28/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 9* - Portfolio: *CASE 2 - 40F, Homemaker, Right Thigh Pain - 5 Years, Back Pain - 5 Years, Accident - 5 Years Ago, Femur Fracture -> Surgery, Rod Removed - 1 Year Ago, HTN - Now Normal Without Medication, Pulse 80 bpm, Temp 98.7 F, BP 120/80 mmHg, PICCLE Absent, Provisional: Post Femur Fracture - Implant Removal - With Back Pain + Thigh Pain*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- 40 years / Female / Homemaker, C/O: Right thigh pain - 5 years, Back pain - 5 years, HOPI: Patient was asymptomatic 5 years ago then developed back pain and right leg pain since due to surgery, N/K/C/O - DM, TB, Epilepsy, N/K/C/O - Hypertension, Past History: Patient met with an accident 5 years ago, Femur fracture -> surgery was done, Rod has removed 1 year ago, Patient had hypertension but now it is normal without medication, Personal History: Diet - Mixed, Sleep - Adequate, B&B - Normal, Appetite - Normal, Addictions - Nil, Family History: No similar family history, General Examination: Pulse - 80 bpm, Temp - 98.7 F, Blood pressure - 120/80 mmHg, PICCLE - Absent, Provisional: Post femur fracture - Implant removal - with back pain and thigh pain.
- Good details: Age / Sex / Occupation - 40F, Homemaker, C/C - Right thigh pain 5 years, Back pain 5 years - duration given, HOPI - Asymptomatic 5 years ago, then back pain + right leg pain since due to surgery, Past - Accident 5 years ago, Femur fracture -> surgery, Rod removed 1 year ago, HTN - now normal without medication, Personal - Diet Mixed, Sleep Adequate, B&B Normal, Appetite Normal, Addictions Nil, Family - No similar history, Vitals - Pulse 80, Temp 98.7F, BP 120/80 - complete, PICCLE Absent - complete, Provisional - Post femur fracture - Implant removal - with back pain + thigh pain - given.
- Gaps: *No Local Examination - Thigh / Back - Inspection, Palpation, Movement, Gait - missing - critical in thigh + back pain.* *No Character of Pain - Site, Onset, Character, Radiation, Aggravating / Relieving, Morning stiffness, Numbness / Tingling, Weakness - missing.* *"Back pain and right leg pain since due to surgery"* - unclear - pain started after accident, after surgery, or after rod removal? *No RR, SpO2 - vitals incomplete.* *No Systemic Examination - CVS, RS, CNS, P/A missing.* *No Investigations - X-ray Femur / Spine, CBC, ESR, CRP, Vitamin D, Calcium - missing.* *No Surgery details - Which femur? Right? Open / Closed? Intramedullary nail? - missing.* *No Rod removal details - Why removed? Infection? Pain? - missing.* *HTN contradiction - N/K/C/O Hypertension vs "Patient had hypertension but now normal"* - which one?
*Score: 1 / 2*
- Partial recall - timeline + surgery + rod removal + vitals good, but local exam + pain character + investigations + systemic missing.
- *Next target:* Always do Local Examination - Thigh: Inspection - Scar, Swelling, Deformity, Gait, Palpation - Tenderness - thigh, Scar, Movement - Hip / Knee ROM, Back: Inspection - Deformity, Palpation - Tenderness - spine, Movement - Flexion / Extension / Lateral, Neurological - Sensation, Power, Reflexes. Always record Pain - Right thigh pain - site - anterior / posterior / lateral, Character - dull, aching, sharp, Radiation - hip to knee, Aggravating - walking, standing, Relieving - rest, Numbness / Tingling / Weakness? Always record Vitals - all 5 - BP, PR, RR, Temp, SpO2. Always record Systemic - all 4 systems. Always record Investigations - X-ray Femur + Spine, CBC, ESR, CRP, Vitamin D, Calcium. Always clarify - Accident -> Fracture -> Surgery -> Pain since when? -> Rod removal 1 year ago -> Pain improved / worsened? Always record Surgery - Right femur, Intramedullary nail, Date. Always clean HTN - K/C/O HTN on medication / not on medication, BP now normal.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Accident 5 years ago -> Femur fracture -> Surgery -> Rod removed 1 year ago -> Back pain + Right thigh pain 5 years - sequence described.
- But no explanation in own words of why femur fracture causes thigh pain 5 years later, why back pain occurs after femur fracture, why rod removal matters.
- No explanation of post-fracture pain - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Femur fracture -> surgery with rod / nail -> bone heals, but soft tissue, muscle, scar, altered gait -> chronic thigh pain. Explain: Back pain 5 years = altered gait, limb length difference, muscle imbalance after femur fracture -> lumbar strain, compensatory back pain. Explain: Rod removal 1 year ago = implant removal can cause pain if bone weak, or relieve pain if implant was irritating - need to know pain before vs after removal. Explain: 40F Homemaker - standing, walking, household work - load on thigh + back. Explain: HTN now normal without medication = not on antihypertensive now, BP 120/80 confirms.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Surgery done, Rod removed - mentioned.
- Provisional - given.
- But no student plan - no investigation plan, no management plan.
- No application of 5 years pain + rod removal to care - no X-ray, no physiotherapy.
*Score: 0 / 2*
- Not met - no care plan.
- *Next target:* Add: X-ray - Right Femur + Lumbar Spine - AP + Lateral, CBC, ESR, CRP, Vitamin D, Calcium, DEXA if needed. Add management - Analgesia - Paracetamol, Physiotherapy - quadriceps strengthening, hip / knee ROM, back strengthening, gait training, Weight reduction if overweight, Avoid prolonged standing, squatting, Use walking aid if needed, Calcium + Vitamin D if deficient, Follow-up, Refer - Orthopaedics. Add: If back pain + thigh pain 5 years post-fracture - urgent - check X-ray - non-union, malunion, implant site infection, limb length, gait.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional: Post femur fracture - Implant removal - with back pain and thigh pain - given.
- But no differential list.
- No analysis of alternative causes: Post-fracture non-union vs Malunion vs Implant site infection vs Lumbar disc vs Muscle strain.
*Score: 1 / 2*
- Partial analysis - provisional specific, but not differentiated.
- *Next target:* Add differential table: Post-Fracture Chronic Pain / Malunion / Non-union - supports Accident 5 years ago, Femur fracture -> surgery, Rod removed 1 year ago, Right thigh pain 5 years, Back pain 5 years; against - no X-ray given, no deformity, shortening given. Implant Site Infection - supports Pain after surgery, Rod removed 1 year ago; against - Temp 98.7F, PICCLE absent, no fever, redness, discharge given. Lumbar Disc / Sciatica - supports Back pain 5 years, Right leg pain; against - pain is thigh, not radiating to foot, no numbness / tingling given. Muscle Strain / Gait Alteration - supports Back pain + thigh pain, Homemaker, altered gait after fracture; against - need gait exam. Must analyze: Is pain due to bone - non-union, malunion - or soft tissue - muscle, scar - or nerve - sciatica? Is pain before rod removal vs after rod removal - improved or worsened?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Negatives - N/K/C/O DM, TB, Epilepsy, Hypertension, Addictions Nil - show judgment.
- "HTN now normal without medication" + BP 120/80 - shows judgment - you checked BP and medication status.
- But no judgment on 5 years pain - chronic, not acute - not flagged.
- No judgment on rod removal - why removed? - not evaluated.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - negatives + BP show judgment, but rod removal / chronic pain missed.
- *Next target:* Add: Can I label post-fracture pain without X-ray, gait, neuro exam? What is most urgent - 40F, 5 years pain, rod removed 1 year ago - is this non-union, infection, or chronic pain? What is the risk if I miss non-union / infection? What would I do differently - ask pain before vs after rod removal, ask gait, limb length, ask fever, discharge, check scar, check X-ray? Reflection on 40F Homemaker - 5 years thigh + back pain, post-fracture, rod removed - impact on household work, walking, family, quality of life, need for physiotherapy, pain management?
### 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: Accident 5 Years Ago -> Femur Fracture -> Surgery -> Rod Removal -> Thigh Pain + Back Pain -> Examination -> X-ray -> Non-union vs Infection vs Muscle Strain -> Management, OR patient education sheet for Post Femur Fracture - Physiotherapy, Gait, Calcium, Vitamin D, when to go to hospital - fever, discharge, severe pain, unable to walk.
### Summary Sheet - Roll No. 9 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Timeline + surgery + rod removal good, local exam / pain / investigations missing
2. Understand | 1 | Sequence described, post-fracture pain mechanism not explained
3. Apply | 0 | No investigation / management plan
4. Analyze | 1 | Provisional specific, no differential table
5. Evaluate | 1 | Negatives + BP show judgment, rod removal missed
6. Create | 0 | No original product
**Total** | **4 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 9 - Progression:*
- CASE 1 T2DM 61M = 5/12, *This portfolio = 4/12*
- *Progress -1, but timeline is your strength:* Accident 5 years ago -> Femur fracture -> Surgery -> Rod removed 1 year ago -> Thigh pain + Back pain 5 years - that is a clean surgical timeline, and BP 120/80 + HTN now normal without medication is a good BP / medication catch. And Provisional - Post femur fracture - Implant removal - with back pain + thigh pain - is specific.
- *Critical learning from this case:* You have a 5-year pain case with no pain description - site, character, radiation, aggravating / relieving, numbness / tingling - and no local examination - thigh scar, tenderness, gait, back tenderness, neuro exam. In post-fracture pain, Local Exam + X-ray ARE the case. Add Local Exam + Pain Character + Gait + X-ray + Pain Before vs After Rod Removal, and this case becomes 7-8/12.
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