45.關於三叉神經痛的介入性治療，目前證據支持下列何種治療可達到較完全和最長期的疼痛 緩解?
(A) Microvascular decompression (MVD)
(B) Radiofrequency ablation (Gasserian ganglion)
(C) Percutaneous balloon microcompression
(D) Stereotactic radiosurgery
(E) Glycerol rhizotomy

1. 一位 56 歲婦女經歷車禍，撞傷左側顏面產生骨折，左顏面術後兩年仍持續抱怨以下部位疼 痛：skin of the tip and lateral aspect of the nose, intranasal mucosa, the infraorbital skin, intraoral maxillary mucosa, upper lip, upper teeth, the ear pinna and caudal head. 請問該婦女的神經痛 與何處神經較不相關？ (A) the ophthalmic (V1) division of the trigeminal nerve (B) the maxillary (V2) division of the trigeminal nerve (C) the mandibular (V3) division of the trigeminal nerve (D) upper cervical nerves (E) all

2. 此婦女抱怨吃東西就產生劇烈牙痛，但又說不出是哪幾顆牙齒痛，且疼痛可幅射到臉頰甚 至頸部，請問這可能是? (A) a feature of the trigeminal complex (B) referral of pain (C) the phenomenon of convergence onto a single central neuron receiving input from different primary afferents (D) widespread distribution of nociceptive input of the trigeminal complex (E) all

3. 此婦女的咀嚼動作併發劇烈牙痛，且痛到臉&頸部，請問以下何種解釋或併發現象是錯誤？ (A)與 peripheral sensitization 相關 (B)這是 trigeminal brain stem interneurons 誘發 peripheral sensitization 所致 (C)與 central sensitization 相關 (D)這是因為 trigeminal brain stem sensory nuclei 整合接受 nociceptive input from oral and craniofacial primary afferents (E) noxious stimulation mediated by trigeminal–parabrachial circuits 可能導致食慾喪失

04. 關於纖維肌痛症 (fibromyalgia) 的定義，下列哪一項為 1990 年 ACR 的舊定義，而不屬於2010 年的新定義： (A)廣泛性疼痛(widespread pain index, WPI)為計算疼痛分布在身體 19 個區塊的數量 (B)疼痛部位需分布在身體的上、下、左、右、及中軸等部位 (C)症狀嚴重度 (Symptom Severity Scale, SSS)包括疲憊程度、記憶力減弱、睡眠不足 (D)SSS 還包括身體症狀，如頭痛、下腹痛、憂鬱等症狀 (E)身體症狀是指過去半年內曾發生的病史

5. 當病人一再來門診或急診要求注射成癮性止痛藥時，下列哪些現象暗示病患可能有「成癮」現 象？ (A)病人抱怨最近的處方的止痛時間不夠久，藥效變差 (B)病人抱怨最近疼痛加重厲害，發作頻繁，他把三天的藥一天吃完 (C)病人自述出現嗜睡、噁心、性欲降低、便秘，但是疼痛都沒有減輕 (D)病人自述沒吃止痛藥會睡不著，希望睡前加重劑量輔助睡眠 (E)病人最近反覆敘述藥物遺失，而且發生很多次

6. 根據2014年 "National Institute for Health and Clinical Excellence" 對癌症末期瀕死病人的最 好的支持性治療 ("Best Practice in the Last Hours and Days of Life")，下列哪一項敘述不正 確： (A) Decisions are made to discontinue inappropriate interventions. (B) Discontinue or reduce subcutaneous opioid analgesics to avoid conscious depression or disturbance (C) "As-required" subcutaneous medication is prescribed according to an agreed protocol to manage pain, agitation, nausea and vomiting, and respiratory tract secretions (D) Family and carers are given appropriate written information. (E) A plan of care is explained and discussed with the patient, family, and carers.

7. 下列關於 WHO Analgesic Ladder 的三階梯(3 steps)用藥，哪一項較不正確： (A) Paracetamol (Acetaminophen) 是 step I 用藥，也可以是 step II 用藥 (B) Tramadol 是 weak opioid, 屬於 step II 用藥 (C) Hydromorphone, oxycodone 是 strong opioids, 屬於 step III 用藥 (D) Ketamine 作用於 opioid-resistant pain, 可歸類於 step III 用藥 (E) Buprenorphine 是 partial opioid agonist, 歸類於 step II 用藥

8. 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.

9. Based on clinical situations, which kind of opioids owns the highest oral bioavailability ? (A) Hydromorphone (B) Morphine (C) Pethidine (meperidine) (D) Oxycodone (E) Tramadol

10. 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) trigeminal neuralgia (B) atypical facial pain (C) postherpetic neuralgia (D) vascular facial pain

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