A 28 yo female, single, call-center agent came to your clinic due to abdominal pain. She noted a vague, diffuse pain over the umbilical area associated with loss of appetite for 2 days. She was absent from her work and took Aluminum Hydroxide and Hyoscine-N-butylbromide which afforded temporary relief. However yesterday, symptoms progressed. This time she noted the pain was localized at the right lower quadrant associated with 3 episodes of vomiting. She took Metoclopramide without any relief. Morning prior to consult, pain became generalized and further aggravated by walking hence this consultation. At the ER, patient was seen awake, febrile and not in respiratory distress. She has dry lips and sunken eyeballs. Chest examination was unremarkable except for tachycardia. Upon examination of the abdomen, no previous scars noted. There was tympany on auscultation and direct and rebound tenderness on all quadrants. Patient complained of abdominal pain when the right thigh was flexed with passive internal rotation. Rectal examination revealed tenderness in the suprapubic area. I.E. was not done. End of the case. Learning Objectives: During the session, the student will be able to; 1. To give a primary impression of the case 2. Explain the signs and symptoms of the patient 3. Enumerate and discuss the laboratory work ups needed and explain the expected laboratory results 4. Give at least 1 differential diagnosis (per student) and discuss why it can be ruled out as a primary impression 5. Discuss the pathophysiology and progression of acute appendicitis leading to perforation and generalized peritonitis. 6. Explain the potential complications of delayed diagnosis and treatment of acute appendicitis and their impact on patient outcomes.