29/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 9* - Portfolio: *CASE 3 - 56F, Homemaker, Headache - 2 Months, Blurring of Vision (Left Eye) - 2 Years, K/C/O Hypertension - Cilnidipine IP 10 mg, Cataract Surgery Right Eye - 4 Years Ago, Hysterectomy - 30 Years Ago, Pulse 80 bpm, Temp 98.7 F, BP 130/80 mmHg, PICCLE Absent, CNS c/c/c, CVS S1 S2 (+), Provisional: Cataract Surgery / Hypertensive with Blurring of Vision*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- 56 years / Female / Homemaker, C/O: Headache - 2 months, Blurring of vision (Left eye) - 2 years, HOPI: Patient was asymptomatic 2 months ago then developed headache since 2 months and blurring of vision since 2 years, Patient is K/C/O - Hypertension, Past History: K/C/O Hypertension (Rx: Cilnidipine IP 10mg), N/K/C/O DM, TB, Epilepsy, Patient had cataract surgery of right eye 4 years ago, Patient had hysterectomy 30 years ago, Personal History: Diet - Mixed, Appetite - Normal, B&B - Normal, Sleep - Adequate, Addictions - Nil, Family History: No family history, General Examination: Pulse - 80 bpm, Temp - 98.7 F, B.P - 130/80 mmHg, PICCLE - Absent, Systemic Examination: CNS - c/c/c, CVS - S1S2 +, Provisional Diagnosis: Cataract Surgery / Hypertensive with blurring of vision.
- Good details: Age / Sex / Occupation - 56F, Homemaker, C/C - Headache 2 months, Blurring vision Left eye 2 years - duration given, HOPI - Asymptomatic 2 months ago, then headache 2 months, blurring 2 years, Past - K/C/O HTN - Cilnidipine IP 10 mg - dose given, N/K/C/O DM, TB, Epilepsy, Cataract surgery Right eye 4 years ago, Hysterectomy 30 years ago, Personal - Diet Mixed, Appetite Normal, B&B Normal, Sleep Adequate, Addictions Nil, Family - No family history, Vitals - Pulse 80, Temp 98.7F, BP 130/80 - complete, PICCLE Absent - complete, Systemic - CNS c/c/c, CVS S1 S2 (+) - given, Provisional - Cataract Surgery / Hypertensive with blurring of vision - given.
- Gaps: *No Headache character - Site, Onset, Character, Radiation, Aggravating / Relieving, Associated - nausea, vomiting, photophobia, dizziness - missing.* *No Vision details - Left eye blurring - gradual / sudden, pain, redness, discharge, glasses, diplopia - missing.* *No Eye Examination - Visual acuity, Pupil, Fundus, Lens, Redness - missing - critical in blurring vision.* *No RS, P/A - systemic incomplete - only CNS + CVS given.* *No RR, SpO2 - vitals incomplete.* *No Investigations - Blood sugar, Fundoscopy, Eye exam, BP monitoring - missing.* *C/C contradiction - "asymptomatic 2 months ago" vs "blurring 2 years"* - which one? *Provisional is not a diagnosis - "Cataract Surgery / Hypertensive" - is it cataract left eye, hypertensive retinopathy, or both?* *Hysterectomy 30 years ago - at age 26 - why? - not asked - relevant?*
*Score: 1 / 2*
- Partial recall - demographics + HTN drug + eye / surgery history + vitals good, but headache / vision character + eye exam + investigations + diagnosis missing.
- *Next target:* Always record Headache - Site - frontal / occipital / unilateral, Character - throbbing, dull, tight, Severity, Duration, Aggravating - stress, light, Relieving - rest, medication, Associated - nausea, vomiting, photophobia, dizziness, blurred vision. Always record Vision - Left eye blurring - gradual / sudden, pain, redness, discharge, glasses, diplopia, night vision, halos. Always do Eye Examination - Visual acuity - 6/6, 6/18, Pupil - reaction, Lens - opacity, Fundus - retinopathy, Redness. Always record Systemic - all 4 systems - CVS, RS, CNS, P/A. Always record Vitals - all 5 - BP, PR, RR, Temp, SpO2. Always record Investigations - FBS, PPBS, HbA1c, Fundoscopy, Eye - Visual acuity, Slit lamp, BP monitoring. Always write Provisional - Left Eye Cataract? Hypertensive Retinopathy? - one diagnosis. Clean contradiction - asymptomatic 2 months ago vs blurring 2 years.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- HTN on Cilnidipine 10 mg -> Headache 2 months + Blurring vision Left eye 2 years, Cataract surgery Right eye 4 years ago - listed.
- But no explanation in own words of why HTN causes headache + blurring, why cataract causes blurring, why left eye now after right eye 4 years ago.
- No explanation of HTN, Cilnidipine, Cataract - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: HTN - high BP damages small vessels in eye - retina - hypertensive retinopathy -> blurring vision, and high BP -> headache. Explain: Cataract = lens becomes cloudy, opaque -> blurring vision, gradual, painless, no redness - Right eye cataract 4 years ago, operated, now Left eye blurring 2 years = Left eye cataract likely - bilateral cataract, common in 56F. Explain: Cilnidipine 10 mg = calcium channel blocker, lowers BP, BP 130/80 = controlled on medication. Explain: Headache 2 months + Blurring 2 years - different timelines - blurring is chronic, headache is recent - are they related or separate? - headache may be HTN, blurring may be cataract.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- On Cilnidipine IP 10 mg - mentioned.
- Provisional - given.
- But no student plan - no investigation plan, no management plan.
- No application of HTN + blurring + headache to care - no BP monitoring, no eye exam.
*Score: 0 / 2*
- Not met - no care plan.
- *Next target:* Add: BP monitoring, FBS, PPBS, HbA1c - to rule out DM - DM also causes blurring, Fundoscopy, Eye - Visual acuity, Slit lamp, Cataract grading, Lipid profile, ECG. Add management - Continue Cilnidipine 10 mg - check regularity, BP monitoring daily, Diet - low salt, Exercise, Eye - Refer Ophthalmology - urgent - cataract left eye?, Surgery if cataract confirmed, Glasses if needed, Headache - Analgesia - Paracetamol, Follow-up, Refer - Medicine / Ophthalmology. Add: If headache + blurring + HTN - urgent - check BP, check fundus, rule out hypertensive emergency, papilloedema.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional: Cataract Surgery / Hypertensive with blurring of vision - given.
- But no differential list.
- No analysis of alternative causes: Left Eye Cataract vs Hypertensive Retinopathy vs Diabetic Retinopathy vs Glaucoma vs Refractive Error.
*Score: 1 / 2*
- Partial analysis - provisional mentions cataract + HTN, but not differentiated.
- *Next target:* Add differential table: Left Eye Cataract - supports 56F, Blurring vision Left eye 2 years, gradual, Cataract surgery Right eye 4 years ago - bilateral cataract, N/K/C/O DM - DM also causes cataract; against - no lens opacity given, no eye exam given. Hypertensive Retinopathy - supports K/C/O HTN, Headache 2 months, Blurring 2 years, On Cilnidipine; against - BP 130/80 - controlled, no fundus findings given. Diabetic Retinopathy - supports Blurring vision; against - N/K/C/O DM, Appetite Normal, no polyuria given. Glaucoma - supports Headache, Blurring vision; against - no eye pain, redness, halos given, need IOP. Refractive Error - supports Blurring vision; against - no glasses history given. Must analyze: Is blurring due to cataract - lens - or retina - HTN / DM - or refractive - glasses? Is headache due to HTN, eye strain, or migraine?
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Negatives - N/K/C/O DM, TB, Epilepsy, Addictions Nil - show judgment.
- BP 130/80 + Cilnidipine 10 mg - shows judgment - you checked BP control.
- Cataract surgery Right eye 4 years ago + Hysterectomy 30 years ago - shows judgment - you took surgical history.
- But no judgment on blurring 2 years - chronic, not acute - not flagged.
- No judgment on headache 2 months - new - not flagged as urgent.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - negatives + BP + surgery history show judgment, but headache / blurring urgency missed.
- *Next target:* Add: Can I label cataract / hypertensive retinopathy without eye exam, fundus, visual acuity? What is most urgent - 56F, headache 2 months + blurring 2 years + HTN - is this hypertensive emergency, papilloedema, or cataract? What is the risk if I miss glaucoma - vision loss? What is the risk if I miss hypertensive retinopathy - stroke, kidney damage? What would I do differently - ask headache character, vision details, check visual acuity, check fundus, check BP monitoring, check blood sugar? Reflection on 56F Homemaker - 2 years blurring left eye, 2 months headache - impact on household work, reading, cooking, fall risk, need for eye surgery, family support?
### 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: Headache + Blurring Vision -> HTN? -> Eye Exam -> Cataract vs Retinopathy vs Glaucoma -> Management, OR patient education sheet for HTN + Eye - BP Monitoring, Low Salt, Eye Check, when to go to hospital - severe headache, sudden vision loss, eye pain / redness.
### Summary Sheet - Roll No. 9 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | HTN drug + eye / surgery history good, headache / vision / eye exam missing
2. Understand | 1 | HTN + cataract listed, mechanism not explained
3. Apply | 0 | No eye / BP plan
4. Analyze | 1 | Provisional mentions cataract + HTN, no differential table
5. Evaluate | 1 | Negatives + BP show judgment, urgency 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, CASE 2 Post Femur Fracture 40F = 4/12, *This portfolio = 4/12*
- *Progress flat, but drug history is now your strength:* K/C/O Hypertension - Rx: Cilnidipine IP 10 mg - that is the first time you gave drug + dose, and BP 130/80 = controlled - that is good. And Cataract surgery Right eye 4 years ago + Hysterectomy 30 years ago is a complete surgical history.
- *Critical learning from this case:* You have a vision case with no vision examination - Visual acuity, Pupil, Lens, Fundus - and no headache description - site, character, associated. In blurring vision, Eye Exam IS the case. Add Headache Character + Vision Details + Eye Exam + Fundoscopy + FBS / HbA1c, and this case becomes 7-8/12
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