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

1. Which of the following is the unacceptable statement about peripheral nerve block? (A) Post-amputation pain can be easily treated by analgesia (B) Phantom pain may enhance with time (C) Phantom pain is the painful sensations referred to the amputation stump (D) Pre-amputation pain increases the risk of phantom pain (E) Phantom pain can be prevented by a preoperative epidural blockade

2. About image-guided lumbar sympathetic block, which the following indication is not proper? (A) Sympathetically maintained pain (B) Reflex sympathetic dystrophy (C) Phantom low limb pain (D) Raynaud’s disease (E) Chronic pancreatitis

3. Predictive factors for development of chronic pain include the following item? (1) moderate to severe preoperative pain, (2) an operation with risk of nerve damage, (3)the intensity of acute early postoperative pain (4) female patients. (A) all of the above are all risk factors (B) (1)+(2)+(3) (C) (1)+(2) (D) (4) (E) none of them

4. Choice a right description about limb pain after surgery: (A) Phantom pain is experienced only about 5-10% of cases. (B) Phantom pain may initially magnify but seldom fade over time. (C) Neural blockade has no effect on the incidence of phantom limb pain. (D) Stump pain is usually the result of neuroma at the site of nerve transection and characterized by dysesthesia. (E) None of above is right

5. Choice a right equianalgesic factors compared to subcutaneous morphine. (A) Morphine (oral) 0.50 (B) Codeine (oral) 0.20 (C) Alfentanil (subcutaneous) 1.0 (D) Oxycodone (parenteral) 5.0 (E) None of above is 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.

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.

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