21. Which of the following describing the phenomenon of Wind-Up is right?
(A) a form of heterosynaptic activity-dependent plasticity
(B) elicited by repeated A-β-fiber stimuli
(C) a co-release with glutamate of neuromodulators such as substance P and calcitonin gene-related peptide (CGRP) from the nociceptor central terminals
(D) NMDA receptor is not recruited
(E) all of the above are right

17. Arrange the pain intensity of the following conditions from the strongest to the least according to long form McGill Pain Questionnaire. 1. Labor pain, 2 Amputation of digit, 3. Male low abdominal surgery 4. Fracture : (A) 1＞2＞3＞4 (B) 2＞1＞4＞3 (C) 2＞1＞3＞4 (D) 1＞2＞4＞3 (E) None of above is right

18. Choice a wrong description about complex regional pain syndrome (CRPS): (A) CRPS I develop more often than CRPS II (B) CRPS is characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissue. (C) Sympathetic paravertebral ganglia blockade has no effect on CRPS. (D) Transcutaneous electrical nerve stimulation (TENS) may be effective in some cases. (E) Epidural spinal cord stimulation has shown efficacy in some cases

19. Choice a wrong description about pain following spinal cord injury (SCI): (A) Pain exists only at the level or below the level of injury cord. (B) The pain after SCI was composed of both nociceptive and neuropathic pain. (C) Psychological issues have tremendous importance in the expression of pain. (D) Tricyclic antidepressants may be effective for neuropathic SCI pain. (E) Clonidine administered spinally play some roles for SCI pain

20. Which of the following treatment is NOT the indication for limbs pain induced by increased spasticity after C7 incomplete spinal cord injury? (A) Joint positioning and range-of-motion (ROM) exercises. (B) Treat underlying spasticity-triggering events (infection, pressure ulcer, etc). (C) Serial casting or dynamic splinting to relieve already-occurred contractures. (D) Oral narcotics, like codeine or tramadol. (E) Anti-spasticity blocks via Botulinum toxins, phenol, or ethanol.

22. During peripheral sensitization of nociceptors, which of the coupling is wrong? (A) prostaglandin E2 (PGE2) EP receptor (B) bradykinin B2 receptor (C) heat TRPV1 receptor (D) ATP P2Y re (E) all of the above are right

23. Spinothalamic tract is the pathway most closely associated with pain. Which region in the spinal grey matter is the main origin of the spinothalamic tract to transmit pain? (A) lamina I (B) lamina II (C) lamina VII (D) lamina VIII (E) lamina X

24. Which of the following is the acceptable statement about pathogenesis of FMS? (A) There is evidence to suggest that FMS is a disorder of abnormal processing of sensory information within the central nervous system. (B) Several neurochemical mediators of pain, substance P, nerve growth factor, dynorphin A, glutamate, nitric oxide, serotonin and noradrenaline are viewed as pronociceptive because they carry or amplify afferent signals, leading to the brain perception of increased pain. (C) The elevation of cerebrospinal fluid substance P in FMS is due to lowered activity of cerebrospinal fluid substance P esterase because the rate of cleavage of libeled substance P by FMS cerebrospinal fluid was lower than normal. (D) In different subtypes of FMS, it is believed that nerve growth factor may be responsible for the elevated cerebrospinal fluid substance P through its effects on central sensitization and neuroplasticity. (E) A specific Gi-protein-coupled receptor in peripheral blood leukocytes was found to be dysfunctional in patients with FMS. This resulted in lower baseline, also depressed intracellular levels of cyclic AMP and proposed as a diagnostic test for FMS.

25. When the administration of opioids failed to manage pain or the dose of opioids are noted to escalate, the following differential diagnosis should be considered, except: (A) Limited absorption of oral preparations-vomiting or gastric stasis. (B) Pain poorly responsive to opioids alone- such as Neuropathic pain (C) Pharmacological factors: Opioid-induced hyperalgesia and allodynia (D) Psychological factors: Distress, Anxiety or Depression (E) All of the above should be considered

26. Nociceptive pain: (A) Occurs only in laboratory animals. (B) Occurs under conditions of normal peripheral and central nervous system function. (C) Typically responds poorly to opioid analgesics. (D) Typically responds poorly to NSAIDs. (E) Typically responds favorably to adjuvant analgesics.

27. A patient had chronic pain over the neck, medial scapula, anterior chest, medial aspect of arm and forearm. Horner's syndrome was also noted. Which root compression is the most likely? (A) C5 root compression (B) C6 root compression (C) C7 root compression (D) C8 root compression (E) T1 root compression