23. Which neurological signs and symptoms of complex regional pain syndrome (CRPS) among the followings is the highest?
(A) Hyperesthesia/allodynia
(B) Coordination deficits
(C) Tremor
(D) Muscle spasm
(E) Paresis

19. If we apply light touch stimulus to lesion side in painful neuropathies, it will evoke neuropathic pain, which afferent fiber is involved among the followings? (A) A-alpha fiber (B) A-beta fiber (C) A-delta fiber (D) C fiber (E) A-delta and C fiber

20. 關於鴉片類藥物的敘述，下列何者最不正確？ (A) Hydromorphone 效力比 morphine 強 3-5 倍(口服)，且具有 NMDA 受體拮抗劑與血 清素再吸收抑制(serotonin reuptake inhibitor)的特性 (B) Buprenorphine 具有 μ receptor partial agonist 及 κ antagonist 之性質 (C) Meperidine(pethidine)具有高度親脂性，容易引發「尋藥行為」(drug-seeking behavior) (D) Tapentadol 具有 μ agonist 與 noradrenaline reuptake inhibitor 之性質 (E) 以皮下作為給藥路徑可以提供緩慢穩定的吸收，唯給藥量不宜超過 5 mL/hr

21. Which of the following is the acceptable statement about the local anaesthetic blocks and epidurals? (A) In the management of chronic pain, diagnostic nerve blocks may help in locating the origin of pain, but are unreliable as prognostic aids for neurolytic or neurodestructive procedures. (B) Pain originating from malfunctioning CNS pain modulation may also be relieved by a peripheral nerve block. (C) Epidural local anaesthetic blocks cannot reliably predict the effect of spinal cord stimulation. (D) “Pulsed radiofrequency” treatment: lower temperature applied； less effective； fewer adverse effect compared with conventional radiofrequency denervation. (E) All of the above

22. What is the following description about tension-type headache is FALSE? (A) may be associated with stress (B) associated with vomiting (C) bilateral (D) most common in adolescence (E) pain may involve teeth, forehead & neck

24. Which following statement about pain assessment is true? (A) The McGill Pain Questionnaire (MPQ) has become the most widely used clinical and research tool for measuring pain. (B) The McGill Pain Questionnaire is designed to assess the multidimensional nature of pain experience and has been demonstrated to be a reliable, valid and consistent measurement tool. (C) Descriptors in the McGill Pain Questionnaire fall into 4 major groups, including: sensory, affective, evaluative, and miscellaneous (D) The main disadvantage of VAS is the assumption that pain is a unidimensional experience that can be measured with a single-item scale. (E) All the above are true.

25. Which statement of the followings is wrong? (A) Pain cannot be explained purely by a simple perception-action model. (B) Pain is unlikely be underpinned by a single unified motivation value system. (C) Pain is likely to be underpinned by a number of distinct systems of action, including innate, habit-like, and goal-directed systems. (D) Understanding decision making is likely to be critical for understanding the complexity of intrinsic pain modulation pathways. (E) All the above are correct

26. 關於纖維肌痛症 (fibromyalgia) 的定義，下列哪一項為 1990 年 ACR 的舊定義，而不屬於2010 年的新定義： (A) 廣泛性疼痛(widespread pain index, WPI)為計算疼痛分布在身體 19 個區塊的數量 (B) 疼痛部位需分布在身體的上、下、左、右、及中軸等部位 (C) 症狀嚴重度 (Symptom Severity Scale, SSS)包括疲憊程度、記憶力減弱、睡眠不足 (D) SSS 還包括身體症狀，如頭痛、下腹痛、憂鬱等症狀 (E) 身體症狀是指過去半年內曾發生的病史

27. Which of the drugs below is the most useful prophylactic drugs for chronic tension type headache (CTTH) in clinical practice ? (A) beta blocker (B) anticonvulsant such as gabapentin (C) tricyclic antidepressant such as amitriptyline (D) SSRI (Selective serotonin re-uptake inhibitors), such as Fluoxetine (prozac) (E) weak opioids such as tramadol

28. 關於鴉片類藥物的敘述，下列何者最不正確？ (A) Codeine 在肝臟中經 cytochrome P450 2D6 進行 O-demethylation 後會產生 morphine (B) Tramadol 屬於 weak opioid 類藥物，口服生物利用率(oral bioavailability)差，對 neuropathic pain 和 fibromyalgia 效用不佳 (C) Tramadol 造成嚴重呼吸抑制的風險極低，但嚴重腎功能障礙或嚴重藥物過量時仍可能 發生 (D) Oxycodone 的口服生物利用率比 morphine 高，且比較沒有 active metabolite 的疑慮 (E) 肝腎功能障礙對於 methadone 的代謝清除率(clearance)並沒有明顯的影響

29. 下列對於肌筋膜疼痛及纖維肌痛的比較，何者錯誤：