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105年 - 105 台灣疼痛醫學會專科醫師考題#122415

科目：台灣疼痛醫學會專科醫師 | 年份：105年 | 選擇題數：50 | 申論題數：0

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所屬科目：台灣疼痛醫學會專科醫師

選擇題 (50)

1. 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
2. Which characteristic of headache below dose not belong to diagnostic criteria for migraine? (A) Unilaterallocation (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 缸 e characteristic of headache of diagnostic criteria for rnigraine
3. About the intrathecal drug delivery system, which of the following statements is NOT correct? (A) It places medication directly into the cerebrospinal fluid that surrounds the spinal cord. (B) Morphine delivered directly to the intrathecal space is particularly effective because it does no have to circulate systemically to reach the CSF and the dorsal horn of the spinal cord. (C) As a result, much smaller doses are needed (e.g., approximately 1/30 of an oral morphine dose), and the frequency of side effects is reduced. (D) Advantages of intrathecal therapy in pain includes effective pain relief, reduced side effects for patients, reduced consumption of systemic medication, improved ability to perform ADLs, and enhanced quality of life.
4. Which one of the following statements is appropriate? (A) Na+ channel activation is involved in the initiation of action potential of neurons. (B) Ca2+ channel activation is responsible for the repolarization of cardiac excitable cells. (C) GABAA receptor is a voltage-gated Cl- channel. (D) The resting membrane potential of most excitable cells is around 70 mV.
5. 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) C4 (B) C5 (C) C6 (D) C7
6. Which is NOT true regarding ultrasound-guided stellate ganglion block (A) commonly used as the diagnosis and management of sympathetically mediated pain and vascular insufficiency of head, neck and upper extremity (B) stellate ganglion could be located over the longus colli muscle at C6 level (C) left-side esophagus could be found more frequently than right-side esophagus in the sonogram (D) none of the above
7. Which is NOT true regarding tension-type headache? (A) may be associated with stress (B) pulsating (C) bilateral (D) none of the above
8. Correct comparisons between osteoarthritis (OA) and rheumatoid arthritis (RA) dose not include: (A) Steroids and the newer drugs that focus on controlling cytokines, such as tumor necrosis factor (TNF), may reduce pain in OA and RA (B) OA mainly involve the joints and RA may present extra-articular features (C) OA appears to be a mechanically driven, and RA presents an immunologically driven disorder (D) Pain management is similar in RA and OA, but the main focus is on controlling the disease process through the use of disease-modifying antirheumatic drugs (DMARDs) (E) Female sex is a common factor in either OA or RA
9. 有關癌症患者的疼痛治療，下列何者正確？ (A)約有 6~7 成疼痛是來自腫瘤直接侵犯造成 (B)cancer therapy 造成的疼痛很少見 (C)NSAID 是屬於第二線用藥 (D)physical modality 中熱療及電療為絕對禁忌 (E)為避免 tumor spreading，手術止痛不予採行
10. 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)此兩個腦區籍由系統中的 mesolimbic p 剖 hway 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 J (reward system) (E)與酒精成癮的機制是同一套神經興奮系統
11. 類鴉片藥物目前仍是臨床上用於疼痛控制的最主要藥物，以下有關於類鴉片藥物使用之注 意事項何者為是? (A)類鴉片藥物是作用於類鴉片受體而產生止痛作用，各受體間有 Cross tolerance 存在，故 使用 opioid rotation 和替代性並不能降低其相關之副作用 並增強其止痛效果。 (B)慢性疼痛病人在使用嗎啡時最擔心的就是所謂的被貼標籤(stigmatization)。 (C)長期使用嗎啡時，其代謝產物 M6G 具有止痛作用，而另一代謝產物 M3G 則會產生副 作用。 (D) Buprenorphine 的 first pass 較低，故口服錠效果佳。 (E) Codeine 之主要作用是經由肝臟之 glucuronidation、N-demethylation 和 D-demethylation 而轉化成約 2-10％的嗎啡而產生止痛作用。
12. 目前對 Chronic tension-type headache (CTTH) 的認識，下列何者不正確？ (A)發作時，在腦血流中有明顯的 CGRP 增加 (B)與 myofascial pain 有關，可以用注射 botulinum 治療 (C)以 Beck’s depression scale 評分，可以發現頭痛頻率與 depression 程度有關 (D)以 pressure-pain threshold 測量，可以發現疼痛閾值改變不大 (E) TCA (Tricyclic antidepressant) 可以當第一線用藥
13. 周邊神經切除會形成 neuroma 引起疼痛，下列敘述何者不正確： (A)是因為 axon 不正常的 regenerative sprouting (B)疼痛發生大多與 C-fiber 出現不正常的 ectopic firing 有關 (C)糖尿病或神經炎，也會出現 microneuroma，引起疼痛 (D)在新生兒周邊神經損傷，反而少出現神經瘤 (E) Tineal sign 可以作為診斷 ectopic firing 的依據
14. 利用手術或介入性阻斷技術減少癌症疼痛的方式，下列敘述何者效果最差： (A)以 internal surgical fixation 減少脊椎病理性骨折的疼痛 (B)以 epidural steroid 減輕腫瘤浸潤引起的 lumbosacral radiculopathy (C)以 iv PCA 減輕 radiation-induced brachial plexopathy (D)以 neurolytic celiac plexus blockade 控制胰臟癌引起的腹痛 (E)以 intrathecal morphine pump 治療 peritoneal carcinomatosis-induced pain
15. 下列關於 opioid rotation 或 opioid switch，哪一種敘述較不正確： (A)opioid switch/rotation 意思是指改變鴉片藥物的給藥途徑，可以提高止痛效果 (B)動物實驗上可發現，鴉片受器剔除小鼠仍可以保留部分對 fentanyl 注射的止痛效果 (C)理論基礎是基於人體對 opioid receptor 的 binding profile 及 affinity 具有基因多樣性 (heterogenecity) (D)臨床上已成為改善癌症病人的嗎啡類藥物效果的常用方式. (E) tramadol 換成 morphine 不能稱為 opioid switch
16. Which one of the following statement is most appropriate? (A) Morphine can act on µ1 and µ2 opioid receptors. (B) µ1 opioid receptor can modulate Na+ and Cl- channels via G-protein. (C) For human adults, the intrathecal bolus dose of morphine is 3-10 mg. (D) For human adults, the intrathecal bolus dose of morphine is 3-10 µg.
17. 一位末期肝癌疼痛的病患，因口服嗎啡已經造成嚴重的嘔吐，考慮改由脊髓腔內(intrathecal) 持續給藥，因其每天劑量達 600 mg，經換算後脊髓給藥劑量應為每天約： (A) 1 mg (B) 2 mg (C) 6 mg (D) 10 mg (E) 20 mg
18. Which of the following statement concerning “central pain” is LEAST likely: (A) Central pain is defined as pain caused by a lesion or dysfunction in the CNS (B) The most common cause is traumatic spinal cord injuries (C) In stroke the onset of pain is early (D) In stroke the pain is most frequently a hemipain (E) Central pain is dominated by abnormalities in the sensibility to temperature
19. Choose one wrong description about opioid use: (A) Acute opiate administration activated opiate receptors in central and peripheral nervous system. (B) Protein kinase A (PKA) and CREB were also activated after opiate administration (C) Repeatedly seeking opioid from other clinicians is a more predictive addiction indicator. (D) Requesting specific drugs is a more predictive addiction indicator. (E) Aggressive complaining about needing more drug is a less predictive addiction indicator.
20. A patient is positioned prone in the fluoroscopic table, the T1-T4 spinous processes are identified on the ipsilateral side, and a skin weal is raised 4-5 cm lateral to the spinous process. A spinal needle is directed to the lamina and “walked” laterally until there is loss of resistance. These procedures are consistent with which type of block? (A) Stellate ganglion (B) Thoracic sympathetic (C) Interpleural (D) Thoracic epidural
21. Which of the following activities will exacerbate pain the most in an elderly patient with severe spinal stenosis? (A) Walking uphill (B) Walking downhil. (C) Riding a bicycle (D) Bending forward Standing
22. 抗憂鬱劑常被用在治療慢性神經病理性疼痛緩解，以下有關於此類藥物之敘述何者為非? (A)三環抗憂鬱劑是慢性疼痛治療的首選藥物。 (B) Amitriptyline 可同時抑制 Serotonin 和 Noradrenaline 兩神經傳遞物質之回收，效果較其 他選擇性回收抑制劑之治療效果佳，其 NNT 為 14 左右。 (C)三環抗憂鬱劑之止痛效果，主要並非來自於其鎮靜或是抗焦慮之作用。 (D)近來之研究發現三環抗憂鬱劑也具有抑制鈉離子通道及 NMDA 受體之作用。 (E)青光眼及攝護腺肥大是使用三環抗憂鬱劑的禁忌症。
23. Which of the following statement concerning “postoperative pain” is least likely? (A) Management of postoperative pain is challenging. (B) Management of postoperative pain is based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission. (C) Chronic pain after surgery is an underdiagnosed condition (D) Advances in understanding the genetic profile of patients should help improve treatment of postoperative pain. (E) It is not essential that the neuronal response to surgery be blocked to achieve the task of optimal pain control.
24. Which of the following statement concerning “muscle pain” is least likely? (A) Muscle pain is distinct from cutaneous pain. (B) Muscle pain is one of the most common pain complaints. (C) Muscle nociceptors are free nerve endings that are connected to the central nervous system. (D) Most nociceptors cannot be excited by algesic agents, including bradykinin, serotonin. (E) In damaged muscle, the nociceptors have a lowered mechanical threshold.
25. Which of the following diagnostic tests that aid in the diagnosis of complex regional pain syndrome? (A) Bone scintigraphy (B) Plain radiography and X-ray bone densitometry (C) Quantitative sensory testing (D) Skin temperature measurement (E) All of above
26. 下列關於癌症病人的 breakthrough pain，下列敘述何者較 不正確 ： (A)包括了 incident pain 及 spontaneous pain (B)一般不把"end-of-dose failure of analgesic" 歸類在 breakthrough pain (C)疼痛的特性包括了 somatic pain, visceral pain, neuropathic pain 或 mixed type (D) fentanyl buccal film 可以用來控制中重度的 breakthrough pain (E) breakthrough pain 的發生機率並不大，一般只出現在癌症末期或瀕死病人
27. Which management for acute orofacial pain is not advisable? (A) NSAlDs exert their actions in damaged tissue through blockade of prostaglandin synthesis (B) NSAIDs may moderate e 旺 icacy 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.
28. 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) 病忠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)病人說吃完藥舒服很多 (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
29. 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.
30. Which drug below is less likely an option for inhibiting central sensitization following acute postoperative pain: (A) NMDA antagonist (B) Opioid (C) COX2-inhibitor (D) Pre-emptive analgesia (E) Gabapentin
31. 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
32. Which medication below is not suggested in fibromyalgia syndrome (FMS): (A) Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) (B) Pregabalin (C) Tricyclics (amitriptyline, nortriptyline, doxepin, cyclobenzaprine) (D) Opioids (E) All of the above treatments are suggested for pain management of OA
33. Choose one wrong description about pain assessment. (A) McGill Pain Questionnaire (MPQ) had been used in Chinese (B) Short-Form MPQ consists both sensory and affective categories. (C) Neuropathic pain also has specific pain questionnaire, like DN4. (D) Visual analog scales (VASs) measure only in pain intensity. (E) Neuropathic pain and non-neuropathic pain evaluation cannot be
34. Which is NOT true regarding cluster headache? (A) ipsilateral ptosis, miosis, or nasal congestion might occur (B) with or without aura (C) usually unilateral (D) none of the above
35. Which of the following event is not related to Microglia to develop pain hypersensitivity following peripheral nerve injury? (A) up-regulated P2X4R expression (P2X4R+) (B) ATP stimulation in the presence of extracellular Ca2+ causes the P2X4R to open a non-selective cation-permeable channel (C) p38 mitogen-activated protein kinase mediates further Microglial Signaling (D) release of Brain-Derived Neurotrophic Factor (BDNF) (E) all of the above are involved to develop pain hypersensitivity following peripheral nerve injury.
36. A rise in post-synaptic Ca2+ concentration is an essential central step for virtually all forms of LTP. The rise of post-synaptic Ca2+ concentration is not attributed to (A) NMDA receptors (B) T-type VGCCs (voltage-gated calcium channel) (C) Ca2+-permeable AMPA receptors (D) P2X4R (E) release of Ca2+ from intracellular Ca2+ stores
37. When Rexed’s laminae was applied divide the spinal cord to different laminae. Which of the following description was wrong? (A) Lamina II is also known as the substantia gelatinosa (B) most A-δ fiber will transmit the noxious sensation to lamina I and V (C) most C fiber will transmit the noxious sensation to lamina I and II (D) A-δ fiber and C fiber will transmit innocuous sensation to different laminae from noxious sensation (E) all of the above are correct description
38. For Chronic pain patients (CPPs), which of the following description is wrong: (A) In tertiary treatment facilities, depression has been reported in 10-100% of CPPs (B) Successful treatment of depression reduce the effect of pain interference. (C) Anxiety disorders are common in CPPs (D) The incidence of de novo opioid addiction is increased in CPPs (E) CPPs should be offered smoking cessation treatment.
39. Coxibs cause less adverse effect than NSAIDs except which of the following one? (A)Upper GI bleeding (B) Anemia (C) Asthma (D) Congestive heart failure (E) Lower GI bleeding
40. Which of the following commonly used opioids has the highest oral bioavailability? (A) hydromorphone (B) morphine . (C) pethidine (D) codeine (E) methadone
41. Which of the following statement about post-herpetic neuralgia (PHN) is wrong? (A) The most common sites for PHN are the mid-thoracic dermatomes and ophthalmic division of the trigeminal nerve. (B) Men are more often affected than women. (C) The pain is usually described as burning or electric shock-like. (D) The risk for PHN increase with age. (E) Carbamazepine may not be appropriate in PHN.
42. Which of the following statement about tramadol is wrong? (A) Oral tramadol has high bioavailability in the range of 80~90%. (B) Tramadol has good efficacy for neuropathic pain and fibromyalgia. (C) The risk for respiratory depression is lower than morphine at equianalgisic doses. (D) Nausea and vomiting seldom occur in patients with tramadol. (E) The tramadol is affected by cytochrome P450 2D6 activity.
43. Which of the following statement concerning “joint pain” is least likely? (A) In a normal joint, only intense pressure on the joint and movements exceeding the working range elicit pain. (B) Under pathological conditions such as joint inflammation, hypersensitivity of the nociceptive system occurs frequently and leads to pain on palpation. (C) Mechanical sensitization of joint nociceptors is generated by numerous inflammatory mediators, including prostaglandins and cytokines. (D) Spinal sensitization involves excitatory amino acids, neuropeptides, and spinal prostaglandins. (E) Better understanding of pain mechanisms can't improve pain therapy.
44. Which one of the following statement is most appropriate? (A) Gabapentin is an anticonvulsant and analgesic. (B) Minocycline is not an antibiotic. (C) Nifedipine (adalat) is a T-type Na+ channel opener. (D) ∧-Conotoxins are derived from snakes..
45. Indications for lumbar epidural steroid injections include all of the following, EXCEPT? (A) Radicular pain with corresponding sensory change (B) Radiculopathy due to herniated disc with failed conservative treatment (C) Acute herpes zoster in the lumbar dermatomes (D) Posterlaminectomy (failed back) syndrome without radiculopathy
46. 下列有關慢性疼痛的流行病學調查, 何者正確? (A) regional pain syndrome 中最常見的是下肢疼痛 (Lower limb pain) I. (B) widespread body pain(例如 fibromyalgia) 男性的發生率高於女性 (C) cohort study 與 case-control study 是慢性疼痛流行病學研究適當的研究方法 (D)慢性疼痛議題容易進行 population based 的流行病學調查. (E)以上皆不正確
47. Which one of the following statement is most appropriate? (A)Glutamate can act on AMPA and NMDA receptors. (B) Minocycline can inhibit astrocyte activation. (C) Glial activation has nothing to do with nerve injury-induced neuropathic pain. (D) Astrocyte is not a glial cell.
48. All if the following are red flags in patients with low back pain, EXCEPT: (A) History of prolonged corticosteroid use (B) Saddle anesthesia (C) Age of 36 years (D) Urine retention (E) Bowel incontinence
49. Which one of the following neuropathic pain conditions is not likely responded to spinal cord stimulation? (A) CRPS type I (B) CRPS type II (C) Central post-stroke pain (D) Occlusive peripheral vascular disease (E) Diabetic neuropathy
50. 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.

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