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) Thrombangitis obliterans
(E) Radiation-induced plexopathy

40. Which one of the following neuropathic pain conditions is not likely responded to spinal cord stimulation? (A) Diabetic neuropathy (B) CRPS type I (C) CRPS type II (D) Central post-stroke pain (E) Occlusive peripheral vascular disease

41. 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 flow in 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.

42. 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

43. 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) Facet syndrome at C5-6 (C) C5-C6 disc protrusion (D) Compression of the C5 nerve root by an osteophyte

45. Examination of a patient with neck and shoulder pain reveals referred pain in the lateral aspect of the forearm, with weakness and dysfunction of the biceps and brachioradialis, and hypoesthesia in the lateral aspect of the forearm and thumb. The patient most likely has a lesion of which nerve root? (A) C7 (B) C6 (C) C5 (D) C4

46. A 25-year-old, obese man complains of a burning pain in the anterolateral thigh. Deep tendon reflexes and findings in a motor examination are normal. There is a slight sensory deficit in the lateral thigh that corresponds to the painful area. What is the most appropriate diagnostic block to perform on this patient? (A) Epidural local anesthetic and sterioid (B) Trigger point injection (C) Lumbar sympathetic block (D) Lateral femoral cutaneous nerve block (E) Illioinguinal nerve block

47. A 27-year-old woman with a history of malignant melanoma and multiple subcutaneous metastases has been successfully managed with slowly increasing doses of MS-Contin (Morphine SR), in conjunction with doxepin and ibuprofen. She calls the pain center to complain of a new onset of increasing nausea, vomiting, and headaches, as well as poor pain control. The most appropriate immediate action would be to (A) speak with the patient by telephone and tell her to increase the MS-Contin (B) see the patient as soon as possible to determine if there is a new, treatable source of pain (C) schedule the patient for an evaluation in your office within the week (D) switch to a fentanyl patch since the patient is nauseated and may be unable to take oral analgesics (E) add ondansetron for nausea and vomiting so she is able to continue to take oral analgesics

48. 下列何者與痛覺神經傳導無關 (A) Dorsal root ganglion (B) Spinothalamic tract (C) Ventral 'poster, and lateral nuclei of the thalamus (D) Precentral gyrus (E) Parietal codex

49. 肉毒桿菌素(botulinum toxin type A) 目前用來治療筋膜炎(myofacial pain syndrome) 注射激發點(trigger point)注射,其作用機轉是經由 (A)減少突觸前 (presynapse) acetylcholine 的釋放 (B)減少突觸前(presynapse) 鈣離子的吸收 (C)永久性阻斷 acetylcholine esterase的作用 (D)阻止運動神經 sodium channel 的開放 (E)破壞運動終板的接受器

50. Therapeutic plasma concentrations of a passive fentanyl patch多於貼上皮膚後多久達成? (A) ＜2 hours (B) ＜4 hours (C) 8 hours (D) 12 hours (E) 12-24 hours