43. Indications for lumbar epidural steroid injections include all of the following, EXCEPT?
(A) Radicular pain with corresponding sensory change
(B) Radiculopathy due to herniated disc with failed conservative treatment
(C) Acute herpes zoster in the lumbar dermatomes
(D) Post laminectomy failed back syndrome without radiculopathy

39. Which one of the following intervention provides the worst therapeutic effect of pain relief for lumbar spinal radicular pain? (A) transforaminal epidural steroids injection (B) radiofrequency denervation (C) spinal cord stimulation (D) lumbar sympathetic block (E) caudal steroids injection

40. Which of the following statement concerning hypnotic analgesia is least likely: (A) Hypnosis has been highly associated with theta activity (4~8 Hz) using EEG methods. (B) Hypnotic analgesia can be understood as the result of a placebo manipulation, and it is not more than just relaxation. (C) Increases in hypnotic relaxation are associated with increases in regional cerebral blood flowin the occipital cortex. (D) Deep relaxation, dissociated imagery and focused analgesia produced significant reductions on all pain-related measures. (E) Descending projections from amygdale, PAG and locus coeruleus contribute to modulate nociceptive processes in the brain stem and the spinal cord.

41. A parturient of heroin abuse history ask for painless labor, which one is improper? (A) Meperidine (B) Continuous epidural analgesia (C) Nitrous oxide (D) Butorphanol (E) Intrathecal morphine

42. Which of the following is the unacceptable statement about peripheral nerve block? (A) Occipital nerve block is indicated for occipital and posterior auricular neuralgia. (B) Lateral cutaneous nerve of the thigh: local anaesthetic block of this nerve is indicated for diagnosis and treatment of meralgia paresthetica. (C) Sacral plexus block, transforaminal through the sacral foramina, may be indicated for temporary relief of sciatic pain. (D) Suprascapular nerve block is indicated for postsurgical pain relief, for assessment of shoulder pain and to facilitate physical therapy of the shoulder joint in painful shoulder stiffness and pain secondary to CRPS. (E) For classical trigeminal neuralgia, blocks of the Gasserian ganglion with glycerol or radiofrequency are now the commonly used alternatives when microvascular decompression is not available or cannot be used.

44. Which of the following is the acceptable statement about pathogenesis of FMS? (A) There is evidence to suggest that FMS is a disorder of abnormal processing of sensory information within the central nervous system. (B) Several neurochemical mediators of pain, substance P, nerve growth factor, dynorphin A, glutamate, nitric oxide, serotonin and noradrenaline are viewed as pronociceptive because they carry or amplify afferent signals, leading to the brain perception of increased pain. (C) The elevation of cerebrospinal fluid substance P in FMS is due to lowered activity of cerebrospinal fluid substance P esterase because the rate of cleavage of libeled substance P by FMS cerebrospinal fluid was lower than normal. (D) In different subtypes of FMS, it is believed that nerve growth factor may be responsible for the elevated cerebrospinal fluid substance P through its effects on central sensitization and neuroplasticity. (E) A specific Gi-protein–coupled receptor in peripheral blood leukocytes was found to be dysfunctional in patients with FMS. This resulted in lower baseline, also depressed intracellular levels of cyclic AMP and proposed as a diagnostic test for FMS.

45. A 52-year-old man complains of a sudden onset of severe stabbing pain in the left jaw and cheek that subsides in less than a minute. He is pain-free during the intervals between attacks. Activities such as combing his hair and shaving can cause the onset of this facial pain. He is otherwise healthy. The most likely diagnosis is? (A) Atypical facial pain (B) Vascular facial pain (C) Postherpetic neuralgia (D) Trigeminal neuralgia

46. Which statement regarding complex regional pain syndrome (CRPS) is True? (A) Causalgia, or burning pain, is now categorized as CRPS type I. (B) The term “reflex sympathetic dystrophy” (RSD), or CRPS type II, refers to a syndrome similar to causalgia but with a specific nerve lesion. (C) Etiology involves only peripheral over-reactions after nerve and/or soft tissue damage. (D) The signs and symptoms in CRPS are heterogeneous； which reflect underlying sensory, autonomic, and motor dysfunctions. (E) Sympathetic blockade is the gold standard of treatment.

47. When the administration of opioids failed to manage pain or the dose of opioids is noted to escalate, the following differential diagnosis should be considered, except: (A) Limited absorption of oral preparations—vomiting or gastric stasis. (B) Pain poorly responsive to opioids alone- such as Neuropathic pain (C) Pharmacological factors: Opioid-induced hyperalgesia and allodynia (D) Psychological factors: Distress, Anxiety or Depression (E) All of the above should be considered

48. Which statement about trigeminal autonomic cephalgias (TAC) is wrong? (A) Oxygen inhalation is a safe and effective method for acute treatment of cluster headache (B) Midbrain and pontine activation play a pivotal role in either initiation or termination of the acute attack of migraine (C) The forehead, temporal, orbit and occiput are the most frequent sites of hemicrania continua. (D) Paroxysmal hemicrania responds in a dramatic and absolute fashion to indomethacin. (E) Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is usually maximal in the ophthalmic distribution of trigeminal nerve.

49. As we know, bone scan is the most common diagnostic tool for bone metastasis. Which limitation is incorrect? (A) Bone scan is characterized by high sensitivity and high specificity (B) Any positive findings should be corresponded to painful sites with further evaluation of CT or plain radiographs(C) Bone scan doesn’t evaluate the structural integrity (D) Most common pattern of metastasis in bone scan is “hot spot” with radioisotope accumulation for new bone reaction (E) Some cancers may not show “hot spot” pattern, such as melanoma and multiple myeloma