5. 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) C4
(B) C5
(C) C6
(D) C7

1. In neuropathic pain, the hyperexcitability demonstrated by wide-dynamic range cells in the dorsal horns seems to be related to increase basal release of excitatory amino acids, such as (A) Dopamine (B) Glutamate (C) Acetylcholine (D) GABA (E) Norepinephrine

2. Which characteristic of headache below dose not belong to diagnostic criteria for migraine? (A) Unilaterallocation (B) Pulsating quality (C) Moderate or severe pain intensity (D) Aggravation by or causing avoidance of routine physical activity (i.e. walking or climbing stairs) (E) All of above 缸 e characteristic of headache of diagnostic criteria for rnigraine

3. About the intrathecal drug delivery system, which of the following statements is NOT correct? (A) It places medication directly into the cerebrospinal fluid that surrounds the spinal cord. (B) Morphine delivered directly to the intrathecal space is particularly effective because it does no have to circulate systemically to reach the CSF and the dorsal horn of the spinal cord. (C) As a result, much smaller doses are needed (e.g., approximately 1/30 of an oral morphine dose), and the frequency of side effects is reduced. (D) Advantages of intrathecal therapy in pain includes effective pain relief, reduced side effects for patients, reduced consumption of systemic medication, improved ability to perform ADLs, and enhanced quality of life.

4. Which one of the following statements is appropriate? (A) Na+ channel activation is involved in the initiation of action potential of neurons. (B) Ca2+ channel activation is responsible for the repolarization of cardiac excitable cells. (C) GABAA receptor is a voltage-gated Cl- channel. (D) The resting membrane potential of most excitable cells is around 70 mV.

6. Which is NOT true regarding ultrasound-guided stellate ganglion block (A) commonly used as the diagnosis and management of sympathetically mediated pain and vascular insufficiency of head, neck and upper extremity (B) stellate ganglion could be located over the longus colli muscle at C6 level (C) left-side esophagus could be found more frequently than right-side esophagus in the sonogram (D) none of the above

7. Which is NOT true regarding tension-type headache? (A) may be associated with stress (B) pulsating (C) bilateral (D) none of the above

8. Correct comparisons between osteoarthritis (OA) and rheumatoid arthritis (RA) dose not include: (A) Steroids and the newer drugs that focus on controlling cytokines, such as tumor necrosis factor (TNF), may reduce pain in OA and RA (B) OA mainly involve the joints and RA may present extra-articular features (C) OA appears to be a mechanically driven, and RA presents an immunologically driven disorder (D) Pain management is similar in RA and OA, but the main focus is on controlling the disease process through the use of disease-modifying antirheumatic drugs (DMARDs) (E) Female sex is a common factor in either OA or RA

9. 有關癌症患者的疼痛治療，下列何者正確？ (A)約有 6~7 成疼痛是來自腫瘤直接侵犯造成 (B)cancer therapy 造成的疼痛很少見 (C)NSAID 是屬於第二線用藥 (D)physical modality 中熱療及電療為絕對禁忌 (E)為避免 tumor spreading，手術止痛不予採行

10. 關於嗎啡類藥物成癮的機轉敘述，下列何者錯誤: (A)大腦中 ventral tegmental area (VTA) 及 nucleus accumbens (NA)為最重要影響腦區 (B)此兩個腦區籍由系統中的 mesolimbic p 剖 hway 連接 (C)與神經傳遞物血清素 (serotonin) 的分泌有關 (D)此中樞神經網路代表了動物行為的「獎懲系統 J (reward system) (E)與酒精成癮的機制是同一套神經興奮系統

11. 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。