35. Which of the following statement concerning "phantom limb pain" is most likely:
(A) Phantom pain is the painful sensations referred to the amputation stump
(B) Phantom pain may enhance with time
(C) Preamputation pain increases the risk of phantom pain
(D) Phantom pain can be prevented by a preoperative epidural blockade
(E) Postamputation pain can be easily treated by analgesia

31. A 27-year-old woman with a history of malignant melanoma and multiple subcutaneous metastases has been successfully managed with slowly increasing doses of MS-Contin (Morphine SR), in conjunction with doxepin and ibuprofen. She calls the pain center to complain of a new onset of increasing nausea, vomiting, and headaches, as well as poor pain control. The most appropriate immediate action would be to (A) speak with the patient by telephone and tell her to increase the MS-Contin (B) see the patient as soon as possible to determine if there is a new, treatable source of pain (C) schedule the patient for an evaluation in your office within the week (D) switch to a fentanyl patch since the patient is nauseated and may be unable to take oral analgesics (E) add ondansetron for nausea and vomiting so she is able to continue to take oral analgesics

32. 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, lycinergic and GABAergic.

33. Regarding NSAIDs or Coxibs, which of the following statement is least likely: (A) Ketorolac is one of the acidic anti-inflammatory analgesics with high potency and fast elimination. (B) Paracetamol is an non-acidic antipyretic analgesic with weak inhibition on cyclooxygenase. (C) The analgesic effect, as demonstrated by number-needed-to-treat (NNT), of oral Tramadol (100 mg) is better than oral Celecoxib (400 mg). (D) Topical NSAIDs are effective in strains and sprains and in arthritic conditions. (E) Paracetamol is an alternative for analgesic in patients with exacerbation of asthma.

34. Regarding antidepressant analgesics, which of the following statement is least likely: (A) According to NNT data in treating postherpetic neuralgia, imipramine has slightly better analgesic effect than oxycodone. (B) Desipramine (25-300 mg/day, oral) has low potency of anticholinergic effect and sedation. (C) Fluoxetine (5-40 mg/day, oral) has no anticholinergic and sedative effects. (D) Venlafaxine is relatively free of muscarinic cholinergic, histaminic and alpha-adrenergic receptor effects. (E) The analgesic effect of antidepressants in treating neuropathic pain is dependent of its antidepressant action.

36. Which of the following statement concerning "cytokines" is least likely: (A) Cytokines mediate the communication from the immune system to the peripheral nervous system and CNS, and to endocrine systems (B) IL-1, IL-6 and TNF-α are pro-inflammatory cytokines (C) Intraperitoneal injection of IL-1β in rats generate hyperalgesia that can not be abolished by vagotomy (D) Bradykinin activates macrophages that release TNF-α, which sensitizes nociceptors by the production of IL-6 and IL-1β (E) IL-6 and TNF-α, released intraneurally by macrophages, are involved in neuropathic pain

37. Ramsay Hunt syndrome (herpes zoster oticus) occurs when herpes zoster involves the: (A) gasserian ganglion (B) geniculate ganglion (C) ciliary ganglion (D) sphenopalatine ganglion (E) trigeminal nerve

38. In neuropathic pain, the hyperexcitability demonstrated by wide-dynamic range cells in the dorsal horns seems to be related to increase basal release of excitatory amino acids, such as (A) Dopamine (B) Glutamate. (C) Acetylcholine. (D) GABA. (E) Norepinephrine.

39. Which of the following statement concerning "central pain" is least likely: (A) Central pain is defined as pain caused by a lesion or dysfunction in the CNS (B) The most common cause is traumatic spinal cord injuries (C) In stroke the onset of pain is early (D) In stroke the pain is most frequently a hemipain (E) Central pain is dominated by abnormalities in the sensibility to temperature

40. The current guidelines on the management of acute low back pain in primary care include the following, EXCEPT (A) Reassure patients because the prognosis is most favorable (B) Advise or encourage complete bed rest (C) Prescribe analgesics medication if necessary (D) Encourage to stay active (E) Consider spinal manipulation (chiropractic) for pain relief

41. 下列有關 Phantom pain 的敘述何者正確? (A) 所有截肢病患都會出現 Phantom pain (B) 常見 Telescoping phenomenon (患肢感覺 shrinkage, 甚至縮進 stump 內) (C) 早期給予大劑量強效嗎啡止痛可以降低 Phantom pain 發生機率 (D) 病人若出現 radiating, lancinating or paroxysmal pain, 首選治療藥物是大劑量 Gabapentin, 可從每天 1200mg 作為起始劑量 (E) Physical therapy 例如 massage, manipulation 或 acupuncture, hypnosis 等整合療法對 Phantom pain 無效