21/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 2* - Portfolio: *CASE 4 - 80F, Pain Right Hip & Upper Right Thigh - 6 Days, Inability to Stand / Walk Following Fall From Bed - 6 Days, T2DM - 5 Years - Metformin 500 mg Irregular, HbA1c 8.4%, X-ray: Displaced, Comminuted (Rt) Proximal Femoral Trochanteric - Intertrochanteric Fracture, Provisional Diagnosis: Intertrochanteric Fracture Following Low Energy Fall (Age Related Osteoporosis)*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Age: 80 years, C/C: Pain in right hip & upper Rt thigh - 6 days, Inability to stand or walk following a fall from medium height - 6 days, H/o Type 2 diabetes mellitus for 5 years, HOPI: Able to perform routine daily activities 6 days ago then accidentally slipped and fell on her right side from her bed, Following fall she developed severe pain over Rt hip region sudden in onset, continuous, aggravated by movement, relieved by rest, She was unable to stand or bear wt on her Rt lower limb following fall, No H/o loss of consciousness, head injury, seizure, chest pain or palpitations preceding the fall, She is a known case of type-2 diabetes mellitus, irregular oral medication, Past H/o: DM - diagnosed 5 years ago following ↑ frequency of urination & thirst, taking Metformin 500mg irregularly, irregular blood glucose monitoring, N/K/C/O - HTN / TB / COPD / epilepsy, No previous major surgeries, No previous major fractures, H/o blood transfusion - [REDACTED], Tab Iron - IFA, Personal H/o: Diet mixed, Appetite Normal, Sleep disturbed due to pain, Bowel & Bladder regular, No addictions, Family H/o: No significant H/o Diabetes, HTN, General Examination: Pt C/C/C well oriented to TPP, O/E: Pallor - mild (+), Icterus (-), Cyanosis (-), Clubbing (-), Lymphadenopathy (-), Edema (-), Vitals: BP 140/80 mmHg, PR 86 bpm, RR 19/min, Temp 98F, SpO2 97% on RA, Inspection: Rt lower limb shortened & externally rotated, Swelling present in Rt hip region, movement restricted, Movements: Active movements restricted due to pain, unable to bear wt, Palpation: Local tenderness over (Rt) hip, Local temp not raised, Systemic Examination: CVS S1 S2 (+) no murmur, RS BAE (+) no added sounds, CNS NFND, P/A soft - NT, Investigations: Xray - displaced, comminuted fracture (Rt) proximal femoral trochanteric region, intertrochanteric fracture, Hb, Blood urea, HbA1c 8.4%, PPBS, Serum creatinine, Provisional Diagnosis: 80 y old female c h/o Type 2 diabetes - 5 years, displaced, comminuted (Rt) intertrochanteric fracture of femur following low energy fall (age related osteoporosis).
- Good details: Timeline - routine activities 6 days ago, fall from bed, pain 6 days, inability to stand / walk 6 days - chronology clear, pain pattern - severe, sudden, continuous, aggravated movement, relieved rest, fall - slipped, right side, from bed, low energy, inability to bear weight, negatives - No LOC, head injury, seizure, chest pain, palpitations preceding fall - important, DM - 5 years, ↑ frequency urination & thirst, Metformin 500 mg irregularly, irregular glucose monitoring, HbA1c 8.4% - uncontrolled, blood transfusion - [REDACTED], IFA - anaemia, PICCLE - Pallor mild +, rest absent - complete, vitals - all 5 - BP, PR, RR, Temp, SpO2 - complete, local exam - Inspection + Movements + Palpation - shortened & externally rotated, swelling Rt hip, movement restricted, unable to bear weight, tenderness Rt hip, temp not raised - complete, systemic exam - all 4 systems, investigations - X-ray + Hb + Blood urea + HbA1c 8.4% + PPBS + Serum creatinine - complete, provisional diagnosis given.
- Gaps: *No Sex stated in demographics - "Age: 80 years" only - but "her" in HOPI - Female - assume 80F.* *No Occupation.* *No Investigation RESULTS except HbA1c 8.4%* - Hb, Blood urea, PPBS, Serum creatinine values not given. *No Neurovascular Examination - distal pulses, sensation, capillary refill - missing in fracture.* *No X-ray of pelvis / contralateral hip.* *"Fall from medium height" vs "fall from her bed"* - contradiction - bed = low height.
*Score: 2 / 2*
- Full recall - history + local exam + vitals + X-ray + diagnosis complete, best in Roll 2 so far.
- *Next target:* Always record Sex + Occupation - e.g. 80F, Homemaker / Retired. Always record Investigation RESULTS - Hb - value, Blood urea - value, PPBS - value, Serum creatinine - value - not just list. Always do Neurovascular Examination - Distal pulses - Dorsalis pedis, Posterior tibial, Sensation, Capillary refill, Compartment - in hip fracture. Always clarify - Fall from bed = low energy fall, not medium height. Always record X-ray - Pelvis with both hips.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Fall from bed -> severe pain Rt hip -> shortened & externally rotated -> unable to bear weight -> intertrochanteric fracture - described.
- Provisional Diagnosis links low energy fall + age related osteoporosis - good.
- But no explanation in own words of why 80F + low energy fall causes intertrochanteric fracture, why shortened & externally rotated = fracture, why DM + HbA1c 8.4% matters.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: 80F, age related osteoporosis = bones weak, low bone density, low energy fall from bed = enough to break hip. Explain: Intertrochanteric fracture = fracture between greater and lesser trochanter of femur, proximal femur. Explain: Shortened & externally rotated = fracture, muscle pull - gluteus, iliopsoas pull proximal fragment, limb shortens, foot rotates out. Explain: Severe pain, aggravated movement, relieved rest, unable to bear weight = fracture, cannot load hip. Explain: DM 5 years, Metformin irregular, HbA1c 8.4% = uncontrolled DM - poor wound healing, infection risk, need to control sugar before surgery. Explain: Pallor mild + + IFA + blood transfusion history = anaemia - need Hb before surgery. Explain: No LOC, head injury, seizure, chest pain, palpitations preceding fall = fall was mechanical - slip, not syncope / seizure / cardiac.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Investigations - X-ray, Hb, Blood urea, HbA1c, PPBS, Serum creatinine - listed.
- Provisional Diagnosis - given.
- But no student plan - no management plan - no analgesia, no immobilisation, no surgery referral, no DM control.
- No application of HbA1c 8.4% + Pallor + age 80 to care - no pre-op workup.
*Score: 1 / 2*
- Partial application - investigations applied, but no treatment plan.
- *Next target:* Add: Management - Analgesia - Paracetamol, avoid NSAIDs if kidney / age, Immobilisation - traction / splint, do not bear weight, Nil by mouth if surgery planned, IV fluids, Blood sugar monitoring - HbA1c 8.4% - control before surgery, CBC - Hb - Pallor +, Blood grouping, ECG, Chest X-ray, Anaesthesia fitness, Refer - Orthopaedics - urgent - intertrochanteric fracture needs surgery - DHS / PFN, Physiotherapy - post-op mobilisation, Fall prevention - home safety, calcium, vitamin D, osteoporosis treatment, Diet - protein, calcium, Follow-up. Add: If 80F, HbA1c 8.4%, Pallor +, fracture - urgent - check Hb, blood sugar, ECG, Chest X-ray, admit Orthopaedics.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional Diagnosis: Displaced, comminuted (Rt) intertrochanteric fracture of femur following low energy fall (age related osteoporosis) - specific, with X-ray support.
- But no differential list - no analysis of alternative causes: Intertrochanteric vs Femoral neck vs Subtrochanteric vs Pelvic fracture.
- No analysis of X-ray - displaced, comminuted - what does it mean - not interpreted.
*Score: 1 / 2*
- Partial analysis - diagnosis specific, but not differentiated.
- *Next target:* Add differential table: Intertrochanteric Fracture - supports 80F, fall from bed, pain Rt hip, shortened & externally rotated, swelling, tenderness, unable to bear weight, X-ray - displaced, comminuted, proximal femoral trochanteric region; against - none, X-ray confirms. Femoral Neck Fracture - supports 80F, fall, pain hip, shortened & externally rotated, unable to bear weight; against - X-ray shows trochanteric region, not neck, intertrochanteric has more swelling / blood loss. Subtrochanteric Fracture - supports fall, pain hip / thigh, unable to bear weight; against - X-ray shows trochanteric, not subtrochanteric. Pelvic Fracture - supports fall, pain hip, unable to bear weight; against - X-ray shows femur, not pelvis, local tenderness Rt hip, not pelvis. Must analyze: Is fracture due to osteoporosis - age 80F, low energy fall - or pathological - DM, anaemia, no previous fractures, no cancer history? Is fall due to mechanical slip or syncope - No LOC, chest pain, palpitations - mechanical.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Negatives - No LOC, head injury, seizure, chest pain, palpitations preceding fall, No previous major fractures, No previous major surgeries - show judgment - you ruled out syncope / seizure / cardiac fall.
- Local temp not raised - shows judgment - you ruled out infection / cellulitis.
- HbA1c 8.4% + irregular Metformin + irregular glucose monitoring - shows judgment - you flagged uncontrolled DM.
- But no judgment on surgery urgency - 80F, 6 days already - delay - not flagged.
- No judgment on anaemia - Pallor + IFA + transfusion history - not flagged for surgery risk.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - negatives + DM + temp show judgment, but surgery delay / anaemia risk missed.
- *Next target:* Add: Can I label osteoporosis without DEXA / calcium / vitamin D? What is most urgent - 80F, 6 days post-fall, displaced comminuted fracture, unable to bear weight, HbA1c 8.4%, Pallor + - is she fit for surgery? What is the risk if surgery delayed - bed sores, pneumonia, DVT, muscle wasting? What is the risk if DM uncontrolled - HbA1c 8.4% - wound infection, delayed healing? What would I do differently - check Hb, blood sugar, ECG, Chest X-ray, DEXA, calcium, vitamin D, ask about osteoporosis treatment, fall history? Reflection on 80F - fall from bed at home, 6 days pain, unable to stand / walk - impact on daily activities, family care, need for home safety, fall prevention, osteoporosis screening?
### 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: Elderly Female + Fall From Bed + Pain Hip + Shortened & Externally Rotated + Unable to Bear Weight -> Intertrochanteric vs Neck vs Subtrochanteric -> Examination -> X-ray Pelvis -> Management, OR patient education sheet for Hip Fracture + Osteoporosis - fall prevention, home safety, calcium, vitamin D, DM control, when to go to hospital - fall, hip pain, unable to walk.
### Summary Sheet - Roll No. 2 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | History + local exam + X-ray + diagnosis complete, best in Roll 2
2. Understand | 1 | Fracture pattern described, osteoporosis / DM mechanism not explained
3. Apply | 1 | Investigations listed, no analgesia / surgery / DM plan
4. Analyze | 1 | Diagnosis specific, no differential table
5. Evaluate | 1 | Negatives + DM show judgment, surgery delay / anaemia missed
6. Create | 0 | No original product
**Total** | **6 / 12** | **Competent - Proficient**
*Overall CBME Feedback for Roll 2 - Progression:*
- CASE 1 SOB + Face Swelling + Edema 70M = 5/12, CASE 2 HTN + CKD + Dialysis = 5/12, CASE 3 T2DM + HTN + CKD + Breathlessness 49F = 5/12, *This portfolio = 6/12*
- *Progress +1, and this is your best case so far:* Local Examination - Inspection: Rt lower limb shortened & externally rotated, Swelling Rt hip, movement restricted, Movements: Active restricted, unable to bear weight, Palpation: Local tenderness Rt hip, Local temp not raised - that is a textbook hip fracture exam, and you did it. And Provisional Diagnosis - 80 year old female, T2DM 5 years, displaced comminuted Rt intertrochanteric fracture following low energy fall (age related osteoporosis) - is the most specific diagnosis in Roll 2. And HbA1c 8.4% + irregular Metformin is a good DM control catch.
- *Critical learning from this case:* You have a surgical emergency - 80F, 6 days post-fall, displaced comminuted fracture - but you have no management plan - analgesia, immobilisation, Orthopaedics referral, surgery - DHS / PFN, DM control, anaemia workup. Add Management + Neurovascular Exam + Investigation RESULTS - Hb, urea, PPBS, creatinine - and this case becomes 8-9/12.
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