38. Regarding the biological effects of exogenous nerve growth factor (NGF) on pain-signaling systems in normal animals in animals with nerve injury, which of the following statement is most likely occurred in DRG:

(A) Decreases in substance P, increases in CGRP and trkA.
(B) Decreases in substance P, brain-derived neurotrophic factor (BDNF).
(C) Decreases in substance P, increase in BDNF
(D) Decreases in substance P, CGRP and trkA.
(E) Decreases in substance P, TRPV1, sodium channels.

34. Which of following description about using anticonvulsants (used as Analgesic Drugs is "Correct"? (A) Most commonly used anticonvulsants as analgesics appear to work through potentiation of voltage-gated sodium and calcium channels (B) Sodium channel subtype 1.4 &1.5 are highly expressed in neuronal cell and could be the drug target for anticonvulsant medication (C) Gabapentinoid (Gabapentin & Pregabalin) works on GABA receptor (D) Topiramate works only on voltage-gated sodium channel (E) Lamotrigine and Phenytoin work on voltage-gated sodium channels

35.Which of following description about "antidepressant analgesic" is "Correct"? (A) In terms of treatment efficacy (smaller number needed to treat NNT), pregabalin is much better than tricyclic antidepressant and listed as first line therapy for neuropathic pain (B) In terms of treatment efficacy (smaller number needed to treat NNT), SSRI is better than SNRI for common neuropathic pain such as postherpetic neuralgia or painful diabetic polyneuropathy (C) Venlafaxine is effective for treatment of neuropathic pain associated with beast cancer. (D) For painful diabetic neuropathy, comparison of amitriptyline and pregabalin showed no difference in pain relief but fewer adverse effects with pregabalin. (E) All of above

36. Regarding the peripheral mechanisms of cutaneous nociception, which of the following statement is least likely: (A) Following a cutaneous injury, primary hyperalgesia develops at the site of injury, which is called sensitization. This sensitization is due to the local release of inflammatory mediators such as interleukins (IL-10) and prostaglandin E1. (B) Secondary hyperalgesia was induced in the surrounding uninjured skin, which is due to sensitization of neurons in the central nervous system. (C)hen nerves are severed, spontaneous activity and ectopic mechanical, thermal, and chemical sensitivity develop in the injured nociceptors. (D) The properties of nearby, uninjured nociceptors are also changed. (E) In both injured and uninjured nociceptors, responsiveness to adrenergic agents can develop, which may account for involvement of the sympathetic nervous system in certain forms of neuropathic pain.

37. Regarding the molecular biology of sensory transduction, which of the following statement is least likely: (A) Chemotransducers are metabotropic receptors, which is the slowest form of chemical transduction. (B) Thermotransducers include TRPA1–TRPV2, TRPV3 and TRPV4, TRPA1, TRPM3, TRPM8, TRPC5, K2P, which can respond to a wide range of temperatures. (C) The underlying mechanisms of mechanotransducers vary as a function of stimulus (stretch versus pressure) and the tissue stimulated. (D)Piezo1 and 2 channels are also refered to mechanotransducers. (E) Polymodalities existed across these transducers (many transducers are activated by several stimulus, e.g., thermo- and mechanotransducers also have chemosensitities).

39. Regarding the neuron–glial interactions within the spinal cord after peripheral nerve injury (PNI), which of the following statement is least likely: (A) Up-regulated P2X4R expression is induced in microglia within the spinal cord by PNI. (B) In this P2X4R+ state, microglia release BDNF, which inhibits neurons in the spinal nociceptive processing network. (C) Minocycline and propentofylline is glial-specific inhibitors. (D) MAPKs, p38, is the intracellular mediator of P2X4R–BDNF signaling in microglia-mediated post–nerve injury pain states. (E) BDNF from microglia is a critical signaling molecule mediating the central pathophysiological effects of PNI.

40. Regarding Central Nervous System Mechanisms of Pain Modulation, which of the following statement is least likely: (A) Pain-modulating systems involve a network with major relays in the midbrain periaqueductal gray and rostral ventrolateral medulla. (B) This network exerts bidirectional control over dorsal horn nociceptive transmission by means of separate anti- and pro-nociceptive output from the RVM. (C) The PAG–RVM system is the central substrate for the actions of opioid and non-opioid analgesic drugs. (D) The PAG–RVM system receives direct and indirect input from nociceptive transmission pathways to modulate nociception. (E) It strongly links with the hypothalamus and limbic forebrain , through which cognitive and emotional factors can regulate pain processing.

41.關於叢發性頭痛(cluster headache)之描述，下列何者有誤: (A)位於眼眶、上眼眶及/或顳部重度疼痛，好發於雙側，如不治療可持續 15 至 180 分鐘。 (B)男性較容易發生叢發性頭痛 (C)發作頻率為每二日一次至每日八次 (D)會伴隨至少一項自主神經症狀，如結膜充血、流淚、鼻腔充血、流鼻水、瞳孔縮小及眼 皮下垂等。 (E)若兩次叢發期間隔 1 個月以上的緩解期，則稱作「陣發叢發性頭痛(episodic cluster headache)」。

42.有關偏頭痛(migraine)之敘述，下列何者有誤？ (A)每月發作一至兩次的病人不須使用預防性用藥 (B)每月發作五次以上的病人應使用預防性用藥 (C) Propranonol 及 Gabapentin 可作為預防性用藥 (D) Aspirin 對許多急性發作病人有效 (E) Ergotamine 對較嚴重的偏頭痛是目前首選用藥

43.關於典型三叉神經痛(classic trigeminal neuralgia)的治療，下列何者可做為 Carbamazepine 替代用藥? (A) Lamotrigine (B) Oxcarbazepine (C) Pregabalin (D) Baclofen (E)以上皆是

44.有關緊張型頭痛(Tension-type headache)之敘述，下列何者有誤？ (A)頭痛中最常見的一種類型 (B)好發於青壯年，女性多於男性。 (C)多為單側，位於枕頸部、頂顳部，常為緊束感、重壓感的表現。 (D)中樞疼痛機轉在慢性緊張型頭痛扮演較重要角色 (E)藥物選擇上主要採用 NSAIDs 以減輕症狀