101年 - 101 台灣疼痛醫學會專科醫師考題#125038

1. Which of the following statement regarding opioids is wrong: (A) Opioids inhibit voltage-dependent calcium channels. (B) Opioids attenuate excitability of terminals or neurons. (C) Opioid receptors are located postsynaptically on interneurons. (D) Opioid cause antinociception by decreased activity in inhibitory descending controls. (E) Important supraspinal sites opioid actions are the periaqueductal grey and the rostroventral medulla.

2. Which of the following is the acceptable statement about postoperative pain? (A) form of acute pain due to the surgical trauma with an inflammatory reaction. (B) May initiate an afferent neuronal barrage. (C) May become chronic in some patients. (D) Associated with autonomic, endocrine-metabolic, physiological and behavioral responses. (E) All of the above statements.

3. Which of the following indication for sympathetic blocks is wrong: (A) Stellate ganglion block for head and neck. (B) Stellate ganglion and 1st and 2nd thoracic ganglia blocks for upper limb. (C) Greater and lesser splanchnic nerve blocks for visceral pain from upper abdomen. (D) Ganglion impar block for visceral pain from descending colon and pelvic organs. (E) Lumbar sympathetic ganglia blocks for lower extremities.

4. Which of the following statements about transcutaneous electrical nerve stimulation (TENS) is right: (A) Adverse effect includes transient increases in pain and muscle twitching. (B) TENS safe for infant during delivery can be applied over or anywhere near the pregnant uterus. (C) Cardiac pacemakers with fixed frequencies may malfunction by TENS. (D) Stimulating post part of neck may be dangerous, due to induce spasms the intrinsic muscle of larynx. (E) Skin redness under electrodes after TENS was not reported.

5. Following right anterolateral cordotomy, which symptom is not related to procedure? (A) Left side leg weakness (B) Respiratory dysfunction (C) Left side dysesthetic pain (D) Ataxia (E) Bladder dysfunction

6. Following statements about anticonvulsants in neuropathic pain is wrong: (A) Carbamazepine provides satisfactory pain control in trigeminal neuralgia (B) Tolerability is better with oxcarbazepine compared with carbamazepine (C) Lamotrigine reduces pain intensity in HIV neuropathy (D) Gabapentin directly modifies sodium channel currents (E) Gabapentin improves postherpetic neuralgia.

7. Which of the following statement concerning the cause of cancer pain is least likely? (A) Vanilloid receptor TRPV1 is expressed in most nociceptors, it detects heat and extracellular protons. (B) In order to detect noxious mechanical stimuli, nociceptors express mechanically gated channels that initiate a signally cascade upon excessive stretch. (C) Low pH can activate acid-sensing ion channel-3 (ASIC-3). (D) Tumour cells can release protons and produce local acidosis. (E) TRPV1 is activated when the pH rise above 6.0.

8. Which of the following statement concerning the treatment of cancer pain is least likely? (A) Obeying the principles of the analgesic ladder approach, 71% of patients will achieve good pain relief without further intervention. (B) Oral morphine remains the drug of choice according to the analgesic ladder of the WHO. (C) The most common use of radiotherapy is for metastases abdominal pain. (D) The patient with advanced cancer is in the dynamic state with changing pathology. (E) About 60% of patients who receive radiotherapy will achieve at least 50% pain relief.

9. Which of the following statement concerning the pain in the elderly is least likely? (A) The elderly are less likely than younger patients to report pain associated with acute pathology. (B) The prevalence of chronic pain appears peaked at late-life. (C) Among chronic pain patients, there may be a change in the quality but not the intensity of chronic pain with age. (D) The affective and cognitive components of pain do not appear to be age related. (E) Pain in the elderly is often undertreated, which may be due to the increased risks associated with pharmacotherapy in this group.

10. Which of the following statement concerning the assessment of cancer pain is least likely: (A) A high pain prevalence of 50-70% among patients with newly diagnosed cancer. (B) Bone metastases are the most common cause of chronic pain in cancer patients. (C) The vertebrae are the most common sites of bony metastases. (D) Epidural compression of the spinal cord is the second most common neurological complications of cancer. (E) The cause of under-treatment of cancer pain is inadequate assessment.

11. Which of the following is the unacceptable statement about postoperative pain related to acute pain mechanisms? (A) A decrease in the nociceptor threshold is due to changes in the transducers themselves (autosensitization). (B) An increase in the excitability of the terminal membrane is initiated by sensitizing agents (heterosensitization). (C) Enhanced responsiveness of central pain transmission neurons is due to wind-up. (D) Enhanced responsiveness of central pain transmission neurons is due to facilitated synaptic responses. (E) Enhanced responsiveness of central pain transmission neurons is due to increase inhibition.

12. Which of the following statement concerning the epidemiology of pain is least likely? (A) In adult, the most common regional pain syndromes are those of low back, hip and shoulder pain. (B) Higher prevalence rates are noted in women who report more severe and persistent pain. (C) Abdominal pain predominates at older ages, while oral and facial pain among young adults. (D) Social disadvantages also characterize persons at increased risk of pain. (E) Mechanical factors are important in the development of back pain and extremity pain.

13. 下列關於 placebo analgesia 的敘述何者錯誤? (A) 暗示、建議、期待、或制約(conditioning)都是增強 placebo analgesia 的重要因素。 (B) 與 placebo analgesia有關的生理結構可能是1 有關的生理結構可能是limbic system(包括amygdala, ventral striatum, anterior cingulate,和prefrontal cortex)。 (C) 在不同疼痛模型,出現Placebo effect 比率的人數(responder)不同；在拔牙後疼痛實驗佔 20%,在止血帶誘發疼痛低於10%。 (D) 不同疼痛模型,placebo analgesia 在VAS的強度也不同；如拔牙後疼痛實驗 responder 與 non-responder 可以相差到5分。 (E) Nocebo 與 placebo相反,是指經過治療(處理)後,結果反而無效或是疼痛加劇；例如利 用暗示,使原本有效的N₂O拔牙止痛,變得更痛。

14. 某個止痛藥物實驗,利用實驗性疼痛(如:止血帶誘發缺血性疼痛)檢測此藥物的真實止痛效果,並需要看出 placebo effect。其結果如下圖:A代表正常情況下的疼痛方式,B代表經藥物作用結果。請問下列實驗設計相關的敘述,何者正確:
(A) 其分組設計是:a:不治療組(no treatment), b:偽藥組(sham), c:給藥組 (B) 其分組設計是:a:偽藥組, b:低劑量給 藥組, C:高劑量給藥組 (C) 其分組設計是:a:給痛藥+拮抗藥物組, b:偽藥組,C:給藥組 (D) 真正的止痛作用(active effect)為區塊1 (E) 其中 placebo effect 為區塊2

15. 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) 此兩個腦區藉由系統中的mesolimbic pathway 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」(reward system) (E) 與酒精成癮的機制是同一套神經興奮系統

16. 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)病患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

17. 關於催眠(hypnosis)及催眠止痛(hypnotic analgesia),何者敘述錯誤? (A) 不只是一種魔術,催眠可能有效止痛 (B) 利用的是「暗示」(suggestion)的技巧,與心理層面有關,不影響生理功能 (C)可以造成精神放鬆,注意力轉移,對人、時、地的錯誤判斷,及改變個人經驗 (D) 催眠止痛要達到長期的效果,需要以暗示方法改變(或主導)病人的疼痛經驗 (E) 催眠止痛改變病人的疼痛經驗的方式有:解離式想像法(dissociated imagery)、集中注意力法(focused analgesia)、重新詮釋法 (reinterpretation)

18. 對於兒童或嬰、幼兒的疼痛評估方法及技巧,下列敘述何者錯誤? (A)為了避免詢問者造成誤差,詢問兒童疼痛的字句最好都要一致 (B) 對兒童解釋疼痛程度時,父母可以適度的協助,避免錯誤 (C) VAS (visual analogue scale)可以適用於小兒5歲以上 (D) 臉譜圖(face pain scale)可以適用於年齡3歲以上 (E)行為觀察如:哭、臉部表情、身體姿勢等,也可以當成疼痛評估,但在急性短暫疼痛(如打針)較準確

19. Which of the following is the unacceptable statement? (A) The idea of pre-emptive analgesia is based on clinical observations demonstrating that if the afferent traffic of pain signals is prevented from reaching the central nociceptive neurons by preinjury administration of analgesics, sensitization of the central neurons will not take place or will be reduced. (B) Even though there are the negative findings of clinical studies of pre-emptive analgesia, we may not discard the hypothesis that central sensitization is an important mechanism in postoperative pain (C) Evidence from clinical studies suggests that acute, postoperative pain involves multiple mechanisms, including sensitization of peripheral and central neuronal pathway. (D) Postoperative pain may include a combination of nociceptive, inflammatory, visceral and neuropathic pain mechanisms. (E) If a patient records a baseline visual analogue scale score in excess of 30 mm, they would probably have recorded at least moderate pain on a four-point categorical scale.

20. Which management for acute orofacial pain is not advisable? (A) NSAIDs exert their actions in damaged tissue through blockade of prostaglandin synthesis (B) NSAIDs may moderate efficacy for inhibiting postoperative edema (C) NSAIDs may be used for pretreating patients before dental surgery (D) Opioids may play a more direct role in pain management than NSAIDs thromboembolic complications (E) The local application of exogenous opioids may prevent the degradation of endogenous opioid peptides may provide a new approach to pain management.

21. Which characteristic of headache below dose not belong to diagnostic criteria for migraine? (A) Unilateral location (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 are characteristic of headache of diagnostic criteria for migraine

22. Which of the following is the unacceptable statement about Fibromyalgia syndrome (FMS)? (A) Epidemiology studies indicate that FMS is present in at least 2% of the general population. (B) FMS tender points have the same refer pain to a zone of reference as the myofascial pain syndrome trigger points in general. (C) The criteria of American College of Rheumatology (Wolfe et al 1990) for FMS required the component: a history of widespread pain for at least 3 months. (D) The criteria of American College of Rheumatlogy (Wolfe et al 1990) for FMS required the component: pain sensitivity to 4 kg of digital pressure at 11 or more of 18 anatomically defined tender points (E) A reasonably accurate clinical estimate of the correct amount of pressure can be obtained by pressing the examining thumb against a surface until the blood flow to the mid-portion of the thumb nail blanches.

23. The most useful prophylactic drugs for chronic tension type headache: (A) Acetaminophen (B) Tricyclic antidepressant (C) Gabapentin (D) NSAIDs (E) Propranolol

24. Which of the following is the unacceptable statement about Fibromyalgia syndrome (FMS)? (A) It is very likely that an affective disorder is one of the causes of FMS. (B) There is evidence to suggest that FMS is a disorder of abnormal processing of sensory information within the central nervous system, (C) Several neurochemical mediators of pain (substance P, nerve growth factor, dynorphin A, glutamate, nitric oxide, serotonin and noradrenaline) are believed to play a role in the pathogenesis of FMS. (D) There is still no cure for FMS, so its management is non-specific, multimodal, expectant and symptomatic. (E) The use of opioids in patients with FMS is controversial.

25. Based on clinical experience, which level radicular pain is often associated with chronic headache and involved mainly the neck and upper shoulder? (A) C2 (B) C3 (C) C4 (D) C5 (E) C6

26. 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CRPSI的incidence約為1-2%。 (B) 女性比男性更容易發生CRPS。 (C) CRPS type II 病患其通常進展為具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) CRPSI病人在半邊身體或患肢同側上方發展為 hypoaesthesia 及 hypoalgesia

27. A patient had pain over the neck, medial scapula, anterior chest, medial aspect of arm and forearm. Hormer's syndrome was also noted. Which root compression is the most likely? (A) C5 root compression (B) C6 root compression (C) C7 root compression (D) C8 root compression (E) T1 root compression

28. A patient suffered from chronic low back pain with radiating to anteromedial thigh and anterior knee. Muscle weakness was observed in the quadriceps and iliopsoas. 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

29. Which prevalence of central pain among the following disorders is the highest? (A) Multiple sclerosis (B) Stroke (C) Epilepsy (D) Parkinson's disease (E) Syringomyelia

30. Based on published monotherapy clinical trials, which one has negative results for treating postherpetic neuralgia? (A) Amitriptyline (B) Gabapentin (C) Oxycodone (D) Carbamezepine (E) Topical lidocaine patch

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

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

33. Which of the following statements concerning nociception is FALSE? (A) Overstimulation of pressure receptors results in the sensation of pain. (B) Nociceptors may be exteroceptors. (C) The sense organs for pain are free nerve endings. (D) Peripheral afferent pain fibers send projections to the dorsal horn of the spinal cord.

34. 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

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

36. What is the following description about tension-type headache is FALSE? (A) may be associated with stress (B) associated with vomiting (C) bilateral (D) most common in adolescence (E) pain may involve teeth, forehead & neck

37. Which following item is not a criterion for the diagnosis of migraine? (A) Aggravation by or causing avoidance of routine physical activity (B) Unilateral location (C) Moderate or severe pain intensity (D) Throbbing/stabbing quality (E) All are criteria for diagnosis of migraine

38. 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.

39. 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

40. Which one of the following neuropathic pain conditions is not likely responded to spinal cord stimulation? (A) Diabetic neuropathy (B) CRPS type I (C) CRPS type II (D) Central post-stroke pain (E) Occlusive peripheral vascular disease

41. Which of the following statement concerning hypnotic analgesia is least likely: (A) Hypnosis has been highly associated with theta activity (4~8 Hz) using EEG methods. (B) Hypnotic analgesia can be understood as the result of a placebo manipulation, and it is not more than just relaxation. (C) Increases in hypnotic relaxation are associated with increases in regional cerebral blood flow in the occipital cortex. (D) Deep relaxation, dissociated imagery and focused analgesia produced significant reductions on all pain-related measures. (E) Descending projections from amygdale, PAG and locus coeruleus contribute to modulate nociceptive processes in the brain stem and the spinal cord.

42. 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

43. A 26-year-old weight lifter felt a sharp pain in the neck, radiating to the dorsal aspect of the forearm during his workout. Over the next few days he noted progressive numbness of the thumb and index finger. He also complained of decreased ability to perform bicep curls. On examination by his primary care doctor, a markedly diminished biceps reflex was found. Which of the following is the most likely cause of the patient's problem? (A) Facture C5 vertebra (B) Facet syndrome at C5-6 (C) C5-C6 disc protrusion (D) Compression of the C5 nerve root by an osteophyte

44. A 61-year-old woman presents to the pain clinic with a chief complaint of left shoulder and arm pain 3 years after undergoing radiation therapy for breast cancer. Physical examination reveals lymphedema of the left axilla with noticeable skin changes. Examination of the left supraclavicular area precipitates a sharp pain that radiates down her left arm. Which of the following is her likely diagnosis? (A) Tumor metastasis (B) Cervical radiculopathy (C) Reflex sympathetic dystrophy (D) Thrombangitis obliterans (E) Radiation-induced plexopathy

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

46. A 25-year-old, obese man complains of a burning pain in the anterolateral thigh. Deep tendon reflexes and findings in a motor examination are normal. There is a slight sensory deficit in the lateral thigh that corresponds to the painful area. What is the most appropriate diagnostic block to perform on this patient? (A) Epidural local anesthetic and sterioid (B) Trigger point injection (C) Lumbar sympathetic block (D) Lateral femoral cutaneous nerve block (E) Illioinguinal nerve block

47. A 27-year-old woman with a history of malignant melanoma and multiple subcutaneous metastases has been successfully managed with slowly increasing doses of MS-Contin (Morphine SR), in conjunction with doxepin and ibuprofen. She calls the pain center to complain of a new onset of increasing nausea, vomiting, and headaches, as well as poor pain control. The most appropriate immediate action would be to (A) speak with the patient by telephone and tell her to increase the MS-Contin (B) see the patient as soon as possible to determine if there is a new, treatable source of pain (C) schedule the patient for an evaluation in your office within the week (D) switch to a fentanyl patch since the patient is nauseated and may be unable to take oral analgesics (E) add ondansetron for nausea and vomiting so she is able to continue to take oral analgesics

48. 下列何者與痛覺神經傳導無關 (A) Dorsal root ganglion (B) Spinothalamic tract (C) Ventral 'poster, and lateral nuclei of the thalamus (D) Precentral gyrus (E) Parietal codex

49. 肉毒桿菌素(botulinum toxin type A) 目前用來治療筋膜炎(myofacial pain syndrome) 注射激發點(trigger point)注射,其作用機轉是經由 (A)減少突觸前 (presynapse) acetylcholine 的釋放 (B)減少突觸前(presynapse) 鈣離子的吸收 (C)永久性阻斷 acetylcholine esterase的作用 (D)阻止運動神經 sodium channel 的開放 (E)破壞運動終板的接受器

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