31. Which of the following opioid is a μ-Opioid receptor partial agonist?
(A) Oxymorphone
(B) Buprenorphine.
(C) Nalbuphine
(D) Pentazocine
(E) Methadone

32. Which of the folllowing pharmacokinetics and pharmacodynamics is seldom associated with aging? (A) slowed elimination of the drug and active and toxic metabolites (B) increased bioavailability of drugs, that are highly protein-bound. (C) increased drug elimination time (D) increased sensitivity to both the desired and undesired effects of opioids (E) all of the above pharmacokinetics and pharmacodynamics are associated with aging

33. Which opioid owns the highest conversion factor to morphine minigram equivalents? (A) codeine (B) hydromorphone (C) oxycodone (D) morphine (E) fentanyl transdermal patch (in ug/hr)

34. Which of the following consideration for the use of adjuvants in the older persons is correct? (A) amitriptyline has more anticholinergic adverse effects than second-generation tricyclic antidepressants (nortriptyline or desipramine) (B) Serotonin and norepinephrine reuptake inhibitors (SNRIs) have fewer of these undesired effects from tricyclic antidepressants but a greater risk of drug interactions and elevation of liver enzymes (C) Antiepileptic drugs are first-line agents to treat neuropathic pain in older persons with labeled indications (D) carbamazepine may be useful for neuropathic pain, but less ideal in older adults due to drug interactions, renal, liver, and hematologic toxicity (E) all of the above are correct descriptions for adjuvants use in older persons

35. Which of the following description for the analgesic pharmacology in infants and children is wrong? (A) Neonates and young children have increased maturation of hepatic enzymes involved in the metabolism of analgesics such as opioids and amide local anesthetics (B) Neonates and young infants have decreased plasma concentrations of albumin and α1 acid glycoprotein, leading to decreased protein binding and greater concentrations of unbound, pharmacologically active drug (C) Neonates also have reduced glomerular filtration rates in the first few weeks of life resulting in slower elimination of many drugs (D) Young infants have significantly less of pseudocholinesterase compared to the adult population, leading to prolonged clearance of the ester-type local anesthetics (E) all of the above are correct descriptions

36. 下列何項診斷為最常見的遺傳性神經病變(hereditary neuropathy) ? (A) Fabry’s disease (B) Inherited erythromelalgia (C) Charcot-Marie-Tooth disease (CMT) (D) Familial amyloid polyneuropahty (E) Guillain-Barre Syndrome (GBS)

37. 下列有關 complex regional pain syndrome (CRPS)的 interventional therapies 敘述何者正確? (A) Sympathetic block 目前被認為是 CRPS 第一線的標準介入性治療 (B) 由於 CRPS 皆有 sympthetically maintained pain (SMP), 因此 systemic infusion of sympatholytic agent (例如 phentolamine)具有很好的療效 (C) 目前實證醫學證據顯示針對下肢的 CRPS, spinal cord stimulation 比 dorsal root ganglion stimulation 的療效更佳 (D) 相較於 conservative treatment, spinal cord stimulation 於 CRPS 的療效目前已有 prospective randomized controlled trial 證實 (E) 以上皆正確

38. 針對免疫正常的病患, 下列何節段最常出現 herpes zoster? (A) Cranial (B) Cervical (C) Thoracic (D) Lumbar (E) Sacral

39. 下列何項藥物不屬於 central neuropathic pain 的 first line therapy ? (A) Tramadol (B) Amitriptyline (C) Gabapentin (D) Duloxetine (E) Pregabalin

40. 認知行為療法(Cognitive-behavioral therapy CBT)為全方位疼痛治療的必要模式之一，下列何項是 CBT 的重要組成要素? (A) 教育病患有關疼痛及其相關症候群的內容 (B) 協助病患專注於增加自身活動及功能提升而非止痛 (C) 教育訓練病患有關 biofeedback, relaxation 及 stress management 的技巧 (D) 協助病患進行未來目標的設定 (goal setting for the future) (E) 以上皆是

41. Which one of the following statement is correct? (A) Functional imaging techniques applied for the study of pain are positron emission tomography (PET), functional magnetic resonance imaging (fMRI), near-infrared spectroscopy (NIRS), multi-channel electroencephalography (EEG) and magnetoencephalography (MEG), and intracranial recordings. (B) NIRS is an optical approach that also analyses changes in hemoglobin oxygenation levels by using light in the near infrared range (650 to 950 nm). (C) EEG and MEG are noninvasive neurophysiologic techniques that measure the respective electrical potentials and magnetic fields generated by neuronal activity of the brain and propagated to the surface of the skull where they are picked up with EEG electrodes or, in the case of its magnetic counterpart, received by supra conducting quantum interference device (SQUID) sensors located outside the skull. (D) (D.) Invasive recordings, which are assessed during neurosurgical interventions in patients ongoing epileptic surgery, or deep brain stimulation (DBS) procedures (most common in Parkinson disease), are extremely helpful to directly measure supraspinal pain signals. (E) All of the above are correct.

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