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.

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

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.

32.Which of the following symptom is not often seen in patients with physical dependence (abstinence syndrome -(withdrawal) ) ? (A) abdominal cramps (B) constipationn (C) vomiting (D) pupil dilatation (E) sweating

33.以下為 failed back surgery syndrome 常見的鑑別診斷與其常見症狀,下列何者配對有誤? (A) Lateral canal stenosis: relief with sitting (B) Painful discs: relief with sitting (C) Neuropathic pain: Leg pain Burning dysesthesia (D) Recurrent HNP: Vary with location. Leg pain ＞ LBP (E) SI joint pain: Gluteal pain with referral to leg and groin

34.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.