100年 台灣疼痛醫學會專科醫師考題 --- 筆試部分 (單選題)
作答時間：100分鐘 總題數：50題
姓名:______
- Descending inhibitory pathways typically involve which of the following neurochemical
mechanisms EXCEPT?
(A) Noradrenergic
(B) Cholinergic
(C) Enkephalinergic
(D) Serotonergic
2. Which of the following is the unacceptable statement about peripheral nerve block?
(A) Occipital nerve block is indicated for occipital and posterior auricular neuralgia.
(B) Lateral cutaneous nerve of the thigh: local anaesthetic block of this nerve is indicated for
diagnosis and treatment of meralgia paraesthetica.
(C) Sacral plexus block, transforaminal through the sacral foramina, may be indicated for
temporary relief of sciatic pain.
(D) Suprascapular nerve block is indicated for postsurgical pain relief, for assessment of shoulder
pain and to facilitate physical therapy of the shoulder joint in painful shoulder stiffness and
pain secondary to CRPS.
(E) For classical trigeminal neuralgia, blocks of the Gasserian ganglion with glycerol or
radiofrequency are now the commonly used alternatives when microvascular decompression is
not available or cannot be used.
3. The stellate ganglion:
(A) receives fibers whose cell bodies are located primarily at the C4-C7 levels of the spinal cord
(B) is primarily a parasympathetic ganglion
(C) may be blocked with little danger of complications
(D) lies at the level of high cervical vertebra
(E) is a fusion of the inferior cervical and upper thoracic ganglia
4. Which of the following statement concerning “phantom limb pain” is most likely:
(A) Post-amputation pain can be easily treated by analgesia
(B) Phantom pain may enhance with time
(C) Phantom pain is the painful sensations referred to the amputation stump
(D) Pre-amputation pain increases the risk of phantom pain
(E) Phantom pain can be prevented by a preoperative epidural blockade
5. Which of the following statement concerning “central pain” is least likely:
(A) Central pain is dominated by abnormalities in the sensibility to temperature
(B) The most common cause is traumatic spinal cord injuries
(C) Central pain is defined as pain caused by a lesion or dysfunction in the CNS
(D) In stroke the onset of pain is early
(E) In stroke the pain is most frequently a hemipain
6. 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.
7. 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
8. 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.
9.Which NSAID has the lowest risk of GI bleeding？
(A) Diclofenac.
(B) Piroxicam.
(C) Indomethacin.
(D) Celebrex.
(E) Ketoprofen
10. About the surgical management of pain, which one statement of the followings is wrong?
(A) Neuropathic pain due to a compressive lesion may be completely relieved by surgery,
particularly if there has been little damage.
(B) There may be severe continuing pain with relatively minor damage (e.g. root compression).
(C) For the majority of patients with neuropathic pain, the realistic goal of treatment, in a
multidisciplinary pain clinic, is total analgesia and improvement in functional status.
(D) Any operation for treating pain should aim to be specific, localized into the pain area, carry
minimal risk and long-lasting.
(E) Neurosurgeons generally try the most peripheral procedures before working centrally within
the CNS, while giving preference to non-neuroablative operation, if possible.
11. Which of the following statements regarding morphine is true?
(A) Morphine is absolutely contraindicated in non-cancer pain management.
(B) The constipation induced by morphine treatment can be reversed by naloxone.
(C) In patients with renal failure, morphine-3-glucuronide may be accumulated and induce
stronger analgesic effect.
(D) Its metabolite, morphine-3-glucuronide, is a potent analgesic.
12. Indications for lumbar epidural steroid injections include all of the following, EXCEPT?
(A) Post-laminectomy (failed back) syndrome without radiculopathy
(B) Radicular pain with corresponding sensory change
(C) Radiculopathy due to herniated disc with failed conservative treatment
(D) Acute herpes zoster in the lumbar dermatomes
13. Which of the following is the acceptable statement about neurodestructive RF lesions?
(A) These temperatures are a result of 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℃
(E) All of the above
14. Which of the following statement concerning hypnotic analgesia is least likely:
(A) Hypnosis has been highly associated with theta activity (4~8 Hz) using EEG methods.
(B) Hypnotic analgesia can be understood as the result of a placebo manipulation, and it is not more than just relaxation.
(C) Increases in hypnotic relaxation are associated with increases in regional cerebral blood flow in the occipital cortex.
(D) Deep relaxation, dissociated imagery and focused analgesia produced significant reductions on all pain-related measures.
(E) Descending projections from amygdale, PAG and locus coeruleus contribute to modulate nociceptive processes in the brain stem and the spinal cord.
15. 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 not
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.
16. 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
17. Which postoperative factor may not delay recovery:
(A) Pain
(B) Nausea and vomiting
(C) Ileus
(D) Hypothermia
(E) Optimal mobilization
18. 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
19. 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
20. 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
21. A 27-year-old woman with a history of malignant melanoma and multiple subcutaneous metastases has been successfully managed with slowly increasing doses of MS-Contin (Morphine SR), in conjunction with doxepin and ibuprofen. She calls the pain center to complain of a new onset of increasing nausea, vomiting, and headaches, as well as poor pain control. The most appropriate immediate action would be to
(A) speak with the patient by telephone and tell her to increase the MS-Contin
(B) see the patient as soon as possible to determine if there is a new, treatable source of pain
(C) schedule the patient for an evaluation in your office within the week
(D) switch to a fentanyl patch since the patient is nauseated and may be unable to take oral
analgesics
(E) add ondansetron for nausea and vomiting so she is able to continue to take oral analgesics
22. Piriformis syndrome是由於梨狀肌(piriform muscle)壓迫那一條神經所導致?
(A)股神經(femoral nerve)
(B) 坐骨神經 (sciatic nerve)
(C) 股外側皮神經 (lateral femoral cutaneous nerve)
(D) 腓總神經 (common peroneal nerve)
23. 根據 American College of Rheumatology的定義，在其挑定全身的18處解剖區域中若有幾
處痛點即可診斷為Fibromyalgia Syndrome：
(A) 7
(B) 9
(C) 11
(D) 13
(E) 15
24.下列何者不具有Na channel blocker 的作用：
(A)Amitriptyline
(B) Carbamazepine (Tegretol)
(C) Lidocaine
(D) Gabapentin (Neurontin)
(E) Mexiletine (Mexitil)
25. 下列有關Complex regional pain syndrome(CRPS)之敘述，何者最不正確？
(A)依發生率及盛行率而言，CRPS typeⅠ比typeⅡ多
(B)估計骨折後進展成為CRPS typeⅠ之發生率1-2％
(C)估計因周邊神經損傷後進展成為CRPS typeⅡ之發生率平均約4％
(D)女比男之發生率約為1: 2到1: 4之間 (男比女多)
(E)交感神經阻斷術可做為診斷及治療的方式
26. 一位45歲男性椎間盤突出，引起頸部、肩甲骨內側、前胸上臂及前臂內側疼痛，伴隨有
前臂尺側部位麻木，以及眼瞼下垂。請問最有可能壓迫到之神經根位置為？
(A)C5 root (C4-5 disc)
(B) C6 root (C5-6 disc)
(C) C7 root (C6-7 disc)
(D) C8 root (C7-T1disc)
(E) T1 root (T1-2 disc)
27. 下列哪一項病理現象，不代表周邊神經損傷後引起的脊髓中樞敏感化
(central sensitization)：
(A) Receptive field alteration
(B) microglial activation
(C) Windup, after-discharge
(D) Wallerian degeneration
(E) Descending dis-inhibition
28. 有關Local anaesthetic blocks and epidurals下列敘述，何者為真？
(A)Pain relief from a saline ‘block’ certainly by itself mean that the pain is ‘psychogenic’ or that the patient is malingering.
(B)Except for phantom limb pain, neurolytic, neurodestructive nerve blocks are often indicated for patients with chronic pain and a normal life expectancy.
(C)A component of sympathetically maintained pain is present in about two-third of cases with CRPS types I and II.
(D)Postoperative myocardial infarction, respiratory and renal failure, stroke, and in some studies even mortality, were reduced by perioperative lumbar epidural analgesia
(E)The duration of pain relief after epidural steroid injections is reasonable to expect a longer effect in patients without a recurrent mechanical irritation of the nerve root after the pain is gone for this episode.
29. 以下敘述何者為非?
(A)穀氨酸鹽(glutamate) 之受體包括APMA及NMDA等受體
(B)三磷酸腺苷（ATP）之受體為P2X受體
(C) P物質 (substance P) 之受體 (receptor) 為 COX-2受體
(D)體抑素 (somatostatin) 之受體為 SST1-3等受體
(E)疼痛刺激活化c-fiber 後會導致 P物質 (substance P)、血管活性腸肽 (vasoactive intestine
polypeptide, VIP)、體抑素 (somatostatin)、三磷酸腺苷（ATP）及穀氨酸鹽 (glutamate) 等
物質之釋放
30. 下列有關老年病患疼痛問題之敘述何者正確?
(A) 針對手術後疼痛，老年病患較年輕病患更常主動表達疼痛問題
(B) 即使有認知功能障礙的老年病患，仍應該積極處理其疼痛
(C) 慢性疼痛問題在老年人之發生率遠高於年輕人
(D)老年慢性疼痛病患比年輕病患更容易受到憂鬱的影響
(E)以上皆正確
31. 環氧酶(cyclooxygenase) 的抑制是非類固醇抗炎止痛劑的主要作用機轉，請問下列何者不是第一型環氧酶(COX-1) 存在或表現(expression) 之處？
(A)細胞素(cytokine)
(B)腎臟
(C)中樞神經系統
(D)血小板
(E)胃黏膜
32. 偏頭痛(migraine headache)之臨床症狀，何者除外?
(A)單側頭痛且有脈搏跳動感
(B)患側臉潮紅
(C)畏光、畏聲
(D)伴有噁心、嘔吐
33. 對帶狀疱疹(Herpes zoster)之叙述，何者不實?
(A)與誘發麻疹(measles)之病毒(virus)相同
(B)好發於中胸椎皮節和三义神經第一支
(C)於急性期前期投與Acyclovir,可减少發生併發症
(D)帶狀疱疹後神經痛(Post-herpetic neuralgia)為併發症之一，會導致神經病變而疼痛
34. 那些不是星狀神經結阻斷術(stellate ganglion block)之併發症及副作用?
(A) 出現Horner’s syndrome
(B)吞嚥時如有東西擋在咽喉內
(C)氣胸
(D)同側顏面温度下降
35. 肉毒桿菌素( botulinum toxin type A) 目前用來治療筋膜炎(myofacial pain syndrome) 注射激發點(trigger point) 注射，其作用機轉是經由
(A)減少突觸前(presynapse) acetylcholine 的釋放
(B)減少突觸前(presynapse) 鈣離子的吸收
(C)永久性阻斷acetylcholine esterase 的作用
(D)阻止運動神經sodium channel 的開放
(E)破壞運動終板的接受器
36. 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)青光眼及攝護腺肥大是使用三環抗憂鬱劑的禁忌症。
(C)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。
(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)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。
37. 抗癲癇藥物也是用於治療慢性神經病理性疼痛的主要藥物之一，下列有關於抗癲癇藥物之敘述何者為非?
(A)所有抗癲癇藥物之作用機轉均為抑制離子通道，而抑制神經之病態性興奮。
(B) Gabapetin的結構類似GABA，但卻並不作用於GABAA 或GABAB受體，其主要是作
用於鈣離子通道之次單元，而抑制鈣離子流及興奮性胺基酸之釋放。
(C) NNT是用於表示止痛效果的指標，而NNH則是用來表示止痛藥物副作用之指標。
(D)大部分的抗癲癇藥物是以”use-dependent”的方式作用於阻斷鈉離子通道，而產生抑制神經
過度興奮的神經病理性疼痛。
(E)Carbamazepine對於中風後之中樞性疼痛之止痛效果，優於lamotrigine。
38. 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)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。
(B)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。
(C)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。
(D)Buprenorphine的first pass較低，故口服錠效果佳。
(E)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)。
39. 以下有關於癌症病人疼痛治療的敘述，何者正確？
(A)應優先使用注射方式給藥
(B)應優先使用短效藥物
(C)應優先使用非鴉片類止痛藥
(D)物理治療通常對急性疼痛無效
(E)應單獨使用鴉片類藥物，不需和其他藥物併用
40. 針對dental pain使用NSAIDs治療，有哪些需要注意的事情？
A、用codeine當第一線止痛藥，效果比NSAIDs好。
B、用口服的NSAIDs，onset較慢。
C、若已經成為慢性疼痛，反覆給予的效果並不好。
(A)只有A+B正確
(B)只有B+C正確
(C)只有C正確
(D)A+B+C皆正確
41. 針對三叉神經痛的診斷和治療，以下何者是正確的？
A、必須跟鼻竇炎、齒齦炎等疾病做鑑別診斷
B、高頻熱凝療法(radiofrequency thermocoagulation) 就止痛效果而言，乃是the most
effective percutaneous technique and also more effective than stereotactic radiosurgery。
C、如果為非典型的三叉神經痛，做microvascular decompression效果不錯
D、就所有ablative techniques而言，迦瑪刀(stereotactic radiosurgery) 雖不是最有效，但可
能是最安全的處置。
(A) A+B
(B) A+B+C
(C) A+C+D
(D) A+D
(E) A+B+C+D
42. 腰椎交感神經叢神經阻斷術 (lumbar sympathetic blockade) 的適用症，下列何者不包括?
(A)acute herpes zoster
(B) lumbar facet syndrome
(C) vascular insufficiency
(D) phantom limb pain
(E)reflex sympathetic dystrophy
43. 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)20 mg
(B) 10 mg
(C) 6 mg
(D) 2 mg
(E) 1 mg
44. 下列有關spinal cord injury (SCI)之後引起之疼痛，下列敘述，何者較不正確？
(A) 慢性SCI疼痛，大約佔SCI之65％
(B) 慢性SCI疼痛病人當中，大約有1/3病人具有嚴重疼痛
(C) 可區分為musculoskeltal pain，visceral pain以及nreuropathic pain (above-level pain、at-level、below-level)
(D) 其中以neuropathic pain最常見，約佔慢性SCI pain之58％
(E) 一般而言，眾多藥物及治療方式當中，較難有長時間而滿意的止痛療效
45. 週邊神經傷害後，DRG與 Dorsal Horn 所生變化何者為非：
(A)Increase in NO synthase
(B)Changes in Na+ channels and Ca++ channels
(C)Sympathetic sprouting
(D)Increase in opioids receptors
(E)Increased wind-up
46. 就step-wise approach of chronic pain的處置流程而言，Pulsed radiofrequency最早適合於哪一步驟之前？
(A) Physical therapy
(B) Peripheral analgesia
(C) Weak opioids
(D) Strong opioids
(E) Intrathecal opioids
47.下列有關針灸的敘述何者正確？
(A)目前醫學界認為針灸造成的止痛作用是placebo effect
(B)目前醫學界認為針灸造成的止痛作用主要是psychological effect
(C)針灸對neuropathic pain無效益
(D)中醫針灸的理論基礎是源起於道教的觀念
(E)以上皆正確
48. 腰椎或頸椎部位最常見需要手術的原因，且手術比其他治療方式預後較好的是?
(A) Herniated intervertebral disc (HIVD)
(B) Osteoporosis
(C) Facet arthropathy
(D) Degenerated discs
(E) Spinal stenosis
49. 一個因外傷而將左下腳(left lower leg)截肢的15歲少年，最後發展phanton pain (幻肢痛)，雖經多種方法止痛，仍未獲得疼痛舒緩，因此接受脊椎神經刺激術(spinal cord stimulation)，請問應放在哪一個脊椎範圍為佳
(A)頸椎位置
(B)中至下頸椎位置
(C)上至中胸椎位置
(D)中至下胸椎位置
(E)腰椎位置
50. Which one of the following statements is appropriate?
(A) Ca2+ channel activation is responsible for the repolarization of cardiac excitable cells.
(B)GABAA receptor is a voltage-gated Cl- channel.
(C)Na+ channel activation is involved in the initiation of action potential of neurons.
(D) The resting membrane potential of most excitable cells is around 70 mV.