20. Which management for acute orofacial pain is not advisable?
(A) NSAIDs exert their actions in damaged tissue through blockade of prostaglandin synthesis
(B) NSAIDs may moderate efficacy for inhibiting postoperative edema
(C) NSAIDs may be used for pretreating patients before dental surgery
(D) Opioids may play a more direct role in pain management than NSAIDs thromboembolic complications
(E) The local application of exogenous opioids may prevent the degradation of endogenous opioid peptides may provide a new approach to pain management.

複選題16. 當病人一再來門診或急診要求注射成癮性止痛藥時,下列哪些現象暗示病患可能有「成癮」 現象? (A)病人抱怨最近的處方的止痛時間不夠久,藥效變差 (B)病患抱怨最近疼痛加重厲害,發作頻繁,他把三天的藥一天吃完 (C)病人自述出現嗜睡、噁心、性欲降低、便秘,但是疼痛都沒有減輕 (D)病人自述沒吃止痛藥會睡不著,希望睡前加重劑量輔助睡眠 (E)病人最近反覆敘述藥物遺失,而且發生很多次

17. 關於催眠(hypnosis)及催眠止痛(hypnotic analgesia),何者敘述錯誤? (A) 不只是一種魔術,催眠可能有效止痛 (B) 利用的是「暗示」(suggestion)的技巧,與心理層面有關,不影響生理功能 (C)可以造成精神放鬆,注意力轉移,對人、時、地的錯誤判斷,及改變個人經驗 (D) 催眠止痛要達到長期的效果,需要以暗示方法改變(或主導)病人的疼痛經驗 (E) 催眠止痛改變病人的疼痛經驗的方式有:解離式想像法(dissociated imagery)、集中注意力法(focused analgesia)、重新詮釋法 (reinterpretation)

18. 對於兒童或嬰、幼兒的疼痛評估方法及技巧,下列敘述何者錯誤? (A)為了避免詢問者造成誤差,詢問兒童疼痛的字句最好都要一致 (B) 對兒童解釋疼痛程度時,父母可以適度的協助,避免錯誤 (C) VAS (visual analogue scale)可以適用於小兒5歲以上 (D) 臉譜圖(face pain scale)可以適用於年齡3歲以上 (E)行為觀察如:哭、臉部表情、身體姿勢等,也可以當成疼痛評估,但在急性短暫疼痛(如打針)較準確

19. Which of the following is the unacceptable statement? (A) The idea of pre-emptive analgesia is based on clinical observations demonstrating that if the afferent traffic of pain signals is prevented from reaching the central nociceptive neurons by preinjury administration of analgesics, sensitization of the central neurons will not take place or will be reduced. (B) Even though there are the negative findings of clinical studies of pre-emptive analgesia, we may not discard the hypothesis that central sensitization is an important mechanism in postoperative pain (C) Evidence from clinical studies suggests that acute, postoperative pain involves multiple mechanisms, including sensitization of peripheral and central neuronal pathway. (D) Postoperative pain may include a combination of nociceptive, inflammatory, visceral and neuropathic pain mechanisms. (E) If a patient records a baseline visual analogue scale score in excess of 30 mm, they would probably have recorded at least moderate pain on a four-point categorical scale.

21. Which characteristic of headache below dose not belong to diagnostic criteria for migraine? (A) Unilateral location (B) Pulsating quality (C) Moderate or severe pain intensity (D) Aggravation by or causing avoidance of routine physical activity (i.e. walking or climbing stairs) (E) All of above are characteristic of headache of diagnostic criteria for migraine

22. Which of the following is the unacceptable statement about Fibromyalgia syndrome (FMS)? (A) Epidemiology studies indicate that FMS is present in at least 2% of the general population. (B) FMS tender points have the same refer pain to a zone of reference as the myofascial pain syndrome trigger points in general. (C) The criteria of American College of Rheumatology (Wolfe et al 1990) for FMS required the component: a history of widespread pain for at least 3 months. (D) The criteria of American College of Rheumatlogy (Wolfe et al 1990) for FMS required the component: pain sensitivity to 4 kg of digital pressure at 11 or more of 18 anatomically defined tender points (E) A reasonably accurate clinical estimate of the correct amount of pressure can be obtained by pressing the examining thumb against a surface until the blood flow to the mid-portion of the thumb nail blanches.

23. The most useful prophylactic drugs for chronic tension type headache: (A) Acetaminophen (B) Tricyclic antidepressant (C) Gabapentin (D) NSAIDs (E) Propranolol

24. Which of the following is the unacceptable statement about Fibromyalgia syndrome (FMS)? (A) It is very likely that an affective disorder is one of the causes of FMS. (B) There is evidence to suggest that FMS is a disorder of abnormal processing of sensory information within the central nervous system, (C) Several neurochemical mediators of pain (substance P, nerve growth factor, dynorphin A, glutamate, nitric oxide, serotonin and noradrenaline) are believed to play a role in the pathogenesis of FMS. (D) There is still no cure for FMS, so its management is non-specific, multimodal, expectant and symptomatic. (E) The use of opioids in patients with FMS is controversial.

25. Based on clinical experience, which level radicular pain is often associated with chronic headache and involved mainly the neck and upper shoulder? (A) C2 (B) C3 (C) C4 (D) C5 (E) C6

26. 下列有關 Complex regional pain syndrome (CRPS)的敘述何者不正確? (A) 骨折後,發展成為CRPSI的incidence約為1-2%。 (B) 女性比男性更容易發生CRPS。 (C) CRPS type II 病患其通常進展為具有非對稱性遠端肢體疼痛及腫脹但並沒有神經損傷。 (D) CRPS 病患有相當高比例,同時罹患憂鬱症及焦慮症。然而目前並沒有證據顯示 CRPS 是種心因性問題。 (E) CRPSI病人在半邊身體或患肢同側上方發展為 hypoaesthesia 及 hypoalgesia