22. 以下敘述何者錯誤？
(A) Trigeminal pain 是 a bottom-up process.
(B) Trigeminal pain 可能與“top-down” nociceptive mechanisms 相關
(C)大腦皮質是 a major source of top-down modulation of pain
(D) pain perception 並非是 an active process
(E) Noxious inputs can modulate spinal outflow via the brain stem structures in a bidirectional fashion.

18. Peripheral nerve injuries are often associated with neuropathic pain. Which of the following statement is least likely: (A) Nerve injury causes sprouting (or phenotypic changes) of large-diameter primary afferents from the deep dorsal horn into lamina I & II. (B) The cholera toxin B subunit is the primary marker used for sprouting of injured primary nerves. (C) During inflammatory pain, the dorsal root ganglion in the involved nerve show similar changes as seen in neuropathic pain. (D) Peripheral nerve injury may cause ongoing activity and after-discharges. (E) The overall increased excitatory drive may be combined with a compromised inhibitory control in the dorsal horn.

19. Which of the following description about cancer pain mechanism is wrong, ( if ABCD are all right , choice E)? (A) Ischemia is involved in cancer pain mechanism. (B) Tumor-induced release of protons is one of the possible mechanisms of cancer pain. (C) Nerve growth factors (NGF) is involved in some cancer pain mechanism. (D) Cyclooxygenase (COX) is not involved in cancer pain mechanism. (E) All the above descriptions are right.

20. 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

21. A patient suffered from chronic low back pain with radiating to buttock, poster lateral thigh and lateral aspect of lower leg. Muscle weakness was observed in the extensor hallucis longus and tibialis anterior. Which lumbosacral root compression is the most likely？ (A) L2 root compression (B) L3 root compression (C) L4 root compression (D) L5 root compression (E) S1 root compression

23. Which of the following is not true about objective characteristics of muscle pain? (A) No flexor reflexes when the muscle is painfully stimulated (B) Autonomic symptoms such as a drop in blood pressure, sweating (C) Convergent input from muscle and other sources to central neurons (D) Supraspinal processing in centers different from those for cutaneous pain (E) All of the above are correct.

24. ORL1 是 opioid receptors 家族中，最後被發現的一種，下列關於它的特性的敘述何者不正確？ (A)別名為 Nociceptin/orphanin FQ (B)與其他成員，同樣屬於 G protein-coupled receptor (GPCR), 有 7 個跨膜結構域 (transmembrane domain) (C)同樣可調控 Ca+2 及 K+離子的通透性，減少神經元的興奮性 (D)對一般的 opioid receptor agonists 的親和力很弱 (E)此受器的興奮可能出現疼痛過度(hyperalgesia)，出現 “anti-opioid effect”

25. 關於 下列作用於 opioid receptor 的藥劑，何者不正確？ (A) hydromorphone 是 pure mu agonist，口服劑量的強度是 morphine 的 3-5 倍 (B) Methadone 是 pure opioid agonist 也是 NMDA receptor antagonist 和 serotonin 的回收抑制劑 (reuptake inhibitor), 常用於戒癮的 maintenance therapy (C) buprenorphine 是 agonist-antagonist；口服會因 first pass effect 而效果大減 (D) oxycodone 是半合成的 pure mu opioid agonist, 口服劑量的強度是 morphine 的 1.5-2 倍 (E) Tapentadol 是 mu agonist, 也是 norepinephrine reuptake inhibitor，適合用於神經病變 疼痛

26. 關於使用鴉片類藥物出現的耐受性(tolerance)，下列敘述何者正確： (A)都必須要長期使用才會產生 (B)止痛耐受性、腸胃耐受性、鎮靜耐受性、及呼吸耐受性都是經由同樣機轉產生 (C)膽囊收縮素 (Cholecystokinin)的 anti-opioid effect，是造成耐受性的原因之一 (D)不同鴉片類藥物的高交叉耐受性 (cross tolerance)，造成藥物轉換(opioid rotation)上的主要障礙 (E)耐受性是造成鴉片成癮的主因

27. Which of the following description about autonomic, endocrine and immune interactions in pain is correct? (A) Signaling from the immune system to the CNS via vagal afferents and possibly small-diameter afferents innervating somatic tissues to induce sickness behavior (B) Modulation of the immune system and the inflammatory response by CNS circuits that control the production and release of neuroendocrine hormonal mediators in the sympathoadrenal stress axis (C) Coupling of the sensory nociceptive and sympathetic efferent components of the peripheral nervous system in the setting of inflammation and nerve injury to produce sympathetically maintained pain (D) All of above

28. Which of the following is the acceptable statement about neurodestructive RF lesions? (A) These temperatures are resulted from friction heat. (B) The size of RF lesion with 22 gauge RF needle is around with a radius of 5 mm (C) The heat is generated on the tip of RF needle. The RF needle then heat up the tissues. (D) The RF permanent neurodestructive lesion is formed when neural temperatures exceed 42 C (E) All of the above