10. Which of the following statement concerning the assessment of cancer pain is least likely:
(A) A high pain prevalence of 50-70% among patients with newly diagnosed cancer.
(B) Bone metastases are the most common cause of chronic pain in cancer patients.
(C) The vertebrae are the most common sites of bony metastases.
(D) Epidural compression of the spinal cord is the second most common neurological complications of cancer.
(E) The cause of under-treatment of cancer pain is inadequate assessment.

6. Following statements about anticonvulsants in neuropathic pain is wrong: (A) Carbamazepine provides satisfactory pain control in trigeminal neuralgia (B) Tolerability is better with oxcarbazepine compared with carbamazepine (C) Lamotrigine reduces pain intensity in HIV neuropathy (D) Gabapentin directly modifies sodium channel currents (E) Gabapentin improves postherpetic neuralgia.

7. Which of the following statement concerning the cause of cancer pain is least likely? (A) Vanilloid receptor TRPV1 is expressed in most nociceptors, it detects heat and extracellular protons. (B) In order to detect noxious mechanical stimuli, nociceptors express mechanically gated channels that initiate a signally cascade upon excessive stretch. (C) Low pH can activate acid-sensing ion channel-3 (ASIC-3). (D) Tumour cells can release protons and produce local acidosis. (E) TRPV1 is activated when the pH rise above 6.0.

8. Which of the following statement concerning the treatment of cancer pain is least likely? (A) Obeying the principles of the analgesic ladder approach, 71% of patients will achieve good pain relief without further intervention. (B) Oral morphine remains the drug of choice according to the analgesic ladder of the WHO. (C) The most common use of radiotherapy is for metastases abdominal pain. (D) The patient with advanced cancer is in the dynamic state with changing pathology. (E) About 60% of patients who receive radiotherapy will achieve at least 50% pain relief.

9. Which of the following statement concerning the pain in the elderly is least likely? (A) The elderly are less likely than younger patients to report pain associated with acute pathology. (B) The prevalence of chronic pain appears peaked at late-life. (C) Among chronic pain patients, there may be a change in the quality but not the intensity of chronic pain with age. (D) The affective and cognitive components of pain do not appear to be age related. (E) Pain in the elderly is often undertreated, which may be due to the increased risks associated with pharmacotherapy in this group.

11. Which of the following is the unacceptable statement about postoperative pain related to acute pain mechanisms? (A) A decrease in the nociceptor threshold is due to changes in the transducers themselves (autosensitization). (B) An increase in the excitability of the terminal membrane is initiated by sensitizing agents (heterosensitization). (C) Enhanced responsiveness of central pain transmission neurons is due to wind-up. (D) Enhanced responsiveness of central pain transmission neurons is due to facilitated synaptic responses. (E) Enhanced responsiveness of central pain transmission neurons is due to increase inhibition.

12. Which of the following statement concerning the epidemiology of pain is least likely? (A) In adult, the most common regional pain syndromes are those of low back, hip and shoulder pain. (B) Higher prevalence rates are noted in women who report more severe and persistent pain. (C) Abdominal pain predominates at older ages, while oral and facial pain among young adults. (D) Social disadvantages also characterize persons at increased risk of pain. (E) Mechanical factors are important in the development of back pain and extremity pain.

13. 下列關於 placebo analgesia 的敘述何者錯誤? (A) 暗示、建議、期待、或制約(conditioning)都是增強 placebo analgesia 的重要因素。 (B) 與 placebo analgesia有關的生理結構可能是1 有關的生理結構可能是limbic system(包括amygdala, ventral striatum, anterior cingulate,和prefrontal cortex)。 (C) 在不同疼痛模型,出現Placebo effect 比率的人數(responder)不同；在拔牙後疼痛實驗佔 20%,在止血帶誘發疼痛低於10%。 (D) 不同疼痛模型,placebo analgesia 在VAS的強度也不同；如拔牙後疼痛實驗 responder 與 non-responder 可以相差到5分。 (E) Nocebo 與 placebo相反,是指經過治療(處理)後,結果反而無效或是疼痛加劇；例如利 用暗示,使原本有效的N2O拔牙止痛,變得更痛。

14. 某個止痛藥物實驗,利用實驗性疼痛(如:止血帶誘發缺血性疼痛)檢測此藥物的真實止痛效果,並需要看出 placebo effect。其結果如下圖:A代表正常情況下的疼痛方式,B代表經藥物作用結果。請問下列實驗設計相關的敘述,何者正確:(A) 其分組設計是:a:不治療組(no treatment), b:偽藥組(sham), c:給藥組 (B) 其分組設計是:a:偽藥組, b:低劑量給 藥組, C:高劑量給藥組 (C) 其分組設計是:a:給痛藥+拮抗藥物組, b:偽藥組,C:給藥組 (D) 真正的止痛作用(active effect)為區塊1 (E) 其中 placebo effect 為區塊2

15. 關於嗎啡類藥物成癮的機轉敘述,下列何者錯誤: (A)大腦中 ventral tegmental area (VTA)及nucleus accumbens (NA)為最重要影響腦區 (B) 此兩個腦區藉由系統中的mesolimbic pathway 連接 (C)與神經傳遞物血清素(serotonin)的分泌有關 (D) 此中樞神經網路代表了動物行為的「獎懲系統」(reward system) (E) 與酒精成癮的機制是同一套神經興奮系統

複選題16. 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)病人自述出現嗜睡、噁心、性欲降低、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