15. Based on clinical situations, which kind of opioids owns the highest oral bioavailability ?
(A) Hydromorphone
(B) Morphine
(C) Pethidine (meperidine)
(D) Oxycodone
(E) Tramadol

複選題11. 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)病人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

12. 根據2014年 "National Institute for Health and Clinical Excellence" 對癌症末期瀕死病人的最 好的支持性治療 ("Best Practice in the Last Hours and Days of Life")，下列哪一項敘述不正 確： (A) Decisions are made to discontinue inappropriate interventions. (B) Discontinue or reduce subcutaneous opioid analgesics to avoid conscious depression or disturbance. (C) "As-required" subcutaneous medication is prescribed according to an agreed protocol to manage pain, agitation, nausea and vomiting, and respiratory tract secretions (D) Family and carers are given appropriate written information. (E) A plan of care is explained and discussed with the patient, family, and carers.

13. 下列關於 WHO Analgesic Ladder 的三階梯(3 steps)用藥，哪一項較不正確： (A) Paracetamol (Acetaminophen)是 step I 用藥，也可以是 step II 用藥 (B) Tramadol 是 weak opioid,屬於 step II 用藥 (C) Hydromorphone, oxycodone 是 strong opioids, 屬於 step III 用藥 (D) Ketamine 作用於 opioid-resistant pain, 可歸類於 step III 用藥 (E) Buprenorphine 是 partial opioid agonist, 歸類於 step II 用藥

14. About chemical neurolytic nerve blocks, which one of following statements is wrong? (A) Phenol or ethanol is usually used for chemical denervation (B) The duration of these blocks is often disappointingly brief. (C) They may induce deafferentation-neuropathic type pain. (D) They are often indicated for patients with chronic pain and a normal life expectancy. (E) They can be used in patients with advanced cancer disease.

16. A 52-year-old man complains of a sudden onset of severe, stabbing pain in the left jaw and cheek that subsides in less than a minute. He is pain-free during the intervals between attacks. Activities such as combing his hair and shaving can cause the onset of this facial pain. He is otherwise healthy. The most likely diagnosis is (A) trigeminal neuralgia (B) atypical facial pain (C) postherpetic neuralgia (D) vascular facial pain

17. Which following item is not a criterion for the diagnosis of migraine? (A) Aggravation by or causing avoidance of routine physical activity (B) Unilaterallocation (C) Moderate or severe pain intensity (D) Throbbing/stabbing quality (E) All are criteria for diagnosis of migraine

18. 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.

19. 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.

20. About the failed back surgery syndrome (FBSS), which one of the following procedure may be the last to be considered due to possible poor response? (A) caudal steroids injection (B) epidural adhesive lysis (C) spinal cord stimulation (D) radiofrequency denervation (E) lumbar sympathetic block

21. A patient suffered from chronic low back pain with radiating to buttock, poster lateral thigh and lateral aspect of lower leg. Muscle weakness was observed in the extensor hallucis longus and tibialis anterior. Which lumbosacral root compression is the most likely？ (A) L2 root compression (B) L3 root compression (C) L4 root compression (D) L5 root compression (E) S1 root compression