9. 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

5. 當病人一再來門診或急診要求注射成癮性止痛藥時，下列哪些現象暗示病患可能有「成癮」現 象？ (A) 病人抱怨最近的處方的止痛時間不夠久，藥效變差 (B) 病人抱怨最近疼痛加重厲害，發作頻繁，他把三天的藥一天吃完 (C) 病人自述出現嗜睡、噁心、性欲降低、便秘，但是疼痛都沒有減輕 (D) 病人自述沒吃止痛藥會睡不著，希望睡前加重劑量輔助睡眠 (E) 病人最近反覆敘述藥物遺失，而且發生很多次

6. 下列對於肌筋膜疼痛及纖維肌痛的比較，何者錯誤： (A)(B)(C)(D)(E)

7. 關於鴉片類藥物的敘述，下列何者最不正確？ (A) Hydromorphone 效力比 morphine 強 3-5 倍(口服)，且具有 NMDA 受體拮抗劑與血 清素再吸收抑制(serotonin reuptake inhibitor)的特性 (B) Buprenorphine 具有 μ receptor partial agonist 及 κ antagonist 之性質(C) Meperidine(pethidine)具有高度親脂性，容易引發「尋藥行為」(drug-seeking behavior) (D) Tapentadol 具有 μ agonist 與 noradrenaline reuptake inhibitor 之性質 (E) 以皮下作為給藥路徑可以提供緩慢穩定的吸收，唯給藥量不宜超過 5 mL/hr

8. 關於纖維肌痛症 (fibromyalgia) 的定義，下列哪一項為 1990 年 ACR 的舊定義，而不屬於2010 年的新定義： (A) 廣泛性疼痛(widespread pain index, WPI)為計算疼痛分布在身體 19 個區塊的數量 (B) 疼痛部位需分布在身體的上、下、左、右、及中軸等部位. (C) 症狀嚴重度 (Symptom Severity Scale, SSS)包括疲憊程度、記憶力減弱、睡眠不足 (D) SSS 還包括身體症狀，如頭痛、下腹痛、憂鬱等症狀. (E) 身體症狀是指過去半年內曾發生的病史.

10. Which one of the following does not belong to opioid receptor gene family? (A) MU (B) DELTA (C) KAPPA (D) Cannabinoid receptor (E) ORL1

11. Which one of the following is not the common adverse effect of opioid?(A) Nausea (B) Agitation (C) Cognitive impairment (D) Miosis (E) Constipation

12. 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.

13. 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.

14. 下列何者是研究 neuropathic pain 機轉常用的 animal model? (A) Complete Freund's adjuvant intraplantar injection (B) Colonic balloon distension (C) Intraplantar fomalin injection (D) Sciatic nerve chronic constriction injury (E) Intraosseous tumor cell injection

15. 下列在 pain hypersensitivity 的 pathogenesis 有關 microglia 的敘述何者錯誤? (A) microglia 在 peripheral nerve injury 後的早期,就會被 activate 而釋放 proinflammatory cytokines (B) Microglia 在 spinal cord dorsal horn 中的數量,會在 peripheral nerve injury 後增加 (C) Pain hypersensitivity state 時 microglia 會 release CX3CL (fractalkine)作用在 neuron 上增加 neuronal excitability (D) neuropathic pain state 時 microglia 的 P2X4receptor 會 upregulation (E) microglia activation 的 process 與 p38 Mitogen-Activated Protein Kinase 的 phosphorylation 有關,可以 turn on downstream 的 signal