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98年 - 98 台灣疼痛醫學會專科醫師考題#122439

科目：台灣疼痛醫學會專科醫師 | 年份：98年 | 選擇題數：50 | 申論題數：0

試卷資訊

所屬科目：台灣疼痛醫學會專科醫師

選擇題 (50)

1. 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。
2. 抗癲癇藥物也是用於治療慢性神經病理性疼痛的主要藥物之一，下列有關於抗癲癇藥物之敘述何 者為非? (A) 所有抗癲癇藥物之作用機轉均為抑制離子通道，而抑制神經之病態性興奮。 (B) Carbamazepine 對於中風後之中樞性疼痛之止痛效果，優於 lamotrigine。 (C) NNT 是用於表示止痛效果的指標，而 NNH 則是用來表示止痛藥物副作用之指標。 (D) Gabapetin 的結構類似 GABA，但卻並不作用於 GABAA 或 GABAB 受體，其主要是作用於鈣 離子通道之次單元，而抑制鈣離子流及興奮性胺基酸之釋放。 (E) 大部分的抗癲癇藥物是以”use-dependent”的方式作用於阻斷鈉離子通道，而產生抑制神經過度 興奮的神經病理性疼痛。
3. 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。
4. A patient had chronic pain over the neck, medial scapula, anterior chest, medial aspect of arm and forearm. Hormer's syndrome was also noted. Which root compression is the most likely？ (A)C5 root compression (B) C6 root compression (C) C7 root compression (D)C8 root compression (E) T1 root compression
5. A patient suffered from chronic low back pain with radiating to buttock, poster lateral thigh and lateral aspect of lower leg. Muscle weakness was observed in the extensor hallucis longus and tibialis anterior. Which lumbosacral root compression is the most likely？ (A) L2 root compression (B) L3 root compression (C) L4 root compression (D) L5 root compression (E) S1 root compression
6.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
7.下列有關針灸的敘述何者正確？ (A)中醫針灸的理論基礎是源起於道教的觀念 (B)目前醫學界認為針灸造成的止痛作用是 placebo effect (C)目前醫學界認為針灸造成的止痛作用主要是 psychological effect (D)針灸對 neuropathic pain 無效益 (E)以上皆正確
8. Which of the following is NOT the acceptable statement about the definition of chronic pelvic pain (CPP) without identified pathology? (A) menstrual pelvic pain of 6 or more months’ duration (B) severe enough to cause functional disability or to require medical or surgical treatment (C) non-opioid analgesics are the typical first step of treatment (D) the use of opioids is controversial (E) the best evidence-based treatment of patients with CPP is multidisciplinary care
9. Visceral pain has the following properties except: (A) It is diffuse and poorly localized. (B) It is referral pain and not felt at the source. (C) It is produced by stimuli different from those adequate for activation of somatic nociceptors. (D) It is characterized by distinct sensations. (E) It is associated with strong emotional and autonomic responses.
10. Allodynia can be defined as: (A) hypersensitivity to a painful stimulus (B) summation of mildly painful stimuli that causes severe pain (C) pain caused by a nonpainful stimulus (D) pain present in an area of numbness
11. A 26-year-old weight lifter felt a sharp pain in the neck, radiating to the dorsal aspect of the forearm during his workout. Over the next few days he noted progressive numbness of the thumb and index finger. He also complained of decreased ability to perform bicep curls. On examination by his primary care doctor, a markedly diminished biceps reflex was found. Which of the following is the most likely cause of the patient’s problem? (A) Facture C5 vertebra (B) C5-C6 disc protrusion (C) Facet syndrome at C5-6 (D) Compression of the C5 nerve root by an osteophyte
12. Ramsay Hunt syndrome (herpes zoster oticus) occurs when herpes zoster involves the: (A) gasserain ganglion (B) geniculate ganglion (C) ciliary ganglion (D) sphenopalatine ganglion (E) trigeminal nerve
13. A 52-year-old man complains of a sudden onset of severe, stabbing pain in the left jaw and cheek that subsides in less than a minute. He is pain-free during the intervals between attacks. Activities such as combing his hair and shaving can cause the onset of this facial pain. He is otherwise healthy. The most likely diagnosis is (A) trigeminal neuralgia (B) atypical facial pain (C) postherpetic neuralgia (D) vascular facial pain
14.疾病和傷害經常造成疼痛及痛覺過敏(hyperalgesia)其中有一部份起源於發炎介質(inflammatory mediators)在週邊神經末稍的作用下影響相關之敘述何者是錯誤的? (A)這些介質除了 arachidonic acid metabolites； bradykinin 還有如 ATP 及 NO 之小分子。 (B)如 TNF，IL1 和 NGF 也和疼痛有關。 (C)可以經由活化 Nociceptive terminals。 (D)可以經由 nociceptors 基因表現的調節。 (E) CNS 無此類發炎介質引起之疼痛作用。
15.下列何者對研究疼痛在腦部的研究所提供的訊息最有限? (A) EEG (B) EP (Evoked Potential) (C) PET (Positron emission tomography) (D) SPECT (Single photon emission computed tomography) (E) fMRI (functional magnetic resonance imaging)
16.在疼痛機轉下行性調控的控制中，下列何者沒有參與其中? (A) Enkephalinergic (B) Serotonergic (C) Cholinergic (D) Noradrenergic (E)以上皆有參與
17. Which of the following statement concerning “autonomic-endocrine-immune interaction in pain” is least likely? (A) Cytokines are involved in the sensitization of nociceptors during inflammation and may lead to hyperalgesia (B) Proinflammatory cytokines are synthesized and released by macrophages and other immune-related cells (C) IL-4 is categorized as an anti-inflammatory interleukin (D) IL-1, IL-10 and TNF-α are categorized as proinflammatory cytokines (E) TNF-α induces synthesis and release of IL-8, which activates sympathetic terminals that synthesize nociceptors via β2-adrenoceptors
18. The formal presentation of Myofascial Pain syndrome diagnostic criteria includes each of the following, EXCEPT (A) Resolution of the symptoms after Trigger Point Injection with local anesthetic (B) Referral pain is evident (C) Twitch response and Trigger Points are the common features (D) Limited ROM of the affected muscle or muscles (E) Widespread body pain
19. The current guidelines on the management of acute low back pain in primary care include the following, EXCEPT (A) Reassure patients because the prognosis is most favorable (B) Advise or encourage complete bed rest (C) Prescribe analgesics medication if necessary (D) Encourage to stay active (E) Consider spinal manipulation (chiropractic) for pain relief
20. Which of the following statement is wrong in Repetitive Strain Injury (RSI) ? (A) Blood flow and temperature of the affected limb will be reduced at rest (B) RSI is a normally preventable condition (C) There is multiple folds increase in blood flow with exercise in the painful limb (D) Peripheral nerve injury is a recognized cause of regional pain (E) Treatment with analgesics is seldom advocated for RSI except for short periods
21. Which statement about “chronic pain and emotion” is wrong? (A) The psychological impact and behavioural course of painful conditions varies among individuals. (B) Chronic pain is always associated with depression. (C) Depression makes social and occupational functioning more difficult and appears to intensify pain. (D) Sleep disturbance is one of the diagnosic criterial for depression.
22. Which statement about pain is wrong? (A) Pain is an objective, perceptual experience. (B) No iso-morphic relationship exits between tissue damage and pain report. (C) One characteristic differentiating pain from pure sensation is its affective and cognitive components. (D) Pain must be viewed as a complex phenomenon that incorporates physical, psychosocial and behavioral factor
23. Physical dependence is defined by the abstinence syndrome (withdrawal), but which item below is NOT included: (A) abdominal cramps (B) restlessness (C) pupil constriction (D) sweating (E) dysphoria
24. Which measurement for pain is seldom used in pediatric patients? (A) Poker Chip Tool (B) Oucher scale (C) McGill Pain Questionnaire (D) Faces Pain Scale - Revised (FPS-R) (E) Neonatal Facial Action Coding System (NFACS)
25. What is the following description about tension-type headache is FALSE? (A) may be associated with stress (B) pain may involve teeth, forehead & neck (C) bilateral (D) associated with vomiting (E) most common in adolescence
26. Which following item is a probably more predictive addiction indicator? (A) Obtaining prescription drugs from non-medical sources (B) Requesting specific drugs (C) Unapproved use of the drug to treat another symptom (D) Openly acquiring similar drugs from other medical sources (E) Aggressive complaining about needing more of the drug
27.下列有關老年病患疼痛問題之敘述何者正確? (A)即使有認知功能障礙的老年病患, 仍應該積極處理其疼痛 (B)慢性疼痛問題在老年人之發生率遠高於年輕人 (C)針對手術後疼痛, 老年病患較年輕病患更常主動表達疼痛問題 (D)老年慢性疼痛病患比年輕病患更容易受到憂鬱的影響 (E)以上皆正確
28.下列有關慢性疼痛的流行病學調查, 何者正確? (A)regional pain syndrome 中最常見的是下肢疼痛 (Lower limb pain) (B)widespread body pain(例如 fibromyalgia) 男性的發生率高於女性 (C)cohort study 與 case-control study 是慢性疼痛流行病學研究適當的研究方法 (D)慢性疼痛議題容易進行 population based 的流行病學調查 (E)以上皆不正確

29.About the following CT-guided intervention, which indication is NOT proper?

(A) Sympathetically maintained pain (B) Reflex sympathetic dystrophy (C) Chronic pancreatitis (D) Raynaud syndrome (E) Failed back surgery syndrome.
30.About the physiologic anatomy of nociception, which one of the following statements is NOT correct? (A)First-order (primary afferent) nociceptive neurons are sensory neurons that are specialized to detect the presence and signal the location, quality, and intensity of tissue-damaging stimuli. (B)The cell bodies of primary afferent nociceptive neurons are located in dorsal root ganglia and trigeminal ganglia. (C)WDR neurons encode the intensity of inputs over the entire range of innocuous and noxious stimuli, whereas nociceptive-specific neurons do respond to innocuous stimuli. (D)After initial synaptic processing at the spinal segmental level, nociceptive information is carried to the brain by direct axonal projections to the thalamus, brainstem and hypothalamus/forebrain. (E)The primary somatosensory cortex (SI) is located in the postcentral gyrus and extends from the interhemispheric fissure to the sylvian fissure.
31.下列對 CRPS (complex regional pain syndrome) 的敘述何者不正確？ (A)有灼熱痛 (burning pain) (B)合併持續疼痛(ongoing pain)及突發性疼痛(breakthrough pain) (C)對嗎啡類止痛藥的反應不錯，常須合併這類藥物使用 (D)疼痛也會合併肌痛點的表現 (E)治療的首要目標為恢復正常生活作息
32.一位末期肝癌疼痛的病患，因口服嗎啡已經造成嚴重的嘔吐，考慮改由脊髓腔內(intrathecal) 持續給藥，因其每天劑量達 600 mg，經換算後脊髓給藥劑量應為每天約： (A) 1 mg (B) 2 mg (C) 6 mg (D) 10 mg (E) 20 mg
33.Nociceptive pain： (A) Occurs only in laboratory animals. (B) Occurs under conditions of normal peripheral and central nervous system function. (C) Typically responds poorly to opioid analgesics. (D) Typically responds poorly to NSAIDs. (E) Typically responds favorably to adjuvant analgesics.
34.局部麻醉劑主要的作用是經由? (A) sodium channel blocking effect (B) potassium channel blocking effect (C) GABA system (D) NMDA system (E) all of above
35.Which of the following statement concerning “central pain” is LEAST likely: (A) Central pain is defined as pain caused by a lesion or dysfunction in the CNS (B) The most common cause is traumatic spinal cord injuries (C) In stroke the onset of pain is early (D) In stroke the pain is most frequently a hemipain (E) Central pain is dominated by abnormalities in the sensibility to temperature
36.A parturitient of heroin abuse history, asking for painless labor, which one is improper? (A) Meperidine (B) Continuous epidural analgesia (C) Nitrous oxide (D) Butorphanol (E) Intrathecal morphine
37.A 61-year-old woman presents to the pain clinic with a chief complaint of left shoulder and arm pain for 3 years after undergoing radiation therapy for breast cancer. Physical examination reveals lymphedema of the left axilla with noticeable skin changes. Examination of the left supraclavicular area precipitates a sharp pain that radiates down her left arm. Which of the following is likely diagnosis for her clinical presentation ? (A) Radiation-induced plexopathy (B)Tumor metastasis (C) Reflex sympathetic dystrophy (D) Cervical radiculopathy (E) Thrombangiitis obliterans
38.Which of the following activities will exacerbate pain the most in an elderly patient with severe spinal stenosis? (A) Walking uphill (B) Walking downhill (C) Riding a bicycle (D) Bending forward Standing
39.Which NSAID has the lowest risk of GI bleeding？ (A) Ibuprofen. (B) Diclofenac. (C) Indomethacin. (D) Piroxicam. (E) Ketoprofen.
40.就 step-wise approach of chronic pain 的處置流程而言，Pulsed radiofrequency 最早適合於哪一步驟之 前？ (A) Physical therapy (B) Peripheral analgesia (C) Weak opioids (D) Strong opioids (E) Intrathecal opioids
41.有關癌症患者的疼痛治療，下列何者正確？ (A)約有 6~7 成疼痛是來自腫瘤直接侵犯造成 (B) cancer therapy 造成的疼痛很少見 (C) NSAID 是屬於第二線用藥 (D)physical modality 中熱療及電療為絕對禁忌 (E) 為避免 tumor spreading，手術止痛不予採行
42.癌症病人，因病灶刺激橫膈膜，何部位會有 referred pain？ (A)肩胛骨中間 (B)肩膀 (C)耳朵 (D) 鼠蹊部 (E) 膝關節
43.以下有關於癌症病人疼痛治療的敘述，何者正確？ (A)應優先使用注射方式給藥 (B) 應優先使用非鴉片類止痛藥 (C) 應優先使用短效藥物 (D)物理治療通常對急性疼痛無效 (E) 應單獨使用鴉片類藥物，不需和其他藥物併用
44.下列何種慢性疼痛病患接受 spinal cord stimulation 的治療效果最好？ (A)refractory angina pectoris (B) complex regional pain syndromes (C) phantom pain (D) postherpetic neuralgia (E) complete nerve root avulsion
45. All if the following are red flags in patients with low back pain, EXCEPT: (A)History of prolonged corticosteroid use (B) Saddle anesthesia (C) Age of 36 years (D) Urine retention (E) Bowel incontinence
46. therapeutic plasma concentrations of a passive fentanyl patch 多於貼上皮膚後多久達成? (A)12-24 hours (B)＜ 12 hours (C) ＜ 8 hours (D)＜ 4 hours (E) ＜ 2 hours
47.Celiac Plexus 的解剖位置 (A) L1 (B) T10 (C) T6 (D) L4 (E) T8
48.關於 Tramadol，下列何者有誤? (A) 有鎮咳的作用 (B) 對 mu receptor 有親和力(Affinity) (C) 呼吸抑制作用很少，為其優點 (D) 具止痛作用可完全被 Naloxone 拮抗
49.使用硬脊膜外麻醉來減輕第二產程疼痛時，必須阻斷至哪一節神經 (A)T11-T12 (B) S2-S4 (C) L3-L4 (D) T10-L1 (E) L2-L4
50.對於一位腎衰竭的病患，為瞭解其股骨骨折產生的急性疼痛，下列何種藥物不適合此病患？ (A)Morphine (B) Codeine (C) Hydromorphine (D)Meperidine (E) Fentanyl

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