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

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

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

42. 下列有關脊髓損傷後的慢性疼痛之敘述何者錯誤? (A) 脊髓損傷節段以下由於已無知覺,因此不會有疼痛感覺,脊髓損傷後的慢性疼痛都是 at-level neuropathic pain. (B) 脊髓損傷後的慢性疼痛常合併有重度憂鬱等的情緒面向 (C) 脊髓損傷後的慢性疼痛依舊可以使用脊椎內嗎啡幫浦作為止痛處置,然常效果不盡理想,需要合併給予如 clonidine 等輔助性藥物 (D) 心理諮商訪談及認知行為療法是脊髓損傷後的慢性疼痛常用且效果顯著的治療 (E) 脊髓損傷後的慢性疼痛不全然是 Neuropathic,有部分是 chronic musculoskeletal pain

43. Which medication below is not suggested in fibromyalgia syndrome (FMS): (A) Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) (B) Pregabalin (C) Tricyclics (amitriptyline, nortriptyline, doxepin, cyclobenzaprine) (D) Opioids (E) All of the above treatments are suggested for pain management of OA

44. 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) Thromboangiitis obliterans (E) Radiation-induced plexopathy

45. A 26-year-old weight lifter felt a sharp pain in the neck, radiating to the dorsal aspect of the forearm during his workout. Over the next few days he noted progressive numbness of the thumb and index finger. He also complained of decreased ability to perform bicep curls. On examination by his primary care doctor, a markedly diminished biceps reflex was found. Which of the following is the most likely cause of the patient's problem? (A) Facture C5 vertebra (B) C5-C6 disc protrusion (C) Facet syndrome at C5-6 (D) Compression of the C5 nerve root by an osteophyte

46. Which of the following statements regarding corticosteroid use is NOT true? (A) 30-50% of patients on chronic oral corticosteroid therapy suffer from osteoporotic fractures. (B) Corticosteroid users are at increased risk of NSAID-related GI bleeding. (C) Corticosteroid use can be associated with weight gain, hypertension and hyperglycemia. (D) Osteoporosis is only a concern in patients who have been on corticosteroids for over 12 months.