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 nerveB.Ulnar nerveC.Radial nerveD.Anterior interosseous nerveE.Posterior interosseous nerve2.Rupture or acute transection of the central slip of the extensor expansion at or near itsinsertion results?A.Mallet fingerB.Boutonniere deformity (Buttonhole deformity)C.Swan-neck deformity of fingerD.Claw-deformity of the fingerE.Hyperextension deformity of proximal interphalangeal joint3.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，PaCO238-50mmHgB.P H 7.19-7.31；PaO220-24 mmHg，PaCO250-62mmHgC.P H 7.04-7.19；PaO210-20 mmHg，PaCO262-85mmHgD.P H 6.90-7.04；PaO24-10 mmHg，PaCO285-104mmHgE.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 longusB.a bductor pollicis brevisC.a dductor pollicisD.F lexor pollicis longusE.Flexor pollicis brevis7.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 IVB.Dorsal intercalated segmental instability (DISI) 常發生在Lunate or erilunatedislocation之後C.Volar intercalated segmental instability (VISI) 常發生在triquetrolunatedissociation 或midcarpal instabilityD.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)Wristextension；(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.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.Clinodactyly10.手部骨骼最常見的原發生骨瘤(Primary bone tumor) 為何？A.E nchondromaB.O steoid osteomaC.B enign osteoblastomaD.A neurysmal 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？A.ATP ⌫ AMPB.AMP ⌫ InosineC.Inosine ⌫ HypoxanthineD.Hypoxanthine ⌫ Xanthine + SuperoxideE.Superoxide ⌫ Hydrogen Peroxide12.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.C5-6B.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.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？A.ScaphoidB.LunateC.TriquetrunD.Pisiform15.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 0.03B.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 – radialisD.P almaris longus18.Fracture at the hook of hamate is best demonstrated by which view of the x-ray:A.A p view of handB.L ateral view of handC.C arpal tunnel viewD.N one of the aboveE.A & B19.Kienbock’s disease is necrosis ofA.H amateB.L unateC.C apitateD.T rapeziumE.Trapezoid20.Volar plate arthroplasty uses the volar plate as aA.d istally based flapB.p roximally based flapC.f ree graft without pedicleD.N one of the aboveE.All of the Above21.Proximal row carpectomy means the removal of the following structures：A.ScaphoidB.LunateC.TriquetrumD. A & BE. A.B.C22.In congenital constriction band syndrome, which is (are) true:A.C an be associated with synductylyB.C an be operated with good result (cosmetically and functionally)C.T reated with staged excision of the constriction ring staged Z-plastyD.A ll of the aboveE.None of the Aboveceration of ulnar nerve at wrist level resultsA.L oss of finger abduction-adductionB.L oss 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.E xtensor tendonB.V olar PlateC.F asiaD.N one of the aboveE. A & B25.In triphalangeal thumb, which is (are) true:A.E xtraphalanx between the two normal phalanges of the thumbB.C an be associated with polydactyly and cleft handC.C an be associated with first web contractureD.A ll of the aboveE.None of the above26.In Madelung’s deformity:A.T here is shortening of radius at the wristB.T he ulnar half of radius is more affectedC.T here is limited wrist motionD.T he 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.T he nail should be replaced as a stentB.L arge avulsed fragment should be retrieve and replace into the defectC.N ail bed should repair with fine chromic sutureD.O nly 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 cause of ulnar drift of metacarpophalanged joint inrheumatoid 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.T he transfer tendon should have adeguate strength and excursionB.T he transfer tendon can have more than one function if strong enoughC.S ynergism of donor and recipient is importantD.E arly transfer as internal splint is beneficialE.None of above30.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 graftingC.T opograph map is useful for matching fascicular orientationD.E lectric stimulation of denervated muscle is important after surgeryE.None of above31.Which of the following about scapholunate dissociation is false?A.A rthroscopy is more accurate than arthrography in diagnosisB.I t is the most common cause of DISIC.S L gap widening > 3mm is a significant radiography findingD.T ear of membranous portion of SL ligament is clinical significantE.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.E xtensor hood insufficencyB.A loose flexor digitorum superficialisC.A bnormal intrinsic insertion to dorsal sideD.A trapezoidal middle phalanxE.None of above33.Which of the following about diagnosis of clinical scaphoid fracture is false?A.R adiography cannot be used as the gold standard of diagnosisB.F racture happened more than 2 weeks can be easily detect by x-ray or bone scanC.P atients with positive clinical signs by normal radiography are not uncommonD.S cintigraphy 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 tendoninjury?A.M assive crush injuryB.D irty and contaminated woundC.I njury to neurovascular bundle or palmar plateD.I nexperience surgeonE.Significant loss of skin coverage35.In operation for de-Quervain’s disease, the following condition may be one of thecomplications, EXCEPT：A.I njury of the radial nerveB.I njury of median nerveC.P rolapse of abductor pollicis longus tendonD.P rolapse of extensor pollicis brevis tendonE.Incomplete release of the compartment36.Eponychial marsupialization is the treatment of:A.A pypical mycobacterial tenosynovitisB.F elonC.C hronic paronychiaD.C hronic tenosynovitisE.Glomus tumor37.The stability of proximal interphalangeal joint is maintained by, EXCEPT:A.J oint contoursB.V olar plateC.I ntercapsular ligamentsD.R etinacular lligamentsE.Extrinsic Tendons38.Functions of lumbrical muscles in hand are, EXCEPT:A.F lex the metacarpophalangeal jointsB.F lex the proximal interphalangeal jointsC.E xtend the distal interphalangeal jointsD.E xtend the proximal interphalangeal joints39.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 anomaliesD.小指頭最常發生Congenital amputationE.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 deformityB.C amptodactylyC.C linodactylyD.D up uytren’s contractureE.Gordon’s syndrome41.Colle’s fracture最常合併下列那一根tendon rupture?A.E xtensor pollicis longusB.F lexor digitorum profundus to the index fingerC.F lexor Digitorum profundun to the middle fingerD.F lexor digitorum superficialis to the middle fingerE.Flexor pollicis longus42.In patients with isolated syndactyly of the hand, the most commonly involved web space isthe :A.F irstB.S econdC.T hirdD.T ourthE.Fifth43.Kanavel’s 4 cardinal signs for pyogenic flexor tenosynoritis including each, XECPT:A.E xtreme tenderness along the entire sheathB.I nability to flex the digit to the palmC.M arked pain on passive extensionD.S amiflexed 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tendongrafD.T endon不夠長，關節又不能動，只好作tendon graftE.Tendon graft術前最重要的條件是指關節有Passive full range of motion46.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 contractureC.T reatment of abnormal phalanxD.T reatment for five-fingered handE.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 deviation48.Which of the following scaphoid fracture configuration is most unstable?A.F racture of the scaphoid tuberosilyB.S mall fracture (＜1/3) of the proximal pole of the scaphoidC.D irect transverse fracture through the midthird of the scaphoidD.H orizontal 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.A bsence of pulseB.L oss of 2-point discriminationC.P ain with passive stretchingD.P allorE.Paralysis50.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 ofsuperficialis tendon.B.D uring operation of tendon repair or tendon graft, the A2 and A4 pulley should bepreserved 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 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。