27. A 25-year-old, obese man complains of a burning pain in the anterolateral thigh. Deep tendon reflexes and findings in a motor examination are normal. There is a slight sensory deficit in the lateral thigh that corresponds to the painful area. What is the most appropriate diagnostic block to perform on this patient?
(A) Epidural local anesthetic and sterioid
(B) Trigger point injection
(C) Lateral femoral cutaneous nerve block
(D) Illioinguinal nerve block
(E) Lumbar sympathetic block

23. Which of the following statement concerning painful polyneuropathies with prevalent loss of small fibres is most likely: (A) Chronic renal failure neuropathy. (B) Diabetes mellitus neuropathy. (C) Alcoholic neuropathy. (D) Myeloma neuropathy. (E) soniazid neuropathy.

24. About chemical neurolytic nerve blocks, which one of following statements is wrong? (A) Phenol or ethanol is usually used for chemical denervation. (B) The duration of these blocks is often disappointingly brief. (C) They may induce deafferentation-neuropathic type pain. (D) They are often indicated for patients with chronic pain and a normal life expectancy. (E) They can be used in patients with advanced cancer disease.

25. Choice a right description about treatment of cancer pain. (A) Because of the complexity of cancer pain, 3 analgesic ladder from WHO was not useful. (B) Surgery, Chemotherapy and radiotherapy are not the analgesic titration for cancer pain. (C) Only 10-20% of patients ultimately require regular strong opioids. (D) Constipation is common for opioid use, but laxative can be used only when symptom exists. (E) None of above is right

26. 有關 hyperalgesia 的描述何者為非？ (A) 組織受傷會導致許多促進發炎反應的化學物質的釋放，包括 bradykinin，prostaglandins， leukotrienes，serotonin，histamine，substance P，thromboxanes，platelet-activating factor， adenosine，ATP， protons 以及 free radicals 等等 (B) Hyperalgesia 不僅發生在受傷的區域，也會發生在周圍未受傷的區域 (C) 在周圍未受傷害的區域產生的 hyperalgesia 稱之為 primary hyperalgesia. (D) 在發炎反應的時候，marcopharges 會釋放 cytokines 來調節發炎反應。 (E) 促進發炎反應之因子，如 cytokine 會促進神經生長因子之產生，再直接或間接地加強疼 痛現象。

28. Which of the following treatment is NOT the indication for limbs pain induced by increased spasticity after C7 incomplete spinal cord injury? (A) Joint positioning and range-of-motion (ROM) exercises. (B) Treat underlying spasticity-triggering events (infection, pressure ulcer, etc). (C) Serial casting or dynamic splinting to relieve already-occurred contractures. (D) Oral narcotics, like codeine or tramadol. (E) Anti-spasticity blocks via Botulinum toxins, phenol, or ethanol.

29. Which of the following is the acceptable statement about pathogenesis of FMS? (A) There is evidence to suggest that FMS is a disorder of abnormal processing of sensory information within the central nervous system. (B) Several neurochemical mediators of pain, substance P, nerve growth factor, dynorphin A, glutamate, nitric oxide, serotonin and noradrenaline are viewed as pronociceptive because they carry or amplify afferent signals, leading to the brain perception of increased pain. (C) The elevation of cerebrospinal fluid substance P in FMS is due to lowered activity of cerebrospinal fluid substance P esterase because the rate of cleavage of libeled substance P by FMS cerebrospinal fluid was lower than normal. (D) In different subtypes of FMS, it is believed that nerve growth factor may be responsible for the elevated cerebrospinal fluid substance P through its effects on central sensitization and neuroplasticity. (E) A specific Gi-protein–coupled receptor in peripheral blood leukocytes was found to be dysfunctional in patients with FMS. This resulted in lower baseline, also depressed intracellular levels of cyclic AMP and proposed as a diagnostic test for FMS.

30. 下列關於 placebo analgesia 的敘述何者錯誤？ (A) 暗示、建議、期待、或制約(conditioning)都是增強 placebo analgesia 的重要因素。 (B) 與 placebo analgesia 有關的生理結構可能是 limbic system (包括 amygdala, ventral striatum，anterior cingulate，和 prefrontal cortex)。 (C) 在不同疼痛模型，出現 Placebo effect 比率的人數(responder)不同；在拔牙後疼痛實驗佔20% '在止血帶誘發疼痛低於 10%。 (D) 不同疼痛模型，placebo analgesia 在 VAS 的強度也不同；如拔牙後疼痛實驗 responder 與 non-responder 可以相差到 5 分。 (E) Nocebo 與 placebo 相反，是指經過治療(處理)後，結果反而無效或是疼痛加劇；例如利用暗示，使原本有效的 N20 拔牙止痛，變得更痛。

31. Which of the following examination is required to be certain of the degree of arachnoiditis? (A) CT (B) MRI (C) Myelography (D) NCV+EMG (E) x-ray

32. When the administration of opioids failed to manage pain or the dose of opioids are noted to escalate, the following differential diagnosis should be considered, except: (A) Limited absorption of oral preparations—vomiting or gastric stasis. (B) Pain poorly responsive to opioids alone- such as Neuropathic pain (C) Pharmacological factors: Opioid-induced hyperalgesia and allodynia (D) Psychological factors: Distress, Anxiety or Depression (E) All of the above should be considered

33. Which of the following statement concerning the complex regional pain syndromes (CRPS) is least likely: (A) CRPS is characterized by pain, abnormal regulation of blood flow and sweating, as well as tropic changes of skin and subcutaneous tissues. (B) Reflex sympathetic dystrophy (RSD) usually develops after injury to a major peripheral nerve. (C) RSD is also called CRPS type I. (D) In addition to positive sensory phenomena, up to 50% of patients with chronic CRPS type I develop hypoaesthesia and hypoalgesia on the entire half of the body. (E) Spontaneous pain or allodynia/hyperalgesia occurs, which is not limited to the territory of a single peripheral nerve in patients with CRPS type I.