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台灣疼痛醫學會專科醫師
> 108年 - 108 台灣疼痛醫學會專科醫師考題#122407
108年 - 108 台灣疼痛醫學會專科醫師考題#122407
科目：
台灣疼痛醫學會專科醫師 |
年份：
108年 |
選擇題數：
50 |
申論題數：
0
試卷資訊
所屬科目：
台灣疼痛醫學會專科醫師
選擇題 (50)
1. 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.
2. 骨癌或骨轉移引起之疼痛治療論述，以下一者為非，請指出。 (A) 該類疼痛常引起骨骼相關事件(Skeletal-related events)，如骨折等。 (B) 該類疼痛作用機轉常合併傷害感受性及神經病變性之疼痛。 (C) 使用之藥物治療常以抗痙攣藥物為主，鴉片類藥物一般沒效。 (D) 雙磷酸盬及抗 RANK-L 抗體之藥物，可減緩骨轉移而避免疼痛。 (E) 其中因有發炎因素，非類固醇之消炎藥物也有一定的止痛效果。
3. 在癌病疼痛的治療中，須作鴉片類藥物之「轉換」或「輪替」(Switching or Rotation)，以下 一者論述為非，請指出。 (A) 在病人使用該鴉片類藥物，發生無法忍受的副作用時考慮使用。 (B) 病人使用之鴉片類藥物有止痛效果，但效果不佳，又無法增加劑量。 (C) 該藥長期使用後，效果開始不佳，甚至增加劑量也沒得到更好效果。 (D) 在轉換前已有效控制疼痛者，算出的日總劑量應減少 25-50%為準。 (E) 在轉換前效果己經不理想者，算出的日總劑量應增加 50-100%為準。
4. 病人已服用長效型 Oxycodone CR (20mg) 2# q12h，同時其突發痛使用口服嗎啡之劑量 (Rescue dose)為短效型 Oxycodone (5mg) 2#，且每天平均使用 4 次，才能有效控制其疼痛， 請問如何調整其新的劑量？下列論述只有一項為正確，請指出。 (A) 目前每天使用長效型 Oxycodone CR 之總劑量 = 60mg /天。 (B) 目前每天突發痛使用短效型 Oxycodone 之總劑量 = 20mg /天。 (C) 調整為新的長效型 Oxycodone CR (20mg) 每日總劑量 = 80mg /天。 (D) 新的突發痛處置使用之短效型 Oxycodone (5mg)劑量為 = 1# prn。 (E) 為使病人有效且方便，轉換為強效型 Hydromorphone SR (8mg) 2-3# qd。
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.
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
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
16. 下列哪一個腦區與疼痛的情感面向最相關 (A) Ventrolateral Thalamus (B) Anterior Cingulate cortex ACC (C) Insular cortex IC (D) Secondary motor cortex M2 (E) Primary sensory cortex S1
17. A patient with recent leg amputation presents with pain at the site of the stump. Which of the following statements about stump pain is FALSE? (A) The incidence of severe pain is probably seen in only 5-10% of cases. (B) It is present in the majority of patients with phantom pain. (C) It is present in the first week after amputation and always subsides with surgical healing. (D) It can be associated with sensory abnormalities. (E) All of the above are true.
18. Which patient with complex regional pain syndromes (CRPS) is most likely to have the worst outcome? (A) Patient who had a fracture leading to CRPS (B) Patient who had a nerve injury in the lower extremity with warm CRPS (C) Patient who had a nerve injury in the upper extremity with cold CRPS (D) Patient who had a nerve injury in the upper extremity with warm CRPS (E) Patient who has depression disorder
19. Which of the following is true of typical trigeminal neuralgia? (A) It is associated with masseter muscle weakness. (B) It is characterized by episodic bursts of bilateral, severe, lancinating pain lasting 30-60 minutes. (C) There is an absence of sensory deficits. (D) Tricyclic antidepressants are considered first-line therapy. (E) It is associated with visual changes.
20. Which of the following statements about central post-stroke pain (CPSP) is FALSE? (A) The most common form of chronic pain after stroke is musculoskeletal pain and its ratio is estimated to be 40%. (B) Most of the CPSP develops with brain stem infarctions. (C) The lesion responsible for pain in CPSP is actually located in the contralateral thalamus. (D) The recommendations for the first-line treatment of central pain are as follows: pregabalin (150–600 mg/day), gabapentin (1200–3600 mg/day), and tricyclic antidepressant (25–150 mg/day). (E) Contraindications to treatment with tricyclic antidepressants, particularly in the elderly, include patients with cardiac conduction abnormalities, congestive heart failure, and convulsive disorders.
21. Which of the following statements about peripheral neuropathic pain (PNP) is FALSE? (A) The most commonly described spontaneous symptoms of PNP are deep aching in the extremities and a superficial burning, stinging, or prickling pain. (B) The incidence of ongoing pain at rest is high in patients with PNP. (C) The incidence of joint hyperalgesia is high (around 50%) in patients with PNP. (D) The incidence of edema is low in patients with PNP. (E) The incidence of sympathetically maintained pain is low in patients with PNP.
22. Which opioid described below belong to “full agonist”? (A) buprenorphine (B) fentanyl (C) nalbuphine (D) butorphanol (E) naltrexone .
23. 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.
24. About diagnostic nerve blocks, which one of following statements is wrong? (A) May help in locating the origin of pain. (B) Pain originating from malfunctioning CNS pain modulation may also be relieved by a peripheral nerve block. (C) Repeated diagnostic blocks are mandatory before any attempted chemical or physical denervation. (D) Are reliable as prognostic aids for neurolytic procedures. (E) Pain relief from a saline block does not indicate a psychogenic pain or malingered pain.
25. 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
26. 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 embloism (B) myocardial complications (C) pulmonary infectious complications (D) cerebral complications (E) other thromboembloic complications
27. Which of the following statement concerning painful polyneuropathies with prevalent loss of small fibres is most likely: (A) Chronic renal failure neuropathy. (B) Diabetes mellitus neuropathy. (C) Alcoholic neuropathy. (D) Myeloma neuropathy.. (E) soniazid neuropathy.
28. 關於疼痛臨床研究與止痛方式的統計，下列何者正確？ (A) 一般而言，某種止痛方式的 number need to treat 介於 8-12 之間，表示該方式是有效的 (B) 統計結果 Number need to treat 數值愈大，表示該止痛方式效果越好 (C) 統計結果 Number need to harm 不適合用以表達副作用或併發症的的發生率. (D) 比較不同止痛方式的效果時，病人自控式止痛的嗎啡用量是很好的指標，比 pain score 更為客觀. (E) 以上皆不正確.
29. Which of the following statements concerning the difference between phenol and alcohol when used in neurolytic blocks is/are FALSE?. (A) Phenol takes 15 minutes for neurolysis whereas alcohol’s neurolytic effect is immediate. (B) Phenol usually does not produce pain on injection. (C) Intrathecal alcohol is hypobaric, whereas phenol is hyperbaric. (D) Phenol is approximately twice as efficacious as alcohol..
30. 下列有關慢性下背痛之保守治療效果，針對短週期緩解疼痛效果而言，依系統性回顧，下 列何者最差？ (A) Acupuncture (B) NSAIDs analgesics (C) Opioids analgesics (D) Low-level Laser therapy (E) TENS (Transcutaneous Electrical Nerve Stimulation)
31. 下列何者在 fibromyalgia syndrome 之臨床表現，出現頻率最低？ (A) Sleep disorder (B) DepressionTramadol (C) Irritable bowel syndrome (D) Morning stiffness (E) Dizziness and lightheadedness
32.有關 myofascial pain 和 fibromyalgia syndrome 在臨床表現之差異比較，下列敘述何者較不正確？ (A) 依疼痛形式而言，fibromyalgia syndrome 通常全身廣泛分配 (B) 導致頭痛的原因，在 myofascial pain 中，通常源自 occipital region (C) 兩者皆易有 sleep disturbance(D) Myofascial pain 易容易出現 taut band (E) Myofascial pain 通常不會有 irritable bowel syndrome
33. Which of the following is not true about the properties of visceral pain? (A) It is diffuse in character and poorly localized. (B) It is typically referred rather than being felt at the source. (C) It is produced by stimuli different from those adequate for activation of somatic nociceptors. (D) Distention of hollow organs may induce adequate stimuli for production of visceral pain. (E) It is associated with emotional and autonomic responses but much less than those associated with somatic pain.
34. Which of the following is not true about post-mastectomy pain? (A) Mastectomy may result in chronic pain in as many as half of those patients. (B) This pain often starts immediately or a few days postoperatively. (C) This pain is usually neuropathic in character. (D) It is suspected that the intercostobrachial nerve is often damaged during axillary node dissection (E) The incidence of phantom breast syndrome 1 year after surgery is less than 5%.
35. Which of the following is not true about chronic pelvic pain without pathology (CPP)? (A) CPP is defined as non-menstrual pelvic pain of 6 or more months’ duration that is severe enough to cause functional disability or to require medical or surgical treatment. (B) CPP is common and estimated to account for 40% of all gynecologic diagnostic laparoscopies. (C) A history of childhood physical and/or sexual abuse has been correlated with the development of CPP. (D) The best evidence-based management of patients with CPP is multidisciplinary care.. (E) All of the answers above are correct.
36. Which of the following painful disorder is more common in male patients than in female patients?(A) migraine (B) rheumatoid arthritis (C) irritable bowel syndrome (D) cornary artery disease ( older than 60 years old) (E) all of the above are more common than in female patients.
37. According to the long-form McGill Pain Questionnaire (MPQ) pain rating index scores, which of the following acute pain status is rated the highest pain score? (A) Amputation of digit (B) Labor pain (C) Abdominal gynecological surgery (D) Fracture. (E) Lower abdominal surgery (males)
38. Which of the followings is probabaly a less predictive addition indicator? (A) Selling prescription drugs (B) Multiple episodes of loss of prescriptions (C) Repeated resistance to changes in therapy despite clear evidence of adverse physical or psychological effects from the drug (D) Resistance to a change in therapy associated with “tolerable” adverse effects with expressions of anxiety related to the return of severe symptoms (E) Concurrent abuse of alcohol or illicit drugs
39. Which of the following symptom is not often seen in patients with physical dependence (abstinence syndrome -(withdrawal) ) ? (A) abdominal cramps (B) constipationn (C) vomiting (D) pupil dilatation (E) sweating
40. Pain disorder may result in the sleep problem, and which of the sleep pattern is not often seen in patients: (A) acute pain following surgical procedures is associated with reduced and fragmented sleep (B) acute postsurgical pain may result in diminished amounts of slow wave and rapid eye movement (REM) sleep (C) patients with chronic pain may suffered from reduced sleep efficiency and altered sleep architecture (increased wakefulness and stage 1 non-REM sleep) (D) subjects subjected to noxious stimuli during all stages of sleep will demonstrate a sleep awakening response and a moderate level of cortical arousal. (E) all of the above are common found in pain patients
41. 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.
42.About image-guided lumbar sympathetic block, which the following indication is not proper? (A) Sympathetically maintained pain (B) Reflex sympathetic dystrophy (C) Phantom low limb pain (D) Raynaud’s disease (E) Chronic pancreatitis
43. 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). (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.
44. Choice a right description about treatment of cancer pain. (A) Because of the complexity of cancer pain, 3 analgesic ladder from WHO was not useful. (B) Surgery, Chemotherapy and radiotherapy are not the analgesic titration for cancer pain. (C) Only 10-20% of patients ultimately require regular strong opioids. (D) Constipation is common for opioid use, but laxative can be used only when symptom exists. (E) None of above is right
45. 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.
46. 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
47. 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 pe 口 nanent neurodestructive lesion is formed when neural temperatures exceed 42 C (E) All of the above
48. 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
49. 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
50. Based on clinical situations, which kind of opioids owns the highest oral bioavailability ? (A) Hydromorphone (B) Morphine (C) Pethidine (meperidine) (D) Oxycodone (E) Tramadol
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(A)(B)(C)(D)(E)