Asqzybn98年台湾疼痛医学会专科医师考题 笔试部分单选题.docx
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Asqzybn98年台湾疼痛医学会专科医师考题笔试部分单选题
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1我们‖打〈败〉了敌人。
②我们‖〔把敌人〕打〈败〉了。
XX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:
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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)T1rootcompression
5.Apatientsufferedfromchroniclowbackpainwithradiatingtobuttock,posterlateralthighandlateralaspectoflowerleg.Muscleweaknesswasobservedintheextensorhallucislongusandtibialisanterior.Whichlumbosacralrootcompressionisthemostlikely?
(A)L2rootcompression
(B)L3rootcompression
(C)L4rootcompression
(D)L5rootcompression
(E)S1rootcompression
6.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-basedtreatmentofpatientswithCPPismultidisciplinarycare
9.Visceralpainhasthefollowingpropertiesexcept:
(A)Itisdiffuseandpoorlylocalized.
(B)Itisreferralpainandnotfeltatthesource.
(C)Itisproducedbystimulidifferentfromthoseadequateforactivationofsomaticnociceptors.
(D)Itischaracterizedbydistinctsensations.
(E)Itisassociatedwithstrongemotionalandautonomicresponses.
10.Allodyniacanbedefinedas:
(A)hypersensitivitytoapainfulstimulus
(B)summationofmildlypainfulstimulithatcausesseverepain
(C)paincausedbyanonpainfulstimulus
(D)painpresentinanareaofnumbness
11.A26-year-oldweightlifterfeltasharppainintheneck,radiatingtothedorsalaspectoftheforearmduringhisworkout.Overthenextfewdayshenotedprogressivenumbnessofthethumbandindexfinger.Healsocomplainedofdecreasedabilitytoperformbicepcurls.Onexaminationbyhisprimarycaredoctor,amarkedlydiminishedbicepsreflexwasfound.Whichofthefollowingisthemostlikelycauseofthepatient’sproblem?
(A)FactureC5vertebra
(B)C5-C6discprotrusion
(C)FacetsyndromeatC5-6
(D)CompressionoftheC5nerverootbyanosteophyte
12.RamsayHuntsyndrome(herpeszosteroticus)occurswhenherpeszosterinvolvesthe:
(A)gasserainganglion
(B)geniculateganglion
(C)ciliaryganglion
(D)sphenopalatineganglion
(E)trigeminalnerve
13.A52-year-oldmancomplainsofasuddenonsetofsevere,stabbingpainintheleftjawandcheekthatsubsidesinlessthanaminute.Heispain-freeduringtheintervalsbetweenattacks.Activitiessuchascombinghishairandshavingcancausetheonsetofthisfacialpain.Heisotherwisehealthy.Themostlikelydiagnosisis
(A)trigeminalneuralgia
(B)atypicalfacialpain
(C)postherpeticneuralgia
(D)vascularfacialpain
14.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,whichactivatessympatheticterminalsthatsynthesizenociceptorsviaβ2-adrenoceptors
18.TheformalpresentationofMyofascialPainsyndromediagnosticcriteriaincludeseachofthefollowing,EXCEPT
(A)ResolutionofthesymptomsafterTriggerPointInjectionwithlocalanesthetic
(B)Referralpainisevident
(C)TwitchresponseandTriggerPointsarethecommonfeatures
(D)LimitedROMoftheaffectedmuscleormuscles
(E)Widespreadbodypain
19.Thecurrentguidelinesonthemanagementofacutelowbackpaininprimarycareincludethefollowing,EXCEPT
(A)Reassurepatientsbecausetheprognosisismostfavorable
(B)Adviseorencouragecompletebedrest
(C)Prescribeanalgesicsmedicationifnecessary
(D)Encouragetostayactive
(E)Considerspinalmanipulation(chiropractic)forpainrelief
20.WhichofthefollowingstatementiswronginRepetitiveStrainInjury(RSI)?
(A)Bloodflowandtemperatureoftheaffectedlimbwillbereducedatrest
(B)RSIisanormallypreventablecondition
(C)Thereismultiplefoldsincreaseinbloodflowwithexerciseinthepainfullimb
(D)Peripheralnerveinjuryisarecognizedcauseofregionalpain
(E)TreatmentwithanalgesicsisseldomadvocatedforRSIexceptforshortperiods
21.Whichstatementabout“chronicpainandemotion”iswrong?
(A)Thepsychologicalimpactandbehaviouralcourseofpainfulconditionsvariesamongindividuals.
(B)Chronicpainisalwaysassociatedwithdepression.
(C)Depressionmakessocialandoccupationalfunctioningmoredifficultandappearstointensifypain.
(D)Sleepdisturbanceisoneofthediagnosiccriterialfordepression.
22.Whichstatementaboutpainiswrong?
(A)Painisanobjective,perceptualexperience.
(B)Noiso-morphicrelationshipexitsbetweentissuedamageandpainreport.
(C)Onecharacteristicdifferentiatingpainfrompuresensationisitsaffectiveandcognitivecomponents.
(D)Painmustbeviewedasacomplexphenomenonthatincorporatesphysical,psychosocialandbehavioralfactors.
23.Physicaldependenceisdefinedbytheabstinencesyndrome(withdrawal),butwhichitembelowisNOTincluded:
(A)abdominalcramps
(B)restlessness
(C)pupilconstriction
(D)sweating
(E)dysphoria
24.Whichmeasurementforpainisseldomusedinpediatricpatients?
(A)PokerChipTool
(B)Oucherscale
(C)McGillPainQuestionnaire
(D)FacesPainScale-Revised(FPS-R)
(E)NeonatalFacialActionCodingSystem(NFACS)
25.Whatisthefollowingdescriptionabouttension-typeheadacheisFALSE?
(A)maybeassociatedwithstress
(B)painmayinvolveteeth,forehead&neck
(C)bilateral
(D)associatedwithvomiting
(E)mostcommoninadolescence
26.Whichfollowingitemisaprobablymorepredictiveaddictionindicator?
(A)Obtainingprescriptiondrugsfromnon-medicalsources
(B)Requestingspecificdrugs
(C)Unapproveduseofthedrugtotreatanothersymptom
(D)Openlyacquiringsimilardrugsfromothermedicalsources
(E)Aggressivecomplainingaboutneedingmoreofthedrug
27.下列有關老年病患疼痛問題之敘述何者正確?
(A)即使有認知功能障礙的老年病患,仍應該積極處理其疼痛
(B)慢性疼痛問題在老年人之發生率遠高於年輕人
(C)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
(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
28.下列有關慢性疼痛的流行病學調查,何者正確?
(A)regionalpainsyndrome中最常見的是下肢疼痛(Lowerlimbpain)
(B)widespreadbodypain(例如fibromyalgia)男性的發生率高於女性
(C)cohortstudy與case-controlstudy是慢性疼痛流行病學研究適當的研究方法
(D)慢性疼痛議題容易進行populationbased的流行病學調查
(E)以上皆不正確
29.AboutthefollowingCT-guidedintervention,whichindicationisNOTproper?
(A)Sympatheticallymaintainedpain
(B)Reflexsympatheticdystrophy
(C)Chronicpancreatitis
(D)Raynaudsyndrome
(E)Failedbacksurgerysyndrome.
30.Aboutthephysiologicanatomyofnociception,whichoneofthefollowingstatementsisNOTcorrect?
(A)First-order(primaryafferent)nociceptiveneuronsaresensoryneuronsthatarespecializedtodetectthepresenceandsignalthelocation,quality,andintensityoftissue-damagingstimuli.
(B)Thecellbodiesofprimaryafferentnociceptiveneuronsarelocatedindorsalrootgangliaandtrigeminalganglia.
(C)WDRneuronsencodetheintensityofinputsovertheentirerangeofinnocuousandnoxiousstimuli,whereasnociceptive-specificneuronsdorespondtoinnocuousstimuli.
(D)Afterinitialsynapticprocessingatthespinalsegmentallevel,nociceptiveinformationiscarriedtothebrainbydirectaxonalprojectionstothethalamus,brainstemandhypothalamus/forebrain