13. 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.

9. Which one of the following is not transmitter present in primary afferents and spinal dorsal projection neurons? (A) Glutamate (B) GABA (C) Substance P (D) Glycine (E) NMDA

10. Which one of the following does not belong to opioid receptor gene family? (A) MU (B) DELTA (C) KAPPA (D) Cannabinoid receptor (E) ORL1

11. Which one of the following is not the common adverse effect of opioid?(A) Nausea (B) Agitation (C) Cognitive impairment (D) Miosis (E) Constipation

12. 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.

14. 下列何者是研究 neuropathic pain 機轉常用的 animal model? (A) Complete Freund's adjuvant intraplantar injection (B) Colonic balloon distension (C) Intraplantar fomalin injection (D) Sciatic nerve chronic constriction injury (E) Intraosseous tumor cell injection

15. 下列在 pain hypersensitivity 的 pathogenesis 有關 microglia 的敘述何者錯誤? (A) microglia 在 peripheral nerve injury 後的早期,就會被 activate 而釋放 proinflammatory cytokines (B) Microglia 在 spinal cord dorsal horn 中的數量,會在 peripheral nerve injury 後增加 (C) Pain hypersensitivity state 時 microglia 會 release CX3CL (fractalkine)作用在 neuron 上增加 neuronal excitability (D) neuropathic pain state 時 microglia 的 P2X4receptor 會 upregulation (E) microglia activation 的 process 與 p38 Mitogen-Activated Protein Kinase 的 phosphorylation 有關,可以 turn on downstream 的 signal

16. 下列哪一個腦區與疼痛的情感面向最相關 (A) Ventrolateral Thalamus (B) Anterior Cingulate cortex ACC (C) Insular cortex IC (D) Secondary motor cortex M2 (E) Primary sensory cortex S1

17. A patient with recent leg amputation presents with pain at the site of the stump. Which of the following statements about stump pain is FALSE? (A) The incidence of severe pain is probably seen in only 5-10% of cases. (B) It is present in the majority of patients with phantom pain. (C) It is present in the first week after amputation and always subsides with surgical healing. (D) It can be associated with sensory abnormalities. (E) All of the above are true.

18. Which patient with complex regional pain syndromes (CRPS) is most likely to have the worst outcome? (A) Patient who had a fracture leading to CRPS (B) Patient who had a nerve injury in the lower extremity with warm CRPS (C) Patient who had a nerve injury in the upper extremity with cold CRPS (D) Patient who had a nerve injury in the upper extremity with warm CRPS (E) Patient who has depression disorder

19. Which of the following is true of typical trigeminal neuralgia? (A) It is associated with masseter muscle weakness. (B) It is characterized by episodic bursts of bilateral, severe, lancinating pain lasting 30-60 minutes. (C) There is an absence of sensory deficits. (D) Tricyclic antidepressants are considered first-line therapy. (E) It is associated with visual changes.