6. Which of the following description about autonomic, endocrine and immune interactions in pain is correct?
(A) Signaling from the immune system to the CNS via vagal afferents and possibly small-diameter afferents innervating somatic tissues to induce sickness behavior
(B) Modulation of the immune system and the inflammatory response by CNS circuits that control the production and release of neuroendocrine hormonal mediators in the sympathoadrenal stress axis
(C) Coupling of the sensory nociceptive and sympathetic efferent components of the peripheral nervous system in the setting of inflammation and nerve injury to produce sympathetically maintained pain
(D) All of above

2. Which one of the following is not transmitter present in primary afferents and spinal dorsal projection neurons? (A) Glutamate (B) GABA (C) Substance P (D) Glycine (E) NMDA

3. The innervation of deep somatic tissue like muscle and joint is quite complex. Which of the following description is not appropriate? (A) The nociceptors are predominantly activated by non-physiological stimuli which may cause damage to the structures (e.g. overload, twisting, strong pressure, ischemic contraction). information within the central nervous system. (B) During inflammation or after trauma, nociceptors of joint and muscle show pronounced sensitization, in particular for mechanical stimuli. (C) Descending inhibition is enhanced during chronic inflammation but seems to be normalized during acute inflammation. (D) Both primary afferent fibers as well as sympathetic reflexes may aggravate inflammatory lesions. (E) Reduced release of hormones from the hypothalamic-pituitary-adrenal (HPA) axis such as cortisol, adrenal androgens and testosterone may cause a relative loss of anti-inflammatory activity.

4. Pain is a frequent consequence of spinal cord injury (SCI). Which of the following statement is least likely: (A) Below-level neuropathic pain is most likely described as severe or excruciating months or years following initial injury. (B) Damage to the spinothalamic tracts is an important ingredient in the development of neuropathic pain following SCI. (C) Chronic musculoskeletal pain is common in tetraplegic patients after SCI. (D) Patients with cervical SCI are at risk of developing CRPS affecting upper limbs. (E) Below-level neuropathic pain is also referred to deafferentation pain.

5. Which of the following is the acceptable statement about neurodestructive RF lesions? (A) These temperatures are resulted from friction heat. (B) The size of RF lesion with 22 gauge RF needle is around with a radius of 5 mm (C) The heat is generated on the tip of RF needle. The RF needle then heat up the tissues. (D) The RF permanent neurodestructive lesion is formed when neural temperatures exceed 42 C (E) All of the above

7. 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

8. 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

9. 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

10. 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

11. nonsteroidal anti-inflammatory drugs (NSAIDs) 藥物之作用當中，下列何者具有 vasodilatation、降低水分滯留及增加利尿效果之效用？ (A) PGI2 (B) PGD2 (C) PGE2 (D) TXA2 (thromboxane A2) (E) NO

12. 下列有關於 2015 年美國 FDA 對於 NSAID 之警語中，何者為非？ (A) Risk appears to increase with higher doses (B) NSAID use increase risk of heart failure (C) There is insufficient evidence to determine the risk of individual NSAIDs (D) NSAIDs use in patients with risk factors for heart disease does not increase the likelihood of heart attack or stroke (E) NSAIDs increase the risk of heart attack/stroke regardless of existing heart disease