55. 請問執行in-plane approach之interscalene block到位時，局部麻藥於何解剖位置spreading？
(A) middle scalene and posterior scalene muscles
(B) anterior and middle scalene muscles
(C) anterior and posterior scalene muscles
(D) anterior scalene and sternocleidomastoid muscles

51. 體外循環期間利用ACT(Activated clotting time)監測肝素(Heparin)的效用，下列敘何者正確? 1. Hemodilution會延長ACT 2. Hypothermia會延長ACT 3. Thrombocytopenia會延長ACT 4. Platelet lysis會延長ACT 5. Surgical stress會縮短ACT (A) 1+2+3 (B) 1+3+5 (C) 1+3+4 (D) 1+2+3+5 (E) 1+2+3+4+5

52. 下列對awake craniotomy的敘述何者不正確? (A) 神經外科醫師局部麻醉的技術在awake craniotomy相當重要 (B) 局部麻醉技術除pin site infiltration外，也可以做nerve blocks (C) 麻醉醫師對病人的不確定呼吸道及有限的處置呼吸道的空間，必須有處理轉換成全身麻醉之準備，神經外科醫師也必須配合。 (D) 可靠的capnography(監測吐氣CO2)，不能提供確定呼吸次數，所以不需要

53.  請問執行in-plane approach之ilioinguinal nerve block到位時，局部麻藥於何解剖位置spreading？ (A) internal oblique muscle and transversus muscle (B) internal oblique muscle and external oblique muscle (C) transversus muscle之下 (D) external oblique muscle之上

54. 在 Regional Block中，下列何者之anatomic variation 之incidence最低？ (A) Duplicate axillary vein (B) Persistent median artery (C) Cervical rib (D) Sciatic nerve division by piriformis

56. 執行supraclavicular block時可能發生一些adverse effects，下列何者錯誤? (A) Phrenic nerve block發生率約為40-60% (B) 神經阻斷後病人有可能會發生Horner’s syndrome (C) Pneumothorax也是可能的complication之一 (D) 肥胖會增加施打的困難程度 (E) 肥胖會增加施打後complication的發生機會

57. 下列關於小兒區域麻醉的描述, 何者錯誤? (A)小孩的spinal cord和dura sac位置比成人低 (B)小孩的神經纖維隨鞘化尚未發育完全, 因此局部麻醉藥物的onset時間較短(C)兩側iliac crests連線的高度約在L4-L5, 是施行區域麻醉的重要指標 (D)小孩的硬脊膜外麻醉所需的局部麻醉藥物劑量較成人大

58. 關於脊髓麻醉穿刺後頭痛(post–spinal puncture headache)之影響因素何者為非: (A) 年輕女性 (B) 懷孕 (C) 穿刺針的針面方向 (D) 術後活動時機

59.  下列的敘述何者有誤? (A) Diaphragmatic paresis occurs in 100% of patients undergoing an interscalene block, even with dilute local anesthetic solutions (B) 於產生high spinal anesthesia之patients常會有呼吸困難、吸不到氣之抱怨,主因乃源於 significantly decreased inspiratory capacity (C)較好的loss-of-resistance technique 方式為Air in normal saline [3- to 5-mL glass syringe filled with 2 mL of saline and a small (0.25-mL) air bubble] (D). Continuous spinals 並不會增加 Post–spinal Puncture Headache 之機率 (E) Timing of ambulation與增加 Post–spinal Puncture Headache之關連性不大。

60. 下列有關Ultrasound Guidance for Regional Anesthesia的敘述而者有誤? (A) Anisotropy is the change in echogenicity with inclination of the transducer (B) In the infraclavicular region, reverberation artifact deep to the axillary artery can be mistaken for the medial cord of the brachial plexus (C) Brachial Plexus的排列順序(From central to peripheral):Roots→Trunks→Divisions→Cords→Nerves (D) The ideal place for local anesthetic distribution to achieve complete infraclavicular block is posterior to the axillary artery for single shot or catheter placement. (E) Power Doppler is less angle dependent and not subject to aliasing

61. 下列的敘述何者有誤? (A) Tramadol 同時兼具有inhibition of noradrenaline reuptake 及opioid agonist effects (B) Naloxone is a nonselective antagonist at all three (u, δ, κ) receptors (C) 當施行epidural block 若產生遲發性(a delay of 15 to 30 minutes ) 且 higher than expected block develops 時 intrathecal subdural placement of local anesthetic must be considered. (D) Opioid tolerance to respiratory depression, sedation, and nausea often develops faster than tolerance to constipation or miosis (E) Selective COX-2 inhibitors confer an increased risk for thrombosis, myocardial infarction, renal impairment, hypertension, stroke, and liver toxicity。