34. MODULATION OF TRIGEMINAL NOCICEPTION 與何者相關？
(A) Segmental modulation
(B) Descending modulation from the brain stem.
(C) Diffuse noxious inhibitory control.
(D) V Top-down modulation
(E) all

35. Which of the following common manifestations of fibromyalgia syndrome has the lowest prevalence? (A) Widespread pain (B) Peripheral pain generators (C) Fatigue (D) Irritable bladder syndrome (E) Sleep disorder

36. Which of the following is not a common manifestation of the myofascial pain syndrome? (A) Regional body pain and stiffness (B) Abnormal findings on neurological examinationl (C) Limited range of motion of the affected muscle (D) One or more trigger points (E) Referral (triggering) pain from a trigger point to a zone of reference.

37. Which of the following combination of lesion site with referral site describing pain referral is not common in cancer patients suffering from cancer pain? (A) (Diaphragmatic irritation) and (Shoulder) (B) (Urothelial tract) and (Inguinal region and genitalia) (C) (C7–T1 vertebrae) and (Interscapular) (D) (L1–2) and (Sacroiliac joint and hip) (E) all of the above are common found in patients with cancre pain

38. Which of the following suggestion is not advisable for the use of opioids in children with cancer pain? (A) Use the oral route first in most circumstances (B) Treat constipation pre-emptively. (C) If side effects are bothersome with one opioid, consider switching to another one. (D) Use sufficient doses to keep the patient comfortable should be avoided due to the possible occurrence of adverse effects (E) Use the oral route first in most circumstances.

39. Which of the following oral opioids is not recommended for padiatric patients with cancer pain? (A) morphine (B) hydromorphone (C) oxycodone (D) meperidine (pethidine) (E) all of the above can be prescribed for pediatric patients with cancre pain

40. Adjuvant analgesics are often prescribed for managing caner pain, but which of the following drug – indication is not considered? (A) NSAIDs for Soft tissue pain (B) Anticonvulsants for Neuropathic pain (C) Steroids for Soft tissue pain (D) Baclofen for Muscle spasm (E) Benzodiazepines for Muscle spasm

41. Which of the following cell type sense the initial “endanger signal” and participates in the initial phase of pathogenesis of the nerve injury induced neuropathic pain? (A) Microglia (B) Spinal lamina I and II neuron (C) Astrocyte (D) oligodendrocyte

42. Which of the following description about spinal cord plasticity and pain is incorrect? (A) Some spinal nociceptive neurons receive convergent input from high- and low- threshold sensory fibers thus called wide–dynamic range neurons (B) Glutamate is the major fast excitatory neurotransmitter in all nociceptive afferent nerve fibers. Glutamate can bind to three types of ionotropic glutamate receptors and to G protein–coupled metabotropic glutamate receptors to modify neuroexcitability. (C) Hyperalgesia and allodynia can even be induced in humans in the absence of any sensory stimulus, such as during prolonged application of opioids or on abrupt withdrawal of opioids. (D) Spinal nociception is under powerful control from descending inhibitory and facilitatory pathways. Under normal conditions, descending facilitation appears to prevail over inhibitory pathway.

43. 下列關於 opioid rotation 或 opioid switch，哪一種敘述較不正確： (A) opioid switch/rotation 意思是指改變鴉片藥物的給藥途徑，可以提高止痛效果 (B)動物實驗上可發現，鴉片受器剔除小鼠仍可以保留部分對 fentanyl 注射的止痛效果 (C)理論基礎是基於人體對 opioid receptor 的 binding profile 及 affinity 具有基因多樣性 (heterogenecity). (D) 臨床上已成為改善癌症病人的嗎啡類藥物效果的常用方式 (E) tramadol 換成 morphine 不能稱為 opioid switch

44. 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

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