5. 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

1. 抗憂鬱劑常被用在治療慢性神經病理性疼痛緩解，以下有關於此類藥物之敘述何者為非? (A)三環抗憂鬱劑是慢性疼痛治療的首選藥物。 (B)Amitriptyline 可同時抑制 Serotonin 和 Noradrenaline 兩神經傳遞物質之回收，效果較其他選擇 性回收抑制劑之治療效果佳，其 NNT 為 14 左右。 (C)三環抗憂鬱劑之止痛效果，主要並非來自於其鎮靜或是抗焦慮之作用。 (D)近來之研究發現三環抗憂鬱劑也具有抑制鈉離子通道及 NMDA 受體之作用。 (E)青光眼及攝護腺肥大是使用三環抗憂鬱劑的禁忌症。

2. 抗癲癇藥物也是用於治療慢性神經病理性疼痛的主要藥物之一，下列有關於抗癲癇藥物之敘述何 者為非? (A) 所有抗癲癇藥物之作用機轉均為抑制離子通道，而抑制神經之病態性興奮。 (B) Carbamazepine 對於中風後之中樞性疼痛之止痛效果，優於 lamotrigine。 (C) NNT 是用於表示止痛效果的指標，而 NNH 則是用來表示止痛藥物副作用之指標。 (D) Gabapetin 的結構類似 GABA，但卻並不作用於 GABAA 或 GABAB 受體，其主要是作用於鈣 離子通道之次單元，而抑制鈣離子流及興奮性胺基酸之釋放。 (E) 大部分的抗癲癇藥物是以”use-dependent”的方式作用於阻斷鈉離子通道，而產生抑制神經過度 興奮的神經病理性疼痛。

3. 類鴉片藥物目前仍是臨床上用於疼痛控制的最主要藥物，以下有關於類鴉片藥物使用之注意事項 何者為是? (A) 類鴉片藥物是作用於類鴉片受體而產生止痛作用，各受體間有 Cross tolerance 存在，故使用 opioid rotation 和替代性並不能降低其相關之副作用 並增強其止痛效果。 (B) 慢性疼痛病人在使用嗎啡時最擔心的就是所謂的被貼標籤(stigmatization)。 (C) 長期使用嗎啡時，其代謝產物 M6G 具有止痛作用，而另一代謝產物 M3G 則會產生副作用。 (D) Buprenorphine 的 first pass 較低，故口服錠效果佳。 (E) Codeine 之主要作用是經由肝臟之 glucuronidation、N-demethylation 和 D-demethylation 而轉化 成約 2-10％的嗎啡而產生止痛作用。

4. A patient had chronic pain over the neck, medial scapula, anterior chest, medial aspect of arm and forearm. Hormer's syndrome was also noted. Which root compression is the most likely？ (A)C5 root compression (B) C6 root compression (C) C7 root compression (D)C8 root compression (E) T1 root compression

6.下列哪種癌症病人最不易出現骨骼轉移的疼痛？ (A)乳癌 (B)前列腺癌 (C)肺癌 (D)肝癌

7.下列有關針灸的敘述何者正確？ (A)中醫針灸的理論基礎是源起於道教的觀念 (B)目前醫學界認為針灸造成的止痛作用是 placebo effect (C)目前醫學界認為針灸造成的止痛作用主要是 psychological effect (D)針灸對 neuropathic pain 無效益 (E)以上皆正確

8. Which of the following is NOT the acceptable statement about the definition of chronic pelvic pain (CPP) without identified pathology? (A) menstrual pelvic pain of 6 or more months’ duration (B) severe enough to cause functional disability or to require medical or surgical treatment (C) non-opioid analgesics are the typical first step of treatment (D) the use of opioids is controversial (E) the best evidence-based treatment of patients with CPP is multidisciplinary care

9. Visceral pain has the following properties except: (A) It is diffuse and poorly localized. (B) It is referral pain and not felt at the source. (C) It is produced by stimuli different from those adequate for activation of somatic nociceptors. (D) It is characterized by distinct sensations. (E) It is associated with strong emotional and autonomic responses.

10. Allodynia can be defined as: (A) hypersensitivity to a painful stimulus (B) summation of mildly painful stimuli that causes severe pain (C) pain caused by a nonpainful stimulus (D) pain present in an area of numbness

11. 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