23. 根據 American College of Rheumatology 的定義，在其挑定全身的 18 處解剖區域中若有幾 處痛點即可診斷為 Fibromyalgia Syndrome：
(A) 7
(B) 9
(C) 11
(D) 13
(E) 15

19. Correct comparisons between osteoarthritis (OA) and rheumatoid arthritis (RA) dose not include: (A) Steroids and the newer drugs that focus on controlling cytokines, such as tumor necrosis factor (TNF), may reduce pain in OA and RA (B) OA mainly involve the joints and RA may present extra-articular features (C) OA appears to be a mechanically driven, and RA presents an immunologically driven disorder (D) Pain management is similar in RA and OA, but the main focus is on controlling the disease process through the use of disease-modifying antirheumatic drugs (DMARDs) (E) Female sex is a common factor in either OA or RA

20. Which medication below is not suggested in fibromyalgia syndrome (FMS): (A) Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) (B) Pregabalin (C) Tricyclics (amitriptyline, nortriptyline, doxepin, cyclobenzaprine) (D) Opioids (E) All of the above treatments are suggested for pain management of OA

21. A 27-year-old woman with a history of malignant melanoma and multiple subcutaneous metastases has been successfully managed with slowly increasing doses of MS-Contin (Morphine SR), in conjunction with doxepin and ibuprofen. She calls the pain center to complain of a new onset of increasing nausea, vomiting, and headaches, as well as poor pain control. The most appropriate immediate action would be to (A) speak with the patient by telephone and tell her to increase the MS-Contin (B) see the patient as soon as possible to determine if there is a new, treatable source of pain (C) schedule the patient for an evaluation in your office within the week (D) switch to a fentanyl patch since the patient is nauseated and may be unable to take oral analgesics (E) add ondansetron for nausea and vomiting so she is able to continue to take oral analgesics 

22. Piriformis syndrome 是由於梨狀肌(piriform muscle)壓迫那一條神經所導致? (A) 股神經 (femoral nerve) (B) 坐骨神經 (sciatic nerve) (C) 股外側皮神經 (lateral femoral cutaneous nerve) (D) 腓總神經 (common peroneal nerve)

24. 下列何者不具有 Na channel blocker 的作用： (A) Amitriptyline (B) Carbamazepine (Tegretol) (C) Lidocaine (D) Gabapentin (Neurontin) (E) Mexiletine (Mexitil)

25. 下列有關 Complex regional pain syndrome(CRPS)之敘述，何者最不正確？ (A) 依發生率及盛行率而言，CRPS typeⅠ比 typeⅡ多 (B) 估計骨折後進展成為 CRPS typeⅠ之發生率 1-2％ (C) 估計因周邊神經損傷後進展成為 CRPS typeⅡ之發生率平均約 4％ (D) 女比男之發生率約為 1: 2 到 1: 4 之間 (男比女多) (E) 交感神經阻斷術可做為診斷及治療的方式

26. 一位 45 歲男性椎間盤突出，引起頸部、肩甲骨內側、前胸上臂及前臂內側疼痛，伴隨有前臂尺側部位麻木，以及眼瞼下垂。請問最有可能壓迫到之神經根位置為？ (A) C5 root (C4-5 disc) (B) C6 root (C5-6 disc) (C) C7 root (C6-7 disc) (D) C8 root (C7-T1disc) (E) T1 root (T1-2 disc) 

27. 下列哪一項病理現象，不代表周邊神經損傷後引起的脊髓中樞敏感化 (central sensitization)： (A) Receptive field alteration (B) microglial activation (C) Windup, after-discharge (D) Wallerian degeneration (E) Descending dis-inhibition

28. 有關 Local anaesthetic blocks and epidurals 下列敘述，何者為真？ (A) Pain relief from a saline „block‟ certainly by itself mean that the pain is „psychogenic‟ or that the patient is malingering. (B) Except for phantom limb pain, neurolytic, neurodestructive nerve blocks are often indicated for patients with chronic pain and a normal life expectancy. (C) A component of sympathetically maintained pain is present in about two-third of cases with CRPS types I and II. (D) Postoperative myocardial infarction, respiratory and renal failure, stroke, and in some studies even mortality, were reduced by perioperative lumbar epidural analgesia (E) The duration of pain relief after epidural steroid injections is reasonable to expect a longer effect in patients without a recurrent mechanical irritation of the nerve root after the pain is gone for this episode.

29. 以下敘述何者為非? (A)穀氨酸鹽 (glutamate) 之受體包括 APMA 及 NMDA 等受體 (B)三磷酸腺苷(ATP)之受體為 P2X 受體 (C) P 物質 (substance P) 之受體 (receptor) 為 COX-2 受體 (D)體抑素 (somatostatin) 之受體為 SST1-3 等受體 (E)疼痛刺激活化 c-fiber 後會導致 P 物質 (substance P)、血管活性腸肽 (vasoactive intestine polypeptide, VIP)、體抑素 (somatostatin)、三磷酸腺苷(ATP)及穀氨酸鹽 (glutamate) 等物質之釋放