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

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

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。

23. Which of the following statement concerning “postoperative pain” is least likely? (A) Management of postoperative pain is challenging. (B) Management of postoperative pain is based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission. (C) Chronic pain after surgery is an underdiagnosed condition (D) Advances in understanding the genetic profile of patients should help improve treatment of postoperative pain. (E) It is not essential that the neuronal response to surgery be blocked to achieve the task of optimal pain control.

24. Which of the following statement concerning “muscle pain” is least likely? (A) Muscle pain is distinct from cutaneous pain. (B) Muscle pain is one of the most common pain complaints. (C) Muscle nociceptors are free nerve endings that are connected to the central nervous system. (D) Most nociceptors cannot be excited by algesic agents, including bradykinin, serotonin. (E) In damaged muscle, the nociceptors have a lowered mechanical threshold.

25. Which of the following diagnostic tests that aid in the diagnosis of complex regional pain syndrome? (A) Bone scintigraphy (B) Plain radiography and X-ray bone densitometry (C) Quantitative sensory testing (D) Skin temperature measurement (E) All of above

26. 下列關於癌症病人的 breakthrough pain，下列敘述何者較 不正確 ： (A)包括了 incident pain 及 spontaneous pain (B)一般不把"end-of-dose failure of analgesic" 歸類在 breakthrough pain (C)疼痛的特性包括了 somatic pain, visceral pain, neuropathic pain 或 mixed type (D) fentanyl buccal film 可以用來控制中重度的 breakthrough pain (E) breakthrough pain 的發生機率並不大，一般只出現在癌症末期或瀕死病人

27. Which management for acute orofacial pain is not advisable? (A) NSAlDs exert their actions in damaged tissue through blockade of prostaglandin synthesis (B) NSAIDs may moderate e 旺 icacy 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.