21. Which of the following activities will exacerbate pain the most in an elderly patient with severe spinal stenosis?
(A) Walking uphill
(B) Walking downhil.
(C) Riding a bicycle
(D) Bending forward Standing

22. 抗憂鬱劑常被用在治療慢性神經病理性疼痛緩解，以下有關於此類藥物之敘述何者為非? (A)三環抗憂鬱劑是慢性疼痛治療的首選藥物。 (B) Amitriptyline 可同時抑制 Serotonin 和 Noradrenaline 兩神經傳遞物質之回收，效果較其 他選擇性回收抑制劑之治療效果佳，其 NNT 為 14 左右。 (C)三環抗憂鬱劑之止痛效果，主要並非來自於其鎮靜或是抗焦慮之作用。 (D)近來之研究發現三環抗憂鬱劑也具有抑制鈉離子通道及 NMDA 受體之作用。 (E)青光眼及攝護腺肥大是使用三環抗憂鬱劑的禁忌症。

23. Which of the following statement concerning “postoperative pain” is least likely? (A) Management of postoperative pain is challenging. (B) Management of postoperative pain is based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission. (C) Chronic pain after surgery is an underdiagnosed condition (D) Advances in understanding the genetic profile of patients should help improve treatment of postoperative pain. (E) It is not essential that the neuronal response to surgery be blocked to achieve the task of optimal pain control.

24. Which of the following statement concerning “muscle pain” is least likely? (A) Muscle pain is distinct from cutaneous pain. (B) Muscle pain is one of the most common pain complaints. (C) Muscle nociceptors are free nerve endings that are connected to the central nervous system. (D) Most nociceptors cannot be excited by algesic agents, including bradykinin, serotonin. (E) In damaged muscle, the nociceptors have a lowered mechanical threshold.

25. Which of the following diagnostic tests that aid in the diagnosis of complex regional pain syndrome? (A) Bone scintigraphy (B) Plain radiography and X-ray bone densitometry (C) Quantitative sensory testing (D) Skin temperature measurement (E) All of above

26. 下列關於癌症病人的 breakthrough pain，下列敘述何者較 不正確 ： (A)包括了 incident pain 及 spontaneous pain (B)一般不把"end-of-dose failure of analgesic" 歸類在 breakthrough pain (C)疼痛的特性包括了 somatic pain, visceral pain, neuropathic pain 或 mixed type (D) fentanyl buccal film 可以用來控制中重度的 breakthrough pain (E) breakthrough pain 的發生機率並不大，一般只出現在癌症末期或瀕死病人

27. Which management for acute orofacial pain is not advisable? (A) NSAlDs exert their actions in damaged tissue through blockade of prostaglandin synthesis (B) NSAIDs may moderate e 旺 icacy for inhibiting postoperative edema (C)NSAIDs may be used for pretreating patients before dental surgery (D) Opioids may play a more direct role in pain management than NSAIDs thromboembolic complications (E)The local application of exogenous opioids may prevent the degradation of endogenous opioid peptides may provide a new approach to pain management.

28. 當病人一再來門診或急診要求注射成癮性止痛藥時，下列哪些現象暗示病患可能有「成癮」現象? (A) 病人抱怨最近的處方的止痛時間不夠久，藥效變差 (B) 病忠抱怨最近疼痛加重厲害，發作頻繁，他把三天的藥一天吃完 (C)病人說吃完藥舒服很多 (D)病人自述沒吃止痛藥會睡不著，希望睡前加重劑量輔助睡眠 (E)病人最近反覆敘述藥物遺失，而且發生很多次

29. Which of the following is the acceptable statement about pathogenesis of FMS? (A) There is evidence to suggest that FMS is a disorder of abnormal processing of sensory information within the central nervous system. (B) Several neurochemical mediators of pain, substance P, nerve growth factor, dynorphin A, glutamate, nitric oxide, serotonin and noradrenaline are viewed as pronociceptive because they carry or amplify afferent signals, leading to the brain perception of increased pain. (C) The elevation of cerebrospinal fluid substance P in FMS is due to lowered activity of cerebrospinal fluid substance P esterase because the rate of cleavage of libeled substance P by FMS cerebrospinal fluid was lower than normal. (D) In different subtypes of FMS, it is believed that nerve growth factor may be responsible for the elevated cerebrospinal fluid substance P through its effects on central sensitization and neuroplasticity. (E) A specific Gi-protein–coupled receptor in peripheral blood leukocytes was found to be dysfunctional in patients with FMS. This resulted in lower baseline, also depressed intracellular levels of cyclic AMP and proposed as a diagnostic test for FMS.

30. Which drug below is less likely an option for inhibiting central sensitization following acute postoperative pain: (A) NMDA antagonist (B) Opioid (C) COX2-inhibitor (D) Pre-emptive analgesia (E) Gabapentin

31. A 61-year-old woman presents to the pain clinic with a chief complaint of left shoulder and arm pain 3 years after undergoing radiation therapy for breast cancer. Physical examination reveals lymphedema of the left axilla with noticeable skin changes. Examination of the left supraclavicular area precipitates a sharp pain that radiates down her left arm. Which of the following is her likely diagnosis? (A) Tumor metastasis (B) Cervical radiculopathy (C) Reflex sympathetic dystrophy (D) Thrombangitis obliterans (E) Radiation-induced plexopathy

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