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.

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

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)

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.

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.

29.Which one of the following statements is wrong? (A) The perception of pain arising from a noxious stimulus starts with conversion of the energy of the stimulus into an electrical signal in the primary afferent neurons innervating the site of the stimulus. (B) This process of energy conversion is called transduction. (C) The three general modalities of noxious stimuli that impinge on the body are chemical, thermal, and mechanical. (D) Specific proteins or groups of proteins called transducers underlie the process of transduction. (E) All of the above are correct.

30.急性下背痛有許多可能的診斷，下列敘述何者有誤? (A)背痛可能是引起腹膜後炎症的內臟疾病（如胰腺炎）的一個特徵，但在這些疾病中，背痛通常是腹痛的附加症狀 (B)動脈瘤可能以背痛為唯一症狀。 事實上，背痛是大部分因主動脈瘤破裂而突然死亡的患者的唯一症狀 (C)醫學影像學上的脊椎退行性變化、脊椎前移和椎弓峽部骨折，與腰痛在統計學上或臨床上有顯著性相關。因此，這些情況都是診斷疼痛的原因 (D)腰椎感染通常在發病時是很難發現，疼痛可能是唯一的特徵 (E)急性腰痛的病因經常不明。造成這種情況的主要原因是常規的檢查，例如醫學成像，無法確定骨折、惡性腫瘤或感染以外的背痛原因

31.Which one of the following statements is wrong? (A) Pain and hyperalgesia arise in part from the action of inflammatory mediators on the peripheral terminals of nociceptive neurons. (B) The list of inflammatory mediators may include arachidonic acid metabolites, bradykinin, adenosine triphosphate and nitric oxide. (C) A series of inflammatory cytokines and chemokines, such as tumor necrosis factor-α and interleukin-1β, and growth factors, particularly nerve growth factor, are capable of changing the response properties of pain-signaling neurons. (D) The inflammatory mediators may activate nociceptive terminals or regulate gene expression of nociceptors. (E) All of the above are correct.