33. 關於頭頸癌症病人的的敘述，下列何者不恰當？
(A) 頭頸癌病人的疼痛問題，可能是腫瘤本身、化學治療、放射治療、或是手術造成的
(B) 粘膜炎(mucositis)的疼痛機制可能是黏膜產生潰瘍，暴露出神經末梢，使得黏膜表面變 得對疼痛敏感。
(C) 可以用來處置粘膜炎(mucositis)產生的疼痛，包括 topical benzydamine、乳狀鎂(milk of magnesia)、口服 acetaminophen, NSAIDs，甚至是嗎啡類藥物。
(D) 住院的癌症病患如果有嚴重的粘膜炎(mucositis)，可以考慮使用 Intravenous Patient-controlled analgesia (IVPCA) with morphine。
(E) 粘膜炎(mucositis)在頭頸癌病人很常發生，常會造成疼痛問題，是無法預防的 p.

1. Which of the following statement concerning “postoperative pain” is least likely? (A) Management of postoperative pain is challenging. (B) Management of postoperative pain is based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission. (C) Chronic pain after surgery is an underdiagnosed condition (D) Advances in understanding the genetic profile of patients should help improve treatment of postoperative pain. (E) It is not essential that the neuronal response to surgery be blocked to achieve the task of optimal pain control.

2. 下列幾項關於疼痛名詞的定義或說明，依照 Bonica’s Management of Pain 5th ed 或疼痛學 理，哪一項是錯誤？ (A) Anesthesia dolorosa: Spontaneous pain in an area or region that is anesthetic (B) Catastrophizing: A cognitive and emotional process which can be an important predictor of negative response to both acute and chronic pain (C) Chronic widespread pain includes nonradicular back pain, fibromyalgia, irritable bowel syndrome, pelvic pain, tension-type headache, and temporomandibular disorders (TMD). (D) Conditioned pain modulation: a mechanism can be assessed by measuring tonic pain response after a conditioned phasic pain stimulus (E) Hyperpathia: A painful syndrome characterized by an abnormally painful reaction to a stimulus

3. Which of the following statement concerning “muscle pain” is least likely? (A) Muscle pain is distinct from cutaneous pain. (B) Muscle pain is one of the most common pain complaints. (C) Muscle nociceptors are free nerve endings that are connected to the central nervous system. (D) Most nociceptors cannot be excited by algesic agents, including bradykinin, serotonin. (E) In damaged muscle, the nociceptors have a lowered mechanical threshold.

4. Which of the following diagnostic tests that aid in the diagnosis of complex regional pain syndrome? (A) Bone scintigraphy (B) Plain radiography and X-ray bone densitometry (C) Quantitative sensory testing (D) Skin temperature measurement (E) All of above

5. 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.

6. 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

7. 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

8. Which of the following is not true about post-mastectomy pain? (A) Mastectomy may result in chronic pain in as many as half of those patients. (B) This pain often starts immediately or a few days postoperatively. (C) This pain is usually neuropathic in character. (D) It is suspected that the intercostobrachial nerve is often damaged during axillary node dissection (E) The incidence of phantom breast syndrome 1 year after surgery is less than 5%.

9. According to the long-form McGill Pain Questionnaire (MPQ) pain rating index scores, which of the following acute pain status is rated the highest pain score? (A) Amputation of digit (B) Labor pain (C) Abdominal gynecological surgery (D) Fracture. (E) Lower abdominal surgery (males)

10. 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

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