14.對於幻肢痛的預防與治療下列何者為正確？
(A)周術期使用硬膜外注射、周邊神經導管止痛等等方式可完全避免幻肢痛
(B)若發生僅需選擇一種病患認為最有效的治療即可，無須使用多模式治療
(C)抗憂鬱藥、抗癲癇藥、opioid 與 ketamine 都是藥物治療的選項
(D)脊隨神經刺激器(SCS)，用於幻肢痛完全沒效果

1.Which of the following drug is categorized as Agonist-Antagonist and should "Not" be used in opioid tolerant patients. (A) Morphine (B) Tramadol (C) Nalbuphine (D) Hydromorphone (E) Methadone

2. Which one of the following nociceptors is confirmed by microneurography with psychophysical experiments? (A) Rapidly adapting (flutter, vibration) and slowly adapting (pressure) cutaneous echanoreceptors, (B) Aδ-mechanonociceptors (AM [mechano]； sharp pain), (C) C-polymodal nociceptors (CM [mechano] H[heat]； dull, burning [heat] pain), (D) Muscle nociceptors (cramping pain). (E) All of the above

3. Which of following description about opioid receptors is "Incorrect" ? (A) Opioid receptors belong to the superfamily of G protein–coupled receptors (GPCR) (B) Opioid receptors are coupled to Gs protein to trigger downstream signaling. (C) Overall opioid receptor activation leads to inhibit neuronal activity (D) In spinal cord level, opioid receptors are located mostly in the superficial dorsal horn (E) Endogenous opiates maybe released by immune cells and work on both central and peripheral opioid receptors.

4. Which of following description about non-steroidal anti-inflammatory drugs (NSAIDs) pharmacology is "Correct"? (A) NSAIDs work by inhibiting the inflammation associated enzyme cyclooxygenase and lipoxygenase (B) Perioperative use of NSAIDs will not increase the risk of surgical site bleeding (C) NSAIDs will not have drug-drug interaction with anticoagulant (such as warfarin) (D) Cyclooxygenase-2 (Cox-2) is the inducible isoform of cyclooxygenase but is constitutively expressed in certain tissues such as brain and kidney (E) Compared with non-selective NSAIDs, long term use of Cox-2 inhibitors will significantly reduce the risk of serious cardiovascular events, renal failure or congestive heart failure.

5. Which of following description about using anticonvulsants (used as Analgesic Drugs is "Correct"? (A) Most commonly used anticonvulsants as analgesics appear to work through potentiation of voltage-gated sodium and calcium channels (B) Sodium channel subtype 1.4 &1.5 are highly expressed in neuronal cell and could be the drug target for anticonvulsant medication (C) Gabapentinoid (Gabapentin & Pregabalin) works on GABA receptor (D) Topiramate works only on voltage-gated sodium channel (E) Lamotrigine and Phenytoin work on voltage-gated sodium channels Ans: E Chap 35&36

6. For peripheral pain mechanisms and nociceptor sensitization, which one of the following statement is wrong? (A) Sensory neurons commonly identified as nociceptors are those with myelinated (A-fiber) axons, big cell body diameters (＞ 50 μm), that terminate in the deep layers of the spinal cord dorsal horn. (B) The presence or absence of certain markers (e.g., the tetrodotoxin (TTX)-resistant sodium channel NaV1.8, the transient receptor potential vanilloid receptor TRPV1) have been used to identify subsets of nociceptors. (C) More recently, with the ability to analyze many genes expressed in a single cell, patterns of gene expression have been used to further define subpopulations of nociceptors. (D) With respect to cell body size and myelination, it should be appreciated that there exist some large diameter cells with heavily myelinated and rapidly conducting axons that have been documented functionally to be nociceptors. (E) Many non-nociceptors have unmyelinated axons, and thus, axon myelination or cell diameter cannot be applied as reliable criteria to define a nociceptor.

7. For substrates of spinal cord nociceptive processing, which one of the following statement is wrong? (A) The dorsal root ganglion and brainstem nuclei are home to second-order neurons, the first step of central nervous system (CNS) processing. (B) Although it seems like a simple statement that pain-related second-order neurons are the neurons which receive primary afferent input related to tissue damage (i.e., from nociceptors), it must be accepted that this statement may or may not be wholly true because in certain pathologic states, pain can be evoked by non–tissue-damaging stimuli (allodynia). (C) A proto-oncogene, c-fos, is activated after potentially tissue-damaging stimuli are applied to most tissues. (D) A systematic comparison study of Fos and pERK as markers of spinal nociceptive activation revealed greater specificity for activity in nociceptive pathways (vs. nonnociceptive activation) using pERK. (E) Analgesic pharmacologic manipulations such as systemic morphine reduce both the total number of labeled neurons and the total Fos or pERK content of the spinal cord following a noxious stimulus.

8. Which of following description about "antidepressant analgesic" is "Correct"? (A) In terms of treatment efficacy (smaller number needed to treat NNT), pregabalin is much better than tricyclic antidepressant and listed as first line therapy for neuropathic pain (B) In terms of treatment efficacy (smaller number needed to treat NNT), SSRI is better than SNRI for common neuropathic pain such as postherpetic neuralgia or painful diabetic polyneuropathy (C) Venlafaxine is effective for treatment of neuropathic pain associated with breast cancer. (D) For painful diabetic neuropathy, comparison of amitriptyline and pregabalin showed no difference in pain relief but fewer adverse effects with pregabalin. (E) All of above

9. About diagnostic nerve blocks, which one of following statements is wrong? (A) May help in locating the origin of pain. (B) Pain originating from malfunctioning CNS pain modulation may also be relieved by a peripheral nerve block. (C) Repeated diagnostic blocks are mandatory before any attempted chemical or physical denervation. (D) Are reliable as prognostic aids for neurolytic procedures. (E) Pain relief from a saline block does not indicate a psychogenic pain or malingered pain.

10. For substrates of spinal cord nociceptive processing, which one of the following statement is wrong? (A) The spinal cord is segregated into areas that, on gross examination, appear as white and grey matter and consist of predominantly myelinated nerve fiber tracts and cell bodies, respectively. (B) The morphology of neurons in the grey matter of the spinal cord differs depending on location. (C) Using Rexed’s cytoarchitecture-based classification system, there are at least 10 different layers or laminae of neurons—of which the first six (I to VI) are termed the ventral horn of the spinal cord (D) Lamina II is called the substantia gelatinosa due to its gross jellylike appearance in fresh cut tissue. (E) For Lamina X, neurons are arranged around the central canal of the spinal cord. P40-41, C

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