10. Adjuvant analgesics are often prescribed for managing caner pain, but which of the following drug – indication is not considered ?
(A) NSAIDs for Soft tissue pain
(B) Anticonvulsants for Neuropathic pain
(C) Steroids for Soft tissue pain
(D) Baclofen for Muscle spasm
(E) Benzodiazepines for Muscle spasm

6. Which one of the following statements is wrong? (A) Neuron–glial interactions are increasingly recognized as being key for physiological and pathological processes in the central nervous system. (B) Microglia in the spinal dorsal horn respond to injury to peripheral nerves by adopting a specific response state characterized by up-regulation of the purinergic receptor P2X4. (C) In this P2X4R+ state, microglia release brain-derived neurotrophic factor, which disinhibits neurons in the spinal nociceptive processing network. (D) The transformation in processing caused by signaling of P2X4R+ microglia to nociceptive transmission neurons may account for the main symptoms of neuropathic pain in humans. (E) All of the above are correct.

7. Which one of the following statements is wrong? (A) The spinal dorsal horn receives input from a wide variety of primary afferent axons, including nociceptors, which respond to tissue-damaging stimuli from the skin, muscles, joints, and viscera. (B) The patterns of termination of primary afferents within the spinal cord are related to axonal diameter and receptive field modality. (C) Most nociceptive primary afferents have slowly conducting fine myelinated or unmyelinated axons, and they terminate mainly in the deep part of the dorsal horn. (D) Primary afferents release a variety of chemical mediators and on entering the dorsal horn they form excitatory synapses with neurons located within it.

8. Which of the following description about spinal cord plasticity and pain is incorrect? (A) Some spinal nociceptive neurons receive convergent input from high- and low- threshold sensory fibers thus called wide–dynamic range neurons (B) Glutamate is the major fast excitatory neurotransmitter in all nociceptive afferent nerve fibers. Glutamate can bind to three types of ionotropic glutamate receptors and to G protein–coupled metabotropic glutamate receptors to modify neuroexcitability. (C) Hyperalgesia and allodynia can even be induced in humans in the absence of any sensory stimuli, such as during prolonged application of opioids or on abrupt withdrawal of opioids.. (D) Spinal nociception is under powerful control from descending inhibitory and facilitatory pathways. Under normal conditions, descending facilitation appears to prevail over inhibitory pathway.

9. About epidural steroid injection, which one of following statements is wrong? (A) Spinal stenosis is an indication for epidural steroid.. (B) Do not use for non-specific low back pain. (C) Do not repeat more than three times per year. (D) May cause pain from chronic arachnoiditis. (E) Efficacy is less with radicular pain that has lasted longer than 3 months.

11. The innervation of deep somatic tissue like muscle and joint is quite complex. Which of the following description is not appropriate? (A) The nociceptors are predominantly activated by non-physiological stimuli which may cause damage to the structures (e.g. overload, twisting, strong pressure, ischemic contraction). (B) During inflammation or after trauma, nociceptors of joint and muscle show pronounced sensitization, in particular for mechanical stimuli. (C) Descending inhibition is enhanced during chronic inflammation but seems to be normalized during acute inflammation. (D) Both primary afferent fibers as well as sympathetic reflexes may aggravate inflammatory lesions. (E) Reduced release of hormones from the hypothalamic-pituitary-adrenal (HPA) axis such as cortisol, adrenal androgens and testosterone may cause a relative loss of anti-inflammatory activity.

12. Pain disorder may result in the sleep problem, and which of the sleep pattern is not often seen in patients: (A) acute pain following surgical procedures is associated with reduced and fragmented sleep (B) acute postsurgical pain may result in diminished amounts of slow wave and rapid eye movement (REM) sleep (C) patients with chronic pain may suffered from reduced sleep efficiency and altered sleep architecture (increased wakefulness and stage 1 non-REM sleep) (D) subjects subjected to noxious stimuli during all stages of sleep will demonstrate a sleep awakening response and a moderate level of cortical arousal. (E) all of the above are common found in pain patients

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

14. 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

15. 有關 Post-stroke pain 之疼痛症狀類型中，下列描述何者最不適合？ (A) Central post-stroke pain 屬於 neuropathic type (B) Shoulder pain 不屬於 neuropathic type (C) Musculoskeletal pain 不屬於 neuropathic type (D) Headache 屬於 neuropathic pain (E) Spasticity 不屬於 neuropathic type

16. 有關 Common Types of Acute and Chronic Neuropathic Pain 下列敘述，何者最不適合？ (A) Trigeminal neuralgia (TN)(tic douloureux) 屬於 central neuropathic pain (B) Compressive myelopathy from spinal stenosis 屬於 central neuropathic pain (C) HIV myelopathy 屬於 central neuropathic pain (D) Multiple sclerosis-related pain 屬於 central neuropathic pain (E) Syringomyelia 屬於 central neuropathic pain