32. Which medication below is not suggested in fibromyalgia syndrome (FMS):
(A) Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen)
(B) Pregabalin
(C) Tricyclics (amitriptyline, nortriptyline, doxepin, cyclobenzaprine)
(D) Opioids
(E) All of the above treatments are suggested for pain management of OA

28. 當病人一再來門診或急診要求注射成癮性止痛藥時，下列哪些現象暗示病患可能有「成癮」現象? (A) 病人抱怨最近的處方的止痛時間不夠久，藥效變差 (B) 病忠抱怨最近疼痛加重厲害，發作頻繁，他把三天的藥一天吃完 (C)病人說吃完藥舒服很多 (D)病人自述沒吃止痛藥會睡不著，希望睡前加重劑量輔助睡眠 (E)病人最近反覆敘述藥物遺失，而且發生很多次

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. Which drug below is less likely an option for inhibiting central sensitization following acute postoperative pain: (A) NMDA antagonist (B) Opioid (C) COX2-inhibitor (D) Pre-emptive analgesia (E) Gabapentin

31. A 61-year-old woman presents to the pain clinic with a chief complaint of left shoulder and arm pain 3 years after undergoing radiation therapy for breast cancer. Physical examination reveals lymphedema of the left axilla with noticeable skin changes. Examination of the left supraclavicular area precipitates a sharp pain that radiates down her left arm. Which of the following is her likely diagnosis? (A) Tumor metastasis (B) Cervical radiculopathy (C) Reflex sympathetic dystrophy (D) Thrombangitis obliterans (E) Radiation-induced plexopathy

33. Choose one wrong description about pain assessment. (A) McGill Pain Questionnaire (MPQ) had been used in Chinese (B) Short-Form MPQ consists both sensory and affective categories. (C) Neuropathic pain also has specific pain questionnaire, like DN4. (D) Visual analog scales (VASs) measure only in pain intensity. (E) Neuropathic pain and non-neuropathic pain evaluation cannot be

34. Which is NOT true regarding cluster headache? (A) ipsilateral ptosis, miosis, or nasal congestion might occur (B) with or without aura (C) usually unilateral (D) none of the above

35. Which of the following event is not related to Microglia to develop pain hypersensitivity following peripheral nerve injury? (A) up-regulated P2X4R expression (P2X4R+) (B) ATP stimulation in the presence of extracellular Ca2+ causes the P2X4R to open a non-selective cation-permeable channel (C) p38 mitogen-activated protein kinase mediates further Microglial Signaling (D) release of Brain-Derived Neurotrophic Factor (BDNF) (E) all of the above are involved to develop pain hypersensitivity following peripheral nerve injury.

36. A rise in post-synaptic Ca2+ concentration is an essential central step for virtually all forms of LTP. The rise of post-synaptic Ca2+ concentration is not attributed to (A) NMDA receptors (B) T-type VGCCs (voltage-gated calcium channel) (C) Ca2+-permeable AMPA receptors (D) P2X4R (E) release of Ca2+ from intracellular Ca2+ stores

37. When Rexed’s laminae was applied divide the spinal cord to different laminae. Which of the following description was wrong? (A) Lamina II is also known as the substantia gelatinosa (B) most A-δ fiber will transmit the noxious sensation to lamina I and V (C) most C fiber will transmit the noxious sensation to lamina I and II (D) A-δ fiber and C fiber will transmit innocuous sensation to different laminae from noxious sensation (E) all of the above are correct description

38. For Chronic pain patients (CPPs), which of the following description is wrong: (A) In tertiary treatment facilities, depression has been reported in 10-100% of CPPs (B) Successful treatment of depression reduce the effect of pain interference. (C) Anxiety disorders are common in CPPs (D) The incidence of de novo opioid addiction is increased in CPPs (E) CPPs should be offered smoking cessation treatment.