41. Which of the following drug is categorized as Agonist-Antagonist and should "Not" be used in opioid tolerant patients.
(A) Morphine
(B) Tramadol
(C) Nalbuphine
(D) Hydromorphone
(E) Methadone

42. 關於 breakthrough pain (BTP)，下列敘述何者不適當 (A) BTP 的原因與發生的部位就是 baseline persistent pain 相同。 (B) BTP 可以是可預期，或是特定動作或生理反應而產生。 (C)在給予定時止痛藥物之後發生的 BTP，有可能是給予藥物的間距時間過長，通常這樣的 BTP 是可以預期，而且會在固定的期間發生。 (D) 發生 BTP 的時間可能是無法預期，跟特定動作或時間無關。 (E)典型的 BTP 通常在 3-5 分鐘發生，持續約 30 分鐘，每次發生的強度不一定相同。

43. Which of following description about opioid receptors is "Incorrect" ? (A) Opioid receptors belong to the superfamily of G protein–coupled receptors (GPCR) (B) Opioid receptors are coupled to Gs protein to trigger downstream signaling. (C) Overall opioid receptor activation leads to inhibit neuronal activity (D) In spinal cord level, opioid receptors are located mostly in the superficial dorsal horn (E) Endogenous opiates maybe released by immune cells and work on both central and peripheral opioid receptors.

44. Which of following description about non-steroidal anti-inflammatory drugs (NSAIDs) pharmacology is "Correct"? (A) NSAIDs work by inhibiting the inflammation associated enzyme cyclooxygenase and lipoxygenase (B) Perioperative use of NSAIDs will not increase the risk of surgical site bleeding (C) NSAIDs will not have drug-drug interaction with anticoagulant (such as warfarin) (D) Cyclooxygenase-2 (Cox-2) is the inducible isoform of cyclooxygenase but is constitutively expressed in certain tissues such as brain and kidney (E) Compared with non-selective NSAIDs, long term use of Cox-2 inhibitors will significantly reduce the risk of serious cardiovascular events, renal failure or congestive heart failure.

45. Which of following description about using anticonvulsants (used as Analgesic Drugs is "Correct"? (A) Most commonly used anticonvulsants as analgesics appear to work through potentiation of voltage-gated sodium and calcium channels (B) Sodium channel subtype 1.4 &1.5 are highly expressed in neuronal cell and could be the drug target for anticonvulsant medication (C) Gabapentinoid (Gabapentin & Pregabalin) works on GABA receptor (D) Topiramate works only on voltage-gated sodium channel (E) Lamotrigine and Phenytoin work on voltage-gated sodium channels

46. Which of the folllowing medication has a greater and long term effect for palliation of pain than placebo in treating chronic low back pain? (A) bezodiazepaine (B) antidepressants (C) pregabalin (D) opioids (E) none of the above medications can offter a greater and lon-term analgesic effect

47. Which of following description about "antidepressant analgesic" is "Correct"? (A) In terms of treatment efficacy (smaller number needed to treat NNT), pregabalin is much better than tricyclic antidepressant and listed as first line therapy for neuropathic pain (B) In terms of treatment efficacy (smaller number needed to treat NNT), SSRI is better than SNRI for common neuropathic pain such as postherpetic neuralgia or painful diabetic polyneuropathy (C) Venlafaxine is effective for treatment of neuropathic pain associated with beast cancer. (D) For painful diabetic neuropathy, comparison of amitriptyline and pregabalin showed no difference in pain relief but fewer adverse effects with pregabalin. (E) All of above

48. Which one of the following statement about central pain is wrong? (A) Central pain involves plasticity in a single area of CNS. (B)Sensitization of the CNS plays a major role in central pain and involves neuronal hyper-excitability resulting in an increased response to synaptic inputs, decreased threshold, expansion of receptive fields, and access of low-threshold Aβ mechanoreceptors to pain pathways. (C) The clinical consequences of central pain are allodynia, hyperalgesia, and after-sensations. (D) Central sensitization may also include spontaneous discharges. (E) Spontaneous discharges in damaged pain pathways or deafferented rostral neurons may be responsible for spontaneous ongoing or intermittent pain.

49. Which of the following diagnosis due to failed back surgery is not able to get evident diagnostic support from MRI? (A) lateral canal stenosis (B) painful disk (C) recurrent herniated nucleus pulposus (D) SI joint pain (E) MRI can help differential diagnois of all of the above causes of failed back surgery.

50. 見下圖，不同的傷害性刺激 (熱、酸或化學性、機械性刺激、冷) 所興奮的表皮傷害性接受器 (1, 2, 3, 4)，可對應左側四組 A, B, C, D，按 1, 2, 3, 4 正確排列依序為： (A) A, B, C, D (B) A, C, B, D (C) B, C, A, D (D) C, B, D, A (E) D, C, B, A

1. 投擲某種不公正的硬幣一次，出現正面的機率為 ，反面為。若 同時投擲此種硬幣兩枚，則出 現一正一反的機率為何？ (A)(B) (C)(D)

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