30. From the viewpoint of clinical manifestations, structures responsible for generating pain in the nociceptive process from within the head does not inlcude:
(A) large intracranial vessels and dura mater
(B) peripheral terminals of the trigeminal nerve innervating these structures
(C) cortex of brain
(D) central terminals and second-order neurons of the trigeminal nucleus
(E) all of the above are responsible in perception of nociceptive pain within the head

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：

31. Differentiation between cluster headache and other trigeminal autonomic cephalalgias such as paroxysmal hemicranias, SUNCT syndrome and hemicrania continua includes: (A) less severe pain (B) less frequent pain attacks (C) effective prophylactic treatment by methysergide and prednisolone (D) no autonomic features (E) with migrainous features

32. Which of the following statement concerning autonomic- endocrine-immune interaction in pain” is least likely? (A) Cytokines are involved in the sensitization of nociceptors during inflammation and may lead to hyperalgesia. (B) Proinflammatory cytokines are synthesized and released by macrophages and other immune-related cells. (C) IL-4 is categorized as an anti-inflammatory interleukin (D) IL-1, IL-10 and TNF-α are categorized as proinflammatory cytokines. (E) TNF-α induces synthesis and release of IL-8, which activates sympathetic terminals that synthesize nociceptors via β2-adrenoceptors.

33. Which of the description below is not included in the simple diagnostic criteria for migraine? (A) unilateral pain (B) numbness (C) throbbing pain (D) nausea/vomiting (E) photophobia and phonophobia

34. Which of the following statement concerning “spinal cord plasticity and pain” is least likely? (A) A strong and/or sustained activation of nociceptive C fibers may induce the plasticity in spinal cord. (B) Neurotrophic factors BDNF and NGF are thought to be able to induce hyperalgesia on spinal application. (C) In nociceptive pathways, long-term potentiation (LTP) may be triggered by enhanced synaptic activity. (D) LTP may be induced by electrical stimulation and nerve injury, but not hindpaw injection of formalin. (E) In nociceptive pathways, long-term potentiation (LTP) may be triggered by abrupt withdrawal from opioids.

35. During peripheral sensitization of nociceptors, which of the coupling is wrong? (A) prostaglandin E2 (PGE2) --- EP receptor (B) bradykinin --- B2 receptor (C) heat --- TRPV1 receptor (D) ATP --- P2Y receptor (E) all of the above are right

36. Arrange the pain intensity of the following conditions from the strongest to the least according to long form McGill Pain Questionnaire. 1 Labor pain, 2 Amputation of digit, 3 Male low abdominal surgery, 4 Fracture: (A) 1＞2＞3＞4 (B) 2＞1＞4＞3 (C) 2＞1＞3＞4 (D) 1＞2＞4＞3 (E) None of above is right