head - Swelling Right Side Head - 1 Month Ago, No CT / MRI, HTN - Amlodipine 5 mg, Thyroid - Thyroxine, Provisional Diagnosis: Tonic-Clonic Seizures*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Case Details: Age: 50 yr, Sex: Female, Occupation: Housewife, C/C: Headache since 1 month, Dizziness since 1 month, SOB since 2 yrs, HOPI: Asymptomatic 1 month back then developed headache and dizziness on sudden movements due to an event occurred, She has experienced a current shock 1 month ago in which she fell and hit her head on the floor causing swelling on right side of head, Apparently pt did not go for further check up after incident, No H/O - CT / MRI scan, H/O - trauma present, Past H/O: HTN - Yes - Amlodipine Tabs 1P 5mg, Thyroid - Yes - Thyroxine Tabs 1P, N/K/C/O - DM, Asthma, epilepsy, Personal H/O: Diet Mixed, Appetite Normal, Sleep Disturbed, Bowel & Bladder Normal, No Addictions, Family H/O: Not significant, Gen Exam: PICCLE Absent, Temp 98.7°F, BP 130/90 mmHg, PR 82 bpm, RR 16/min, SOB - Grade 2, Provisional Diagnosis: Tonic-clonic seizures.
- Good details: Timeline - SOB 2 years, headache + dizziness 1 month, fall + head injury 1 month ago - chronology clear, trauma - "current shock", fell, hit head on floor, swelling right side head, did not go for check-up, No CT / MRI - important, headache + dizziness on sudden movements, drugs - Amlodipine 5 mg, Thyroxine - complete, vitals - Temp, BP, PR, RR - complete except SpO2, PICCLE Absent, SOB Grade 2.
- Gaps: *Contradiction - Provisional Diagnosis: Tonic-clonic seizures* but *no seizure described* - no loss of consciousness, tongue bite, frothing, jerking, incontinence, post-ictal confusion - not in history. *No Systemic Examination - CVS, CNS, RS, P/A missing - critical in head injury + dizziness + SOB.* *No Neurological Examination - GCS, pupils, power, sensation, balance, fundoscopy - missing.* *No Local Examination - Head swelling - size, tenderness, wound - missing.* *No Investigations - CT head, Blood sugar, Thyroid, ECG.* *SOB 2 years - not explained* - HTN? Thyroid? Asthma? - no details. *"Current shock"* - electric shock? - not clarified.
*Score: 1 / 2*
- Partial recall - trauma + timeline + drugs + vitals good, but exam, neuro exam, investigations, diagnosis mismatch.
- *Next target:* Never write a diagnosis that is not in the history - Tonic-clonic seizures needs seizure history. Always do Systemic Examination - CVS, CNS, RS, P/A. Always do Neurological Examination - GCS 15/15, pupils, power, sensation, balance, gait, fundoscopy - in head injury + headache + dizziness. Always do Local Examination - Head: swelling right side - size, tenderness, wound, bleeding. Always record Investigations - CT head, Blood sugar, Thyroid function, ECG, Chest X-ray. Always clarify - "Current shock" = electric shock? Fall due to shock? Fall due to seizure? Fall due to dizziness? Always record SpO2. Always explain SOB 2 years - on exertion? Grade 2 = ?
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Headache + dizziness on sudden movements after fall + head swelling - described.
- But no explanation in own words of why head injury causes headache / dizziness, why no CT / MRI matters, why SOB 2 years matters.
- No explanation of tonic-clonic seizures - not explained, and not in history.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Fall + hit head + swelling right side = head injury, scalp haematoma, headache + dizziness on sudden movements = post-traumatic headache, vestibular injury, concussion. Explain: No CT / MRI after head injury = missed intracranial bleed, fracture, haematoma - dangerous. Explain: Headache + dizziness on sudden movements = positional, could be vestibular, cervical, post-traumatic. Explain: SOB Grade 2 for 2 years = separate disease - HTN, thyroid, anaemia, heart - needs to be linked, not just listed. Explain: Tonic-clonic seizures = loss of consciousness, jerking, tongue bite, frothing, incontinence - none described here, so cannot diagnose. Explain: HTN - Amlodipine 5 mg, Thyroid - Thyroxine - need BP + thyroid control, both can cause headache / dizziness.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Drugs - Amlodipine 5 mg, Thyroxine - mentioned.
- But no student plan - no investigation plan, no management plan, no urgent CT head.
- No application of head injury + no CT / MRI to care - no urgent referral.
*Score: 0 / 2*
- Not met - only drugs mentioned, no care plan.
- *Next target:* Add: Urgent - CT head - rule out fracture, bleed, haematoma, Blood sugar, Thyroid function, CBC, ECG, Chest X-ray - SOB 2 years, BP monitoring. Add management - Urgent referral - Medicine / Neurology / Neurosurgery, Do not delay CT head - head injury 1 month ago with headache + dizziness, Rest, avoid sudden movements, avoid driving, Headache - Paracetamol, avoid NSAIDs if bleed suspected, Continue Amlodipine + Thyroxine, do not stop, Monitor - headache, vomiting, dizziness, weakness, vision, consciousness, Follow-up, Counsel - if vomiting, weakness, blurred vision, loss of consciousness - go to hospital immediately.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional Diagnosis: Tonic-clonic seizures - wrong, no seizure history.
- No differential list.
- No analysis of alternative causes: Post-traumatic headache vs Post-concussion syndrome vs Cervicogenic headache vs HTN headache vs Thyroid headache vs Seizure.
*Score: 1 / 2*
- Partial analysis - trauma + headache pattern recognized, but diagnosis wrong.
- *Next target:* Add differential table: Post-traumatic Headache / Post-concussion Syndrome - supports 50F, fall 1 month ago, hit head, swelling right side, headache + dizziness on sudden movements, no CT / MRI; against - no vomiting, blurred vision, memory loss mentioned, no neuro exam. Cervicogenic Headache - supports headache + dizziness on sudden movements, fall; against - no neck pain / tightness mentioned. HTN Headache - supports HTN, Amlodipine, BP 130/90; against - BP only 130/90, headache 1 month after fall - timing suggests trauma. Thyroid Headache - supports Thyroid - Thyroxine; against - no thyroid function, no other thyroid symptoms. Tonic-clonic Seizures - supports - nothing; against - No loss of consciousness, tongue bite, frothing, jerking, incontinence, post-ictal confusion, N/K/C/O epilepsy - explicitly no epilepsy. Must analyze: Did she fall because of seizure / electric shock / dizziness / SOB - or did she develop headache / dizziness because of fall? Cause vs effect - not analyzed.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- "Apparently pt did not go for further check up after incident" + "No H/O - CT / MRI scan" - shows judgment - you flagged missing check-up.
- Drugs - Amlodipine + Thyroxine - recorded.
- But no judgment on diagnosis mismatch - tonic-clonic seizures without seizure - not evaluated.
- No judgment on red flags - head injury + headache + dizziness + SOB - not flagged as urgent.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - missing CT / MRI flagged, but diagnosis mismatch / urgency missed.
- *Next target:* Add: Can I label tonic-clonic seizures without any seizure history? No - that is a serious error. What is the risk if I miss intracranial bleed / fracture in a 50F with head injury 1 month ago, swelling, headache + dizziness, no CT / MRI? What is the risk if I miss SOB 2 years cause - HTN, thyroid, heart, lung? What would I do differently - ask: Did she lose consciousness? Tongue bite? Jerking? Frothing? Incontinence? Was fall due to electric shock or seizure or dizziness? Check GCS, pupils, neuro exam, CT head urgently? Reflection on 50F housewife - fall at home, electric shock, no check-up - health-seeking, family support, fall prevention, home safety.
### 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: Fall + Head Injury + Headache + Dizziness, No CT -> Post-traumatic vs Seizure vs Cervicogenic -> Examination -> CT Head + Neuro Exam -> Management, OR patient education sheet for Head Injury - warning signs - vomiting, weakness, blurred vision, loss of consciousness, when to go to hospital, fall prevention, home safety - electric shock.
### Summary Sheet - Roll No. 19 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Trauma + timeline + drugs good, neuro exam / CT / diagnosis mismatch
2. Understand | 1 | Head injury + headache described, mechanism not explained
3. Apply | 0 | No urgent CT / referral plan
4. Analyze | 1 | Trauma pattern recognized, diagnosis wrong - no seizure history
5. Evaluate | 1 | Missing CT flagged, diagnosis mismatch / urgency missed
6. Create | 0 | No original product
**Total** | **4 / 12** | **Emerging - Developing**
*Overall CBME Feedback for Roll 19 - Progression:*
- CASE 1 Back Pain + Pain During Defecation 45M = 4/12, CASE 2 Acute Febrile Illness 45M = 5/12, *This portfolio = 4/12*
- *Progress flat, and this case has a critical error:* Provisional Diagnosis: Tonic-clonic seizures - but you wrote N/K/C/O epilepsy, and you described no loss of consciousness, no jerking, no tongue bite, no frothing, no incontinence - you cannot diagnose seizures without seizure history. That error alone will cost you marks.
- *Critical learning from this case:* You have a head injury with no CT / MRI - that is the real story - Fall 1 month ago, hit head, swelling right side, headache + dizziness on sudden movements, no check-up, no CT / MRI - that is post-traumatic headache until proven otherwise, and it needs an urgent CT head + neuro exam. And SOB 2 years is a separate disease you left unexplained. Add Neuro Exam - GCS, pupils, power, balance - + CT Head + clarify "current shock" - electric shock? seizure? dizziness? - and fix the diagnosis, and this case becomes 8-9/12.
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