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107年 - 台灣疼痛醫學會專科醫師考題#122426

科目：台灣疼痛醫學會專科醫師 | 年份：107年 | 選擇題數：49 | 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 (49)

1. 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
2. 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
3. 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
04. 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
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. 根據2014年 "National Institute for Health and Clinical Excellence" 對癌症末期瀕死病人的最 好的支持性治療 ("Best Practice in the Last Hours and Days of Life")，下列哪一項敘述不正 確： (A) Decisions are made to discontinue inappropriate interventions. (B) Discontinue or reduce subcutaneous opioid analgesics to avoid conscious depression or disturbance (C) "As-required" subcutaneous medication is prescribed according to an agreed protocol to manage pain, agitation, nausea and vomiting, and respiratory tract secretions (D) Family and carers are given appropriate written information. (E) A plan of care is explained and discussed with the patient, family, and carers.
7. 下列關於 WHO Analgesic Ladder 的三階梯(3 steps)用藥，哪一項較不正確： (A) Paracetamol (Acetaminophen) 是 step I 用藥，也可以是 step II 用藥 (B) Tramadol 是 weak opioid, 屬於 step II 用藥 (C) Hydromorphone, oxycodone 是 strong opioids, 屬於 step III 用藥 (D) Ketamine 作用於 opioid-resistant pain, 可歸類於 step III 用藥 (E) Buprenorphine 是 partial opioid agonist, 歸類於 step II 用藥
8. About chemical neurolytic nerve blocks, which one of following statements is wrong? (A) Phenol or ethanol is usually used for chemical denervation (B) The duration of these blocks is often disappointingly brief. (C) They may induce deafferentation-neuropathic type pain. (D) They are often indicated for patients with chronic pain and a normal life expectancy. (E) They can be used in patients with advanced cancer disease.
9. Based on clinical situations, which kind of opioids owns the highest oral bioavailability ? (A) Hydromorphone (B) Morphine (C) Pethidine (meperidine) (D) Oxycodone (E) Tramadol
10. 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) trigeminal neuralgia (B) atypical facial pain (C) postherpetic neuralgia (D) vascular facial pain
11. Which following item is not a criterion for the diagnosis of migraine? (A) Aggravation by or causing avoidance of routine physical activity (B) Unilaterallocation (C) Moderate or severe pain intensity (D) Throbbing/stabbing quality (E) All are criteria for diagnosis of migraine
12. 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.
13. About the failed back surgery syndrome (FBSS), which one of the following procedure may be the last to be considered due to possible poor response? (A) caudal steroids injection (B) epidural adhesive lysis (C) spinal cord stimulation (D) radiofrequency denervation (E) lumbar sympathetic block
14. 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
15. 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
16. 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
17. 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.
18. 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..
19. 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
20. Which of the following is not a common manifestation of the myofascial pain syndrome? (A) Regional body pain and stiffness (B) Abnormal findings on neurological examinationl (C) Limited range of motion of the affected muscle (D) One or more trigger points (E) Referral (triggering) pain from a trigger point to a zone of reference .
21. Which of the following combination of lesion site with referral site describing pain referral is not common in cancer patients suffering from cancer pain? (A) (Diaphragmatic irritation) and (Shoulder) (B) (Urothelial tract) and (Inguinal region and genitalia) (C) (C7–T1 vertebrae) and (Interscapular) (D) (L1–2) and (Sacroiliac joint and hip) (E) all of the above are common found in patients with cancre pain
22. Which of the following suggestion is not advisable for the use of opioids in children with cancre pain? (A) Use the oral route first in most circumstances (B) Treat constipation pre-emptively. (C) If side effects are bothersome with one opioid, consider switching to another one. (D) Use sufficient doses to keep the patient comfortable should be avoided due to the possible occurrence of adverse effects (E) Use the oral route first in most circumstances.
23. Which of the following oral opioids is not recommended for padiatric patients with cancer pain?(A) morphine (B) hydromorphone (C) oxycodone (D) meperidine (pethidine) (E) all of the above can be prescribed for pediatric patients with cancre pain
24. Adjuvant analgesics are often prescribed for managing caner pain, but which of the following drug – indication is not considered ? (A) NSAIDs for Soft tissue pain (B) Anticonvulsants for Neuropathic pain (C) Steroids for Soft tissue pain (D) Baclofen for Muscle spasm (E) Benzodiazepines for Muscle spasm
25. Which of the following cell type sense the initial “endanger signal” and participates in the initial phase of pathogenesis of the nerve injury induced neuropathic pain? (A) Microglia (B) Spinal lamina I and II neuron (C) Astrocyte (D) oligodendrocyte
26. Which of the following description about spinal cord plasticity and pain is incorrect? (A) Some spinal nociceptive neurons receive convergent input from high- and low- threshold sensory fibers thus called wide–dynamic range neurons (B) Glutamate is the major fast excitatory neurotransmitter in all nociceptive afferent nerve fibers. Glutamate can bind to three types of ionotropic glutamate receptors and to G protein–coupled metabotropic glutamate receptors to modify neuroexcitability. (C) Hyperalgesia and allodynia can even be induced in humans in the absence of any sensory stimuli, such as during prolonged application of opioids or on abrupt withdrawal of opioids..(D) Spinal nociception is under powerful control from descending inhibitory and facilitatory pathways. Under normal conditions, descending facilitation appears to prevail over inhibitory pathway.
27. Which of the following statement concerning painful polyneuropathies with prevalent loss of small fibres is most likely: (A) Chronic renal failure neuropathy. I. (B) Diabetes mellitus neuropathy. (C) Alcoholic neuropathy. (D) Myeloma neuropathy.. (E) soniazid neuropathy.
28. 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.
29. 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.
30. Effects on postoperative morbidity of regional anaesthetic or analgesic techniques compared with those of general anaesthesia and systemic postoperative analgesics may reduce the following complications, except: (A) pulmonary embolism (B) myocardial complications (C) pulmonary infectious complications (D) cerebral complications (E) other thromboembolic complications
31. Which of the following drug is categorized as Agonist-Antagonist and should "Not" be used in opioid tolerant patients. (A) Morphine (B) Tramadol (C) Nalbuphine (D) Hydromorphone (E) Methadone
32. Which of following description about opioid receptors is "Incorrect" ? (A) Opioid receptors belong to the superfamily of G protein–coupled receptors (GPCR) (B) Opioid receptors are coupled to Gs protein to trigger downstream signaling. (C) Overall opioid receptor activation leads to inhibit neuronal activity (D) In spinal cord level, opioid receptors are located mostly in the superficial dorsal horn (E) Endogenous opiates maybe released by immune cells and work on both central and peripheral opioid receptors.
33. Which of following description about non-steroidal anti-inflammatory drugs (NSAIDs) pharmacology is "Correct"? (A) NSAIDs work by inhibiting the inflammation associated enzyme cyclooxygenase and lipoxygenase (B) Perioperative use of NSAIDs will not increase the risk of surgical site bleeding (C) NSAIDs will not have drug-drug interaction with anticoagulant (such as warfarin) (D) Cyclooxygenase-2 (Cox-2) is the inducible isoform of cyclooxygenase but is constitutively expressed in certain tissues such as brain and kidney (E) Compared with non-selective NSAIDs, long term use of Cox-2 inhibitors will significantly reduce the risk of serious cardiovascular events, renal failure or congestive heart failure.
34. Which of following description about using anticonvulsants (used as Analgesic Drugs is "Correct"? (A) Most commonly used anticonvulsants as analgesics appear to work through potentiation of voltage-gated sodium and calcium channels (B) Sodium channel subtype 1.4 &1.5 are highly expressed in neuronal cell and could be the drug target for anticonvulsant medication (C) Gabapentinoid (Gabapentin & Pregabalin) works on GABA receptor (D) Topiramate works only on voltage-gated sodium channel (E) Lamotrigine and Phenytoin work on voltage-gated sodium channels
35.Which of following description about "antidepressant analgesic" is "Correct"? (A) In terms of treatment efficacy (smaller number needed to treat NNT), pregabalin is much better than tricyclic antidepressant and listed as first line therapy for neuropathic pain (B) In terms of treatment efficacy (smaller number needed to treat NNT), SSRI is better than SNRI for common neuropathic pain such as postherpetic neuralgia or painful diabetic polyneuropathy (C) Venlafaxine is effective for treatment of neuropathic pain associated with beast cancer. (D) For painful diabetic neuropathy, comparison of amitriptyline and pregabalin showed no difference in pain relief but fewer adverse effects with pregabalin. (E) All of above
36. Regarding the peripheral mechanisms of cutaneous nociception, which of the following statement is least likely: (A) Following a cutaneous injury, primary hyperalgesia develops at the site of injury, which is called sensitization. This sensitization is due to the local release of inflammatory mediators such as interleukins (IL-10) and prostaglandin E1. (B) Secondary hyperalgesia was induced in the surrounding uninjured skin, which is due to sensitization of neurons in the central nervous system. (C)hen nerves are severed, spontaneous activity and ectopic mechanical, thermal, and chemical sensitivity develop in the injured nociceptors. (D) The properties of nearby, uninjured nociceptors are also changed. (E) In both injured and uninjured nociceptors, responsiveness to adrenergic agents can develop, which may account for involvement of the sympathetic nervous system in certain forms of neuropathic pain.
37. Regarding the molecular biology of sensory transduction, which of the following statement is least likely: (A) Chemotransducers are metabotropic receptors, which is the slowest form of chemical transduction. (B) Thermotransducers include TRPA1–TRPV2, TRPV3 and TRPV4, TRPA1, TRPM3, TRPM8, TRPC5, K2P, which can respond to a wide range of temperatures. (C) The underlying mechanisms of mechanotransducers vary as a function of stimulus (stretch versus pressure) and the tissue stimulated. (D)Piezo1 and 2 channels are also refered to mechanotransducers. (E) Polymodalities existed across these transducers (many transducers are activated by several stimulus, e.g., thermo- and mechanotransducers also have chemosensitities).

38. Regarding the biological effects of exogenous nerve growth factor (NGF) on pain-signaling systems in normal animals in animals with nerve injury, which of the following statement is most likely occurred in DRG:
(A) Decreases in substance P, increases in CGRP and trkA. (B) Decreases in substance P, brain-derived neurotrophic factor (BDNF). (C) Decreases in substance P, increase in BDNF (D) Decreases in substance P, CGRP and trkA. (E) Decreases in substance P, TRPV1, sodium channels.
39. Regarding the neuron–glial interactions within the spinal cord after peripheral nerve injury (PNI), which of the following statement is least likely: (A) Up-regulated P2X4R expression is induced in microglia within the spinal cord by PNI. (B) In this P2X4R+ state, microglia release BDNF, which inhibits neurons in the spinal nociceptive processing network. (C) Minocycline and propentofylline is glial-specific inhibitors. (D) MAPKs, p38, is the intracellular mediator of P2X4R–BDNF signaling in microglia-mediated post–nerve injury pain states. (E) BDNF from microglia is a critical signaling molecule mediating the central pathophysiological effects of PNI.
40. Regarding Central Nervous System Mechanisms of Pain Modulation, which of the following statement is least likely: (A) Pain-modulating systems involve a network with major relays in the midbrain periaqueductal gray and rostral ventrolateral medulla. (B) This network exerts bidirectional control over dorsal horn nociceptive transmission by means of separate anti- and pro-nociceptive output from the RVM. (C) The PAG–RVM system is the central substrate for the actions of opioid and non-opioid analgesic drugs. (D) The PAG–RVM system receives direct and indirect input from nociceptive transmission pathways to modulate nociception. (E) It strongly links with the hypothalamus and limbic forebrain , through which cognitive and emotional factors can regulate pain processing.
41.關於叢發性頭痛(cluster headache)之描述，下列何者有誤: (A)位於眼眶、上眼眶及/或顳部重度疼痛，好發於雙側，如不治療可持續 15 至 180 分鐘。 (B)男性較容易發生叢發性頭痛 (C)發作頻率為每二日一次至每日八次 (D)會伴隨至少一項自主神經症狀，如結膜充血、流淚、鼻腔充血、流鼻水、瞳孔縮小及眼 皮下垂等。 (E)若兩次叢發期間隔 1 個月以上的緩解期，則稱作「陣發叢發性頭痛(episodic cluster headache)」。
42.有關偏頭痛(migraine)之敘述，下列何者有誤？ (A)每月發作一至兩次的病人不須使用預防性用藥 (B)每月發作五次以上的病人應使用預防性用藥 (C) Propranonol 及 Gabapentin 可作為預防性用藥 (D) Aspirin 對許多急性發作病人有效 (E) Ergotamine 對較嚴重的偏頭痛是目前首選用藥
43.關於典型三叉神經痛(classic trigeminal neuralgia)的治療，下列何者可做為 Carbamazepine 替代用藥? (A) Lamotrigine (B) Oxcarbazepine (C) Pregabalin (D) Baclofen (E)以上皆是
44.有關緊張型頭痛(Tension-type headache)之敘述，下列何者有誤？ (A)頭痛中最常見的一種類型 (B)好發於青壯年，女性多於男性。 (C)多為單側，位於枕頸部、頂顳部，常為緊束感、重壓感的表現。 (D)中樞疼痛機轉在慢性緊張型頭痛扮演較重要角色 (E)藥物選擇上主要採用 NSAIDs 以減輕症狀
45.關於三叉神經痛的介入性治療，目前證據支持下列何種治療可達到較完全和最長期的疼痛 緩解? (A) Microvascular decompression (MVD) (B) Radiofrequency ablation (Gasserian ganglion) (C) Percutaneous balloon microcompression (D) Stereotactic radiosurgery (E) Glycerol rhizotomy
46. Which of the following is not a “positive” symptoms and signs resulting from nerve injury and disease? (A) Spontaneous paresthesias, dysesthesia, and frank pain (B) Pain evoked by normal weight bearing, movement, and deep palpation (C) numbness (D) allodynia and hyperalgesia (E) Hyperpathia
47. Which of the following painful polyneuropathy involve loss of small fiber? (A) Hypothyroid neuropathy (B) Alcoholic neuropathy (C) Diabetic neuropathy (D) Myeloma neuropathy (E) All of the above involve loss of small fiber
48. Which of the following is not a common sign or symptom in complex regional pain syndrome (CRPS)? (A) Mechanical hyperalgesia (B) Vasodilatation or Vasoconstriction (C) Swelling (D) hyperhidrosis or hypohydrosis (E) all of the above can be clinical signs or symptoms associated with CRPS
49. Which of the following sign/ or symptom after spinal cord injury with its management is not suggested? (A) muscle spasm with oral baclofen (B) hypertension due to autonomic dysreflexia with antihypertensive drugs (C) at/ below level neuropathic pain with pregabalin (D) at/ below level neuropathic pain with duloxetine (E) pain due to fracture/ dislocation with NSAUDs

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