掌指关节脱臼最容易发生在那一部位(完整版)

中華民國手外科醫學會八十六年考題

一、單選題

1.Adductor policis muscle 之神經支配是由？

A.Median nerve

B.Ulnar nerve

C.Radial nerve

D.Anterior interosseous nerve

E.Posterior interosseous nerve

2.Rupture or acute transection of the central slip of the extensor expansion at or near its

insertion results?

A.Mallet finger

B.Boutonniere deformity (Buttonhole deformity)

C.Swan-neck deformity of finger

D.Claw-deformity of the finger

E.Hyperextension deformity of proximal interphalangeal joint

3.有關Kienbock’s Disease的描述，何者為誤？

A.好發年齡為30-50歲

B.好發於慣用手

C.男性較常發生

D.百分之七十五在嚴重外傷後發生

E.Licht man’s分類第一、二級可施以尺骨延長或橈骨短縮手術治療

4.運動員最常見的深屈指肌腱撕裂傷，最常發生於：

A.大拇指

B.食指

C.中指

D.無名指

E.第五指

5.臨床手術時所使用止血帶以不超過1.0至1.5小時為宜，在此程critical time，肢體之

組織代謝指標為？

A.P H 7.31-7.40；PaO224-45 mmHg，PaCO238-50mmHg

B.P H 7.19-7.31；PaO220-24 mmHg，PaCO250-62mmHg

C.P H 7.04-7.19；PaO210-20 mmHg，PaCO262-85mmHg

D.P H 6.90-7.04；PaO24-10 mmHg，PaCO285-104mmHg

E.以上皆非

6.Bennett’s fracture時，第一掌骨（1st metacarpal shaft）骨幹移位之主要原因是因為下

列那一條肌肉拉力所造成的？

A.A bductor pollicis longus

B.a bductor pollicis brevis

C.a dductor pollicis

D.F lexor pollicis longus

E.Flexor pollicis brevis

7.關於Perilunar Instability之陳述，下列何者為「非」？

A.根據Mayfield分類，dorsal radiocarpal ligament斷裂，使Lumate islocation為

stage IV

B.Dorsal intercalated segmental instability (DISI) 常發生在Lunate or erilunate

dislocation之後

C.Volar intercalated segmental instability (VISI) 常發生在triquetrolunate

dissociation 或midcarpal instability

D.Lunate dislocation posterior比anterior常見

E.以上皆非

8.Low radial nerve palsy包括(a)Accessary forearm flexion and supination；(b)Wrist

extension；(c)Digital extension 1,2,3,4,5；(d)Radial abduction of thumb；(e)Radial 2/3 dersal sensation等何者功能之喪失？

A. a.b.c.d.e

B. b.c.d.e

C. c.d.e

D. a.b.c.d

E. a.b.c

9.最常見的手部先天性畸形(Congenital hand anomaly) 為何？

A.Syndactyly

B.Polydactyly

C.Congenital Amputation

D.Camptodaotyly

E.Clinodactyly

10.手部骨骼最常見的原發生骨瘤(Primary bone tumor) 為何？

A.E nchondroma

B.O steoid osteoma

C.B enign osteoblastoma

D.A neurysmal bone cyst

E.Giant cell tumor of bone

11.在Replantation後之Reperfusion Injury造成free radicals induced no reflow phenomenen

中使用Allopurinol主要是在阻斷下列何種反應？

A.ATP ? AMP

B.AMP ? Inosine

C.Inosine ? Hypoxanthine

D.Hypoxanthine ? Xanthine + Superoxide

E.Superoxide ? Hydrogen Peroxide

12.肩部lateral rotation, abduction, foreward flexion,肘關節flexion及腕部、手指、拇指之

extensers功能喪失，主要由Brachial plexus之那幾個roots injury？

A.C5-6

B.C5-6, C7

C.C(7), 8, T1

D.C5-T1

E.以上皆非

13.以下對大肢體截肢病患之摘述，何者為「非」？

A.指位于腕部或腕部以上之截肢

B.即使有適當的低溫處理，大肢體缺氧大于10-12小時，其存活率將大為降低

C.手術時動脈縫合須先于靜脈縫合

D.並不須要做筋膜切開術(Fasciotomy)

E.以上皆非

14.Preiser’s disease指的是那一腕骨之缺血性彎化？

A.Scaphoid

B.Lunate

C.Triquetrun

D.Pisiform

15.腕骨高度比(Carpal height ratio) 是Youm在1978者提出來測定是否有腕骨

collapse，下列陳述何者是不正確的？

A.數值為0.54 0.03

B.以腕骨高度除以第2掌指骨之高度

C.在A-P view x-ray中，手掌移動均不會影響其數值

D.在Kienbock disease中，數值往往會下降

16.有關「交感神經失常症」(Reflex Sympathetic Dystrophy) 病人，較少出現之症狀為：

A.手指感覺降低

B.疼痛

C.關節僵硬

D.指甲顏色變化

17.前臂空間症候群(Compartment syndrove)較常侵犯之肌肉：

A.伸腕尺長肌(Ext. Carpi Ulnaris)

B.屈指長肌(Flexor digitorum longus)

C.B rachio – radialis

D.P almaris longus

18.Fracture at the hook of hamate is best demonstrated by which view of the x-ray:

A.A p view of hand

B.L ateral view of hand

C.C arpal tunnel view

D.N one of the above

E.A & B

19.Kienbock’s disease is necrosis of

A.H amate

B.L unate

C.C apitate

D.T rapezium

E.Trapezoid

20.Volar plate arthroplasty uses the volar plate as a

A.d istally based flap

B.p roximally based flap

C.f ree graft without pedicle

D.N one of the above

E.All of the Above

21.Proximal row carpectomy means the removal of the following structures：

A.Scaphoid

B.Lunate

C.Triquetrum

D. A & B

E. A.B.C

22.In congenital constriction band syndrome, which is (are) true:

A.C an be associated with synductyly

B.C an be operated with good result (cosmetically and functionally)

C.T reated with staged excision of the constriction ring staged Z-plasty

D.A ll of the above

E.None of the Above

https://www.360docs.net/doc/7110244945.html,ceration of ulnar nerve at wrist level results

A.L oss of finger abduction-adduction

B.L oss of thumb adduction

C.L oss of digital balance 4 and 5

D.L oss of ulnar 1/3 volar sensation

E.All of the above

24.Soft tissue arthroplasty for MP joint includes the use of the following tissue:

A.E xtensor tendon

B.V olar Plate

C.F asia

D.N one of the above

E. A & B

25.In triphalangeal thumb, which is (are) true:

A.E xtraphalanx between the two normal phalanges of the thumb

B.C an be associated with polydactyly and cleft hand

C.C an be associated with first web contracture

D.A ll of the above

E.None of the above

26.In Madelung’s deformity:

A.T here is shortening of radius at the wrist

B.T he ulnar half of radius is more affected

C.T here is limited wrist motion

D.T he extension of wrist and supination are more severely affected

E.All of the above

27.Which of the following about treatment for acute nail bed injury is wrong?

A.T he nail should be replaced as a stent

B.L arge avulsed fragment should be retrieve and replace into the defect

C.N ail bed should repair with fine chromic suture

D.O nly full thickness graft of germinal matrix can pcoduce nail growth

E.Dermal or reverse dermal graft is reliable for repair of sterile matrix

28.Which of the following is not a cause of ulnar drift of metacarpophalanged joint in

rheumatoid arthritis?

A.W rist deformity

B.I ntrinsic muscles imbalance

C.f lexor and extensor tendon force

D.f orces of gravity and pinch

E.Contracture of collateral ligament of the joint

29.Which of the following is not true for tendon transfer?

A.T he transfer tendon should have adeguate strength and excursion

B.T he transfer tendon can have more than one function if strong enough

C.S ynergism of donor and recipient is important

D.E arly transfer as internal splint is beneficial

E.None of above

30.Which of the following about forearm level nerve repair is incorrect?

A.F unctional recover of median nerve is better than ulnar nerve.

B.D irect nerve repair under modest tension is better than nerve grafting

C.T opograph map is useful for matching fascicular orientation

D.E lectric stimulation of denervated muscle is important after surgery

E.None of above

31.Which of the following about scapholunate dissociation is false?

A.A rthroscopy is more accurate than arthrography in diagnosis

B.I t is the most common cause of DISI

C.S L gap widening > 3mm is a significant radiography finding

D.T ear of membranous portion of SL ligament is clinical significant

E.Direct repair of ligament is possible even in cases of several month old

32.Which of the following about pathological anatomy of camptodactyly is true?

A.E xtensor hood insufficency

B.A loose flexor digitorum superficialis

C.A bnormal intrinsic insertion to dorsal side

D.A trapezoidal middle phalanx

E.None of above

33.Which of the following about diagnosis of clinical scaphoid fracture is false?

A.R adiography cannot be used as the gold standard of diagnosis

B.F racture happened more than 2 weeks can be easily detect by x-ray or bone scan

C.P atients with positive clinical signs by normal radiography are not uncommon

D.S cintigraphy should not be perform earlier than 48 hours or later than 2 weeks

E.None of above

34.Which of the following is not a contraindication for primary repair of zone II flexor tendon

injury?

A.M assive crush injury

B.D irty and contaminated wound

C.I njury to neurovascular bundle or palmar plate

D.I nexperience surgeon

E.Significant loss of skin coverage

35.In operation for de-Quervain’s disease, the following condition may be one of the

complications, EXCEPT：

A.I njury of the radial nerve

B.I njury of median nerve

C.P rolapse of abductor pollicis longus tendon

D.P rolapse of extensor pollicis brevis tendon

E.Incomplete release of the compartment

36.Eponychial marsupialization is the treatment of:

A.A pypical mycobacterial tenosynovitis

B.F elon

C.C hronic paronychia

D.C hronic tenosynovitis

E.Glomus tumor

37.The stability of proximal interphalangeal joint is maintained by, EXCEPT:

A.J oint contours

B.V olar plate

C.I ntercapsular ligaments

D.R etinacular lligaments

E.Extrinsic Tendons

38.Functions of lumbrical muscles in hand are, EXCEPT:

A.F lex the metacarpophalangeal joints

B.F lex the proximal interphalangeal joints

C.E xtend the distal interphalangeal joints

D.E xtend the proximal interphalangeal joints

39.有關Congenital constriction band syndrome何者為正確？

A.女性比男性多

B.發生率與懷孕之1st trimester之Medication有關

C.通常有associated anomalies

D.小指頭最常發生Congenital amputation

E.中指最常發生此病

40.兩歲小孩兩手小指於PIP Joint先天性之Flexion contracture，無其他先天異常，診斷

為：

A.B outonie’re deformity

B.C amptodactyly

C.C linodactyly

D.D up uytren’s contracture

E.Gordon’s syndrome

41.Colle’s fracture最常合併下列那一根tendon rupture?

A.E xtensor pollicis longus

B.F lexor digitorum profundus to the index finger

C.F lexor Digitorum profundun to the middle finger

D.F lexor digitorum superficialis to the middle finger

E.Flexor pollicis longus

42.In patients with isolated syndactyly of the hand, the most commonly involved web space is

the :

A.F irst

B.S econd

C.T hird

D.T ourth

E.Fifth

43.Kanavel’s 4 cardinal signs for pyogenic flexor tenosynoritis including each, XECPT:

A.E xtreme tenderness along the entire sheath

B.I nability to flex the digit to the palm

C.M arked pain on passive extension

D.S amiflexed position of the digit

E.Uniform swelling of the digit

44.下列手指(Finger)的Pulley中，何者較重要？

A.A1A3

B.A2A4

C.A3A5

D.A1A4

E.A2A3

45.關於Flexor tendon graft 那一項敘述是錯的？

A.過去常為Zone II 之tendon laceration來施行

B.

B.目的是想by pass正常無節的tendon在Zone II 上以求滑動的順暢

C.T endon太短，Bed又太差，無法馬上修補，先放tendon rod留待二次性做tendon

graf

D.T endon不夠長，關節又不能動，只好作tendon graft

E.Tendon graft術前最重要的條件是指關節有Passive full range of motion

46.下面那一項問題不是處理triphalangeal thumb所需考慮的？

A.T reatment of the associated anomalies(例如: polydactyly)

B.T reatment of thumb web contracture

C.T reatment of abnormal phalanx

D.T reatment for five-fingered hand

E.以上皆需考慮

47.有關Radial club hand的敘述，下列何者正確？

A.病患雖已成年，且已適應日常生活，仍應給予手術治療

B.變形程度雖然輕微且有足夠的radial length支持手部，仍應建議手術治療

C.病患elbow flexion時straightened hand無法接近嘴巴，則不做straighten hand的手

術

D.病患有其他先天畸形，長期存活有困難，仍應手術矯正radial deviation

48.Which of the following scaphoid fracture configuration is most unstable?

A.F racture of the scaphoid tuberosily

B.S mall fracture (＜1/3) of the proximal pole of the scaphoid

C.D irect transverse fracture through the midthird of the scaphoid

D.H orizontal oblique fracture through the midthird of the scaphoid

E.Vertical oblique fracture through the midthird of the scaphoid

49.The earliest sign of compartment syndrome of the volar forearm is :

A.A bsence of pulse

B.L oss of 2-point discrimination

C.P ain with passive stretching

D.P allor

E.Paralysis

50.About “flexor tendon surgery”，the following statements which one is incorrect?

A.T he so called “no-man’s land” locates from distal palmar crease to the insertion of

superficialis tendon.

B.D uring operation of tendon repair or tendon graft, the A2 and A4 pulley should be

preserved or be repaired to prevent tendon bowstring.

C.F or preventing adherence of the tendon to the sheath and soft tissure, flexor tenolysis,

if necessary, should be done before 3 months after initial surgery.

D.A bout the timing of the “flexor tendon graft” in patient with relative benign wound,

usually 3 or 4 weeks of elapsing time is sufficient.

E.In young children, the immobilization after flexor tendon surgery is usually more

extensive and prolonged.

51.74歲女性，主訴一週前當以右手食指彈出一顆米粒時，突感疼痛，之後，食指就無

法完全伸直。MPJ的背側則於隔天開始腫痛，但病人也發現有時嚐試幾伸展後，也可以完全伸直，X光顯示完全正常。請問下列那一項最有可能？

A.R upture or attenuation of EDC 2(Extensor Digitorum Communis II)

B.R upture or attenuation of EIP(Extensor Indicis Proprius)

C.S ubluxation of both EDC 2 and EIP due to a tear of the saggital fibers of dorsal hood

at the MPJ level.

D.R upture of the radial collateral ligament of the MPJ

E.Rupture of the central slip at the PIPJ level.

52.腕舟狀骨(Scaphoid) 骨折，需要包石膏固定多久？

A.直到無痛及無腫脹

B.４週

C.８週

D.直至x光片上顯示癒合

E.施行手術就不需要４週以上

53.治療Kienbock’s disease，常施行縮短橈骨長度，或者延長尺骨長度來減少經過尺骨

的負荷。什麼是適當的長度？

A.0.5至1.0mm

B.2mm

C.3mm

D.4mm

E.5mm

54.在Volkmann’s contracture，下列的那肌腱最少被影響？

A.Flexor pollicis longus

B.Flexor digitorum profundus

C.Flexor digitorum superficialis

D.Pronator teres

E.Wrist flexors

二、複選題：

55.In stage I - III of kienbock disease, the following operative methods are not considered:

A.Scaphotrapezial-trapezoid(STT) arthrodesis

B.Shortening osteotomy of distal third radius

C.Total wrist joint arthrodesis

D.Vascularized bone graft

E.Proximal row carpectomy

56.In the following examinations, which of them are not helpful in diagnosis of “Carpal

Tunnel Syndrome”?

A.T ourniquet test

B.P halen’s test

C.F roment’s sign (Bunnell’s “O” sign)

D.T inel’s sign

E.Allen’s test

57.In the following injuries, because of poor prognosis with conservative treatment, which of

them should be treated by operative method?

A.A cute complete rupture of the ulnar collateral ligament of MPJ of the thumb

B.C omplete dorsal dislocation of the MPJ of index

C.A cute Boutonnier’s deformity, closed injury

D.A cute Mallet deformity, closed injury

E.Acute scapholunate dissociation

58.About commonly used eponyms of distal radius fracture, the following statements which

are incorrect?

A.B arton’s fracture: A unstable fracture-subluxation of distal radius with displacement of

the carpus with intraarticular fracture fragment.

B.B ennette’s fracture: Intraarticular fracture-subluxation of 1st metacarpal base.

C.C olles’ fracture: A distal radius fracture with dorsal comminution, dorsal angulation,

and dorsal displacement of distal fragment.

D.D ie-Punch fracture: Styloid process fracture of the distal end radius.

E.Rolando’s fracture: An intraarticular T or Y shape fracture of 5th metacarpal.

59.About “Post-traumatic contracture of the hand”, the following statements which are

incorrect?

A.To prevent post-traumatic contracture, keep an acutely injuried hand in the

“Intrinsic-Plus position” is very important.

B.“Intri nsic-minus position” means MPJ in hyperextension, IPJ in flexion, and

thumb in adduction. An injuried hand will become gradually stiff in this position.

C.“Retinacular-Plus contracture”: While MPJ is flexed, makes flexion of PIPJ more

difficult, means adhesion of its tendon distal to the MPJ level.

D.“Intrinsic-Plus contracture” could be caused by ischemic necrosis of interosseous

muscles.

E.“Retinacular-Plus contracture” is concerned with oblique retinacular ligament,

indicates scarring and adhesion of soft tissue around MP joint

60.The following description are concerned with nerve compression and its anatomical

structure, which of them are incorrect?

A.Arcade of Frohse --- Posterior interosseous nerve

B.Quadrilateral space syndrome --- Suprascapular nerve

C.Guyon’s cana l --- Median nerve

D.Medial head of triceps brachii --- Ulnar nerve

https://www.360docs.net/doc/7110244945.html,certus fibrosus --- Median nerve