28/10/2025
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 6* - Portfolio: *23F, Student, Swelling of Limbs - 6 Months, Facial Puffiness - 3 Months, Giddiness - 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 - Student, chief complaints, HOPI, past history - HTN 7 years on Clonidine Hydrochloride (Arkadin-100), N/K/C/O DM, Asthma, thyroid, Epilepsy, CAD, TB, no surgeries, personal history, general examination, PICCLE, vitals, systemic examination recorded.
- Good details: Easy fatigability & generalized weakness insidious, gradually progressive since 8 years ago, swelling both feet bilateral + facial puffiness, loss of appetite, disturbed sleep, no chest pain, hemoptysis, fever, no burning micturition, hematuria, recurrent UTIs. Requires twice a week dialysis recorded.
- Gaps: SpO2 not recorded. No weight, no urine output, no dialysis details - since when, where. Back pain at age 15 mentioned in chief complaints but not elaborated in HOPI.
*Score: 2 / 2*
- Competency met: Systematic documentation, drug name + dose captured, relevant urinary negatives included.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Symptoms linked - swelling + facial puffiness + fatigability + giddiness.
- But no explanation in own words of why CKD causes facial puffiness, edema, fatigability, giddiness.
- No explanation of why HTN at age 16 years (7 years ago) is unusual - secondary HTN due to CKD vs CKD due to HTN, cause-effect not explained.
- Back pain at age 15 not explained - is it related to CKD onset?
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: CKD -> fluid + salt retention -> pedal edema + facial puffiness, anemia -> fatigability + weakness + giddiness, uremia -> loss of appetite. Explain reverse causation - in a 23F, CKD likely caused HTN, not HTN caused CKD at age 16.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as CKD.
- No investigation plan, no management plan, no staging, no dialysis counseling.
- Dialysis twice a week recorded but not applied - no compliance, no vascular access, no complications.
*Score: 1 / 2*
- Partial application. Diagnosis stated, but not applied to care.
- *Next target:* Add: CBC, RFT - Creatinine, eGFR, Electrolytes, Calcium, Phosphate, PTH, ABG, Urine routine, Urine PCR, USG KUB, ECG, Echo, HbA1c, ANA if indicated. Add management - salt / fluid restriction, BP control, anemia correction, calcium / phosphate control, nephrology follow-up, dialysis schedule, transplant counseling, vaccination, avoid nephrotoxins. Monitor BP, weight, urine output.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No formal differential diagnosis listed.
- But clues for analysis present: Young age 23F, HTN since age 16, back pain since age 15, facial puffiness + non-pitting edema.
- No analysis of causes of CKD in young female: Glomerulonephritis / Nephrotic syndrome vs Congenital / Reflux nephropathy vs Polycystic kidney vs Autoimmune.
- No analysis of edema - Non-pitting noted in PICCLE - unusual for CKD, needs analysis - hypothyroidism? Lymphoedema? Drug?
*Score: 1 / 2*
- Partial analysis - implicit, not explicit.
- *Next target:* Add differential table: CKD due to Chronic Glomerulonephritis - supports young onset, HTN, facial puffiness, edema, fatigability. Nephrotic syndrome - supports facial puffiness + edema + loss of appetite. Congenital / Reflux nephropathy - supports back pain since age 15, recurrent UTIs to be ruled out - already negative. Hypothyroidism - supports non-pitting edema, fatigability, giddiness; against - N/K/C/O thyroid mentioned. Cardiac failure - against - no chest pain, S1 S2 normal. Must analyze non-pitting edema.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for CKD diagnosis or staging, no reflection, no self-assessment.
- No discussion of urgency - dialysis patient with giddiness, RR 22 bpm, BP 130/80 on Clonidine - risk of hypotension / anemia / fluid overload.
- No counseling for young student on dialysis - education, transplant, psychosocial impact.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Why CKD and not just HTN? What is the cause in this young patient? What is the risk if dialysis missed / Clonidine stopped abruptly - rebound HTN? What would I do differently - ask about dialysis history, urine output, family history of kidney disease, childhood UTIs? Reflection on chronic disease in young student - impact on studies, mental health, need for empathetic counseling.
### 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: Young Female with Edema + Facial Puffiness + HTN -> CKD vs Nephrotic vs Thyroid -> Investigations -> Referral, OR patient education sheet for CKD on dialysis - diet, salt, fluid, medication adherence, dialysis schedule, transplant options.
### Summary Sheet - Roll No. 6 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Good documentation, drug name + dialysis captured
2. Understand | 1 | Symptoms listed, CKD mechanism + young-onset HTN not explained
3. Apply | 1 | CKD stated, no investigations / staging / dialysis plan
4. Analyze | 1 | No explicit differential, young CKD cause + non-pitting edema not analyzed
5. Evaluate | 0 | No justification, no counseling for young dialysis patient, no reflection
6. Create | 0 | No original product
**Total** | **5 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 6 - 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, 38F neck + back = 4/12, *This portfolio = 5/12*
- *Progress shown:* Best case for young CKD - HTN since age 16, dialysis history, and urinary negatives all captured. This is different from elderly CKD case.
- *Critical learning from this case:* In a 23-year-old, HTN does NOT cause CKD - CKD causes HTN. Always think cause-effect reversed in young patients. And do not ignore Non-pitting edema - it does not fit classic CKD edema.
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