Concussion and mild traumatic brain injury — branching viva

Stem 1 — Fourteen-year-old rugby player dazed after a tackle (5 minutes)

A fourteen-year-old boy is tackled, strikes his head on the ground, is briefly dazed, sits out for two minutes, and returns to play. That evening he has a headache, feels foggy, has vomited once, and is sensitive to light. His GCS is 15 and his neurological examination is normal. ^[6]

Branch A (examiner): Identify the principle breached at the sideline and explain why a concussed athlete does not return to play the same day. Define concussion using the Amsterdam 2022 consensus. ^{[4] [6]}

Branch B (examiner): State your imaging decision and reproduce the decision rule you apply. Explain why the single vomit does not, on its own, mandate a computed tomography, and what feature you must monitor. ^{[1] [2]}

Branch C (examiner): Outline the graduated return to learn and return to sport, stating the duration of relative rest and the order of the two pathways. Explain the role of his previous concussion in your counselling. ^{[4] [9]}