31. 環氧酶 (cyclooxygenase) 的抑制是非類固醇抗炎止痛劑的主要作用機轉，請問下列何者不 是第一型環氧酶 (COX-1) 存在或表現 (expression) 之處？
(A) 細胞素 (cytokine)
(B) 腎臟
(C) 中樞神經系統
(D) 血小板
(E) 胃黏膜

1. Descending inhibitory pathways typically involve which of the following neurochemical mechanisms EXCEPT? (A) Noradrenergic (B) Cholinergic (C) Enkephalinergic (D) Serotonergic

2. Which of the following is the unacceptable statement about peripheral nerve block? (A) Occipital nerve block is indicated for occipital and posterior auricular neuralgia. (B) Lateral cutaneous nerve of the thigh: local anaesthetic block of this nerve is indicated for diagnosis and treatment of meralgia paraesthetica. (C) Sacral plexus block, transforaminal through the sacral foramina, may be indicated for temporary relief of sciatic pain. (D) Suprascapular nerve block is indicated for postsurgical pain relief, for assessment of shoulder pain and to facilitate physical therapy of the shoulder joint in painful shoulder stiffness and pain secondary to CRPS. (E) For classical trigeminal neuralgia, blocks of the Gasserian ganglion with glycerol or radiofrequency are now the commonly used alternatives when microvascular decompression is not available or cannot be used.

3. The stellate ganglion: (A) receives fibers whose cell bodies are located primarily at the C4-C7 levels of the spinal cord (B) is primarily a parasympathetic ganglion (C) may be blocked with little danger of complications (D) lies at the level of high cervical vertebra (E) is a fusion of the inferior cervical and upper thoracic ganglia

4. Which of the following statement concerning “phantom limb pain” is most likely: (A) Post-amputation pain can be easily treated by analgesia (B) Phantom pain may enhance with time (C) Phantom pain is the painful sensations referred to the amputation stump (D) Pre-amputation pain increases the risk of phantom pain (E) Phantom pain can be prevented by a preoperative epidural blockade

5. Which of the following statement concerning “central pain” is least likely: (A) Central pain is dominated by abnormalities in the sensibility to temperature (B) The most common cause is traumatic spinal cord injuries (C) Central pain is defined as pain caused by a lesion or dysfunction in the CNS (D) In stroke the onset of pain is early (E) In stroke the pain is most frequently a hemipain

複選題6. 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.

7. What is the following description about tension-type headache is FALSE? (A) may be associated with stress (B) associated with vomiting (C) bilateral (D) most common in adolescence (E) pain may involve teeth, forehead & neck

8. In neuropathic pain, the hyperexcitability demonstrated by wide-dynamic range cells in the dorsal horns seems to be related to increase basal release of excitatory amino acids, such as (A) Dopamine (B) Glutamate. (C) Acetylcholine. (D) GABA. (E) Norepinephrine. 

9.Which NSAID has the lowest risk of GI bleeding？ (A) Diclofenac. (B) Piroxicam. (C) Indomethacin. (D) Celebrex. (E) Ketoprofen

10. About the surgical management of pain, which one statement of the followings is wrong? (A) Neuropathic pain due to a compressive lesion may be completely relieved by surgery, particularly if there has been little damage. (B) There may be severe continuing pain with relatively minor damage (e.g. root compression). (C) For the majority of patients with neuropathic pain, the realistic goal of treatment, in a multidisciplinary pain clinic, is total analgesia and improvement in functional status. (D) Any operation for treating pain should aim to be specific, localized into the pain area, carry minimal risk and long-lasting. (E) Neurosurgeons generally try the most peripheral procedures before working centrally within the CNS, while giving preference to non-neuroablative operation, if possible.

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