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111年 - 111 台灣疼痛醫學會專科醫師考題#116969

科目：台灣疼痛醫學會專科醫師 | 年份：111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. Which one of the following does not belong to opioid receptor gene family? (A) MU (B) DELTA (C) KAPPA (D) Cannabinoid receptor (E) ORL1
2. 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
3. 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.
4. 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.
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. nonsteroidal anti-inflammatory drugs (NSAIDs) 藥物之作用當中，下列何者具有 vasodilatation、降低水分滯留及增加利尿效果之效用？ (A) PGI2 (B) PGD2 (C) PGE2 (D) TXA2 (thromboxane A2) (E) NO
12. 下列有關於 2015 年美國 FDA 對於 NSAID 之警語中，何者為非？ (A) Risk appears to increase with higher doses (B) NSAID use increase risk of heart failure (C) There is insufficient evidence to determine the risk of individual NSAIDs (D) NSAIDs use in patients with risk factors for heart disease does not increase the likelihood of heart attack or stroke (E) NSAIDs increase the risk of heart attack/stroke regardless of existing heart disease
13. 下列何者 opioids 及其活性代謝物之血漿半衰期(T1/2)最長？ (A) Morphine (B) Hydromorphone (C) Fentanyl (D) Nalbuphine (E) levophenol Meperidine 5%
14. 下列何者不適合用於 intrathecal route 治療 neuropathic pain 的第一線用藥？ (A) morphine (B) ziconotide (C) hydromorphine (D) baclofen
15. 有關局部麻醉藥，下列何處注射之後之系統性吸收最慢？ (A) intravenous (B) Intercostal (C) Caudal (D) Epidural (E) Sciatic
16. The criteria to classify a neuron as a nociceptor include (A) The presence or absence of axon myelination, cell size, and/or cell content (e.g., peptide or ion channel) as well as central termination pattern. (B) Sensory neurons commonly identified as nociceptors are those with unmyelinated (C-fiber) axons, small cell body diameters (＜20 or 25 μm), that terminate in the superficial layers of the spinal cord dorsal horn. (C) The presence or absence of certain markers (e.g., the tetrodotoxin (TTX)-resistant sodium channel NaV1.8, the transient receptor potential vanilloid receptor TRPV1) have been used to identify subsets of nociceptors. stimuli, such as during prolonged application of opioids or on abrupt withdrawal of opioids.. (D) More recently, with the ability to analyze many genes expressed in a single cell, patterns of gene expression have been used to further define subpopulations of nociceptors. (E) All of the above.
17. Which one of the following statement is wrong? (A)The spinal cord and brainstem nuclei are home to second-order neurons, the first step of central nervous system (CNS) processing. (B) A proto-oncogene, c-fos, is activated after potentially tissue-damaging stimuli are applied to most tissues. (C) A systematic comparison study of Fos and pERK as markers of spinal nociceptive activation revealed greater specificity for activity in nociceptive pathways (vs. non-nociceptive activation) using Fos. (D) The spinal cord is segregated into areas that, on gross examination, appear as white and grey matter and consist of predominantly myelinated nerve fiber tracts and cell bodies, respectively. (E) Using Rexed’s cytoarchitecture-based classification system, there are at least 10 different layers or laminae of neurons—of which the first six (I to VI) are termed the dorsal horn of the spinal cord .
18. Which one of the following statement is correct? (A) Changes in excitability occur in second-order neurons when repetitive or prolonged high-intensity input is received from primary afferent C-fibers. (B) A characteristic of spinal nociceptive systems is that they are under tonic descending inhibition such that a common effect of injury to spinal pathways is a release from this inhibition. (C) The midbrain periaqueductal grey (PAG) and the rostral ventral medulla (RVM), in particular the medullary nucleus raphe magnus (NRM) figured prominently in the original analyses of descending modulation of pain. (D) Stimulation of both somatosensory cortex (SSC) and motor cortex (MC) have been used in the clinical treatment of neuropathic pain, central poststroke pain, and phantom limb pain. (E) All of the above are correct.
19. 關於熱療於治療疼痛的敘述何者有誤? (A) 熱療可以促使組織修復與改變急性疼痛感知 (B) 熱療時，會促使局部組織的血氧分離曲線(oxyhemoglobin dissociation curve)往左偏移合 併局部溫度微上升，使得局部氧氣供應增加 (C) 熱療可使局部疼痛閥值(nociceptive threshold)上升 (D) 局部組織溫度要達到有效治療，一般範圍大致在攝氏 40-45 度 (E) 熱療也會透過間接效應影響交感神經對於血管收縮舒張的控制，來達到對於疼痛的影 響
20. 叢發性頭痛(cluster headache)急性發作時，下列何種藥物不具治療角色? (A) 皮下注射 sumatriptan (B) 經鼻給予 zolmitriptan (C) 經鼻給予 lidocaine 至翼齶窩（pterygopalatine fossa） (D) 靜脈注射 dihydroergotamine (E) 口服 verapamil
21. 下列何者不是偏頭痛（migraine）常見症狀？ (A)單側性疼痛 (B)搏動性疼痛 (C) 痛到眼窩後方 (D) 噁心嘔吐 (E) 對光與聲音敏感
22. 治療 Postamputation pain 下列用藥，何者最不適合？ (A) Imipramine (B) Gabapentine (C) Pregabalin (D) Memantine (E) Tramadol
23. 有關 Post-Herpetic neuralgia (PHN) 導致相關症狀，下列何者描述最不適合？ (A) Ongoing pain at rest (B) Brush-evoked pain (C) Joint hyperalgesia (D) Heat-hyperalgesia (E) Cold-hyperalgesia
24. 有關 Post-stroke pain 之疼痛症狀類型中，下列描述何者最不適合？ (A) Central post-stroke pain 屬於 neuropathic type (B) Shoulder pain 不屬於 neuropathic type (C) Musculoskeletal pain 不屬於 neuropathic type (D) Headache 屬於 neuropathic pain (E) Spasticity 不屬於 neuropathic type
25. 有關 Common Types of Acute and Chronic Neuropathic Pain 下列敘述，何者最不適合？ (A) Trigeminal neuralgia (TN)(tic douloureux) 屬於 central neuropathic pain (B) Compressive myelopathy from spinal stenosis 屬於 central neuropathic pain (C) HIV myelopathy 屬於 central neuropathic pain (D) Multiple sclerosis-related pain 屬於 central neuropathic pain (E) Syringomyelia 屬於 central neuropathic pain
26. 有關 Post-Herpetic Neuralgia (PHN) 治療，就目前已經發表的 Clinical Trials 下列何者藥物， 效果最不明顯(negative results)？ (A) Nortriptyline (B) Carbamazepine (C) Gabapentin (D) Oxycodone (E) Lidocaine-topical
27. 關於鴉片類藥物的敘述，下列何者最不正確？ (A) Codeine 在肝臟中經 cytochrome P450 2D6 進行 O-demethylation 後會產生 morphine (B) Tramadol 屬於 weak opioid 類藥物，口服生物利用率（oral bioavailability）差，對 neuropathic pain 和 fibromyalgia 效用不佳 (C) Tramadol 造成嚴重呼吸抑制的風險極低，但嚴重腎功能障礙或嚴重藥物過量時仍可能發 生 (D) Oxycodone 的口服生物利用率比 morphine 高，且比較沒有 active metabolite 的疑慮 (E) 肝腎功能障礙對於 methadone 的代謝清除率（clearance）並沒有明顯的影響
28. 關於治療 opioid use disorder 藥物的敘述何者有誤? (A) Naltrexone 是 mu-opioid agonist，可以用來治療 opioid use disorder (B) Naltrexone 也可以用來治療 alcohol use disorder (C)使用 Naltrexone 常見的副作用為頭痛、噁心、頭暈、疲勞、鎮定、與焦慮 (D) Buprenorphine有partial agonist作用，對於中樞神經與呼吸抑制作用有天花板效應(ceiling effect) (E) Buprenorphine 採用舌下劑型、黏膜劑型為主，來治療 opioid use disorder，主要是因為口服吸收差以及肝臟的首度效應(first-pass effect)
29. 在考科藍文獻回顧(Cochrane review)治療下背痛實證方面，以下敘述何者有誤? (A) Paracetamol 對於急性下背痛與安慰劑相比，並沒有得到更好的結果 (B) 長期使用 opioids 對於慢性下背痛是安全並且有效的 (C) Radiofrequency denervation 目前沒有高品質的證據顯示對於慢性下背痛病人有好的治療效果 (D) 針灸相對沒治療或是其他中醫治療，對於下背痛的疼痛改善是比較有效的 (E) 合併整脊療法是稍微能夠改善急性或亞急性下背疼痛
30. 關於周邊神經手術的敘述何者有誤？ (A)周邊神經切除術基本考量就是去除製造疼痛的神經與切除不正常的神經傷害(如 neuroma) (B)部分內分泌與風濕疾病是與增加周邊神經纏套(entrapment)風險相關，例如糖尿病 (C) 周邊神經纏套(entrapment)除了來自組織壓迫外，可能與神經缺血也有關係 (D) 診斷 sympathetically maintained pain 有一定診斷標準，例如皮膚顏色改變等等 (E) sympathetically maintained pain 可能與 A、C 神經傷害感受器有關
31. Which of the following opioid is a μ-Opioid receptor partial agonist? (A) Oxymorphone (B) Buprenorphine. (C) Nalbuphine (D) Pentazocine (E) Methadone
32. Which of the folllowing pharmacokinetics and pharmacodynamics is seldom associated with aging? (A) slowed elimination of the drug and active and toxic metabolites (B) increased bioavailability of drugs, that are highly protein-bound. (C) increased drug elimination time (D) increased sensitivity to both the desired and undesired effects of opioids (E) all of the above pharmacokinetics and pharmacodynamics are associated with aging
33. Which opioid owns the highest conversion factor to morphine minigram equivalents? (A) codeine (B) hydromorphone (C) oxycodone (D) morphine (E) fentanyl transdermal patch (in ug/hr)
34. Which of the following consideration for the use of adjuvants in the older persons is correct? (A) amitriptyline has more anticholinergic adverse effects than second-generation tricyclic antidepressants (nortriptyline or desipramine) (B) Serotonin and norepinephrine reuptake inhibitors (SNRIs) have fewer of these undesired effects from tricyclic antidepressants but a greater risk of drug interactions and elevation of liver enzymes (C) Antiepileptic drugs are first-line agents to treat neuropathic pain in older persons with labeled indications (D) carbamazepine may be useful for neuropathic pain, but less ideal in older adults due to drug interactions, renal, liver, and hematologic toxicity (E) all of the above are correct descriptions for adjuvants use in older persons
35. Which of the following description for the analgesic pharmacology in infants and children is wrong? (A) Neonates and young children have increased maturation of hepatic enzymes involved in the metabolism of analgesics such as opioids and amide local anesthetics (B) Neonates and young infants have decreased plasma concentrations of albumin and α1 acid glycoprotein, leading to decreased protein binding and greater concentrations of unbound, pharmacologically active drug (C) Neonates also have reduced glomerular filtration rates in the first few weeks of life resulting in slower elimination of many drugs (D) Young infants have significantly less of pseudocholinesterase compared to the adult population, leading to prolonged clearance of the ester-type local anesthetics (E) all of the above are correct descriptions
36. 下列何項診斷為最常見的遺傳性神經病變(hereditary neuropathy) ? (A) Fabry’s disease (B) Inherited erythromelalgia (C) Charcot-Marie-Tooth disease (CMT) (D) Familial amyloid polyneuropahty (E) Guillain-Barre Syndrome (GBS)
37. 下列有關 complex regional pain syndrome (CRPS)的 interventional therapies 敘述何者正確? (A) Sympathetic block 目前被認為是 CRPS 第一線的標準介入性治療 (B) 由於 CRPS 皆有 sympthetically maintained pain (SMP), 因此 systemic infusion of sympatholytic agent (例如 phentolamine)具有很好的療效 (C) 目前實證醫學證據顯示針對下肢的 CRPS, spinal cord stimulation 比 dorsal root ganglion stimulation 的療效更佳 (D) 相較於 conservative treatment, spinal cord stimulation 於 CRPS 的療效目前已有 prospective randomized controlled trial 證實 (E) 以上皆正確
38. 針對免疫正常的病患, 下列何節段最常出現 herpes zoster? (A) Cranial (B) Cervical (C) Thoracic (D) Lumbar (E) Sacral
39. 下列何項藥物不屬於 central neuropathic pain 的 first line therapy ? (A) Tramadol (B) Amitriptyline (C) Gabapentin (D) Duloxetine (E) Pregabalin
40. 認知行為療法(Cognitive-behavioral therapy CBT)為全方位疼痛治療的必要模式之一，下列何項是 CBT 的重要組成要素? (A) 教育病患有關疼痛及其相關症候群的內容 (B) 協助病患專注於增加自身活動及功能提升而非止痛 (C) 教育訓練病患有關 biofeedback, relaxation 及 stress management 的技巧 (D) 協助病患進行未來目標的設定 (goal setting for the future) (E) 以上皆是
41. Which one of the following statement is correct? (A) Functional imaging techniques applied for the study of pain are positron emission tomography (PET), functional magnetic resonance imaging (fMRI), near-infrared spectroscopy (NIRS), multi-channel electroencephalography (EEG) and magnetoencephalography (MEG), and intracranial recordings. (B) NIRS is an optical approach that also analyses changes in hemoglobin oxygenation levels by using light in the near infrared range (650 to 950 nm). (C) EEG and MEG are noninvasive neurophysiologic techniques that measure the respective electrical potentials and magnetic fields generated by neuronal activity of the brain and propagated to the surface of the skull where they are picked up with EEG electrodes or, in the case of its magnetic counterpart, received by supra conducting quantum interference device (SQUID) sensors located outside the skull. (D) (D.) Invasive recordings, which are assessed during neurosurgical interventions in patients ongoing epileptic surgery, or deep brain stimulation (DBS) procedures (most common in Parkinson disease), are extremely helpful to directly measure supraspinal pain signals. (E) All of the above are correct.
42. Which one of the following statement is wrong? (A) The person who has a chronic pain condition resides in a complex and costly world that is populated not only by themselves but also by their significant others, including health care providers, employers, and third-party payers. (B) People with chronic pain may feel that their health care providers, employers, and even family members are blaming them when their condition fails to respond to treatment as expected. (C) In the absence of cure or even substantial relief, individuals experiencing chronic pain may withdraw from contacts； lose their sources of income； alienate family, friends, and coworkers； and become more and more isolated, despondent, depressed, and, in general, demoralized. (D) Psychosocial and behavioral factors play an insignificant role in the experience, maintenance, and exacerbation of pain and potentially even the cause. (E) Because some level of pain persists in the majority of people with chronic pain regardless of treatment, self-management is an important complement to biomedical approaches.

43. 下列對於肌筋膜疼痛及纖維肌痛的比較，何者錯誤：
44. During peripheral sensitization of nociceptors, which of the coupling is wrong? (A) prostaglandin E2 (PGE2) --- EP receptor (B) bradykinin --- B2 receptor (C) heat --- TRPV1 receptor (D) ATP --- P2Y receptor (E) all of the above are right
45. Arrange the pain intensity of the following conditions from the strongest to the least according to long form McGill Pain Questionnaire. 1 Labor pain, 2 Amputation of digit, 3 Male low abdominal surgery, 4 Fracture: (A) 1＞2＞3＞4 (B) 2＞1＞4＞3 (C) 2＞1＞3＞4 (D) 1＞2＞4＞3 (E) None of above is right
46. Regarding the actions of spinal and supraspinal analgesia for opioids, which of the following statement is most likely: (A) Opioid receptors are mostly located at a predominantly 70% postsynaptic location on the central terminals of only small diameter nociceptive primary afferents. (B) The contribution of kappa, delta and mu receptors to the total opiate binding throughout the spinal cord is estimated to be delta ＞ mu ＞kappa. (C) Opioids inhibit OFF cells via GABA neurons and activate ON cells in the rostromedial medulla (RVM) leading to changes in spinal descending controls. (D) Nitric oxide (NO) is required for the 5-HT-mediated inhibition of PAG output and reversal of antinociception. (E) Fibers descending from the PAG to the dorsal horn of the spinal cord are mostly enkephalinergic, glycinergic and GABAergic.
47. 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
48. 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
49. 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
50. 會影響脊隨內幫浦(intrathecal pump)給藥的因素，下列敘述何者有誤? (A)體溫上升會降低給藥流速 (B)高海拔會增加給藥流速 (C)藥物黏稠度(viscosity)會影響流速 (D)血壓高低也會影響藥物釋放 (E)幫浦的 dead space 與容量

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