Gshjna98年台湾疼痛医学会专科医师考题--- 笔试部分(单选题)

秋风清，秋月明,落叶聚还散,寒鸦栖复惊。百度文库专用98年台灣疼痛醫學會專科醫師考題---筆試部分(單選題)姓名:_____________1.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)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。(C)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。(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)青光眼及攝護腺肥大是使用三環抗憂鬱劑的禁忌症。2.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)Carbamazepine對於中風後之中樞性疼痛之止痛效果，優於lamotrigine。(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)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。(E)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。3.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)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Crosstolerance存在，故使用opioidrotation和替代性並不能降低其相關之副作用並增強其止痛效果。(B)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)。(C)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。(D)Buprenorphine的firstpass較低，故口服錠效果佳。(E)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。4.Apatienthadchronicpainovertheneck,medialscapula,anteriorchest,medialaspectofarmandforearm.Hormer'ssyndromewasalsonoted.Whichrootcompressionisthemostlikely？(A)C5rootcompression(B)C6rootcompression(C)C7rootcompression(D)C8rootcompression(E)T1rootcompression5.Apatientsufferedfromchroniclowbackpainwithradiatingtobuttock,posterlateralthighandlateralaspectoflowerleg.Muscleweaknesswasobservedintheextensorhallucislongusandtibialisanterior.Whichlumbosacralrootcompressionisthemostlikely？(A)L2rootcompression(B)L3rootcompression(C)L4rootcompression(D)L5rootcompression(E)S1rootcompression6.下列哪種癌症病人最不易出現骨骼轉移的疼痛？(A)乳癌(B)前列腺癌(C)肺癌(D)肝癌7.下列有關針灸的敘述何者正確？(A)中醫針灸的理論基礎是源起於道教的觀念(B)目前醫學界認為針灸造成的止痛作用是placeboeffect(C)目前醫學界認為針灸造成的止痛作用主要是psychologicaleffect(D)針灸對neuropathicpain無效益(E)以上皆正確8.WhichofthefollowingisNOTtheacceptablestatementaboutthedefinitionofchronicpelvicpain(CPP)withoutidentifiedpathology?(A)menstrualpelvicpainof6ormoremonths’duration(B)severeenoughtocausefunctionaldisabilityortorequiremedicalorsurgicaltreatment(C)non-opioidanalgesicsarethetypicalfirststepoftreatment(D)theuseofopioidsiscontroversial(E)thebestevidence-basedtreatmentofpatientswithCPPismultidisciplinarycare9.Visceralpainhasthefollowingpropertiesexcept:(A)Itisdiffuseandpoorlylocalized.(B)Itisreferralpainandnotfeltatthesource.(C)Itisproducedbystimulidifferentfromthoseadequateforactivationofsomaticnociceptors.(D)Itischaracterizedbydistinctsensations.(E)Itisassociatedwithstrongemotionalandautonomicresponses.10.Allodyniacanbedefinedas:(A)hypersensitivitytoapainfulstimulus(B)summationofmildlypainfulstimulithatcausesseverepain(C)paincausedbyanonpainfulstimulus(D)painpresentinanareaofnumbness11.A26-year-oldweightlifterfeltasharppainintheneck,radiatingtothedorsalaspectoftheforearmduringhisworkout.Overthenextfewdayshenotedprogressivenumbnessofthethumbandindexfinger.Healsocomplainedofdecreasedabilitytoperformbicepcurls.Onexaminationbyhisprimarycaredoctor,amarkedlydiminishedbicepsreflexwasfound.Whichofthefollowingisthemostlikelycauseofthepatient’sproblem?(A)FactureC5vertebra(B)C5-C6discprotrusion(C)FacetsyndromeatC5-6(D)CompressionoftheC5nerverootbyanosteophyte12.RamsayHuntsyndrome(herpeszosteroticus)occurswhenherpeszosterinvolvesthe:(A)gasserainganglion(B)geniculateganglion(C)ciliaryganglion(D)sphenopalatineganglion(E)trigeminalnerve13.A52-year-oldmancomplainsofasuddenonsetofsevere,stabbingpainintheleftjawandcheekthatsubsidesinlessthanaminute.Heispain-freeduringtheintervalsbetweenattacks.Activitiessuchascombinghishairandshavingcancausetheonsetofthisfacialpain.Heisotherwisehealthy.Themostlikelydiagnosisis(A)trigeminalneuralgia(B)atypicalfacialpain(C)postherpeticneuralgia(D)vascularfacialpain14.疾病和傷害經常造成疼痛及痛覺過敏(hyperalgesia)其中有一部份起源於發炎介質(inflammatorymediators)在週邊神經末稍的作用下影響相關之敘述何者是錯誤的?(A)這些介質除了arachidonicacidmetabolites;bradykinin還有如ATP及NO之小分子。(B)如TNF，IL1和NGF也和疼痛有關。(C)可以經由活化Nociceptiveterminals。(D)可以經由nociceptors基因表現的調節。(E)CNS無此類發炎介質引起之疼痛作用。15.下列何者對研究疼痛在腦部的研究所提供的訊息最有限?(A)EEG(B)EP(EvokedPotential)(C)PET(Positronemissiontomography)(D)SPECT(Singlephotonemissioncomputedtomography)(E)fMRI(functionalmagneticresonanceimaging)16.在疼痛機轉下行性調控的控制中，下列何者沒有參與其中?(A)Enkephalinergic(B)Serotonergic(C)Cholinergic(D)Noradrenergic(E)以上皆有參與17.Whichofthefollowingstatementconcerning“autonomic-endocrine-immuneinteractioninpain”isleastlikely?(A)Cytokinesareinvolvedinthesensitizationofnociceptorsduringinflammationandmayleadtohyperalgesia(B)Proinflammatorycytokinesaresynthesizedandreleasedbymacrophagesandotherimmune-relatedcells(C)IL-4iscategorizedasananti-inflammatoryinterleukin(D)IL-1,IL-10andTNF-arecategorizedasproinflammatorycytokines(E)TNF-inducessynthesisandreleaseofIL-8,whichactivatessympatheticterminalsthatsynthesizenociceptorsvia2-adrenoceptors18.TheformalpresentationofMyofascialPainsyndromediagnosticcriteriaincludeseachofthefollowing,EXCEPT(A)ResolutionofthesymptomsafterTriggerPointInjectionwithlocalanesthetic(B)Referralpainisevident(C)TwitchresponseandTriggerPointsarethecommonfeatures(D)LimitedROMoftheaffectedmuscleormuscle