15. Which of the following description about autonomic, endocrine and immune interactions in pain is correct?
(A) Signaling from the immune system to the CNS via vagal afferents and possibly small-diameter afferents innervating somatic tissues to induce sickness behavior
(B) Modulation of the immune system and the inflammatory response by CNS circuits that control the production and release of neuroendocrine hormonal mediators in the sympathoadrenal stress axis
(C) Coupling of the sensory nociceptive and sympathetic efferent components of the peripheral nervous system in the setting of inflammation and nerve injury to produce sympathetically maintained pain
(D) All of above

11. 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

12. 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.

13. 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

14. 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

16. Which of the following is the acceptable statement about neurodestructive RF lesions? (A) These temperatures are resulted from friction heat. (B) The size of RF lesion with 22 gauge RF needle is around with a radius of 5 mm (C) The heat is generated on the tip of RF needle. The RF needle then heat up the tissues. (D) The RF permanent neurodestructive lesion is formed when neural temperatures exceed 42 C (E) All of the above

17. Pain is a frequent consequence of spinal cord injury (SCI). Which of the following statement is least likely: (A) Below-level neuropathic pain is most likely described as severe or excruciating months or years following initial injury. (B) Damage to the spinothalamic tracts is an important ingredient in the development of neuropathic pain following SCI.(C) Chronic musculoskeletal pain is common in tetraplegic patients after SCI. (D) Patients with cervical SCI are at risk of developing CRPS affecting upper limbs. (E) Below-level neuropathic pain is also referred to deafferentation pain.

18. The innervation of deep somatic tissue like muscle and joint is quite complex. Which of the following description is not appropriate? (A) The nociceptors are predominantly activated by non-physiological stimuli which may cause damage to the structures (e.g. overload, twisting, strong pressure, ischemic contraction). information within the central nervous system. (B) During inflammation or after trauma, nociceptors of joint and muscle show pronounced sensitization, in particular for mechanical stimuli. (C) Descending inhibition is enhanced during chronic inflammation but seems to be normalized during acute inflammation. (D) Both primary afferent fibers as well as sympathetic reflexes may aggravate inflammatory lesions. (E) Reduced release of hormones from the hypothalamic-pituitary-adrenal (HPA) axis such as cortisol, adrenal androgens and testosterone may cause a relative loss of anti-inflammatory activity..

19. 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

20. Which of the following is not a common manifestation of the myofascial pain syndrome? (A) Regional body pain and stiffness (B) Abnormal findings on neurological examinationl (C) Limited range of motion of the affected muscle (D) One or more trigger points (E) Referral (triggering) pain from a trigger point to a zone of reference .

21. Which of the following combination of lesion site with referral site describing pain referral is not common in cancer patients suffering from cancer pain? (A) (Diaphragmatic irritation) and (Shoulder) (B) (Urothelial tract) and (Inguinal region and genitalia) (C) (C7–T1 vertebrae) and (Interscapular) (D) (L1–2) and (Sacroiliac joint and hip) (E) all of the above are common found in patients with cancre pain