1掌指关节脱臼最容易发生在哪一部位

1掌指关节脱臼最容易发生在哪一部位 中華民國手外科醫學會八十六年考題 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. Lichtman’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. PH 7.31-7.40;PaO 24-45 mmHg,PaCO 38-50mmHg 22 B. PH 7.19-7.31;PaO 20-24 mmHg,PaCO 50-62mmHg 22 C. PH 7.04-7.19;PaO 10-20 mmHg,PaCO 62-85mmHg 22 D. PH 6.90-7.04;PaO 4-10 mmHg,PaCO 85-104mmHg 22 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. Abductor pollicis longus B. abductor pollicis brevis C. adductor pollicis D. Flexor 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 86年度考題 - 1 - 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. Enchondroma B. Osteoid osteoma C. Benign osteoblastoma D. Aneurysmal 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. C 5-6 B. C, C5-67 C. C, 8, T (7)1 D. C-T 51 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. 手術時動脈縫合頇先于靜脈縫合 D. 並不頇要做筋膜切開術 (Fasciotomy) E. 以上皆非 14. Preiser’s disease指的是那一腕骨之缺血性彎化, 86年度考題 - 2 - 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. Brachio – radialis D. Palmaris longus 18. Fracture at the hook of hamate is best demonstrated by which view of the x-ray: A. Ap view of hand B. Lateral view of hand C. Carpal tunnel view D. None of the above E. A & B 19. Kienbock’s disease is necrosis of A. Hamate B. Lunate C. Capitate D. Trapezium E. Trapezoid 20. Volar plate arthroplasty uses the volar plate as a A. distally based flap B. proximally based flap C. free graft without pedicle D. None 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. Can be associated with synductyly B. Can be operated with good result (cosmetically and functionally) C. Treated with staged excision of the constriction ring staged Z-plasty 86年度考題 - 3 - D. All of the above E. None of the Above 23. Laceration of ulnar nerve at wrist level results A. Loss of finger abduction-adduction B. Loss of thumb adduction C. Loss of digital balance 4 and 5 D. Loss 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. Extensor tendon B. Volar Plate C. Fasia D. None of the above E. A & B 25. In triphalangeal thumb, which is (are) true: A. Extraphalanx between the two normal phalanges of the thumb B. Can be associated with polydactyly and cleft hand C. Can be associated with first web contracture D. All of the above E. None of the above 26. In Madelung’s deformity: A. There is shortening of radius at the wrist B. The ulnar half of radius is more affected C. There is limited wrist motion D. The 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. The nail should be replaced as a stent B. Large avulsed fragment should be retrieve and replace into the defect C. Nail bed should repair with fine chromic suture D. Only 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. Wrist deformity B. Intrinsic muscles imbalance C. flexor and extensor tendon force D. forces of gravity and pinch E. Contracture of collateral ligament of the joint 29. Which of the following is not true for tendon transfer? A. The transfer tendon should have adeguate strength and excursion B. The transfer tendon can have more than one function if strong enough C. Synergism of donor and recipient is important D. Early transfer as internal splint is beneficial E. None of above 30. Which of the following about forearm level nerve repair is incorrect? A. Functional recover of median nerve is better than ulnar nerve. B. Direct nerve repair under modest tension is better than nerve grafting C. Topograph map is useful for matching fascicular orientation D. Electric stimulation of denervated muscle is important after surgery 86年度考題 - 4 - E. None of above 31. Which of the following about scapholunate dissociation is false? A. Arthroscopy is more accurate than arthrography in diagnosis B. It is the most common cause of DISI C. SL gap widening > 3mm is a significant radiography finding D. Tear 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. Extensor hood insufficency B. A loose flexor digitorum superficialis C. Abnormal 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. Radiography cannot be used as the gold standard of diagnosis B. Fracture happened more than 2 weeks can be easily detect by x-ray or bone scan C. Patients with positive clinical signs by normal radiography are not uncommon D. Scintigraphy 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. Massive crush injury B. Dirty and contaminated wound C. Injury to neurovascular bundle or palmar plate D. Inexperience 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. Injury of the radial nerve B. Injury of median nerve C. Prolapse of abductor pollicis longus tendon D. Prolapse of extensor pollicis brevis tendon E. Incomplete release of the compartment 36. Eponychial marsupialization is the treatment of: A. Apypical mycobacterial tenosynovitis B. Felon C. Chronic paronychia D. Chronic tenosynovitis E. Glomus tumor 37. The stability of proximal interphalangeal joint is maintained by, EXCEPT: A. Joint contours B. Volar plate C. Intercapsular ligaments D. Retinacular lligaments E. Extrinsic Tendons 38. Functions of lumbrical muscles in hand are, EXCEPT: A. Flex the metacarpophalangeal joints B. Flex the proximal interphalangeal joints C. Extend the distal interphalangeal joints D. Extend the proximal interphalangeal joints 86年度考題 - 5 - 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. Boutonie’re deformity B. Camptodactyly C. Clinodactyly D. Dupuytren’s contracture E. Gordon’s syndrome 41. Colle’s fracture最常合併下列那一根tendon rupture? A. Extensor pollicis longus B. Flexor digitorum profundus to the index finger C. Flexor Digitorum profundun to the middle finger D. Flexor 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. First B. Second C. Third D. Tourth E. Fifth 43. Kanavel’s 4 cardinal signs for pyogenic flexor tenosynoritis including each, XECPT: A. Extreme tenderness along the entire sheath B. Inability to flex the digit to the palm C. Marked pain on passive extension D. Samiflexed 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. Tendon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. Tendon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. Treatment of the associated anomalies(例如: polydactyly) B. Treatment of thumb web contracture 86年度考題 - 6 - C. Treatment of abnormal phalanx D. Treatment 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. Fracture of the scaphoid tuberosily B. Small fracture (， 1/3) of the proximal pole of the scaphoid C. Direct transverse fracture through the midthird of the scaphoid D. Horizontal 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. Absence of pulse B. Loss of 2-point discrimination C. Pain with passive stretching D. Pallor E. Paralysis 50. About “flexor tendon surgery”,the following statements which one is incorrect? A. The so called “no-man’s land” locates from distal palmar crease to the insertion of superficialis tendon. B. During operation of tendon repair or tendon graft, the A2 and A4 pulley should be preserved or be repaired to prevent tendon bowstring. C. For 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. About 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. Rupture or attenuation of EDC 2(Extensor Digitorum Communis II) B. Rupture or attenuation of EIP(Extensor Indicis Proprius) C. Subluxation of both EDC 2 and EIP due to a tear of the saggital fibers of dorsal hood at the MPJ level. D. Rupture 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. ,週 C. ,週 D. 直至x光片上顯示癒合 E. 施行手術就不需要,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 86年度考題 - 7 - 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. Tourniquet test B. Phalen’s test C. Froment’s sign (Bunnell’s “O” sign) D. Tinel’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. Acute complete rupture of the ulnar collateral ligament of MPJ of the thumb B. Complete dorsal dislocation of the MPJ of index C. Acute Boutonnier’s deformity, closed injury D. Acute Mallet deformity, closed injury E. Acute scapholunate dissociation 58. About commonly used eponyms of distal radius fracture, the following statements which are incorrect? A. Barton’s fracture: A unstable fracture-subluxation of distal radius with displacement of the carpus with intraarticular fracture fragment. B. Bennette’s fracture: Intraarticular fracture-subluxation of 1st metacarpal base. C. Colles’ fracture: A distal radius fracture with dorsal comminution, dorsal angulation, and dorsal displacement of distal fragment. D. Die-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. “Intrinsic-minus position” means MPJ in hyperextension, IPJ in flexion, and thumb 86年度考題 - 8 - 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 canal --- Median nerve D. Medial head of triceps brachii --- Ulnar nerve E. Lacertus fibrosus --- Median nerve 86年度考題 - 9 -