41. 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

37.下列 opioid 中,何者可能產生 QT prolonged, 甚至導致 torsade de pointes 這種致命性心律不整? (A) Meperidine (B) Methadone (C) Tramadol (D) Buprenorphine (E) Butorphanol

38.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

39. Which one of the following statement about the pathophysiology of herpes zoster is wrong? (A) Herpes zoster most commonly manifests in the distribution of a single dorsal sensory or cranial nerve ganglion. (B) Why the reactivation of virus occurs in one ganglion when latent virus is present throughout the patient’s sensory ganglia is clear. (C) Declining cellular immunity is a major risk factor for reactivation of the virus, which is thought to occur when cell-mediated immunity falls below a critical level. (D) This impression is supported by evidence that even individuals with adequate levels of serum antibodies to varicella-zoster virus (VZV) antigen can, over time, exhibit T cells with reduced ability to proliferate and defend against VZV infections. (E) Cell-mediated immunity appears to play a crucial role in preventing reactivation of latent VZV.

40. Which of the following is the acceptable statement about neurodestructive RF lesions? (A) These temperatures are resulted from friction heat. (B) The size of RF lesion with 22 gauge RF needle is around with a radius of 5 mm (C) The heat is generated on the tip of RF needle. The RF needle then heat up the tissues. (D) The RF permanent neurodestructive lesion is formed when neural temperatures exceed 42 C (E) All of the above

42.有關 Post-stroke pain 之疼痛症狀類型中，下列描述何者最不適合？ (A) Central post-stroke pain 屬於 neuropathic type (B) Shoulder pain 不屬於 neuropathic type (C) Musculoskeletal pain 不屬於 neuropathic type (D) Headache 屬於 neuropathic pain (E) Spasticity 不屬於 neuropathic type

43.Neuropathic pain 有多種不同原因,治療藥物的選擇必須依照病因決定,請問下列敘述,何者錯誤? (A) Amitriptyline 對 Spinal cord injury 的 neuropathic pain 治療效果不佳 (B) Amitriptyline 對 phantom limb pain 的治療效果不佳 (C) Venlafaxine 對 postmastectomy syndrome 的治療效果不佳 (D) Selective Serotonin and Norepinephrine Reuptake Inhibitors 治療 painful diabetic neuropathic pain 的 NNT (number needed to treat) 比 TCA 小 (E) Selective Serotonin and Norepinephrine Reuptake Inhibitors(SNRI)一般比 Selective Serotonin Reuptake Inhibitors(SSRI)對 neuropathic pain 的治療效果好

44.對於催眠,雖然很多人只當它是類似一種魔術表演,但目前越來越多研究證實催眠確實有止痛效果,那麼以下所列疾病或狀況是目前有較多研究證實催眠有效的? (A) Burns (B) Pediatric Pain (C) Cancer (D) Osteoarthritis (E)以上皆是

45.以下那個選項不是發生 local anesthetics systemic toxicity (LAST)時的正確處理? (A) Suppress seizures: Benzodiazepines preferred (B)使用 amiodarone 做為第一線 antiarrhythmic (C)避免使用 calcium channel blockers, beta blockers (D)若使用 lipid emulsion 解毒,病人回復 hemodynamic stable 即立即停止繼續給予 lipid emulsion (E) Maximum dose lipid emulsion 大約 12 mL/kg IV

46. Which of the anticonvulsants has the highest quality of evidence supporting its tolerability and efficacy in reducing SCI neuropathic pain? (A) Pregabalin (B) Gabapnetin (C) Lamotrigine (D) Valproic acid (E) Carbamazepine

47. In addition to A tender spot is found with palpation, with or without referral of pain (“trigger point”). Which of the following symptoms by patient during palpation of tender spot is not commonly found? (A) Muscle stiffness or spasm (B) Limited range of motion of an associated joint (C) Pain worsens at rest (D) Palpation of taut band and/or nodule associated with tender spot (E) All of the above are common found