33.以下為 failed back surgery syndrome 常見的鑑別診斷與其常見症狀,下列何者配對有誤?
(A) Lateral canal stenosis: relief with sitting
(B) Painful discs: relief with sitting
(C) Neuropathic pain: Leg pain Burning dysesthesia
(D) Recurrent HNP: Vary with location. Leg pain ＞ LBP
(E) SI joint pain: Gluteal pain with referral to leg and groin

29.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.

30.急性下背痛有許多可能的診斷，下列敘述何者有誤? (A)背痛可能是引起腹膜後炎症的內臟疾病（如胰腺炎）的一個特徵，但在這些疾病中，背痛通常是腹痛的附加症狀 (B)動脈瘤可能以背痛為唯一症狀。 事實上，背痛是大部分因主動脈瘤破裂而突然死亡的患者的唯一症狀 (C)醫學影像學上的脊椎退行性變化、脊椎前移和椎弓峽部骨折，與腰痛在統計學上或臨床上有顯著性相關。因此，這些情況都是診斷疼痛的原因 (D)腰椎感染通常在發病時是很難發現，疼痛可能是唯一的特徵 (E)急性腰痛的病因經常不明。造成這種情況的主要原因是常規的檢查，例如醫學成像，無法確定骨折、惡性腫瘤或感染以外的背痛原因

31.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.

32.Which of the following symptom is not often seen in patients with physical dependence (abstinence syndrome -(withdrawal) ) ? (A) abdominal cramps (B) constipationn (C) vomiting (D) pupil dilatation (E) sweating

34.About chemical neurolytic nerve blocks, which one of following statements is wrong? (A) Phenol or ethanol is usually used for chemical denervation. (B) The duration of these blocks is often disappointingly brief. (C) They may induce deafferentation-neuropathic type pain. (D) They are often indicated for patients with chronic pain and a normal life expectancy. (E) They can be used in patients with advanced cancer disease.

35.以下各種 Nonsteroidal Anti-Inflammatory Drug 何者可能產生 hepatotoxicity 的機率最高? (A) Indomethacin (B) Diclofenac (C) Naproxen (D) Ibuprofen (E) Meloxicam

36.Which of the following combination of lesion site with referral site describing pain referral is not common in cancer patients suffering from cancer pain? (A) (Diaphragmatic irritation) and (Shoulder) (B) (Urothelial tract) and (Inguinal region and genitalia) (C) (C7–T1 vertebrae) and (Interscapular) (D) (L1–2) and (Sacroiliac joint and hip) (E) all of the above are common found in patients with cancre pain

37.下列 opioid 中,何者可能產生 QT prolonged, 甚至導致 torsade de pointes 這種致命性心律不整? (A) Meperidine (B) Methadone (C) Tramadol (D) Buprenorphine (E) Butorphanol

38.About image-guided lumbar sympathetic block, which the following indication is not proper? (A) Sympathetically maintained pain (B) Reflex sympathetic dystrophy (C) Phantom low limb pain (D) Raynaud’s disease (E) Chronic pancreatitis

39. Which one of the following statement about the pathophysiology of herpes zoster is wrong? (A) Herpes zoster most commonly manifests in the distribution of a single dorsal sensory or cranial nerve ganglion. (B) Why the reactivation of virus occurs in one ganglion when latent virus is present throughout the patient’s sensory ganglia is clear. (C) Declining cellular immunity is a major risk factor for reactivation of the virus, which is thought to occur when cell-mediated immunity falls below a critical level. (D) This impression is supported by evidence that even individuals with adequate levels of serum antibodies to varicella-zoster virus (VZV) antigen can, over time, exhibit T cells with reduced ability to proliferate and defend against VZV infections. (E) Cell-mediated immunity appears to play a crucial role in preventing reactivation of latent VZV.