45. 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

1. Which opioid described below belong to “full agonist”? (A) buprenorphine (B) fentanyl (C) nalbuphine (D) butorphanol (E) naltrexone

2. 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.

3. 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

4. Which kind of animal model of neuropathic pain is thought to have the least characteristics of thermal hyperalgesia? (A) Partial sciatic nerve section. (B) Chronic constriction injury (C) Spinal nerve ligation (D) Spared nerve injury (E) Ischemic peripheral nerve injury

5. What kind of fiber is usually thought to be the cause of tactile allodynia? (A) C fibers (B) Aα fibers (C) Aβ fibers (D) Aδ fibers (E) Sympathetic fibers

6. 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

7. 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

8. 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

複選題9. 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.

10. 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

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