16. Based on clinical situations, which kind of opioids owns the highest oral bioavailability:
(A) Hydromorphone
(B) Morphine
(C) Pethidine (meperidine)
(D) Oxycodone
(E) Tramadol

1. 關於催眠(hypnosis)及催眠止痛(hypnotic analgesia)，何者敘述錯誤？ (A) 不只是一種魔術，催眠可能有效止痛 (B) 利用的是「暗示」(suggestion)的技巧，與心理層面有關，不影響生理功能 (C) 可以造成精神放鬆，注意力轉移，對人、時、地的錯誤判斷，及改變個人經驗 (D) 催眠止痛要達到長期的效果，需要以暗示方法改變(或主導)病人的疼痛經驗 (E) 催眠止痛改變病人的疼痛經驗的方式有：解離式想像法(dissociated imagery)、集中注 意力法(focused analgesia)、重新詮釋法 (reinterpretation)

2. Which of the following statement concerning the treatment of cancer pain is least likely? (A) Obeying the principles of the analgesic ladder approach, 71% of patients will achieve good in relief without further intervention. (B) Oral morphine remains the drug of choice according to the analgesic ladder of the WHO. (C) The most common use of radiotherapy is for metastases abdominal pain. (D) The patient with advanced cancer is in the dynamic state with changing pathology. (E) About 60% of patients who receive radiotherapy will achieve at least 50% pain relief.

3. 有關 hyperalgesia 的描述何者為非？ (A) 組織受傷會導致許多促進發炎反應的化學物質的釋放，包括 bradykinin， prostaglandins，leukotrienes，serotonin，histamine，substance P，thromboxanes， platelet-activating factor，adenosine，ATP， protons 以及 free radicals 等等 (B) Hyperalgesia 不僅發生在受傷的區域，也會發生在周圍未受傷的區域。 (C) 在周圍未受傷害的區域產生的 hyperalgesia 稱之為 primary hyperalgesia (D) 在發炎反應的時候，marcophages 會釋放 cytokines 來調節發炎反應。 (E) 促進發炎反應之因子，如 cytokine 會促進神經生長因子之產生，再直接或間接地加強 疼痛現象。

4. Which of the following statement concerning “animal models of pain” is least likely? (A) When applying Von Frey filaments for identifying mechanical hyperalgesia, one of the drawbacks is that different application speed may generate different forces. (B) The writhing test is frequently referred to as a somatic pain model. (C) The injection of capsaicin is thought to activate TRPV1-expression nociceptors. (D) The injection of Freund’s complete adjuvant (FCA, or CFA) is a model for inflammatory pain. (E) The chronic constriction injury (CCI) model is a partial nerve lesion model.

5. 關於鴉片 類藥物的敘述，以下何者最為正確？ (A) 嗎啡可能使肥胖細胞(mast cell)釋放組織胺(histamine) (B) Methadone 具有 NMDA 受體拮抗劑的特性，且不會被 naloxone 拮抗 (C) 鴉片類藥物作用在腦幹會降低呼吸中樞對缺氧(low PO2)的敏感性 (D) 使用鴉片類藥物造成便秘是屬於中樞性副作用(central side effect) (E) 嗎啡的代謝產物 M3G 與 M6G 均有微弱的止痛效力

6. The effect of placebo will be enhanced by the followings except (A) conditioning by treatment context (B) suggestion by verbal (C) expectation of response (D) desire of pain relief (E) attention to pain

7. 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.

8. Which of the following drug is not suggested to be prescribed to prevent migraine? (A) beta blocker (B) anticonvulsant such as gabapentin (C) tricyclic antidepressant such as amitriptyline (D) SSRI (Selective serotonin re-uptake inhibitors), such as Fluoxetine (prozac) (E) all of the above can be prescribed as preventive medications

9. 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

10. 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

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