6. 主導 prostaglandin 代謝之 COX-2 enzyme 存在於？
(A) inflammatory cells
(B) female reproduction organ
(C) brain
(D) kidney
(E) all of above

2. About image-guided lumbar sympathetic block, which the following indication is not proper? (A) Sympathetically maintained pain (B) Reflex sympathetic dystrophy (C) Phantom low limb pain (D) Raynaud’s disease (E) Chronic pancreatitis

3. Predictive factors for development of chronic pain include the following item? (1) moderate to severe preoperative pain, (2) an operation with risk of nerve damage, (3)the intensity of acute early postoperative pain (4) female patients. (A) all of the above are all risk factors (B) (1)+(2)+(3) (C) (1)+(2) (D) (4) (E) none of them

4. Choice a right description about limb pain after surgery: (A) Phantom pain is experienced only about 5-10% of cases. (B) Phantom pain may initially magnify but seldom fade over time. (C) Neural blockade has no effect on the incidence of phantom limb pain. (D) Stump pain is usually the result of neuroma at the site of nerve transection and characterized by dysesthesia. (E) None of above is right

5. Choice a right equianalgesic factors compared to subcutaneous morphine. (A) Morphine (oral) 0.50 (B) Codeine (oral) 0.20 (C) Alfentanil (subcutaneous) 1.0 (D) Oxycodone (parenteral) 5.0 (E) None of above is right.

7. 下列哪一項病人可能的主訴，較不屬於神經病變性疼痛的症狀： (A) Ongoing pain, touch-evoked pain (B) Tingling, spontaneous pain (C) Pin-prick hyperalgesia, burning sensation (D) Numbness, edema, trophic changes (E) Joint stiffness, soreness, pulling

8. Peripheral nerve injuries are often associated with neuropathic pain. Which of the following statement is least likely: (A) Nerve injury causes sprouting (or phenotypic changes) of large-diameter primary afferents from the deep dorsal horn into lamina I & II. (B) The cholera toxin B subunit is the primary marker used for sprouting of injured primary nerves. (C) During inflammatory pain, the dorsal root ganglion in the involved nerve show similar changes as seen in neuropathic pain. (D) Peripheral nerve injury may cause ongoing activity and after-discharges. (E) The overall increased excitatory drive may be combined with a compromised inhibitory control in the dorsal horn.

9. About epidural steroid injection, which one of following statements is wrong? (A) Spinal stenosis is an indication for epidural steroid. (B) Do not use for non-specific low back pain. (C) Do not repeat more than three times per year. (D) May cause pain from chronic arachnoiditis. (E) Efficacy is less with radicular pain that has lasted longer than 3 months.

10. Which of the following description about cancer pain mechanism is wrong, ( if ABCD are all right , choice E)? (A) Ischemia is involved in cancer pain mechanism. (B) Tumor-induced release of protons is one of the possible mechanisms of cancer pain. (C) Nerve growth factors (NGF) is involved in some cancer pain mechanism. (D) Cyclooxygenase (COX) is not involved in cancer pain mechanism. (E) All the above descriptions are right.

11. Nerve blocks at the ankle include following nerves except (A) sural nerve (B) saphenous nerve (C) cluneal nerve (D) tibial nerve (E) superficial and deep peroneal nerve

12. 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。