10. Which of the following description about cancer pain mechanism is wrong, ( if ABCD are all right , choice E)?
(A) Ischemia is involved in cancer pain mechanism.
(B) Tumor-induced release of protons is one of the possible mechanisms of cancer pain.
(C) Nerve growth factors (NGF) is involved in some cancer pain mechanism.
(D) Cyclooxygenase (COX) is not involved in cancer pain mechanism.
(E) All the above descriptions are right.

6. 主導 prostaglandin 代謝之 COX-2 enzyme 存在於？ (A) inflammatory cells (B) female reproduction organ (C) brain (D) kidney (E) all of above

7. 下列哪一項病人可能的主訴，較不屬於神經病變性疼痛的症狀： (A) Ongoing pain, touch-evoked pain (B) Tingling, spontaneous pain (C) Pin-prick hyperalgesia, burning sensation (D) Numbness, edema, trophic changes (E) Joint stiffness, soreness, pulling

8. Peripheral nerve injuries are often associated with neuropathic pain. Which of the following statement is least likely: (A) Nerve injury causes sprouting (or phenotypic changes) of large-diameter primary afferents from the deep dorsal horn into lamina I & II. (B) The cholera toxin B subunit is the primary marker used for sprouting of injured primary nerves. (C) During inflammatory pain, the dorsal root ganglion in the involved nerve show similar changes as seen in neuropathic pain. (D) Peripheral nerve injury may cause ongoing activity and after-discharges. (E) The overall increased excitatory drive may be combined with a compromised inhibitory control in the dorsal horn.

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. Nerve blocks at the ankle include following nerves except (A) sural nerve (B) saphenous nerve (C) cluneal nerve (D) tibial nerve (E) superficial and deep peroneal nerve

12. 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。

13. 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) 20 mg (B) 10 mg (C) 6 mg (D) 2 mg (E) 1 mg

14. 當病人一再來門診或急診要求注射成癮性止痛藥時，下列哪些現象暗示病患可能有「成癮」 現象? (A) 病人抱怨最近的處方的止痛時間不夠久，藥效變差。 (B) 病患抱怨最近疼痛加重厲害，發作頻繁，他把三天的藥一天吃完。 (C) 病患自述出現嗜睡、噁心、性慾降低、便秘，但是疼痛都沒有減輕。 (D) 病人自述沒吃止痛藥會睡不著，希望睡前加重劑量輔助睡眠。 (E) 病人最近反覆敘述藥物遺失，而且發生很多次。

15. 主導 prostaglandin 代謝之 COX-1 enzyme 存在於？ (A) most tissues (B) platelet (C) G.I. tract (D) kidney (E) all of above

16. Which one of the following intervention provides the worst therapeutic effect of pain relief for lumbar spinal radicular pain? (A) transforminal epidural steroids injection (B) radiofrequency denervation (C) spinal cord stimulation (D) lumbar sympathetic block (E) caudal steroids injection