19. Which of the following is true of typical trigeminal neuralgia?
(A) It is associated with masseter muscle weakness.
(B) It is characterized by episodic bursts of bilateral, severe, lancinating pain lasting 30-60 minutes.
(C) There is an absence of sensory deficits.
(D) Tricyclic antidepressants are considered first-line therapy.
(E) It is associated with visual changes.

15. 下列在 pain hypersensitivity 的 pathogenesis 有關 microglia 的敘述何者錯誤? (A) microglia 在 peripheral nerve injury 後的早期,就會被 activate 而釋放 proinflammatory cytokines (B) Microglia 在 spinal cord dorsal horn 中的數量,會在 peripheral nerve injury 後增加 (C) Pain hypersensitivity state 時 microglia 會 release CX3CL (fractalkine)作用在 neuron 上增加 neuronal excitability (D) neuropathic pain state 時 microglia 的 P2X4receptor 會 upregulation (E) microglia activation 的 process 與 p38 Mitogen-Activated Protein Kinase 的 phosphorylation 有關,可以 turn on downstream 的 signal

16. 下列哪一個腦區與疼痛的情感面向最相關 (A) Ventrolateral Thalamus (B) Anterior Cingulate cortex ACC (C) Insular cortex IC (D) Secondary motor cortex M2 (E) Primary sensory cortex S1

17. A patient with recent leg amputation presents with pain at the site of the stump. Which of the following statements about stump pain is FALSE? (A) The incidence of severe pain is probably seen in only 5-10% of cases. (B) It is present in the majority of patients with phantom pain. (C) It is present in the first week after amputation and always subsides with surgical healing. (D) It can be associated with sensory abnormalities. (E) All of the above are true.

18. Which patient with complex regional pain syndromes (CRPS) is most likely to have the worst outcome? (A) Patient who had a fracture leading to CRPS (B) Patient who had a nerve injury in the lower extremity with warm CRPS (C) Patient who had a nerve injury in the upper extremity with cold CRPS (D) Patient who had a nerve injury in the upper extremity with warm CRPS (E) Patient who has depression disorder

20. Which of the following statements about central post-stroke pain (CPSP) is FALSE? (A) The most common form of chronic pain after stroke is musculoskeletal pain and its ratio is estimated to be 40%. (B) Most of the CPSP develops with brain stem infarctions. (C) The lesion responsible for pain in CPSP is actually located in the contralateral thalamus. (D) The recommendations for the first-line treatment of central pain are as follows: pregabalin (150–600 mg/day), gabapentin (1200–3600 mg/day), and tricyclic antidepressant (25–150 mg/day). (E) Contraindications to treatment with tricyclic antidepressants, particularly in the elderly, include patients with cardiac conduction abnormalities, congestive heart failure, and convulsive disorders.

21. Which of the following statements about peripheral neuropathic pain (PNP) is FALSE? (A) The most commonly described spontaneous symptoms of PNP are deep aching in the extremities and a superficial burning, stinging, or prickling pain. (B) The incidence of ongoing pain at rest is high in patients with PNP. (C) The incidence of joint hyperalgesia is high (around 50%) in patients with PNP. (D) The incidence of edema is low in patients with PNP. (E) The incidence of sympathetically maintained pain is low in patients with PNP.

22. Which opioid described below belong to “full agonist”? (A) buprenorphine (B) fentanyl (C) nalbuphine (D) butorphanol (E) naltrexone .

23. 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.

24. About diagnostic nerve blocks, which one of following statements is wrong? (A) May help in locating the origin of pain. (B) Pain originating from malfunctioning CNS pain modulation may also be relieved by a peripheral nerve block. (C) Repeated diagnostic blocks are mandatory before any attempted chemical or physical denervation. (D) Are reliable as prognostic aids for neurolytic procedures. (E) Pain relief from a saline block does not indicate a psychogenic pain or malingered pain.

25. 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