2/11/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 34* - Portfolio: *70M Retired Auto Driver, Swelling Both Lower Limbs, SOB, Weakness, Loss of Appetite - CKD Stage V*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Department - General Medicine, Demographics with age / sex, Occupation - Retired (Auto driver), chief complaints, HOPI, past history - HTN 4 yrs on Amlodipine 40 mg, DM since 4 yrs, Asthma, family history, personal history - Appetite Decreased, Diet Mixed, Sleep Disturbed, Bowel & Bladder Regular, Addictions - Alcohol, smoking stopped since 2 weeks, general examination, vitals - with SpO2 + Weight 62 kg included, PICCLE - full form written - Pallor Present, Icterus Absent, Clubbing Absent, Cyanosis Absent, Lymphadenopathy Absent, Edema Present, systemic examination - CVS, CNS, RS, P/A recorded, Investigations - [As written - not listed], Provisional Diagnosis - Chronic KD - Stage V due to HTN.
- Good details: Swelling both lower limbs gradual, decreased urine output, generalized weakness, loss of appetite 1 month, SOB. Negatives - No fever, burning micturition. H/O knee pain due to past trauma.
- Gaps: *Amlodipine 40 mg* - dose error, Amlodipine is 5 mg / 10 mg, not 40 mg - likely confusion with Telmisartan 40 mg. *P/A - Soft, tender, NT* - contradictory, tender + Non-Tender cannot be both. No JVP, no lung crepitations, no urine output quantity. No dialysis history. No DM medication. Investigations not listed.
*Score: 2 / 2*
- Competency met: Best documentation in Roll 34 so far - occupation, weight, full PICCLE, smoking / alcohol cessation timing.
- *Next target:* Fix drug dose - Amlodipine 40 mg is wrong. Fix P/A - tender or NT, pick one. Always list investigations with values.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Swelling + SOB + weakness + loss of appetite linked as CKD Stage V due to HTN.
- But no explanation in own words of why CKD Stage V causes swelling, SOB, weakness, loss of appetite, decreased urine.
- No explanation of Pallor + Edema - anemia + fluid overload - not explained.
- No explanation of why HTN causes CKD Stage V, and DM also present - which cause is primary?
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: CKD Stage V -> kidney failure -> fluid overload -> edema + SOB, decreased urine, uremia -> loss of appetite, weakness, nausea. Explain: CKD -> anemia -> Pallor, weakness, easy fatigability, SOB. Explain: HTN 4 yrs + DM 4 yrs both cause CKD - need to explain which is more likely cause, or both together. Explain: Amlodipine also causes pedal edema - need to separate CKD edema vs drug edema.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as Chronic KD - Stage V due to HTN.
- No investigation plan, no management plan. Investigations - "not listed on this page" - so cannot apply.
- No application of SOB + edema to care - no Chest X-ray, no Echo, no dialysis plan.
- No application of alcohol / smoking stopped 2 weeks to care.
*Score: 1 / 2*
- Partial application. Diagnosis stated, but Stage V not applied to care.
- *Next target:* Add: CBC - Pallor, RFT - Urea, Creatinine, eGFR - to prove Stage V, Electrolytes, ABG, Urine routine, Calcium, Phosphate, PTH, Vitamin D, HbA1c - DM, ECG, Chest X-ray, USG KUB, Echo. Add management - fluid / salt restriction, dialysis - is he on dialysis? If Stage V, need nephrology, dialysis planning, treat anemia, BP control, review Amlodipine dose, avoid nephrotoxins, diet - low salt / potassium, alcohol / smoking cessation counseling. Add detailed RS exam - JVP, crepitations, effusion.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No formal differential diagnosis listed, but cause given as HTN.
- No analysis of alternative causes: CKD due to HTN vs DM vs Both vs Obstructive.
- No analysis of swelling + SOB - CKD vs Cardiac failure vs Liver vs Drug.
- No analysis of decreased urine - CKD vs dehydration vs obstruction.
*Score: 1 / 2*
- Partial analysis - implicit, not explicit.
- *Next target:* Add differential table: CKD Stage V due to HTN - supports HTN 4 yrs, swelling, decreased urine, weakness, Pallor, Edema, loss of appetite. CKD due to DM - supports DM 4 yrs, same symptoms; against - DM only 4 yrs, short for Stage V, need HbA1c, retinopathy. Cardiac failure - supports swelling, SOB, weakness, HTN, DM, age 70M; against - no chest pain, no murmurs, need Echo. Liver disease - supports swelling, weakness, loss of appetite, alcohol history; against - no icterus, no ascites mentioned. Drug edema - Amlodipine - supports swelling; against - SOB + decreased urine not explained. Must analyze: HTN vs DM - which caused Stage V?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Stage V - no eGFR, no creatinine given, yet Stage V stated.
- No justification for HTN as cause, when DM also present.
- No judgment on urgency - SOB + edema + decreased urine in 70M = need urgent RFT, electrolytes, ABG.
- No reflection, no self-assessment.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Can I label Stage V without eGFR / creatinine? What is the risk if I miss cardiac failure / pulmonary edema in a 70M with SOB + edema? What would I do differently - do RFT, ECG, Chest X-ray, check JVP, ask about dialysis, orthopnea, PND, chest pain? Reflection on CKD Stage V in retired auto driver - impact on family, dialysis burden, diet, work.
### 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: Swelling + SOB + Decreased Urine in Older Male -> CKD vs Cardiac vs Liver -> Investigations -> Management, OR patient education sheet for CKD Stage V - fluid, salt, diet, dialysis, red flags.
### Summary Sheet - Roll No. 34 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Best documentation in Roll 34, weight + full PICCLE
2. Understand | 1 | CKD linked, Stage V + Pallor + Edema not explained
3. Apply | 1 | CKD Stage V stated, no investigations / dialysis plan
4. Analyze | 1 | HTN as cause stated, DM vs HTN not analyzed
5. Evaluate | 0 | No eGFR to prove Stage V, no urgency
6. Create | 0 | No original product
**Total** | **5 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 34 - Progression:*
- 60F knee + back pain / OA = 4/12, 55F knee + neck pain / Metabolic OA - duplicate = 4/12, 54F farmer knee + neck pain / OA = 4/12, 55F farmer knee pain / Metabolic OA + DM = 4/12, *This portfolio = 5/12*
- *Progress improving:* First 5/12 in Roll 34. Best PICCLE so far - you wrote Pallor Present, Icterus Absent, etc. in full, not just P/I/C/C/L/E. And you recorded Weight 62 kg - first weight in Roll 34.
- *Critical learning from this case:* Two drug errors to fix. Amlodipine 40 mg does not exist - Amlodipine is 5 mg / 10 mg, Telmisartan is 40 mg. And P/A - Soft, tender, NT - tender and Non-Tender cannot both be true. Also, you cannot label CKD Stage V without eGFR / creatinine. Stage V = eGFR <15. Without numbers, it is just CKD. And with DM + HTN both 4 years, you must analyze which caused CKD - do not pick HTN without justification.
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