40. Pain disorder may result in the sleep problem, and which of the sleep pattern is not often seen in patients:
(A) acute pain following surgical procedures is associated with reduced and fragmented sleep
(B) acute postsurgical pain may result in diminished amounts of slow wave and rapid eye movement (REM) sleep
(C) patients with chronic pain may suffered from reduced sleep efficiency and altered sleep architecture (increased wakefulness and stage 1 non-REM sleep)
(D) subjects subjected to noxious stimuli during all stages of sleep will demonstrate a sleep awakening response and a moderate level of cortical arousal.
(E) all of the above are common found in pain patients

36. Which of the following painful disorder is more common in male patients than in female patients?(A) migraine (B) rheumatoid arthritis (C) irritable bowel syndrome (D) cornary artery disease ( older than 60 years old) (E) all of the above are more common than in female patients.

37. 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)

38. Which of the followings is probabaly a less predictive addition indicator? (A) Selling prescription drugs (B) Multiple episodes of loss of prescriptions (C) Repeated resistance to changes in therapy despite clear evidence of adverse physical or psychological effects from the drug (D) Resistance to a change in therapy associated with “tolerable” adverse effects with expressions of anxiety related to the return of severe symptoms (E) Concurrent abuse of alcohol or illicit drugs

39. 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

41. 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.

42.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

43. 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.

44. Choice a right description about treatment of cancer pain. (A) Because of the complexity of cancer pain, 3 analgesic ladder from WHO was not useful. (B) Surgery, Chemotherapy and radiotherapy are not the analgesic titration for cancer pain. (C) Only 10-20% of patients ultimately require regular strong opioids. (D) Constipation is common for opioid use, but laxative can be used only when symptom exists. (E) None of above is right

45. Pain is a frequent consequence of spinal cord injury (SCI). Which of the following statement is least likely: (A) Below-level neuropathic pain is most likely described as severe or excruciating months or years following initial injury. (B) Damage to the spinothalamic tracts is an important ingredient in the development of neuropathic pain following SCI. (C) Chronic musculoskeletal pain is common in tetraplegic patients after SCI. (D) Patients with cervical SCI are at risk of developing CRPS affecting upper limbs. (E) Below-level neuropathic pain is also referred to deafferentation pain.

46. A patient suffered from chronic low back pain with radiating to buttock, poster lateral thigh and lateral aspect of lower leg. Muscle weakness was observed in the extensor hallucis longus and tibialis anterior. Which lumbosacral root compression is the most likely？ (A) L2 root compression (B) L3 root compression (C) L4 root compression (D) L5 root compression (E) S1 root compression