掌指關(guān)節(jié)脫臼最容易發(fā)生在那一部位(完整版)

1、華民國手外科醫(yī)學(xué)會八六年考題86 年度考題- 4 -一、單選題1. Adductor policis muscle 之神經(jīng)支配是由？A.B.C.D.E.Mallet fingerBoutonniere deformity (Buttonhole deformity)Swan-neck deformity of fingerClaw-deformity of the fingerHyperextension deformity of proximal interphalangeal joint5. 臨床手術(shù)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

2、代謝指標為？A. PH 7.31-7.40；PaO2B. PH 7.19-7.31；C.PH 7.04-7.19；D.PH 6.90-7.04； E. 以上皆非PaO2PaO2PaO224-45 mmHg，PaCO220-24 mmHg，PaCO210-20 mmHg，PaCO24-10 mmHg， PaCO238-50mmHg50-62mmHg62-85mmHg85-104mmHgMedian nerveUlnar nerveRadial nerveAnterior interosseous nerve Posterior interosseous nerve2. Rupture or ac

3、ute transection of the central slip of the extensor expansion at or near its insertion results?A.B.C.D.E.3. 有關(guān)Kienbock ' s Disealfe描述，何者為誤？A. 好發(fā)年齡為 30-50 歲B. 好發(fā)於慣用手C .男性較常發(fā)生D. 百分之七十五在嚴重外傷後發(fā)生E. Licht man分類第一、二級可施以尺骨延長或橈骨短縮手術(shù)治療4. 運動員最常見的深屈指肌腱撕裂傷，最常發(fā)生於：A.大拇指B.食指C.中指D.無名指E.第五指6. Bennett ' s frac

4、t時e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 longusB. abductor pollicis brevisC. adductor pollicisD. Flexor pollicis longusE. Flexor pollicis brevis7. 關(guān)於 Perilunar Instability 之陳述，下列何者為非？A. 根據(jù) Mayfield 分類，dorsal radiocar pal ligame nt 斷裂，使 Lumate islocati on 為 stage IV

5、B. Dorsal intercalated segmental instability (DISI) 常發(fā)生在 Lunate or erilunateC.dislocation 之後Volar intercalated segmental instability (VISI) 常發(fā)生在 triquetrolunate dissociation 或 midcarpal instabilityLun ate dislocati on po sterior 比 an terior 常見以上皆非D.E.8. Low radial nerve palsy包括 (a)Accessary forearm

6、flexion and supination (b)Wrist extension；(c)Digital extension 1,2,3,4,5；(d)Radial abduction of thumb；(e)Radial 2/3 dersal sen sation等何者功能之喪失？A.a.b.c.d.eB.b.c.d.eC.c.d.eD.a.b.c.dE.a.b.c9. 最常見的手部先天性畸形 (Congenital hand anomaly) 為何？A.SyndactylyB.PolydactylyC.Congenital AmputationD.CamptodaotylyE.Clinod

7、actyly10. 手部骨骼最常見的原發(fā)生骨瘤(Primary bone tumor) 為何？A. EnchondromaB. Osteoid osteomaC. Benign osteoblastomaD. Aneurysmal bone cystE. Giant cell tumor of bone11. 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(yīng)？A.B.C.D.E.ATP AMPAMP InosineInosin

8、e HypoxanthineHypoxanthine Xanthine + Superoxide Superoxide Hydrogen Peroxide12. 肩部 lateral rotation, abduction, foreward flexion肘關(guān)節(jié) 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.C5-6B.C5-6, C7C.C(7), 8, T1D.C5-T1E.以上皆非13. 以下對大肢體截肢病患之摘述，何者為非？A.B.C.D.E.指位于腕部或腕部以上之截肢 即使有適當?shù)?/p>

9、低溫處理，大肢體缺氧大于 10-12 小時，其存活率將大為降低 手術(shù)時動脈縫合須先于靜脈縫合 並不須要做筋膜切開術(shù) (Fasciotomy)以上皆非14. Preiser ' s dise指的是那一腕骨之缺血性彎化?A. ScaphoidB. LunateC. Triquetr unD. P isiform數(shù)值為0.54±0.03以腕骨高度除以第2掌指骨之高度在A-P view x-ray中，手掌移動均不會影響其數(shù)值在Kienbock disease中，數(shù)值往往會下降交感神經(jīng)失常癥(Reflex Symp athetic Dystro phy)病人，較少出現(xiàn)之癥狀為:15.

10、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.B.C.D.16. 有關(guān)A. 手指感覺降低B. 疼痛C. 關(guān)節(jié)僵硬D. 指甲顏色變化17. 前臂空間癥候群(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 Iongus)C. Brachio -radialisD. P almaris Ion gus18. Fracture at the hook of hamate is best dem

11、 on strated by which view of the x-ray:A. A p view of handB. Lateral view of handC. Carpal tunnel viewD. None of the aboveE. A & B19. Kienbock ' s disease is necrosis ofA. HamateB. Lu nateC. Ca pitateD. Tra peziumE. Tra pezoid20. Volar plate arthroplasty uses the volar plate as aA. distally

12、based flapB. p roximally based flapC. free graft without p edicleD. None of the aboveE. All of the Above21. P roximal row carp ectomy mea ns the removal of the followi ng structuresA.Sca phoidB.Lun ateC.TriquetrumD.A & BE.A.B.C22. In congen ital con strict ion band syn drome, which is (are) true

13、:A. Ca n be associated with syn ductylyB. Ca n be op erated with good result (cosmetically and fun ctio nally)C. Treated with staged excisi on of the con stricti on ring staged Z-p lastyD. All of the aboveE. N one of the Above23. Laceration of ulnar nerve at wrist level resultsA. Loss of finger abdu

14、ction-adductionB. Loss of thumb adductionC. L oss of digital balance 4 and 5D. L oss of ulnar 1/3 volar sensationE. All of the above24. Soft tissue arthroplasty for MP joint includes the use of the following tissue:A. Extensor tendonB. Volar PlateC. FasiaD. None of the aboveE. A & B25.In triphal

15、angeal thumb, which is (are) true:A. Extraphalanx between the two normal phalanges of the thumbB. Can be associated with polydactyly and cleft handC. Can be associated with first web contractureD. All of the aboveE. None of the above26.In Madelung ' s deformity:A. T here is shortening of radius

16、at the wristB. The ulnar half of radius is more affectedC. There is limited wrist motionD. The extension of wrist and supination are more severely affectedE. All of the above27. Which of the following about treatment for acute nail bed injury is wrong?A. The nail should be replaced as a stentB. Larg

17、e avulsed fragment should be retrieve and replace into the defectC. Nail bed should repair with fine chromic sutureD. Only full thickness graft of germinal matrix can pcoduce nail growthE. Dermal or reverse dermal graft is reliable for repair of sterile matrix28. Which of the following is not a caus

18、e of ulnar drift of metacarpophalanged joint in rheumatoid arthritis?A. W rist deformityB. I ntrinsic muscles imbalanceC. f lexor and extensor tendon forceD. f orces of gravity and pinchE. Contracture of collateral ligament of the joint29. Which of the following is not true for tendon transfer?A. Th

19、e transfer tendon should have adeguate strength and excursionB. The transfer tendon can have more than one function if strong enoughC. Synergism of donor and recipient is importantD. Early transfer as internal splint is beneficialE. None of above30. Which of the following about forearm level nerve r

20、epair is incorrect?A. Functional recover of median nerve is better than ulnar nerve.B. Direct nerve repair under modest tension is better than nerve graftingC. Topograph map is useful for matching fascicular orientationD. Electric stimulation of denervated muscle is important after surgeryE. None of

21、 above31. Which of the following about scapholunate dissociation is false?A. Arthroscopy is more accurate than arthrography in diagnosisB. It is the most common cause of DISIC. SL gap widening > 3mm is a significant radiography findingD. Tear of membranous portion of SL ligament is clinical signi

22、ficantE. Direct repair of ligament is possible even in cases of several month old32. Which of the following about pathological anatomy of camptodactyly is true?A. Extensor hood insufficencyB. A loose flexor digitorum superficialisC. Abnormal intrinsic insertion to dorsal sideD. A trapezoidal middle

23、phalanxE. None of above33. Which of the following about diagnosis of clinical scaphoid fracture is false?A. Radiography cannot be used as the gold standard of diagnosisB. Fracture happened more than 2 weeks can be easily detect by x-ray or bone scanC. Patients with positive clinical signs by normal

24、radiography are not uncommonD. Scintigraphy should not be perform earlier than 48 hours or later than 2 weeksE. None of above34. Which of the following is not a contraindication for primary repair of zone II flexor tendon injury?A. M assive crush injuryB. Dirty and contaminated woundC. Injury to neu

25、rovascular bundle or palmar plateD. Inexperience surgeonE. Significant loss of skin coverage35.In operation for de-Quervain ' s disease, the following condition may be one of the complications, EXCEPT：A. I njury of the radial nerveB. I njury of median nerveC. Prolapse of abductor pollicis longus

26、 tendonD. Prolapse of extensor pollicis brevis tendonE. Incomplete release of the compartment36. Eponychial marsupialization is the treatment of:A. A pypical mycobacterial tenosynovitisB. FelonC. Chronic paronychiaD. Chronic tenosynovitisE. Glomus tumor37. The stability of proximal interphalangeal j

27、oint is maintained by, EXCEPT:A. Joint contoursB. Volar plateC. Intercapsular ligamentsD. Retinacular lligamentsE. Extrinsic Tendons38. Functions of lumbrical muscles in hand are, EXCEPT:A. Flex the metacarpophalangeal jointsB. Flex the proximal interphalangeal jointsC. Extend the distal interphalan

28、geal jointsD. Extend the proximal interphalangeal joints39. 有關(guān) Congenital constriction band syndromef可者為正確？A. 女性比男性多B. 發(fā)生率與懷孕之1st trimester之Medication有關(guān)C. 通常有 associated anomaliesD. 小指頭最常發(fā)生 Congenital amputationE.中指最常發(fā)生此病40. 兩歲小孩兩手小指於PIP Joi nt先天性之Flexion con tracture,無其他先天異常，診斷 為：A. Boutonie 'r

29、e deformityB. CamptodactylyC. ClinodactylyD. Dupuytren 's contractureE. Gordon's syndrome41. Colle ' s fracture 常合併下列那一根 ten don rup ture?A. Extensor pollicis longusB. Flexor digitorum profundus to the index fingerC. Flexor Digitorum profundun to the middle fingerD. Flexor digitorum supe

30、rficialis to the middle fingerE. Flexor pollicis longus42.In patients with isolated syndactyly of the hand, the most commonly involved web space is the :A. FirstB. SecondC. ThirdD. TourthE. Fifth43. Kanavel ' s 4 cardinal signs for pyogenic flexor tenosynoritis including each, XECPT:A. Extreme t

31、enderness along the entire sheathB. Inability to flex the digit to the palmC. Marked pain on passive extensionD. Samiflexed position of the digitE. Uniform swelling of the digit44. 下列手指(Finger)的Pulley中，何者較重要？A. A1A3B. A2A4C. A3A5D. A1A4E . A2A345. 關(guān)於 Flexor tendon graft 那一項敘述是錯的？A. 過去常為 Zo ne II 之 t

32、en don laceratio n 來施行B.B. 目的是想by pass正常無節(jié)的tendon在Zone II上以求滑動的順暢C. Te ndon太短，Bed又太差，無法馬上修補，先放 ten don rod留待二次性做ten dongrafD. Te ndon不夠長，關(guān)節(jié)又不能動，只好作 ten don graftE. Te ndon graft術(shù)前最重要的條件是指關(guān)節(jié)有P assive full range of moti on46. 下面那一項問題不是處理triphalangeal thumb所需考慮的？A. Treatment of the associated anomalie例

33、如:polydactyly)B. Treatment of thumb web contractureC. Treatment of abnormal phalanxD. Treatment for five-fingered handE. 以上皆需考慮47. 有關(guān) Radial club hand 的敘述，下列何者正確？A. 病患雖已成年，且已適應(yīng)日常生活，仍應(yīng)給予手術(shù)治療B. 變形程度雖然輕微且有足夠的radial length支持手部，仍應(yīng)建議手術(shù)治療C. 病患 elbow flexion 時 straightened hanc無法接近嘴巴，則不做 straighten hand的手術(shù)D

34、. 病患有其他先天畸形，長期存活有困難，仍應(yīng)手術(shù)矯正radial deviation48. Which of the following scaphoid fracture configuration is most unstable?A. Fracture of the scaphoid tuberosilyB. Small fracture (v 1/3) of the p roximal p ole of the sea phoidC. Direct transverse fracture through the midthird of the scaphoidD. Horizontal

35、 oblique fracture through the midthird of the scaphoidE. Vertical oblique fracture through the midthird of the scaphoid49. The earliest sign of compartment syndrome of the volar forearm is :A. Absence of pulseB. Loss of 2-point discriminationC. Pain with passive stretchingD. PallorE. Paralysis50. Ab

36、out “flexor tendon surger，ythe fo”llowing statements which one is incorrect?A. The so called- m“an'o s land ” locates from distal palmar crease to the insertion ofsuperficialis tendon.B. During operation of tendon repair or tendon graft, the A2 and A4 pulley should bepreserved or be repaired to

37、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 patibeennt iwgnithwroeulantdiv,eusually 3 or 4 weeks of elapsing t

38、ime is sufficient.E. In young children, the immobilization after flexor tendon surgery is usually moreextensive 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(cè)則於隔天開始腫痛，但病人也發(fā)現(xiàn)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

39、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 hoodat the MPJ level.D. Rupture of the radial collateral ligament of the MPJE. Rupture of the central slip at the PIPJ level.52. 腕舟狀骨 (Scaphoid) 骨折，需要包石膏固

40、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(shù)就不需要4週以上53. 治療Kienbock ' s diseas常施行縮短橈骨長度，或者延長尺骨長度來減少經(jīng)過尺骨 的負荷。什麼是適當?shù)拈L度？A. 0.5 至 1.0mmB. 2mm86 年度考題- 10 -C. 3mmD. 4mmE. 5mmFlexor pollicis longusFlexor digitorum profundusFlexor digitorum superficialis Pronator teresWrist flexors54.在Volkmann' s co

41、ntractu,下列的那肌腱最少被影響? A.B.C.D.E.二、複選題：55.In stage I - III of kienbock disease, the following operative methods are not considered:Scaphotrapezial-trapezoid(STT) arthrodesis Shortening osteotomy of distal third radius Total wrist joint arthrodesis Vascularized bone graftProximal row carpectomyA.B.C.D.

42、56.In the following examinations, which of them are not helpful in diagnosis of Tunnel Syndrome ”?A. T ourniquet testB. Phalen 's test C.Froment ' s sign (BunnellD.Tinel ' s sign E. Allen 's tests “ O” sign)E.57.In the following injuries, because of poor prognosis with conservative t

43、reatment, which of them should be treated by operative method?A. A cute complete rupture of the ulnar collateral ligament of MPJ of the thumbB. Complete dorsal dislocation of the MPJ of indexC. A cute Boutonnier ' s deformity, closed injuryD. A cute Mallet deformity, closed injuryE. Acute scapho

44、lunate dissociation58. About commonly used eponyms of distal radius fracture, the following statements which are incorrect?A. Barton 's fracture: A unstable fract-usruebluxation of distal radius with displacement of the carpus with intraarticular fracture fragment.B. Bennette 's fracture: Intraarticular frac-