27/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 9* - Portfolio: *CASE 4 - 49M, Welding Work, Swelling Left Leg - 20 Days, Ulcer - 1 Year, Ulcer Increasing - 3 Months, Accident - 5 Years Ago, Fracture -> Rod Removal -> Wound Over Stitches -> Infection - 1 Year Ago, Gradually Increasing - 3 Months, Painful, No Bleeding, Marginated Well Defined Wound, Edema Present, Healing Over Dressing, Alcohol Present, Smoking Absent, Temp 98.7 F, Pulse 80 bpm, BP 120/80 mmHg, PICCLE All Absent, Local Exam: Edema Present, Varicose Veins Absent, Sensory / Motor Present, Pain Present, Temp Normal, Provisional: Post Traumatic Ulcer - Left Leg*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- 49 years / male / Welding work, C/O: Patient came with complaints of: Swelling of leg (left) - 20 days, Ulcer since 1 year, ulcer increasing since 3 months, HOPI: Patient was asymptomatic 3 months ago, now came with onset 3 months (gradually increasing), duration 3 months, site - left leg, Mode of onset - Due to post operative trauma, patient met with accident 5 years ago, After removal of rod from the fracture after healing, Due to some wound over the stitches, patient developed infection 1 year ago and it is gradually increasing since 3 months, Pain - Painful, Bleeding - No, Surrounding - Marginated wound & well defined, edema is present, Healing - healing over dressing, Past History: N/K/C/O - Diabetes, Hypertension, TB, No similar traumatic wounds, Patient had met with accident 5 years ago, No other surgeries were done, Patient had fracture, Personal History: Diet - Mixed, Sleep - Adequate, B&B - Normal, Addictions - Alcohol present, Smoking - Absent, Family History: No family history, General Examination: Temp - 98.7 F, Pulse - 80 bpm, B.P - 120/80 mmHg, PICCLE - All absent, Local Examination: Examination of affected limb (left leg), Edema - Present, Varicose veins - Absent, Sensory / Motor function - Present, Pain - Present, Temp - Normal, Provisional Diagnosis: Post traumatic ulcer - left leg.
- Good details: Age / Sex / Occupation - 49M, Welding work, C/C - Swelling left leg 20 days, Ulcer 1 year, increasing 3 months - duration given, HOPI - Asymptomatic 3 months ago, onset 3 months, gradually increasing, site left leg, Mode - post operative trauma, Accident 5 years ago, Rod removal after healing, Wound over stitches -> Infection 1 year ago, gradually increasing 3 months, Ulcer details - Painful, No bleeding, Marginated, well defined, edema present, Healing over dressing, Past - N/K/C/O DM, HTN, TB, No similar wounds, Accident 5 years ago, Fracture, No other surgeries, Personal - Diet Mixed, Sleep Adequate, B&B Normal, Alcohol present, Smoking absent, Family - No family history, Vitals - Temp, Pulse, BP - complete, PICCLE All absent - complete, Local Exam - Edema, Varicose veins absent, Sensory / Motor present, Pain present, Temp normal - good, Provisional - Post traumatic ulcer - left leg - given.
- Gaps: *No Ulcer measurements - Size - length x breadth, Depth, Floor, Base, Edge, Discharge - missing - critical in ulcer.* *No Ulcer site details - Anterior / Posterior / Medial / Lateral left leg? Over shin? Over scar? - missing.* *No Swelling details - Pitting / Non-pitting, Up to ankle / leg - missing.* *No RR, SpO2 - vitals incomplete.* *No Systemic Examination - CVS, RS, CNS, P/A missing.* *No Investigations - CBC, ESR, CRP, Blood sugar, X-ray, Wound swab - missing.* *C/C contradiction - Ulcer 1 year vs Asymptomatic 3 months ago vs Onset 3 months* - which one? *"Healing over dressing"* - healing or not healing? - unclear. *No Distal pulses - Dorsalis pedis, Posterior tibial - missing in leg ulcer.*
*Score: 1 / 2*
- Partial recall - timeline + ulcer details + local exam good, but ulcer size / floor / discharge + systemic + investigations + pulses missing.
- *Next target:* Always do Ulcer Examination - Site - left leg - anterior / posterior / medial / lateral, over scar?, Size - cm x cm, Number - single / multiple, Shape, Edge - regular / irregular, Floor - granulation / slough / bone, Base - fixed / mobile, Discharge - serous / purulent / bloody, Surrounding skin - redness, edema, Pigmentation, Pain - painful / painless, Bleeding - yes / no, Smell. Always record Swelling - Pitting / Non-pitting, Extent - ankle / leg / knee. Always record Vitals - all 5 - BP, PR, RR, Temp, SpO2. Always record Systemic - all 4 systems. Always record Investigations - CBC, ESR, CRP, FBS / HbA1c - to rule out DM, X-ray - left leg - osteomyelitis?, Wound swab - culture. Always check Distal Pulses - Dorsalis pedis, Posterior tibial, Capillary refill. Clean contradiction - Ulcer 1 year vs Asymptomatic 3 months ago vs Onset 3 months.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Accident 5 years ago -> Fracture -> Rod removal -> Wound over stitches -> Infection 1 year ago -> Ulcer gradually increasing 3 months -> Swelling 20 days - sequence described.
- But no explanation in own words of why post-operative wound becomes chronic ulcer, why infection 1 year ago leads to non-healing, why swelling occurs.
- No explanation of post traumatic ulcer - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Post operative trauma / wound over stitches -> infection -> tissue damage, poor blood supply, scar tissue -> chronic ulcer, does not heal. Explain: Ulcer 1 year, increasing 3 months = chronic, non-healing, not acute. Explain: Swelling left leg 20 days = infection, inflammation, venous obstruction, edema. Explain: Painful, marginated, well defined = traumatic / infective ulcer, not venous - venous is painless, irregular, with varicose veins - you checked varicose veins absent, good. Explain: Welding work - standing, heat, trauma risk - delays healing. Explain: Alcohol present - poor nutrition, poor healing, liver, infection risk.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Healing over dressing - mentioned.
- Provisional - given.
- But no student plan - no investigation plan, no management plan.
- No application of ulcer + swelling + alcohol to care - no wound care, no antibiotics, no blood sugar.
*Score: 1 / 2*
- Partial application - dressing mentioned, but no care plan.
- *Next target:* Add: CBC, ESR, CRP, FBS / HbA1c, X-ray left leg, Wound swab - culture, USG Doppler if needed. Add management - Wound care - cleaning, dressing, debridement if needed, Antibiotics if infected - after swab, Analgesia - Paracetamol, Limb elevation - swelling, Avoid prolonged standing, welding, Protect leg from trauma, Diet - high protein, vitamin C, Alcohol counselling - stop alcohol, Follow-up, Refer - Surgery / Orthopaedics. Add: If ulcer 1 year, increasing 3 months, swelling 20 days - urgent - check infection, osteomyelitis, blood sugar, pulses.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional: Post traumatic ulcer - left leg - specific.
- Local Exam - Varicose veins absent, Sensory / Motor present, Temp normal - used to rule out venous / neuropathic ulcer - good.
- But no differential table.
- No analysis of alternative causes: Post Traumatic vs Venous vs Diabetic vs Arterial vs Osteomyelitis.
*Score: 1 / 2*
- Partial analysis - provisional specific, varicose / sensory used, but no differential table.
- *Next target:* Add differential table: Post Traumatic Ulcer - supports Accident 5 years ago, Fracture, Rod removal, Wound over stitches -> Infection 1 year ago, Ulcer increasing 3 months, Painful, Marginated well defined, Edema present, Varicose veins absent, Temp normal; against - no size / floor / discharge given. Venous Ulcer - supports Swelling left leg 20 days, Ulcer 1 year, Welding - standing; against - Varicose veins absent, Painful - venous is painless / dull, Ulcer marginated well defined - venous is irregular, shallow. Diabetic Ulcer - supports Ulcer 1 year, non-healing; against - N/K/C/O DM, Sensory / Motor present, Pain present - diabetic is painless, neuropathic. Arterial Ulcer - supports Painful, Ulcer; against - Temp normal, Sensory / Motor present, Varicose absent, need pulses - Dorsalis pedis present / absent? Osteomyelitis - supports Fracture, Rod removal, Wound -> Infection, Ulcer 1 year; against - Temp 98.7F, no fever, no discharge given, need X-ray. Must analyze: Is ulcer due to infection, poor blood supply, or osteomyelitis?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Negatives - N/K/C/O DM, HTN, TB, No similar traumatic wounds, Smoking Absent, Varicose veins Absent - show judgment - you ruled out DM, venous, smoking.
- Sensory / Motor present, Temp normal - shows judgment - you checked nerve + infection.
- But no judgment on 1 year ulcer - chronic, non-healing - not flagged.
- No judgment on alcohol - present - not flagged for healing.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - negatives show judgment, but chronicity / alcohol missed.
- *Next target:* Add: Can I label post traumatic ulcer without size, floor, discharge, X-ray, swab, blood sugar? What is most urgent - 49M, ulcer 1 year, increasing 3 months, swelling 20 days - is this infected, osteomyelitis, or malignant change? What is the risk if I miss osteomyelitis - bone infection, non-healing? What is the risk if I miss DM - N/K/C/O DM, but did you check blood sugar? What would I do differently - measure ulcer, check pulses, check X-ray, check swab, check blood sugar, ask alcohol quantity, duration? Reflection on 49M Welding work - 1 year ulcer, swelling, alcohol - impact on work, standing, welding, family income, need for wound care, alcohol counselling, protective footwear?
### 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: Leg Ulcer -> Site, Size, Edge, Floor, Discharge -> Varicose? Sensory? Pulses? -> Post Traumatic vs Venous vs Diabetic vs Arterial -> Management, OR patient education sheet for Leg Ulcer - Wound Care, Limb Elevation, Protect Leg, Alcohol Stop, when to go to hospital - fever, redness, swelling, discharge, severe pain.
### Summary Sheet - Roll No. 9 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Timeline + ulcer details + local exam good, size / floor / pulses missing
2. Understand | 1 | Sequence described, chronic ulcer mechanism not explained
3. Apply | 1 | Dressing mentioned, no wound care / antibiotic plan
4. Analyze | 1 | Provisional specific, varicose / sensory used, no differential table
5. Evaluate | 1 | Negatives show judgment, chronicity / alcohol missed
6. Create | 0 | No original product
**Total** | **5 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 9 - Progression:*
- CASE 1 T2DM 61M = 5/12, CASE 2 Post Femur Fracture 40F = 4/12, CASE 3 Headache + Blurring Vision 56F = 4/12, *This portfolio = 5/12*
- *Progress +1, and Local Examination is now your strength:* Local Exam - Edema Present, Varicose veins Absent, Sensory / Motor Present, Pain Present, Temp Normal - that is exactly how you rule out venous / neuropathic ulcer, and you did it. And Ulcer details - Painful, No bleeding, Marginated, well defined, Edema present - are good.
- *Critical learning from this case:* You have a 1-year ulcer with no ulcer measurements - Size, Floor, Base, Edge, Discharge - and no distal pulses, no X-ray, no swab. In leg ulcer, Ulcer Examination + Pulses + X-ray ARE the case. Add Ulcer Size / Floor / Discharge + Distal Pulses + X-ray + Swab + Blood Sugar, and this case becomes 8-9/12.
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