28/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 1* - Portfolio: *44M, Decorating Events, Shortness of Breath on Exertion - 2 Months, Non-Pitting Pedal Edema + Facial Edema - 2 Months, Dry Cough - 1 Month*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Demographics with occupation, chief complaints, HOPI, past history - K/C/O HTN, DM 3 years, on Gliclazide 60 mg, Metformin 500 mg, Clonidine 100 mcg, Nifedipine 10 mg, N/K/C/O TB, Asthma, COPD, Epilepsy, no surgery, personal history - Appetite Decreased, Sleep Disturbed, Bowel Constipation, Bladder Normal, Burning micturition after every dialysis, family history, general examination, PICCLE, vitals - with SpO2 included, systemic examination - CVS, CNS, P/A recorded, Reports included.
- Good details: SOB suddenly while climbing stairs, walking, swelling both feet + facial puffiness 2 months, receives twice a week dialysis Wednesday and Friday. No chest pain, fever, hematuria.
- Gaps: No RS examination despite SOB + dry cough. No weight, no urine output, no dialysis duration / since when. No JVP, lung crepitations.
*Score: 2 / 2*
- Competency met: First case in Roll 1 to include Reports. Drug names + doses + dialysis schedule captured.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- SOB + edema + facial puffiness linked as CKD.
- But no explanation in own words of why CKD causes SOB, facial edema, dry cough.
- No explanation of non-pitting vs pitting edema - non-pitting recorded but not explained.
- No explanation of burning micturition after every dialysis - infection? Catheter? Residual urine?
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: CKD -> fluid overload -> SOB on exertion, pedal edema, facial puffiness, dry cough. Explain: Non-pitting edema is unusual in CKD - CKD edema is usually pitting - think hypothyroidism, lymphoedema, drug. Explain: Burning micturition after dialysis = UTI / catheter-related. Explain: Decreased appetite + constipation = uremia.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as CKD.
- Reports given: Hb 11.0 g/dL, Creatinine 0.5 mg/dL.
- No investigation plan beyond these 2, no management plan, no dialysis assessment.
- No application of reports to care - Creatinine 0.5 is normal, not CKD range, not flagged.
*Score: 1 / 2*
- Partial application. Reports included is progress, but not interpreted.
- *Next target:* Add: Repeat Creatinine, Urea, eGFR, Electrolytes, Urine routine, Urine protein, Calcium, Phosphate, ABG, ECG, Chest X-ray, USG KUB. Add management - fluid / salt restriction, BP control, check dialysis adequacy, treat burning micturition - urine culture, avoid Metformin in CKD - Metformin is contraindicated in advanced CKD due to lactic acidosis risk, review with nephrologist. Check RS - crepitations, JVP.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No formal differential diagnosis listed.
- But clues for analysis present: Non-pitting edema, facial puffiness, SOB, dry cough, DM + HTN 3 years only, dialysis twice weekly.
- No analysis of contradictions: Creatinine 0.5 mg/dL does NOT support CKD Stage V / dialysis - needs re-check, lab error, low muscle mass, or wrong report. Hb 11.0 - mild anemia - supports CKD.
- No analysis of facial puffiness + non-pitting edema - hypothyroidism, nephrotic syndrome, lymphoedema vs CKD.
*Score: 1 / 2*
- Partial analysis - implicit, not explicit.
- *Next target:* Add differential table: CKD - supports dialysis twice weekly, SOB, edema, decreased appetite, HTN, DM; against - Creatinine 0.5 normal, DM + HTN only 3 years too short for CKD, non-pitting edema. Nephrotic syndrome - supports facial puffiness, edema, SOB; against - no proteinuria result. Hypothyroidism - supports non-pitting edema, facial puffiness, constipation, decreased appetite, dry cough; against - no cold intolerance mentioned. Cardiac failure - supports SOB, edema, dry cough; against - no chest pain, need ECG / Echo. Must analyze Creatinine 0.5 - this is the key inconsistency in this case.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for CKD despite normal creatinine, no reflection, no self-assessment.
- No discussion of Metformin in dialysis patient - safety issue not flagged.
- No discussion of burning micturition after dialysis - infection risk not evaluated.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Can I label CKD when Creatinine is 0.5? What is the risk if I miss hypothyroidism / cardiac failure? What would I do differently - repeat creatinine, check eGFR, check TSH, check urine protein, ask since when dialysis, what access? Reflection on taking reports at face value without questioning normal creatinine in a dialysis patient.
### 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 checklist: Dialysis Patient Visit - SOB + Edema -> Fluid, BP, Labs, ECG, Chest X-ray, Dialysis Adequacy, Drug Review - Metformin, OR algorithm: Edema - Pitting vs Non-Pitting -> CKD vs Thyroid vs Lymphoedema.
### Summary Sheet - Roll No. 1 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Good documentation, first case with Reports
2. Understand | 1 | SOB + edema listed, non-pitting + burning micturition not explained
3. Apply | 1 | CKD stated, reports given but not interpreted
4. Analyze | 1 | No explicit differential, Creatinine 0.5 contradiction not analyzed
5. Evaluate | 0 | No justification, Metformin safety + normal creatinine not evaluated
6. Create | 0 | No original product
**Total** | **5 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 1 - Progression:*
- 21M itchy scalp / Psoriasis = 5/12, 50F joint pains / no diagnosis = 3/12, 55M vomiting + swelling / Diabetic Nephropathy = 5/12, *This portfolio = 5/12*
- *Progress shown:* First case to include reports - Hb and Creatinine. This is improvement in Apply.
- *Critical learning from this case:* This is the most important case in Roll 1 so far. Creatinine 0.5 mg/dL in a patient on dialysis twice weekly does NOT fit. Always question a normal creatinine in CKD. And Metformin 500 mg in a dialysis patient is a red flag - contraindicated in advanced CKD. Non-pitting edema + facial puffiness + constipation + decreased appetite = also think hypothyroidism. Do not label CKD without checking eGFR + urine protein.
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