25. 下列哪種癌症病人最不易出現骨骼轉移的疼痛？
(A)乳癌
(B)前列腺癌
(C)肺癌
(D)肝癌

26 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。

27. 類鴉片藥物目前仍是臨床上用於疼痛控制的最主要藥物，以下有關於類鴉片 藥物使用之注意事項何者為是? (A) 類鴉片藥物是作用於類鴉片受體而產生止痛作用，各受體間有 Cross tolerance 存在，故使用 opioid rotation 和替代性並不能降低其相關之副作 用 並增強其止痛效果。 (B) 慢性疼痛病人在使用嗎啡時最擔心的就是所謂的被貼標籤(stigmatization)。 (C) 長期使用嗎啡時，其代謝產物 M6G 具有止痛作用，而另一代謝產物 M3G 則會產生副作用。 (D) Buprenorphine 的 first pass 較低，故口服錠效果佳。 (E) Codeine 之主要作用是經由肝臟之 glucuronidation、N-demethylation 和 D-demethylation 而轉化成約 2-10％的嗎啡而產生止痛作用。

28. Which of the following treatment is NOT the indication for limbs pain induced by increased spasticity after C7 incomplete spinal cord injury? (A) Joint positioning and range-of-motion (ROM) exercises. (B) Treat underlying spasticity-triggering events (infection, pressure ulcer, etc). (C) Serial casting or dynamic splinting to relieve already-occurred contractures. (D) Oral narcotics, like codeine or tramadol. (E) Anti-spasticity blocks via Botulinum toxins, phenol, or ethanol.

29. Which one of the following neuropathic pain conditions is not likely responded to spinal cord stimulation? (A) CRPS type I (B) CRPS type II (C) Central post-stroke pain (D) occlusive peripheral vascular disease (E) diabetic neuropathy.

30. In neuropathic pain, the hyperexcitability demonstrated by wide-dynamic range cells in the dorsal horns seems to be related to increase basal release of excitatory amino acids, such as (A) glutamate. (B) GABA. (C) dopamine. (D) acetylcholine (E) norepinephrine.

31. A typical symptoms of a) myocardial ischemia； b) dyspnea on exertion； c) ST segment elevation or depression in the ECG； d) Q wave in the ECG. The above items included in criteria for acute myocardial infarction are: (A) a and b (B) a, b, and c (C) a, c, and d (D)b, c, and d (E) all of them

32. Which of the following statement concerning hypnotic analgesia is least likely: (A) Hypnosis has been highly associated with theta activity (4~8 Hz) using EEG methods. (B) Increases in hypnotic relaxation are associated with increases in regional cerebral blood flow in the occipital cortex. (C) Deep relaxation, dissociated imagery and focused analgesia produced significant reductions on all pain-related measures. (D) Hypnotic analgesia can be understood as the result of a placebo manipulation, and it is not more than just relaxation. (E) Descending projections from amygdale, PAG and locus coeruleus contribute to modulate nociceptive processes in the brain stem and the spinal cord

33. Which following item is not a criterion for the diagnosis of migraine? (A) Throbbing/stabbing quality (B) Aggravation by or causing avoidance of routine physical activity (C) Unilateral location (D) Moderate or severe pain intensity (E) All are criteria for diagnosis of migraine

34. Which of the following is the unacceptable statement about paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) : (A)To treat acute postoperative pain and in the chronic situation for treatment of osteoarthritis, there are differences in efficacy between NSAIDs and paracetamol. (B) To treat acute postoperative pain and in the chronic situation for treatment of osteoarthritis, the efficacy of classical NSAIDs and Coxibs (cyclooxgenase-2-inhibitory non-steroidal anti-inflammatory drugs) is similar. (C) If oral NSAIDs are taken for at least 6 months, the risk of an endoscopic ulcer is 1 in 5, of a symptomatic ulcer is about 1 in 70, of a bleeding ulcer is about 1 in150, and of a death from a bleeding ulcer about 1 in 1300. (D)Coxibs reduce the gastrointestinal bleeding risk compared with NSAIDs. The risk of congestive heart failure is twice as high with chronic NSAID therapy, and increases to over 20 in patients with a previous history. (E) Paracetamol acts as a Cox inhibitor in the brain, explaining both its analgesic and its antipyretic actions

35. Which of the following is the acceptable statement about the local anaesthetic blocks and epidurals? (A) In the management of chronic pain, diagnostic nerve blocks may help in locating the origin of pain, but are unreliable as prognostic aids for neurolytic or neurodestructive procedures. (B) Pain originating from malfunctioning CNS pain modulation may also be relieved by a peripheral nerve block. (C) Epidural local anaesthetic blocks cannot reliably predict the effect of spinal cord stimulation. (D)“Pulsed radiofrequency” treatment: lower temperature applied； less effective； fewer adverse effect compared with conventional radiofrequency denervation. (E) All of the above

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