31. 叢發性頭痛(cluster headache)急性發作時，下列何種藥物不具治療角色?
(A)皮下注射 sumatriptan
(B)經鼻給予 zolmitriptan
(C)經鼻給予 lidocaine 至翼齶窩(pterygopalatine fossa)
(D)靜脈注射 dihydroergotamine
(E)口服 verapamil

1. 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..

2. 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

3. 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.

4. 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.

5. 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.

6. Which one of the following statements is wrong? (A) Neuron–glial interactions are increasingly recognized as being key for physiological and pathological processes in the central nervous system. (B) Microglia in the spinal dorsal horn respond to injury to peripheral nerves by adopting a specific response state characterized by up-regulation of the purinergic receptor P2X4. (C) In this P2X4R+ state, microglia release brain-derived neurotrophic factor, which disinhibits neurons in the spinal nociceptive processing network. (D) The transformation in processing caused by signaling of P2X4R+ microglia to nociceptive transmission neurons may account for the main symptoms of neuropathic pain in humans. (E) All of the above are correct.

7. Which one of the following statements is wrong? (A) The spinal dorsal horn receives input from a wide variety of primary afferent axons, including nociceptors, which respond to tissue-damaging stimuli from the skin, muscles, joints, and viscera. (B) The patterns of termination of primary afferents within the spinal cord are related to axonal diameter and receptive field modality. (C) Most nociceptive primary afferents have slowly conducting fine myelinated or unmyelinated axons, and they terminate mainly in the deep part of the dorsal horn. (D) Primary afferents release a variety of chemical mediators and on entering the dorsal horn they form excitatory synapses with neurons located within it.

8. Which of the following description about spinal cord plasticity and pain is incorrect? (A) Some spinal nociceptive neurons receive convergent input from high- and low- threshold sensory fibers thus called wide–dynamic range neurons (B) Glutamate is the major fast excitatory neurotransmitter in all nociceptive afferent nerve fibers. Glutamate can bind to three types of ionotropic glutamate receptors and to G protein–coupled metabotropic glutamate receptors to modify neuroexcitability. (C) Hyperalgesia and allodynia can even be induced in humans in the absence of any sensory stimuli, such as during prolonged application of opioids or on abrupt withdrawal of opioids.. (D) Spinal nociception is under powerful control from descending inhibitory and facilitatory pathways. Under normal conditions, descending facilitation appears to prevail over inhibitory pathway.

9. About epidural steroid injection, which one of following statements is wrong? (A) Spinal stenosis is an indication for epidural steroid.. (B) Do not use for non-specific low back pain. (C) Do not repeat more than three times per year. (D) May cause pain from chronic arachnoiditis. (E) Efficacy is less with radicular pain that has lasted longer than 3 months.

10. Adjuvant analgesics are often prescribed for managing caner pain, but which of the following drug – indication is not considered ? (A) NSAIDs for Soft tissue pain (B) Anticonvulsants for Neuropathic pain (C) Steroids for Soft tissue pain (D) Baclofen for Muscle spasm (E) Benzodiazepines for Muscle spasm

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