13. 下列何者 opioids 及其活性代謝物之血漿半衰期(T1/2)最長？
(A) Morphine
(B) Hydromorphone
(C) Fentanyl
(D) Nalbuphine
(E) levophenol Meperidine 5%

14. 下列何者不適合用於 intrathecal route 治療 neuropathic pain 的第一線用藥？ (A) morphine (B) ziconotide (C) hydromorphine (D) baclofen

15. 有關局部麻醉藥，下列何處注射之後之系統性吸收最慢？ (A) intravenous (B) Intercostal (C) Caudal (D) Epidural (E) Sciatic

16. The criteria to classify a neuron as a nociceptor include (A) The presence or absence of axon myelination, cell size, and/or cell content (e.g., peptide or ion channel) as well as central termination pattern. (B) Sensory neurons commonly identified as nociceptors are those with unmyelinated (C-fiber) axons, small cell body diameters (＜20 or 25 μm), that terminate in the superficial layers of the spinal cord dorsal horn. (C) The presence or absence of certain markers (e.g., the tetrodotoxin (TTX)-resistant sodium channel NaV1.8, the transient receptor potential vanilloid receptor TRPV1) have been used to identify subsets of nociceptors. stimuli, such as during prolonged application of opioids or on abrupt withdrawal of opioids.. (D) More recently, with the ability to analyze many genes expressed in a single cell, patterns of gene expression have been used to further define subpopulations of nociceptors. (E) All of the above.

17. Which one of the following statement is wrong? (A)The spinal cord and brainstem nuclei are home to second-order neurons, the first step of central nervous system (CNS) processing. (B) A proto-oncogene, c-fos, is activated after potentially tissue-damaging stimuli are applied to most tissues. (C) A systematic comparison study of Fos and pERK as markers of spinal nociceptive activation revealed greater specificity for activity in nociceptive pathways (vs. non-nociceptive activation) using Fos. (D) The spinal cord is segregated into areas that, on gross examination, appear as white and grey matter and consist of predominantly myelinated nerve fiber tracts and cell bodies, respectively. (E) Using Rexed’s cytoarchitecture-based classification system, there are at least 10 different layers or laminae of neurons—of which the first six (I to VI) are termed the dorsal horn of the spinal cord .

18. Which one of the following statement is correct? (A) Changes in excitability occur in second-order neurons when repetitive or prolonged high-intensity input is received from primary afferent C-fibers. (B) A characteristic of spinal nociceptive systems is that they are under tonic descending inhibition such that a common effect of injury to spinal pathways is a release from this inhibition. (C) The midbrain periaqueductal grey (PAG) and the rostral ventral medulla (RVM), in particular the medullary nucleus raphe magnus (NRM) figured prominently in the original analyses of descending modulation of pain. (D) Stimulation of both somatosensory cortex (SSC) and motor cortex (MC) have been used in the clinical treatment of neuropathic pain, central poststroke pain, and phantom limb pain. (E) All of the above are correct.

19. 關於熱療於治療疼痛的敘述何者有誤? (A) 熱療可以促使組織修復與改變急性疼痛感知 (B) 熱療時，會促使局部組織的血氧分離曲線(oxyhemoglobin dissociation curve)往左偏移合 併局部溫度微上升，使得局部氧氣供應增加 (C) 熱療可使局部疼痛閥值(nociceptive threshold)上升 (D) 局部組織溫度要達到有效治療，一般範圍大致在攝氏 40-45 度 (E) 熱療也會透過間接效應影響交感神經對於血管收縮舒張的控制，來達到對於疼痛的影 響

20. 叢發性頭痛(cluster headache)急性發作時，下列何種藥物不具治療角色? (A) 皮下注射 sumatriptan (B) 經鼻給予 zolmitriptan (C) 經鼻給予 lidocaine 至翼齶窩（pterygopalatine fossa） (D) 靜脈注射 dihydroergotamine (E) 口服 verapamil

21. 下列何者不是偏頭痛（migraine）常見症狀？ (A)單側性疼痛 (B)搏動性疼痛 (C) 痛到眼窩後方 (D) 噁心嘔吐 (E) 對光與聲音敏感

22. 治療 Postamputation pain 下列用藥，何者最不適合？ (A) Imipramine (B) Gabapentine (C) Pregabalin (D) Memantine (E) Tramadol

23. 有關 Post-Herpetic neuralgia (PHN) 導致相關症狀，下列何者描述最不適合？ (A) Ongoing pain at rest (B) Brush-evoked pain (C) Joint hyperalgesia (D) Heat-hyperalgesia (E) Cold-hyperalgesia

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