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.

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：

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

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

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

37. Regarding the actions of spinal and supraspinal analgesia for opioids, which of the following statement is most likely: (A) Opioid receptors are mostly located at a predominantly 70% postsynaptic location on the central terminals of only small diameter nociceptive primary afferents. (B) The contribution of kappa, delta and mu receptors to the total opiate binding throughout the spinal cord is estimated to be delta ＞ mu ＞kappa.(C) Opioids inhibit OFF cells via GABA neurons and activate ON cells in the rostromedial medulla (RVM) leading to changes in spinal descending controls. (D) Nitric oxide (NO) is required for the 5-HT-mediated inhibition of PAG output and reversal of antinociception. (E) Fibers descending from the PAG to the dorsal horn of the spinal cord are mostly enkephalinergic, glycinergic and GABAergic.

38. 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) 病患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) 病人自述出現嗜睡、噁心、性欲降低、便秘，但是疼痛都沒有減輕 (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