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75. A 40-year-old female presents with left lower quadrant pain, fever, and leukocytosis. CT scan shows colonic wall thickening with pericolic fat stranding. The most likely diagnosis is:
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Hallmark of perforated peptic ulcer = sudden severe pain with board-like rigidity Mnemonic: Ulcer burst → Rigid gut like a board.

74. Which of the following is a hallmark of perforated peptic ulcer?
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Sudden severe abdominal pain in afib patient → mesenteric ischemia Mnemonic: Afib clot, gut rot = mesenteric crisis.

73. A 60-year-old female with a history of atrial fibrillation presents with sudden severe abdominal pain, vomiting, and bloody diarrhea. On examination, she has abdominal distension and absent bowel sounds. The most likely diagnosis is:
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Bloody nipple discharge → intraductal papilloma Mnemonic: Papilloma pops blood, not fibrous or ovaries.

72. A 50-year-old woman presents with bloody nipple discharge. The most likely diagnosis is:
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نكمل ✅

Small bowel obstruction → colicky pain + air-fluid levels Mnemonic: Small bowel stuck = Air-water circus.

71. A patient presents with colicky abdominal pain, distension, vomiting, and constipation. Abdominal X-ray shows multiple air-fluid levels. The most likely diagnosis is:
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Free air under diaphragm → perforated peptic ulcer Mnemonic: Ulcer pops = Air hops under diaphragm.

70. A patient with acute abdomen shows free air under the diaphragm on erect chest X-ray. The most likely diagnosis is:
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Late signs of acute appendicitis = Rovsing, Psoas, Obturator Mnemonic: RPO = Really Painful Ouch.

69. Which of the following is a late sign of acute appendicitis?
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Mandatory vaccines after splenectomy → pneumococcal & meningococcal Mnemonic: No spleen, clean scene: Pneumo & Meningo must go in.

68. Which of the following vaccinations is mandatory after a splenectomy?
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Massive PR bleeding → diverticulosis Mnemonic: Diverticulosis = Dumping red rivers.

67. The most common cause of massive bleeding per rectum is:
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Cobblestone appearance → Crohn's disease Mnemonic: Crohn’s stones = cobble your gut.

66. Cobble stone appearance is seen in:
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