16. Which one of the following statement is most appropriate?
(A) Morphine can act on µ1 and µ2 opioid receptors.
(B) µ1 opioid receptor can modulate Na+ and Cl- channels via G-protein.
(C) For human adults, the intrathecal bolus dose of morphine is 3-10 mg.
(D) For human adults, the intrathecal bolus dose of morphine is 3-10 µg.

12. 目前對 Chronic tension-type headache (CTTH) 的認識，下列何者不正確？ (A)發作時，在腦血流中有明顯的 CGRP 增加 (B)與 myofascial pain 有關，可以用注射 botulinum 治療 (C)以 Beck’s depression scale 評分，可以發現頭痛頻率與 depression 程度有關 (D)以 pressure-pain threshold 測量，可以發現疼痛閾值改變不大 (E) TCA (Tricyclic antidepressant) 可以當第一線用藥

13. 周邊神經切除會形成 neuroma 引起疼痛，下列敘述何者不正確： (A)是因為 axon 不正常的 regenerative sprouting (B)疼痛發生大多與 C-fiber 出現不正常的 ectopic firing 有關 (C)糖尿病或神經炎，也會出現 microneuroma，引起疼痛 (D)在新生兒周邊神經損傷，反而少出現神經瘤 (E) Tineal sign 可以作為診斷 ectopic firing 的依據

14. 利用手術或介入性阻斷技術減少癌症疼痛的方式，下列敘述何者效果最差： (A)以 internal surgical fixation 減少脊椎病理性骨折的疼痛 (B)以 epidural steroid 減輕腫瘤浸潤引起的 lumbosacral radiculopathy (C)以 iv PCA 減輕 radiation-induced brachial plexopathy (D)以 neurolytic celiac plexus blockade 控制胰臟癌引起的腹痛 (E)以 intrathecal morphine pump 治療 peritoneal carcinomatosis-induced pain

15. 下列關於 opioid rotation 或 opioid switch，哪一種敘述較不正確： (A)opioid switch/rotation 意思是指改變鴉片藥物的給藥途徑，可以提高止痛效果 (B)動物實驗上可發現，鴉片受器剔除小鼠仍可以保留部分對 fentanyl 注射的止痛效果 (C)理論基礎是基於人體對 opioid receptor 的 binding profile 及 affinity 具有基因多樣性 (heterogenecity) (D)臨床上已成為改善癌症病人的嗎啡類藥物效果的常用方式. (E) tramadol 換成 morphine 不能稱為 opioid switch

17. 一位末期肝癌疼痛的病患，因口服嗎啡已經造成嚴重的嘔吐，考慮改由脊髓腔內(intrathecal) 持續給藥，因其每天劑量達 600 mg，經換算後脊髓給藥劑量應為每天約： (A) 1 mg (B) 2 mg (C) 6 mg (D) 10 mg (E) 20 mg

18. Which of the following statement concerning “central pain” is LEAST likely: (A) Central pain is defined as pain caused by a lesion or dysfunction in the CNS (B) The most common cause is traumatic spinal cord injuries (C) In stroke the onset of pain is early (D) In stroke the pain is most frequently a hemipain (E) Central pain is dominated by abnormalities in the sensibility to temperature

19. Choose one wrong description about opioid use: (A) Acute opiate administration activated opiate receptors in central and peripheral nervous system. (B) Protein kinase A (PKA) and CREB were also activated after opiate administration (C) Repeatedly seeking opioid from other clinicians is a more predictive addiction indicator. (D) Requesting specific drugs is a more predictive addiction indicator. (E) Aggressive complaining about needing more drug is a less predictive addiction indicator.

20. A patient is positioned prone in the fluoroscopic table, the T1-T4 spinous processes are identified on the ipsilateral side, and a skin weal is raised 4-5 cm lateral to the spinous process. A spinal needle is directed to the lamina and “walked” laterally until there is loss of resistance. These procedures are consistent with which type of block? (A) Stellate ganglion (B) Thoracic sympathetic (C) Interpleural (D) Thoracic epidural

21. Which of the following activities will exacerbate pain the most in an elderly patient with severe spinal stenosis? (A) Walking uphill (B) Walking downhil. (C) Riding a bicycle (D) Bending forward Standing

22. 抗憂鬱劑常被用在治療慢性神經病理性疼痛緩解，以下有關於此類藥物之敘述何者為非? (A)三環抗憂鬱劑是慢性疼痛治療的首選藥物。 (B) Amitriptyline 可同時抑制 Serotonin 和 Noradrenaline 兩神經傳遞物質之回收，效果較其 他選擇性回收抑制劑之治療效果佳，其 NNT 為 14 左右。 (C)三環抗憂鬱劑之止痛效果，主要並非來自於其鎮靜或是抗焦慮之作用。 (D)近來之研究發現三環抗憂鬱劑也具有抑制鈉離子通道及 NMDA 受體之作用。 (E)青光眼及攝護腺肥大是使用三環抗憂鬱劑的禁忌症。