✅ Model Answer:
• Diagnosis: Acute appendicitis — pain migration from periumbilical to RLQ, anorexia, fever, elevated WBC (18,000) and CRP (80 mg/L), ultrasound shows non-compressible appendix (8 mm diameter) with fat stranding on CT.
• Any other test: Abdominal Ultrasound, CT abdomen shows Appendiceal thickening, periappendiceal fat stranding , Surgical consult, urine pregnancy test (if female), baseline electrolytes, renal function tests, coagulation profile.
• What to do next: NPO, IV fluids (0.9% saline), broad-spectrum antibiotics (piperacillin-tazobactam or ceftriaxone + metronidazole), urgent appendectomy (open or laparoscopic).
• Follow-up plan: Monitor for surgical site infection, pain management, diet advancement as tolerated, monitor wound healing. Discharge with oral antibiotics if needed.

✅ Model Answer:
• Classic presentation:
- Pain migration: Periumbilical pain → migrates to right lower quadrant (RLQ) over 12-24 hours
- Anorexia (loss of appetite)
- Vomiting (usually 1-2 times, follows pain)
- Fever (low-grade, may be higher with perforation)
• Physical examination:
- RLQ tenderness at McBurney's point (1/3 distance from ASIS to umbilicus)
- Guarding and rebound tenderness
- Rovsing's sign (RLQ pain with left-sided palpation)
- Psoas sign (pain on extension of right hip)
- Obturator sign (pain on internal rotation of right hip)

✅ Model Answer:
• Differential diagnoses:
- Mesenteric adenitis (viral, often with URTI, diffuse pain)
- Gastroenteritis (diarrhea, vomiting, diffuse pain)
- Constipation (history of hard stools)
- Ovarian torsion/cyst (in females, pelvic ultrasound)
- Ectopic pregnancy (in adolescent females)
- Pelvic inflammatory disease (in sexually active females)
- Meckel's diverticulitis (may mimic appendicitis)
- Intussusception (in younger children)
- Right-sided pyelonephritis (fever, flank pain)
- Renal colic (hematuria, flank pain)
- Testicular torsion (in males)

✅ Model Answer:
• Ultrasound (US):
- First-line imaging in children (no radiation)
- Findings: Non-compressible appendix, diameter >6-7 mm, wall thickening, periappendiceal fluid, target sign, increased vascularity (Doppler)
- Sensitivity: 80-90%, Specificity: 90-95%
- Limitations: Operator-dependent, retrocecal appendix may be difficult to visualize
• CT (Computed Tomography):
- Reserved for: Inconclusive US, suspected perforation, or obesity
- Findings: Appendiceal wall thickening, periappendiceal fat stranding, appendicolith, abscess formation
- Sensitivity/Specificity: >95%
- Limitation: Radiation exposure (avoid if possible in children)

✅ Model Answer:
• Management:
- Medical preparation: NPO, IV fluids (0.9% saline), electrolyte correction
- Antibiotics: Broad-spectrum (piperacillin-tazobactam or ceftriaxone + metronidazole)
- Pain management: Analgesics (morphine, fentanyl)
- Definitive treatment: Appendectomy (laparoscopic is preferred)
- Non-operative management: May be considered for uncomplicated appendicitis (antibiotics alone) — but surgery remains standard
- Perforated appendicitis: IV antibiotics, fluid resuscitation, surgery (delayed or immediate based on clinical status)

✅ Model Answer:
• Complications:
- Perforation — leading cause of morbidity (15-30% of pediatric cases)
- Peritonitis (generalized or localized)
- Abscess formation (pelvic, subphrenic, or mesenteric)
- Sepsis (if perforation with peritonitis)
- Wound infection (most common post-operative complication)
- Intra-abdominal abscess
- Bowel obstruction (from adhesions)
- Post-operative ileus
- Enterocutaneous fistula (rare)
- Portal vein thrombosis (pylephlebitis — rare)

✅ Model Answer:
• Antibiotic coverage:
- Uncomplicated appendicitis:
• Ceftriaxone + Metronidazole
• Piperacillin-tazobactam (single agent)
- Perforated appendicitis:
• Piperacillin-tazobactam (first-line)
• Ceftriaxone + Metronidazole + Ampicillin
• Meropenem (if severe or ICU)
- Duration:
• Uncomplicated: 1-2 doses pre-op, 24 hours post-op
• Perforated: 5-7 days (clinical response)
- Outpatient antibiotics: May be given if discharged early with uncomplicated appendicitis

✅ Model Answer:
• Prognosis:
- Excellent for uncomplicated appendicitis with prompt surgery
- Good for perforated appendicitis with appropriate antibiotics and surgery
- Mortality: <0.5% in children (higher if delayed presentation)
• Follow-up:
- Wound care: Keep site clean and dry, remove sutures in 7-10 days
- Activity restriction: No heavy lifting for 2-4 weeks, school/work as tolerated
- Monitor for complications: Fever, wound infection, abdominal distension
- Diet: Advance as tolerated (clear liquids → solids)
- Return to activities: Resume normal activities in 2-4 weeks
- Follow-up: In 1-2 weeks for wound check, then as needed