16. Which of the following cell type sense the initial “endanger signal” and participates in the initial phase of pathogenesis of the nerve injury induced neuropathic pain?
(A) Microglia
(B) Spinal lamina I and II neuron
(C) Astrocyte
(D) oligodendrocyte

12. 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

13. About image-guided lumbar sympathetic block, which the following indication is not proper? (A) Sympathetically maintained pain (B) Reflex sympathetic dystrophy (C) Phantom low limb pain (D) Raynaud’s disease (E) Chronic pancreatitis

14. Which one of the following statement about the pathophysiology of herpes zoster is wrong? (A) Herpes zoster most commonly manifests in the distribution of a single dorsal sensory or cranial nerve ganglion. (B) Why the reactivation of virus occurs in one ganglion when latent virus is present throughout the patient’s sensory ganglia is clear. (C) Declining cellular immunity is a major risk factor for reactivation of the virus, which is thought to occur when cell-mediated immunity falls below a critical level. (D) This impression is supported by evidence that even individuals with adequate levels of serum antibodies to varicella-zoster virus (VZV) antigen can, over time, exhibit T cells with reduced ability to proliferate and defend against VZV infections. (E) Cell-mediated immunity appears to play a crucial role in preventing reactivation of latent VZV.

15. 關於 cordotomy 的敘述，下列何者錯誤？ Ablation 目標是 spinothalamic tract (A) Indication 是 bilateral 的 pelvic、flank、chest wall pain (B)因為 opioids treatment 的進步以及 intrathecal pain pump 的發展，cordotomy 的施行比以 前減少 (C)手術方式通常是在 C1/2 level 經皮施行 (D)手術也可在 mid-to-upper thoracic level(T4)施行

17. Which of the following description about spinal cord plasticity and pain is incorrect? (A) Some spinal nociceptive neurons receive convergent input from high- and low- threshold sensory fibers thus called wide–dynamic range neurons (B) Glutamate is the major fast excitatory neurotransmitter in all nociceptive afferent nerve fibers. Glutamate can bind to three types of ionotropic glutamate receptors and to G protein–coupled metabotropic glutamate receptors to modify neuroexcitability. (C) Hyperalgesia and allodynia can even be induced in humans in the absence of any sensory stimuli, such as during prolonged application of opioids or on abrupt withdrawal of opioids.. (D) Spinal nociception is under powerful control from descending inhibitory and facilitatory pathways. Under normal conditions, descending facilitation appears to prevail over inhibitory pathway.

18. 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.

19. 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.

20. 下列有關常用疼痛評估量表的敘述何者正確? (A)常用的疼痛強度量表是 Visual analogue scale, 是用 0 分到 10 讓病患挑選 (B) Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) 用以偵測 neuropathic 的 好處是方便病患自己選答 (C) DN4 雖然項目不多, 但需要 clinician 執行 examination (D) Brief Pain Inventory (BPI) 中有關 Pain Interference 的部分共有 9 個 item, 包括 general activity, mood, walking ability, lifting heavy object, normal work (both housework and work outside the home), relation with other people, language processing, sleep 及 enjoyment of life (E)以上皆正確

21. 下列有關進行 Diagnostic block 預期 Diagnostic confidence 之 specificity and sensitivity 計算 公式，下列選項何者是錯誤？ (A) posttest odds = pretest odds × positive likelihood ratio (B) positive likelihood ratio = sensitivity / (1 − specificity) (C) pretest odds = prevalence / (1 − prevalence) (D) diagnostic confidence = [(posttest odds) / (1 −posttest odds)] × 100% (E)若 specificity 是 65%, 以及 prevalence 是 40%, 則 diagnostic confidence of positive comparative blocks 大約是 66%

22. 下列有關 Painful neuropathy 的敘述何者錯誤？ (A) Fabry disease 雖然以 neuropathic pain 為主要症狀, 但仍有全身性的影響包括心臟與腎臟 (B) Inherited erythromelagia 的成因與鈉離子通道的變異有關 (C) Postherpetic neuralgia 是因為 spinal cord dorsal horn neuron 內 dormant 的 Varicella-zoster virus reactivation 造成神經元破壞而產生 (D) 抗癌化學治療藥物, 例如 cisplatin 或 vincristine 可能會造成 painful neuropathy (E) Alcoholic neuropathy 未必與 thiamine 或其他維生素 B 群 deficiency 相關