I read your article on the RCGP knowledge test (GP, 9 December 2005) with interest, as revalidation and appraisal have long seemed to me to be an appalling waste of resources, and not really a test of anything worthwhile. The questions quoted about appendicitis just confirmed my feelings.
How on earth does knowing the answer to any one of these questions make a doctor a better physician? Does one really stop to send off a mid-stream urine (MSU) test when suspecting appendicitis in general practice? I don't think so. The result may be a week and a perforation away.
Can one trust a urinalysis stick for the diagnosis? I hope not.
Does it matter whether appendicitis is the commonest non-accidental surgical admission in childhood? Not if it's your child or your patient's child with the tummy pain.
Does it really matter where the appendix lies? Not in the least, except to the surgeon.
A retro-caecal appendicitis presents with suspicious symptoms just as any other inflammation in the abdomen, and management is the same from the pre-surgery point of view.
These questions are rubbish, and just go to show, that those devising them have no idea about grass-roots medicine, and, in that, I strongly disagree with Dr Scott.
If we can become surgeons, physicians or GPs without recognising when to be suspicious of an appendix, and without knowing how fickle this diagnosis is in reality, then our mentors have failed us.
These questions are grossly irrelevant and test nothing of any importance to patient care.
Dr Susanna Timmins Ramsgate, Kent.