Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 36* - Portfolio: *38F, Homemaker, Neck Pain - 1 Year, Lower Back Pain - 1 Year*
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 - N/K/C/O HTN, DM, Asthma, Thyroid, personal history - Toddy drinker 10 years, stopped since 2 years, general examination, PICCLE, systemic examination, vitals - with SpO2 included.
- Good details: Neck pain gradual onset, radiating to right upper limb, dragging type, aggravating on work, relieving on medication. Lower back ache radiating to right lower limb, aggravating after walking, standing, relieving after medication.
- Gaps: No duration of radiation, no numbness / tingling / weakness in limbs, no bowel / bladder history, no trauma history. CNS written as "Normal focal neurological deficit" - unclear if NFND meant.
*Score: 2 / 2*
- Competency met: Systematic documentation, radiation pattern well captured.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Radiation pattern described - neck to right upper limb, back to right lower limb.
- But no explanation in own words of what radiation means - nerve root compression / radiculopathy.
- Pallor (+) recorded but not explained. Toddy drinker history recorded but not explained - relevance to pain / nutrition / liver.
- Temp 99.5 °F and RR 21 bpm recorded but not commented on - low-grade fever / tachypnoea not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Dragging + radiating pain = radicular pain, not simple muscle pain. Explain dermatome / nerve root. Explain why pain aggravates on walking / standing - disc / spinal canal. Explain pallor, toddy history, low-grade fever relevance.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as Lower back pain - this is a symptom, not a diagnosis.
- No investigation plan, no management plan, no detailed neurological examination - power, sensation, reflexes, straight leg raise, neck movements.
- No application of radiation to care.
*Score: 1 / 2*
- Partial application. Symptom listed, not a diagnosis applied to care.
- *Next target:* Add: Detailed CNS examination, X-ray cervical spine + LS spine, MRI if red flags, CBC for pallor, ESR/CRP, Vitamin D, Vitamin B12, Calcium. Add management - analgesics, physiotherapy, posture, rest, avoid heavy lifting, referral to Ortho / Neuro if weakness / numbness. Check medication name / dose - "relieving on medication" - which medication?
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No differential diagnosis given.
- No analysis of double radiation - neck + back both radiating to right side. No analysis of causes: Cervical + Lumbar spondylosis / Disc prolapse vs Myofascial pain vs Fibromyalgia vs TB spine - fever 99.5 °F, pallor, chronic pain 1 year - not analyzed.
- No analysis of aggravating factors - walking / standing vs work.
*Score: 0 / 2*
- Not met.
- *Next target:* Add differential table: Cervical + Lumbar radiculopathy / Disc prolapse - supports dragging radiating pain to right upper + lower limb, aggravating on walking / standing; against - need neuro deficit. Spondylosis - supports age 38F, chronic pain, work-related. TB spine - supports chronic back + neck pain, low-grade fever 99.5 °F, pallor, RR 21; against - no weight loss mentioned. Myofascial pain - supports pain on work, relief on medication; against - radiation not typical. Must analyze double-site radiation.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Lower back pain as diagnosis when neck pain is equally prominent.
- No reflection, no self-assessment, no red-flag discussion - weakness, numbness, bowel / bladder, fever, trauma.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Why is this not just Lower back pain? What is the risk if I miss cervical radiculopathy / TB spine? What would I do differently - do full neurological examination, ask about numbness / weakness / bowel / bladder, check for fever cause? Reflection on chronic pain in young female with addiction history - need non-judgmental, holistic care.
### 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: Neck + Back Pain with Radiation -> Red Flags -> Neuro Examination -> Imaging -> Referral, OR patient education sheet for neck + back care for homemaker - posture, exercises, lifting technique, red flags to return.
### Summary Sheet - Roll No. 36 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Good radiation history, SpO2 included
2. Understand | 1 | Radiation described, radiculopathy not explained
3. Apply | 1 | Symptom listed as diagnosis, no neuro exam / investigations
4. Analyze | 0 | No differentials, double radiation + low-grade fever not analyzed
5. Evaluate | 0 | No justification, no red-flag judgment, no reflection
6. Create | 0 | No original product
**Total** | **4 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 36 - 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, 70M swelling + SOB = 5/12, *This portfolio = 4/12*
- *Pattern:* 5th back pain portfolio. Documentation of radiation is better here.
- *Critical learning from this case:* Lower back pain is a symptom, not a diagnosis. Radiating + dragging pain = nerve root. Always do neuro examination and always ask red flags - weakness, numbness, bowel / bladder, fever, weight loss. Do not ignore Temp 99.5 °F in chronic back pain.
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