Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 20* - Portfolio: *70M, Retired Ex-Auto Driver, Swelling Both Lower Limbs, SOB, Weakness, Loss of Appetite - 2 Months*
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 - HTN 4 years on Amlodipine 40 mg, DM 4 years, Asthma, family history, personal history - Alcohol, Smoking, appetite decreased, sleep disturbed, general examination, PICCLE, vitals - with SpO2 and weight, systemic examination recorded.
- Good details: Gradual swelling both lower limbs, decreased urine output, generalised weakness, loss of appetite, knee pain due to past trauma.
- Gaps: No duration of decreased urine output, no urine volume, no JVP, no detailed edema examination - pitting, grade. No medication adherence for DM.
*Score: 2 / 2*
- Competency met: Most complete documentation so far. SpO2 and weight included.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Symptoms linked as swelling + decreased urine + weakness + loss of appetite.
- Pallor (+) and Edema (+) in PICCLE correctly captured.
- But no explanation in own words of why CKD causes swelling, SOB, weakness, loss of appetite, pallor.
- No explanation of why HTN causes CKD, or how DM contributes.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: CKD -> decreased urine -> fluid overload -> edema + SOB, anemia -> pallor + weakness + fatigability, uremia -> loss of appetite. Explain HTN + DM as both causes of CKD.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as Chronic Kidney Disease Stage V due to HTN.
- No investigation plan, no management plan, no staging evidence.
- Amlodipine 40 mg recorded but not applied - dose is unusual, Amlodipine itself can cause pedal edema, not addressed.
*Score: 1 / 2*
- Partial application. Diagnosis stated, but not applied to a safe care plan.
- *Next target:* Add: CBC, RFT - Urea, Creatinine, eGFR, Electrolytes, ABG, Urine routine, Urine protein / PCR, USG KUB, ECG, Echo, TFT, HbA1c. Add management - salt restriction, fluid restriction, BP / sugar control, anemia correction, nephrology referral, dialysis counseling if Stage V, avoid nephrotoxins / NSAIDs. Verify Amlodipine dose with senior / prescription - 40 mg is not standard.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No formal differential diagnosis listed.
- But clues for analysis are present: HTN + DM both present, so cause could be diabetic nephropathy, not only HTN.
- No analysis of alternative causes: Cardiac failure - supports swelling + SOB + weakness, age 70M, HTN, DM, smoking, alcohol; Liver disease - supports swelling, loss of appetite, alcohol; Amlodipine-induced edema - supports swelling.
- No analysis of why Stage V - no eGFR / creatinine given to justify staging.
*Score: 1 / 2*
- Partial analysis - implicit, not explicit.
- *Next target:* Add differential table: CKD due to HTN - supports HTN 4 years, decreased urine, edema, pallor; against - DM also present, need to prove. CKD due to Diabetic Nephropathy - supports DM 4 years, edema, loss of appetite. Cardiac failure - supports SOB, edema, weakness; against - no orthopnoea mentioned, S1 S2 normal. Liver disease - supports edema, loss of appetite, alcohol. Amlodipine edema - supports swelling, on Amlodipine. Use investigations to differentiate.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Stage V or for HTN as cause over DM.
- No reflection, no self-assessment, no discussion of urgency, dialysis, referral, or patient safety - alcohol / smoking counseling.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Can I label Stage V without eGFR / creatinine? What is the risk of labeling Stage V too early? What is urgent here - SOB + edema + decreased urine = need urgent RFT, electrolytes, ECG. What would I do differently - check JVP, lung crepitations, urine output chart, verify drug doses? Reflection on multi-morbidity in elderly.
### 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 with Swelling + SOB + Decreased Urine -> Renal vs Cardiac vs Liver vs Drug -> Investigations -> Referral, OR patient education sheet for CKD - diet, salt, fluid, medication adherence, alcohol / smoking cessation, dialysis counseling.
### Summary Sheet - Roll No. 20 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Excellent documentation, SpO2 + weight included
2. Understand | 1 | Symptoms listed, CKD mechanism not explained
3. Apply | 1 | CKD Stage V stated, no investigations to prove staging, Amlodipine dose not verified
4. Analyze | 1 | No explicit differential, HTN vs DM vs Cardiac vs Drug not analyzed
5. Evaluate | 0 | No justification for Stage V / HTN cause, no reflection
6. Create | 0 | No original product
**Total** | **5 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 20 - Progression:*
- 45F back + knee = 5/12, 60M knee + eye = 4/12, 60F fever + knee = 5/12, 32M fever = 4/12, 36F thyroid nodule = 5/12, 32F SOB + edema = 4/12, 55M HTN + headache = 4/12, 55F back + knee + neck = 5/12, 45F back + knee = 4/12, 50F joints + back = 4/12, *This portfolio = 5/12*
- *Progress shown:* Best case for multi-morbidity - HTN + DM + Asthma + Alcohol + Smoking all captured, PICCLE with both Pallor (+) and Edema (+) captured.
- *Still to improve:* Do not stage CKD without eGFR. Do not attribute CKD to HTN alone when DM is also present. And always check drug-induced edema - Amlodipine is a classic cause.
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