34. MODULATION OF TRIGEMINAL NOCICEPTION 與何者相關？
(A) Segmental modulation
(B) Descending modulation from the brain stem.
(C) Diffuse noxious inhibitory control.
(D) V Top-down modulation
(E) all

30. The innervation of deep somatic tissue like muscle and joint is quite complex. Which of the following description is not appropriate? (A) The nociceptors are predominantly activated by non-physiological stimuli which may cause damage to the structures (e.g. overload, twisting, strong pressure, ischemic contraction). (B) During inflammation or after trauma, nociceptors of joint and muscle show pronounced sensitization, in particular for mechanical stimuli. (C) Descending inhibition is enhanced during chronic inflammation but seems to be normalized during acute inflammation. (D) Both primary afferent fibers as well as sympathetic reflexes may aggravate inflammatory lesions. (E) Reduced release of hormones from the hypothalamic-pituitary-adrenal (HPA) axis such as cortisol, adrenal androgens and testosterone may cause a relative loss of anti-inflammatory activity.

31. 關於疼痛臨床研究與止痛方式的統計，下列何者正確？ (A)一般而言，某種止痛方式的 number need to treat 介於 8-12 之間，表示該方式是有效的 (B)統計結果 Number need to treat 數值愈大，表示該止痛方式效果越好 (C)統計結果 Number need to harm 不適合用以表達副作用或併發症的的發生率 (D)比較不同止痛方式的效果時，病人自控式止痛的嗎啡用量是很好的指標，比 pain score 更為客觀 (E)以上皆不正確

32. 關於鴉片類藥物的敘述，下列何者最不正確？ (A) Hydromorphone 效力比 morphine 強 3-5 倍(口服)，且具有 NMDA 受體拮抗劑與血清素 再吸收抑制(serotonin reuptake inhibitor)的特性 (B) Buprenorphine 具有μreceptor partial agonist 及κantagonist 之性質 (C) Meperidine(pethidine)具有高度親脂性，容易引發「尋藥行為」(drug-seeking behavior) (D) Tapentadol 具有μagonist 與 noradrenaline reuptake inhibitor 之性質 (E)以皮下作為給藥路徑可以提供緩慢穩定的吸收，唯給藥量不宜超過 5 mL/hr

33. 下列對於肌筋膜疼痛及纖維肌痛的比較，何者錯誤：

35. Which of the following common manifestations of fibromyalgia syndrome has the lowest prevalence? (A) Widespread pain (B) Peripheral pain generators (C) Fatigue (D) Irritable bladder syndrome (E) Sleep disorder

36. Which of the following is not a common manifestation of the myofascial pain syndrome? (A) Regional body pain and stiffness (B) Abnormal findings on neurological examinationl (C) Limited range of motion of the affected muscle (D) One or more trigger points (E) Referral (triggering) pain from a trigger point to a zone of reference.

37. 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

38. Which of the following suggestion is not advisable for the use of opioids in children with cancer pain? (A) Use the oral route first in most circumstances (B) Treat constipation pre-emptively. (C) If side effects are bothersome with one opioid, consider switching to another one. (D) Use sufficient doses to keep the patient comfortable should be avoided due to the possible occurrence of adverse effects (E) Use the oral route first in most circumstances.

39. Which of the following oral opioids is not recommended for padiatric patients with cancer pain? (A) morphine (B) hydromorphone (C) oxycodone (D) meperidine (pethidine) (E) all of the above can be prescribed for pediatric patients with cancre pain

40. Adjuvant analgesics are often prescribed for managing caner pain, but which of the following drug – indication is not considered? (A) NSAIDs for Soft tissue pain (B) Anticonvulsants for Neuropathic pain (C) Steroids for Soft tissue pain (D) Baclofen for Muscle spasm (E) Benzodiazepines for Muscle spasm