22. According to the long-form McGill Pain Questionnaire (MPQ) pain rating index scores, which of the following acute pain status is rated the highest pain score?
(A) Amputation of digit
(B) Labor pain
(C) Abdominal gynecological surgery
(D) Fracture.
(E) Lower abdominal surgery (males)

18.叢發性頭痛(cluster headache)急性發作時，下列何種藥物不具治療角色? (A)皮下注射 sumatriptan (B)經鼻給予 zolmitriptan (C)經鼻給予 lidocaine 至翼齶窩（pterygopalatine fossa） (D)靜脈注射 dihydroergotamine (E)口服 verapamil

19.下列有關於 2015 年美國 FDA 對於 NSAID 之警語中，何者為非？ (A) Patients prescribed NSAIDs following a first hear attack were not more likely to die within that first year compared to patients who did not receive NSAIDs. (B) NSAID use increase risk of heart failure (C) There is insufficient evidence to determine the risk of individual NSAIDs (D) NSAIDs use in patients with risk factors for heart disease increase the likelihood of heart attack or stroke (E) NSAIDs increase the risk of heart attack/stroke regardless of existing heart disease

20.關於下肢神經疼痛相關敘述，何者有誤? (A)坐骨神經包含的神經根有 L4, L5, S1, S2, and S3 神經根 (B)有少數(11%)梨狀肌分作兩個部分，主要是因為坐骨神經的腓神經會在梨狀肌區域就被區分出來，走在梨狀肌的中間，故把梨狀肌分成兩個部分 (C)坐骨神經病變是下肢最常見的神經病變 (D)坐骨神經病變的表徵和症狀包括無力、踝關節反射受損、感覺異常、感覺喪失，和(或)神 經分佈區產生疼痛 (E)梨狀肌徵候群最常見的症狀是臀部深部酸痛，通常伴有患側跛行和無法久坐

21.關於頸因性頭痛的敘述，何者有誤? (A)目前針對源自上頸肌(upper cervical muscles)、橫韌帶或翼狀韌帶(transverse or alar ligaments)或硬腦膜(dura mater)的頭痛，尚未開發和驗證診斷測試 (B)對於椎間盤引起的疼痛，椎間盤刺激是唯一可用的診斷測試 (C)最常見的、有紀錄可查的頸源性頭痛來源是 C0-C1 關節。它是大約 56%的揮鞭傷後頭痛 患者的疼痛來源 (D)對於臨床診斷的頸源性頭痛的治療，沒有藥物被證明有效，肉毒桿菌毒素注射無效， 唯一有一致的證據是運動鍛鍊，可以提供一些療效 (E)C2-C3 關節突關節引起的頭痛，目前最佳的證據是使用高頻熱凝術治療第三枕神經

23.關於椎管內止痛藥的敘述，下列何者有誤? (A)硬膜外止痛中使用的局部麻醉劑可能會阻斷交感神經並導致低血壓 (B)使用單獨的鴉片類藥物(opioids)的硬膜外止痛不太可能導致低血壓 (C)在停止硬膜外止痛約 2 小時後，如果有持續或加重的運動功能降低，並且應將脊柱血腫、脊柱膿腫和鞘內導管移位作為鑑別診斷的一部分 (D)椎管內單劑量鴉片類藥物給藥，大約有 20%至 50%的患者可能會發生與其相關的噁心和 嘔吐 (E)與使用嗎啡進行硬膜外止痛相比，單獨使用芬太尼(fentanyl)或與局部麻醉劑合併使用無法 降低噁心和嘔吐的發生率

24.The innervation of deep somatic tissue like muscle and joint is quite complex. Which of the following description is not appropriate? (A) The nociceptors are predominantly activated by non-physiological stimuli which may cause damage to the structures (e.g. overload, twisting, strong pressure, ischemic contraction). information within the central nervous system. (B) During inflammation or after trauma, nociceptors of joint and muscle show pronounced sensitization, in particular for mechanical stimuli. (C) Descending inhibition is enhanced during chronic inflammation but seems to be normalized during acute inflammation. (D) Both primary afferent fibers as well as sympathetic reflexes may aggravate inflammatory lesions. (E) Reduced release of hormones from the hypothalamic-pituitary-adrenal (HPA) axis such as cortisol, adrenal androgens and testosterone may cause a relative loss of anti-inflammatory activity.

25.關於 referred pain 和 radicular pain 的敘述，何者有誤? (A) Radicular pain is lancinating in quality, like an electric shock, and travels into the lower limb along a narrow band (B) Somatic referred pain is perceived as a dull, aching sensation； it radiates slowly over relatively wide areas (C) The causes of somatic referred pain and radicular pain are quite different, and their mechanisms are different (D) The mechanism of radicular pain is irritation of the dorsal root ganglion of a spinal nerve (E) This is correct that somatic referred pain does not extend below the knee and that, therefore, pain below the knee must be radicular in origin.

26.關於 neuraxial opioid 敘述，下列何者有誤? (A)與口服或注射鴉片類藥物相比，使用局部麻醉劑於硬膜外和周邊神經阻滯技術可提供更好的鎮痛效果 (B)確定鴉片類藥物臨床藥理學的最重要因素之一是其脂溶性程度 (C)親水性鴉片類藥物，例如 fentanyl，傾向於保留在 CSF 內並產生延遲作用與持續時間較長的止痛作用 (D)與單獨使用局部麻醉劑或鴉片類藥物相比，局部麻醉劑-鴉片類藥物組合可提供更好的術後止痛效果 (E)腎上腺素可改善硬膜外止痛，可增加感覺阻滯，一般以 2 至 5 μg/mL 的濃度給藥，但也與運動功能阻滯惡化有關

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 one of the following statements is wrong? (A) All nociceptors are myelinated. (B) Following a cutaneous injury, enhanced pain in response to cutaneous stimuli, called hyperalgesia, develops at the site of injury (primary hyperalgesia) and in the surrounding uninjured skin (secondary hyperalgesia). (C) Tissue injury leads to enhanced responsiveness of nociceptors, called sensitization, which accounts for primary hyperalgesia. (D) When nerves are severed, spontaneous activity and ectopic mechanical, thermal, and chemical sensitivity develop in the injured nociceptors.