5/11/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 7* - Portfolio: *26F, Works in Household, Fever and Chills - 7 Days, Generalized Body Pains - 7 Days, Nose Bleeding and Bleeding from Mouth - 6 Days*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Demographics - Age / Sex: 26 years / Female, Occupation: Works in household, chief complaints - Fever and chills since 7 days, Generalized body pains since 7 days, Nose bleeding and bleeding from mouth since 6 days, HOPI - apparently asymptomatic 7 days ago, then developed fever sudden in onset, gradually progressive, associated with chills, Generalized body pain, bleeding from nose, mucosal bleeding during brushing, History of Past Illness - No H/O HTN, DM, Epilepsy, Asthma, TB, Personal History - Diet Mixed, Appetite Decreased, Sleep Adequate, Bowel & Bladder Regular, Addictions Nil, On Examination - PICCLE: P - Pallor Present (+), I - Icterus Absent (-), C - Cyanosis Absent (-), C - Clubbing Absent (-), L - Lymphadenopathy Absent (-), E - Edema Absent (-), Diagnosis - Dengue fever.
- Good details: Duration - fever 7 days, bleeding 6 days, onset - sudden, progressive, chills, mucosal bleeding during brushing - important detail, occupation recorded - first time in Roll 7 occupation is given.
- Gaps: *Vitals - Not recorded - No BP, PR, RR, SpO2, Temp.* *Systemic Examination - Not recorded - No CVS, RS, CNS, P/A.* *No bleeding details* - how much nose bleed, how many episodes, gum bleeding, other bleeding - urine, stool, vomiting blood? *No fever details* - high grade, continuous / intermittent, rash, headache, retro-orbital pain, joint pain? *No investigations* - NS1, Dengue IgM / IgG, Platelet count, CBC, Haematocrit - none given despite diagnosis Dengue. *No tourniquet test, no rash examination.*
*Score: 1 / 2*
- Partial recall - occupation + bleeding during brushing + PICCLE good, but vitals, systemic exam, bleeding examination, investigations missing.
- *Next target:* Always record Vitals - BP, PR, RR, SpO2, Temp - in a bleeding fever patient, BP + pulse pressure + postural BP are life-saving. Always record Systemic Examination - CVS, RS, CNS, P/A. Always examine for rash, petechiae, purpura, gum bleeding, lymph nodes, spleen / liver. Always record bleeding - amount, frequency, sites. Always record platelet count + haematocrit if you label Dengue.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Fever + body pain + bleeding pattern described - sudden fever, chills, generalized body pain, nose + mouth bleeding.
- Diagnosis - Dengue fever given.
- But no explanation in own words of why dengue causes body pain, bleeding, pallor.
- No explanation of Pallor (+) - anaemia / blood loss - not explained. No explanation of fever 7 days - dengue fever usually 2-7 days, bleeding on day 6 = critical phase - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Dengue virus -> fever, severe body pain / breakbone pain, low platelets -> bleeding from nose, gums. Explain: Bleeding on day 6 = critical phase - plasma leakage, low platelets, risk of shock. Explain: Pallor = anaemia from bleeding + low platelets. Explain: Mucosal bleeding during brushing = gum bleeding due to low platelets. Explain: Fever 7 days + bleeding = warning sign, needs hospital admission, not home care.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Diagnosis given - Dengue fever.
- No investigation plan, no management plan.
- No application of bleeding to care - no platelet check, no bleeding control, no fluid management.
- No application of fever 7 days to care - no NS1 / IgM.
*Score: 1 / 2*
- Partial application - diagnosis stated, but not applied to care.
- *Next target:* Add: CBC - Hb, Platelet count, Haematocrit, TLC, Dengue NS1 Antigen, Dengue IgM / IgG, RFT, LFT, Urine routine, Blood grouping. Add management - Admit, monitor vitals every 2-4 hours, BP, pulse pressure, urine output, platelet + haematocrit daily, oral fluids / ORS, paracetamol for fever - avoid aspirin / ibuprofen / NSAIDs - increases bleeding, avoid IM injections, check for warning signs - severe abdominal pain, persistent vomiting, bleeding, drowsiness, cold extremities, refer - ICU if shock / severe bleeding. Add: Check for rash, petechiae, tourniquet test, spleen / liver.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Diagnosis - Dengue fever - given as single diagnosis, no differential list.
- No analysis of alternative causes: Dengue vs Malaria vs Typhoid vs Leptospirosis vs Chikungunya vs Viral fever with thrombocytopenia.
- No analysis of why bleeding + fever + body pain = dengue, not malaria / typhoid.
*Score: 1 / 2*
- Partial analysis - pattern recognized - fever + body pain + bleeding = dengue, but not differentiated.
- *Next target:* Add differential table: Dengue Fever - supports 26F, fever 7 days, chills, generalized body pain, nose + gum bleeding, Pallor; against - no NS1 / platelet count, no rash mentioned. Malaria - supports fever + chills, body pain; against - no rigors / sweating cycle, no splenomegaly mentioned, no bleeding usually. Typhoid - supports fever 7 days, body pain; against - no abdominal pain, constipation / diarrhoea, rose spots mentioned, bleeding less common. Leptospirosis - supports fever, body pain, bleeding; against - no jaundice, conjunctival suffusion, muscle pain, exposure mentioned - Icterus absent. Chikungunya - supports fever, severe body / joint pain; against - bleeding less common. Must analyze: Is bleeding due to low platelets from dengue or due to other cause? Is fever 7 days still dengue or secondary infection?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Dengue without NS1 / IgM / platelet count.
- No judgment on urgency - bleeding 6 days + fever 7 days + Pallor = warning signs, needs admission - not prioritized.
- No judgment on drug safety - paracetamol vs NSAIDs in dengue - not evaluated.
- No reflection.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Can I label Dengue without NS1 / platelet count? What is the risk if I miss dengue shock / severe bleeding in a 26F with nose + mouth bleeding for 6 days? What would I do differently - check BP + pulse pressure, check platelet + haematocrit urgently, ask about abdominal pain, vomiting, drowsiness, urine output, check for petechiae / rash? Reflection on dengue in household worker - mosquito exposure, water storage, family members with fever?
### 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: Fever + Bleeding -> Dengue vs Malaria vs Typhoid -> Examination -> NS1 + Platelet + Haematocrit -> Management, OR patient education sheet for Dengue - fluids, warning signs, avoid NSAIDs, mosquito prevention.
### Summary Sheet - Roll No. 7 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Occupation + bleeding during brushing good, vitals / investigations missing
2. Understand | 1 | Fever + body pain + bleeding described, critical phase not explained
3. Apply | 1 | Dengue stated, no NS1 / platelet / fluid plan
4. Analyze | 1 | Pattern recognized, no differential table
5. Evaluate | 0 | No justification, bleeding urgency missed
6. Create | 0 | No original product
**Total** | **4 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 7 - Progression:*
- 42M swelling both legs / Transplant 2021 = 2/12, 65M pain left knee 1 day = 2/12, 50F pain right knee 2 years = 2/12, *This portfolio = 4/12*
- *Progress improving:* First jump in Roll 7 - 2 -> 4. For the first time you gave a diagnosis - Dengue fever - and you captured occupation + a key detail - mucosal bleeding during brushing. That pattern recognition - fever + body pain + bleeding = dengue - is good clinical thinking.
- *Critical learning from this case:* Dengue without platelet count + haematocrit + NS1 is an incomplete diagnosis. Bleeding for 6 days + Pallor + fever 7 days = warning signs, not routine fever. You must record vitals - BP, pulse pressure, postural BP - and check for shock, severe abdominal pain, vomiting, drowsiness. And never give aspirin / ibuprofen in dengue - it increases bleeding, only paracetamol. Fix vitals + investigations + warning signs, and this case becomes 7-8/12.
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