15. Regarding antidepressant analgesics, which of the following statement is least likely:
(A) According to NNT data in treating postherpetic neuralgia, imipramine has slightly better analgesic effect than oxycodone.
(B) Desipramine (25-300 mg/day, oral) has low potency of anticholinergic effect and sedation.
(C) Fluoxetine (5-40 mg/day, oral) has no anticholinergic and sedative effects.
(D) Venlafaxine is relatively free of muscarinic cholinergic, histaminic and alpha-adrenergic receptor effects.
(E) The analgesic effect of antidepressants in treating neuropathic pain is dependent of its antidepressant action.

11.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

12. A 61-year-old woman presents to the pain clinic with a chief complaint of left shoulder and arm pain 3 years after undergoing radiation therapy for breast cancer. Physical examination reveals lymphedema of the left axilla with noticeable skin changes. Examination of the left supraclavicular area precipitates a sharp pain that radiates down her left arm. Which of the following is her likely diagnosis? (A) Tumor metastasis (B) Cervical radiculopathy (C) Reflex sympathetic dystrophy (D) Thrombangiitis obliterans (E) Radiation-induced plexopathy

13. When will you make a surgical suggestion as you manage a patient with neck or low back pain? (A) Intractable symptoms for one week (B) No changes in physical findings and no response to conservative management for two weeks (C) Obvious radicular sign without findings of correctable anatomical problem for more than one month (D) No improvement with progressive neurologic deficit in two weeks (E) Mild improvement for more than one month but less than three months

14. Which of the following statement concerning “phantom limb pain” is most likely: (A) Phantom pain is the painful sensations referred to the amputation stump (B) Phantom pain may enhance with time (C) Preamputation pain increases the risk of phantom pain (D) Phantom pain can be prevented by a preoperative epidural blockade (E) Postamputation pain can be easily treated by analgesia

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

17. 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.

18. Among the following pain disorders, which will produce the highest pain rank index (PRI) by the McGill Pain Questionnaire? (A) Trigeminal neuralgia (B) Pericoronitis (C) burning pain syndrome (D) Reversible pulpitis (E) Temporomandibular disorders (TMD)

19. If we apply light touch stimulus to lesion side in painful neuropathies, it will evoke neuropathic pain, which afferent fiber is involved among the followings? (A) A-alpha fiber (B) A-beta fiber (C) A-delta fiber (D) C fiber (E) A-delta and C fiber

20. 關於鴉片類藥物的敘述，下列何者最不正確？ (A) Hydromorphone 效力比 morphine 強 3-5 倍(口服)，且具有 NMDA 受體拮抗劑與血 清素再吸收抑制(serotonin reuptake inhibitor)的特性 (B) Buprenorphine 具有 μ receptor partial agonist 及 κ antagonist 之性質 (C) Meperidine(pethidine)具有高度親脂性，容易引發「尋藥行為」(drug-seeking behavior) (D) Tapentadol 具有 μ agonist 與 noradrenaline reuptake inhibitor 之性質 (E) 以皮下作為給藥路徑可以提供緩慢穩定的吸收，唯給藥量不宜超過 5 mL/hr

21. Which of the following is the acceptable statement about the local anaesthetic blocks and epidurals? (A) In the management of chronic pain, diagnostic nerve blocks may help in locating the origin of pain, but are unreliable as prognostic aids for neurolytic or neurodestructive procedures. (B) Pain originating from malfunctioning CNS pain modulation may also be relieved by a peripheral nerve block. (C) Epidural local anaesthetic blocks cannot reliably predict the effect of spinal cord stimulation. (D) “Pulsed radiofrequency” treatment: lower temperature applied； less effective； fewer adverse effect compared with conventional radiofrequency denervation. (E) All of the above