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

46. 下列有關 Complex regional pain syndrome(CRPS)的敘述何者不正確？ (A) 骨折後，發展成為 CRPS I 的 incidence 約為 1-2%。 (B) 女性比男性更容易發生 CRPS。 (C) CRPS typeII 病患其通常進展為其有非對稱性遠端肢體疼痛及腫脹但並沒有神經損傷。 (D) CRPS 病患有相當高比例，同時罹患憂鬱症及焦慮、症。然而目前並沒有證據顯示 CRPS 是種心因性問題。 (E) 有50%慢性CRPS I病人在半邊身體或患肢同側上方發展為hypoaesthesia及hypoalgesia。

47. 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

48. 一個因外傷而將左下腳(left lower leg)截肢的 15 歲少年，最後發展 phanton pain (幻肢痛)， 雖經多種方法止痛，仍未獲得疼痛舒緩，因此接受脊椎神經刺激術(spinal cord stimulation)， 請問應放在哪一個脊椎範圍為佳？ (A) 頸椎位置 (B) 中至下頸椎位置 (C) 上至中胸椎位置 (D) 中至下胸椎位置 (E) 腰椎位置

49. The formal presentation of myofascial Pain syndrome diagnostic criteria includes each of the following, EXCEPT: (A) Resolution of the symptoms after Trigger Point injetction with local anesthetic (B) Widespread body pain (C) Limited ROM ofthe atfected muscle or muscles (D) Referral pain is evident (E) Twitch response and Trigger Points are the common features

1. Descending inhibitory pathways typically involve which of the following neurochemical mechanisms EXCEPT? (A) Noradrenergic (B) Cholinergic (C) Enkephalinergic (D) Serotonergic

2. 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 paraesthetica. (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.

3. The stellate ganglion: (A) receives fibers whose cell bodies are located primarily at the C4-C7 levels of the spinal cord (B) is primarily a parasympathetic ganglion (C) may be blocked with little danger of complications (D) lies at the level of high cervical vertebra (E) is a fusion of the inferior cervical and upper thoracic ganglia

4. Which of the following statement concerning “phantom limb pain” is most likely: (A) Post-amputation pain can be easily treated by analgesia (B) Phantom pain may enhance with time (C) Phantom pain is the painful sensations referred to the amputation stump (D) Pre-amputation pain increases the risk of phantom pain (E) Phantom pain can be prevented by a preoperative epidural blockade

5. Which of the following statement concerning “central pain” is least likely: (A) Central pain is dominated by abnormalities in the sensibility to temperature (B) The most common cause is traumatic spinal cord injuries (C) Central pain is defined as pain caused by a lesion or dysfunction in the CNS (D) In stroke the onset of pain is early (E) In stroke the pain is most frequently a hemipain

複選題6. 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.