Secondary headache and raised intracranial pressure — branching viva

Stem 1 — Eight-year-old with a progressive morning headache (5 minutes)

An eight-year-old boy presents with a six-week history of daily headache that is present on waking, eases through the morning, and worsens with coughing and bending. His mother reports early-morning vomiting, and his teacher reports he is quieter at school. His neurological examination, including fundoscopy, is normal. ^[11]

Branch A (examiner): List the red flags in this history, and explain why a normal examination does not make this headache safe. State the cardinal rule about progressive, morning, or vomiting headache in a young child. ^{[3] [12]}

Branch B (examiner): State your investigation of choice and the reason it is preferred over computed tomography. Explain why a lumbar puncture is not your first step, and describe the HeadSmart symptom cluster that frames your reasoning. ^{[1] [11]}

Branch C (examiner): The imaging shows a posterior fossa tumour with early obstructive hydrocephalus. Outline your immediate disposition, who you involve, and how you address the raised pressure and the cerebrospinal-fluid flow. ^{[10] [11]}