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Episode 49 Carpal Tunnel Syndrome

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Answers for Episode 48 Osteoporosis/RA

Question 1

A 64-year-old postmenopausal woman with rheumatoid arthritis presents after sustaining a vertebral fracture. Which factor most strongly contributes to her increased fracture risk compared to age-matched controls?

B. Chronic systemic inflammation activating osteoclasts

 Question 2

According to current recommendations, which patient should undergo bone mineral density (BMD) screening for osteoporosis?

C. A 42-year-old woman with RA taking ≥2.5 mg prednisolone daily for 4 months

Question 3

Which medication is most effective for increasing bone mineral density and reducing vertebral fractures in patients with RA and glucocorticoid-induced osteoporosis?

C. Denosumab

Paper for Next Week:

Michael Kj, Jesper Petersen, Michael Ries Dünweber, Jesper L.vind Andersen, Lars Engebretsen, Stig Peter Magnusso,Dilemma in the Treatment of Sports Injuries in Athletes: Tendon Overuse, Muscle Strain, and Tendon Rupture, Scandinavian Journal of Medicine & Science in Sports, 2025; 35:e70026

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 48 Osteoporosis

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Answers for Episode 47 Fibromyalgia

Question 1: Pathophysiology

A 42-year-old woman presents with chronic widespread pain, fatigue, and cognitive difficulties. Functional MRI reveals increased activation in the posterior insula and secondary somatosensory cortex. Which of the following neurotransmitters is most likely elevated in her cerebrospinal fluid and contributes to her pain hypersensitivity?

B. Substance P

Question 2: Diagnosis

According to the 2016 American College of Rheumatology (ACR) criteria, which of the following combinations is sufficient to establish a diagnosis of fibromyalgia?

C. WPI = 5, SSS = 9, symptoms for 3 months

Question 3: Treatment

A 50-year-old female with fibromyalgia is started on pharmacologic therapy. Which of the following medications is FDA-approved for fibromyalgia and has shown efficacy at doses of 300–600 mg/day?

B. Pregabalin

Paper for Next Week:

Mikahla E. Gay, Jose G. Lima, Vanessa Vieites, Starlie C. Belnap, Richard Morgan
Comparison of Diagnostic Modalities for Carpal Tunnel Syndrome: A Systematic Review, Cureus, September 17, 2025 

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 42 Osteoarthritis

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Answers for Episode 41 Hemorrhoids

Question 1:

A 45-year-old patient with grade III internal hemorrhoids is concerned about postoperative pain and urinary retention. The surgeon recommends a modified office-based procedure that uses negative pressure and an elastic coil instead of a traditional band. Which treatment is being described?

B. Modified rubber band ligation (RBL)

Question 2:

A patient with grade II hemorrhoids and a bleeding tendency is seeking a minimally invasive treatment with low risk of complications. The physician recommends a sclerosant that has shown high patient satisfaction but carries a rare risk of anaphylactic shock. Which agent is being described?

B. Polidocanol foam

Question 3:

A colorectal surgeon is evaluating treatment options for a patient with grade III hemorrhoids. The goal is to reduce postoperative pain, bleeding, and hospital stay. Which combination of procedures has been shown to achieve these outcomes more effectively than stapled hemorrhoidopexy (SH) alone?

C. SH with Doppler-guided hemorrhoidal artery ligation (DG-HAL)

Paper for Next Week: 

Andrea Di Matteo and Paul Emery, “Rheumatoid arthritis: a review of the key clinical features and ongoing challenges of the disease,” Panminerva Medica, December 2024, Vol. 66, No. 4, pp. 427–442.

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. 

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 41 Hemorrhoids

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Answers for Episode 40 Diarrhea 

Paper for Next Week: 

Alice Courties, Inès Kouki, Nadine Soliman, Sylvain Mathieu, Jérémie Sellam, Osteoarthritis year in review 2024: Epidemiology and therapy, Osteoarthritis and Cartilage,  32 (2024) 1397–1404

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 Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

 Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. 

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 40 Diarrhea

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“The Ghost Map” by Steven Berlin Johnson, Riverhead 2006

Some good You Tube presentations on this.

“Superiority” by Arthur C. Clarke  https://nob.cs.ucdavis.edu/classes/ecs153-2019-04/readings/superiority.pdf

WHO rehydration formula: https://www.who.int/publications/i/item/WHO-FCH-CAH-06.1

I didn’t discuss POCUS for Hydration Assessment: https://www.pocus.org/inferior-vena-cava-ivc-assessment-for-volume-status-in-point-of-care-ultrasound-pocus-setting/

Answers for Episode 39 Constipation 

Question 1:

A 68-year-old woman with chronic constipation is prescribed magnesium oxide. After several weeks, she presents with lethargy and muscle weakness. Her serum magnesium level is elevated. Which of the following factors most likely contributed to her condition?

C. Delayed colonic transit time

Question 2:

Which of the following medications acts by inhibiting the ileal bile acid transporter (IBAT) and promotes colonic motility through serotonin release?

C. Elobixibat

Question 3:

A randomized controlled trial compared the efficacy of polyethylene glycol (PEG) 3350 to placebo in patients with chronic constipation. What was the reported treatment success rate in the PEG group?

C. 52%

Paper for Next Week:

Sung Il Kang, Latest Research Trends on the Management of Hemorrhoids, Journal of the Anus, Rectum and Colon (2025; 9(2): 179–191):

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 39 Constipation

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Answers for Episode 38 Diverticulitis 

Question 1: Pathophysiology and Risk Factors

A 65-year-old male presents with left lower quadrant abdominal pain and fever. CT confirms acute uncomplicated diverticulitis. Which of the following lifestyle factors is most strongly associated with a decreased risk of developing diverticulitis?

C. Vigorous cardiovascular activity

Question 2: Diagnostic Imaging

Which of the following imaging modalities is considered the gold standard for diagnosing acute diverticulitis?

C. Computed Tomography (CT) scan with or without IV contrast

Question 3: Treatment Guidelines

According to recent evidence and guidelines, which of the following patients with acute uncomplicated diverticulitis should still be treated with antibiotics?

C. A 70-year-old immunocompromised patient

Paper for Next Week:

Christopher J. Black & Alexander C. Ford (2025) An evidence-based update on the diagnosis and management of irritable bowel syndrome, Expert Review of Gastroenterology & Hepatology, 19:3, 227-242,

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 38 Diverticulitis

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Answers for Episode 37 Cholelithiasis

Question 1: Pathophysiology and Risk Factors

A 45-year-old woman presents with intermittent right upper quadrant pain after meals. She has a BMI of 32 and is on estrogen-containing oral contraceptives. Ultrasound confirms the presence of gallstones. Which of the following best explains the pathophysiology of her condition?

B. Supersaturation of bile with cholesterol leading to crystal formation

Question 2: Diagnostic Imaging

A 60-year-old man presents with fever, jaundice, and right upper quadrant pain. Labs show elevated bilirubin and alkaline phosphatase. Ultrasound reveals gallstones but no ductal dilation. Which imaging modality is most appropriate to both diagnose and treat a suspected common bile duct obstruction?

C. Endoscopic retrograde cholangiopancreatography (ERCP)

Question 3: Pharmacologic Therapy

A patient with asymptomatic cholesterol gallstones is not a surgical candidate. Which of the following pharmacologic agents is most appropriate for attempting gallstone dissolution?

C. Ursodeoxycholic acid (ursodiol)

Paper for Next Week:

Mariko Hojo, Tomoyoshi Shibuya and Akihito Nagahara, Management of Chronic Constipation: A Comprehensive Review, Intern Med 64: 7-15, 2025

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 37 Gallstones

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 Answers for Episode 36 Hepatitis

 Question 1: Hepatitis A Prognosis and Management

A 68-year-old man presents with fatigue, jaundice, and elevated liver enzymes. He is diagnosed with acute hepatitis A. Which of the following factors is most associated with increased risk of fulminant hepatitis A and poor prognosis?

C. Advanced age (>75 years)

Question 2: Hepatitis B Treatment Strategy

A 35-year-old man with chronic hepatitis B is started on antiviral therapy. After one year, his HBV DNA is undetectable and he has achieved e-antigen seroconversion. What is the most appropriate next step in management?

C. Continue nucleos(t)ide therapy to reduce relapse risk

Question 3: Hepatitis C Screening and Treatment

A public health initiative aims to reduce hepatitis C prevalence in a U.S. population. Which of the following strategies is supported by recent clinical trial data and national guidelines?

C. Implement universal screening for adults aged 18–79 and treat with pan-genotypic DAAs

Paper for Next Week:

Sonia Wu,  Maher Al Khaldi, Carole S. Richard, François Dagbert, “Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence”  Clinics in Colon and Rectal Surgery(2024;37:359–367):

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 36 Hepatitis

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Answers for Episode 35 Inflammatory Bowel Disease

Question 1: Diagnosis and Biomarkers

A 35-year-old patient presents with chronic gastrointestinal symptoms. Endoscopic and histologic findings are inconclusive for either ulcerative colitis or Crohn’s colitis. Which of the following biomarkers is most useful in differentiating Crohn’s colitis from ulcerative colitis in cases of indeterminate colitis?

C. Human alpha defensin 5 (DEFA5)

Question 2: Surgical Management

Which of the following surgical procedures is considered the gold standard for treating refractory ulcerative colitis while preserving fecal continence?

B. Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA)

Question 3: COVID-19 and IBD Care

During the COVID-19 pandemic, which of the following strategies was most commonly implemented to maintain continuity of care for patients with inflammatory bowel disease?

C. Virtual consultations and contact center services (CCS)

Paper for Next Week:

Mark W. Jones ; Connor B. Weir ; Mia Marietta, Gallstones (Cholelithiasis) StatPearls [Internet], Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Last Update: June 2, 2025.

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 35 Inflammatory Bowel Disease

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Answers for Episode 34 Irritable Bowel Syndrome

Question 1: Pathophysiology

A 34-year-old woman presents with chronic abdominal pain and alternating bowel habits. She is diagnosed with IBS. Which of the following findings is most consistent with the current understanding of IBS pathophysiology?

C. Altered gut microbiota and increased visceral hypersensitivity

Question 2: Treatment – IBS-D

A 45-year-old male with IBS-D has failed dietary and lifestyle interventions. He is now being considered for pharmacologic therapy. Which of the following medications is most appropriate as a first-line treatment for diarrhea and abdominal pain?

B. Eluxadoline 100 mg BID

Question 3: Dietary Management

A 29-year-old female with IBS-D reports worsening symptoms after meals. She is interested in dietary interventions. Which of the following is the most evidence-based dietary strategy for symptom relief?

C. Low-FODMAP diet with phased reintroduction

Paper for Next Week:

Matthew August Odenwald and Sonali Paul, Viral Hepatitis: Past, present, and future, World Journal of Gastroenterology, April 14, 2022, 28, 14

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 34 Irritable Bowel Syndrome

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Answers for Episode 33 Peptic Ulcer Disease

Question 1: H. pylori Eradication Therapy

A 45-year-old male patient is diagnosed with a peptic ulcer and tests positive for Helicobacter pylori. He has no history of NSAID use. According to the JSGE guidelines, which of the following is the most appropriate first-line eradication regimen?

C. Vonoprazan + amoxicillin + clarithromycin

Question 2: NSAID-Induced Ulcer Management

A 68-year-old female with osteoarthritis is on chronic NSAID therapy and has a history of peptic ulcer bleeding. According to the guidelines, which of the following is the most appropriate strategy to prevent ulcer recurrence?

C. Continue NSAIDs and add celecoxib with a proton pump inhibitor

Question 3: LDA-Related Ulcer Prevention

A 72-year-old male with coronary artery disease is prescribed low-dose aspirin (LDA). He has a history of peptic ulcer disease. According to the guidelines, which of the following is the best strategy to prevent recurrence of LDA-related peptic ulcers?

B. Vonoprazan 10 mg daily

Paper for next week: 

Amosy Ephreim M’Koma, Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview, Medicina 2022, 58, 567.

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 33 Peptic Ulcer Disease

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Answers for Episode 32 GERD

Question 1: Diagnostic Strategy

A 45-year-old male presents with persistent heartburn and regurgitation despite an 8-week trial of single-dose PPI therapy. He denies dysphagia, weight loss, or gastrointestinal bleeding. Endoscopy reveals no erosive esophagitis or Barrett’s esophagus. What is the most appropriate next step in management?
C. Perform prolonged wireless pH monitoring off PPI therapy

Question 2: Pharmacologic Management

Which of the following adjunctive therapies is most appropriate for a patient with GERD who experiences breakthrough symptoms despite optimized PPI therapy?

A. Alginate antacids

Question 3: Surgical Considerations

A 52-year-old obese female with confirmed GERD and a large hiatal hernia is considering surgical intervention. Which of the following procedures is most appropriate as a primary anti-reflux intervention?

C. Roux-en-Y gastric bypass

Paper for next week:

Kai-Yue Huang, Feng-Yun Wang, Mi Lv, Xiang-Xue Ma, Xu-Dong Tang, Lin Lv, Irritable bowel syndrome: Epidemiology, overlap disorders pathophysiology and treatment, World J Gastroenterol 2023 July 14; 29(26): 4120-4135

 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 47 Fibromyalgia 

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 Answers for Episode 46 Gout

Question 1: Pathophysiology and Molecular Mechanisms

A 58-year-old male presents with recurrent gout flares. Genetic testing reveals a mutation in the NFAT5 gene. Based on recent findings, which of the following best describes the role of NFAT5 in gout pathogenesis?

C. NFAT5 enhances uric acid production through a feedback loop involving aldose reductase

Question 2: Diagnostic Imaging in Gout

According to the 2023 EULAR recommendations, which imaging modality is most effective for both diagnosing gout and monitoring crystal deposition and inflammation?

C. Dual-Energy Computed Tomography (DECT)

Question 3: Therapeutic Innovations

A new oral drug, dapansutrile (OLT1177), is being evaluated in Phase II/III trials for gout. What is its primary mechanism of action?

C. Selective inhibition of the NLRP3 inflammasome

Paper for Next Week: 

Fiona Kirkham-Wilson, Elaine Dennison1, Osteoporosis and Rheumatoid Arthritis: A Review of Current Understanding and Practice, British Journal of Hospital Medicine, 2024 Nov 30;85(11):1-11.

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Episode 32 GERD

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Answers for Episode 31 Vitamin D

Question 1: Vitamin D Metabolism

A 45-year-old woman with chronic liver disease is found to have low serum 25-hydroxyvitamin D [25(OH)D] levels despite adequate sun exposure and oral vitamin D₃ supplementation. Which of the following best explains her low 25(OH)D levels?

 
B. Impaired hepatic 25-hydroxylation

Question 2: Clinical Application of Supplementation

A 68-year-old man with a history of bariatric surgery presents for evaluation of vitamin D status. His serum 25(OH)D is 12 ng/mL. Which of the following is the most appropriate form of vitamin D supplementation for this patient?

C. Calcifediol (25-hydroxyvitamin D)

Question 3: Vitamin D Toxicity

A 55-year-old woman presents with fatigue, nausea, and confusion. Labs reveal hypercalcemia, suppressed PTH, and a serum 25(OH)D level of 180 ng/mL. She reports taking high-dose vitamin D supplements for several months. Which of the following best explains her condition?

C. Exogenous vitamin D toxicity

Paper for next week:

Tomoari Kamada, Kiichi Satoh, Toshiyuki Itoh, Masanori Ito, Junichi Iwamoto, Tadayoshi Okimoto, Takeshi Kanno, Mitsushige Sugimoto, Toshimi Chiba, Sachiyo Nomura, Mitsuyo Mieda, Hideyuki Hiraishi, Junji Yoshino, Atsushi Takagi, Sumio Watanabe,Kazuhiko Koike,

Evidence-based clinical practice guidelines for peptic ulcer disease 2020, J Gastroenterol (2021) 56:303–322

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 Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

 Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

 Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 31 Vitamin D

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 Answers for Episode 30 Testosterone Deficiency

Question 1: Diagnosis and Management

A 58-year-old male presents with fatigue, decreased libido, and erectile dysfunction. His total testosterone (TT) level is 11.5 nmol/L on two separate morning measurements. His free testosterone (FT) is 210 pmol/L. Luteinizing hormone (LH) is elevated. Which of the following is the most appropriate next step?

C. Initiate lifestyle modification and consider testosterone therapy

Question 2: Adverse Effects

A 65-year-old man on long-acting testosterone undecanoate injections presents for routine follow-up. His hematocrit has increased from 46% to 55% over the past 6 months. He is otherwise asymptomatic. What is the most appropriate management?

B. Switch to a transdermal testosterone formulation

Question 3: Contraindications

A 52-year-old male with a history of prostate cancer (Gleason 7, treated with radical prostatectomy 2 years ago) presents with symptoms of testosterone deficiency. His PSA is undetectable, and digital rectal exam is normal. His TT is 7.8 nmol/L. What is the most appropriate next step?

B. Begin testosterone therapy with close monitoring

Paper for next week:

FNU Tanvir , Gurkamal Singh Nijjar , Smriti Kaur Aulakh , Yasmeen Kaur , Sumerjit Singh ,

Kanwarmandeep Singh , Abhinandan Singla , Ajay Pal Singh Sandhu , Shivansh Luthra , Harman Antaal (August 24, 2024) Gastroesophageal Reflux Disease: New Insights and Treatment Approaches. Cureus 16(8): e67654.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 30 Testosterone Deficiency

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Answers for Episode 29 Gestational Diabetes

Question 1: 

 A 32-year-old Hispanic woman, G3P2, presents for her 28-week prenatal visit. Her 1-hour 50-g glucose challenge test is elevated, and a follow-up 3-hour 100-g oral glucose tolerance test confirms gestational diabetes mellitus (GDM). She is otherwise healthy, with a BMI of 33 kg/m². She asks whether her condition will resolve after delivery.

Which of the following best explains the underlying pathophysiology of her condition?

B. Chronic β-cell dysfunction unmasked by pregnancy

Question 2: 

A 29-year-old woman with a history of GDM is enrolled in a longitudinal study. Her disposition index (DI) is measured annually. Over 5 years, her DI steadily declines, although her fasting glucose remains within the normal range. Which of the following best describes the clinical significance of a declining disposition index in this patient

 C. It reflects progressive β-cell failure and precedes hyperglycemia

Question 3: 

A randomized controlled trial evaluates the effect of troglitazone in Hispanic women with prior GDM. Participants are stratified by changes in insulin sensitivity and insulin secretion after 3 months of treatment. One group shows a 50% reduction in insulin output and a 0% annual incidence of diabetes. Which of the following best explains the protective effect observed in this group?

B. Reduced β-cell secretory load due to improved insulin sensitivity

Paper for next week:

Andrea Giustina, et. al., Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows Endocr Rev, 2024 Apr 27;45(5):625–654. 

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 29 Gestational Diabetes

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Answers for Episode 28 Polycystic Ovarian syndrome

Question 1: Diagnosis and Pathophysiology

A 24-year-old woman presents with irregular menstrual cycles and concerns about excessive facial hair. Physical examination reveals mild hirsutism and acne. Laboratory testing shows mildly elevated total testosterone and normal thyroid function. Transvaginal ultrasound reveals 24 follicles in the right ovary and an ovarian volume of 12 mL. Which of the following best explains the underlying pathophysiology of this patient’s condition?

C. Increased luteinizing hormone (LH) secretion and insulin resistance

Question 2: Management

A 29-year-old woman with PCOS and a BMI of 32 kg/m² presents with concerns about infertility. She has been attempting to conceive for 8 months. Her cycles are irregular, occurring every 40–60 days. She is not on any medications. Which of the following is the most appropriate first-line pharmacologic treatment to induce ovulation?

B. Letrozole

Question 3: Long-Term Complications

A 35-year-old woman with a history of PCOS presents for a routine follow-up. She has a BMI of 28 kg/m² and reports daytime fatigue and snoring. Which of the following long-term complications is she at significantly increased risk for, independent of her BMI?

B. Obstructive sleep apnea

Paper for next week:

Geoffrey Hackett, Michael Kirby, Rowland W. Rees, T. Hugh Jones, Asif Muneer,  Mark Livingston, Nick Ossei-Gerning, Janine David, Jeff Foster, Philip A. Kalra, Sudarshan Ramachandran, The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice, World J Mens Health 2023 Jul 41(3): 508-537

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 28 Polycystic Ovarian Syndrome

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Answers for Episode 27 Metabolic Syndrome

Question 1: Pathophysiology

A 52-year-old male with central obesity, elevated triglycerides, and hypertension is diagnosed with metabolic syndrome. Which of the following best describes the role of free fatty acids (FFAs) in the development of insulin resistance in this condition?

C. FFAs impair insulin signaling by altering the insulin receptor substrate pathway

Question 2: Clinical Biomarkers

Which of the following biomarkers is most consistently decreased in patients with metabolic syndrome and is known for its anti-inflammatory and insulin-sensitizing properties?

C. Adiponectin

Question 3: Diagnostic Criteria

According to the harmonized definition by the International Diabetes Federation and the American Heart Association/NHLBI, which of the following combinations qualifies a patient for a diagnosis of metabolic syndrome?

C. Central obesity, low HDL cholesterol, and elevated blood pressure

Paper for next week:

Thomas A. Buchanan, Anny H. Xiang, Kathleen A. Page, and Richard M. Watanabe, What Is Gestational Diabetes—Really?, Diabetes 2025;74:1037–1046

Important legal things:

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 23.1  Amber Healy DO Diabetologist

A fantastic conversation with one of my favorite colleagues. A lot to learn from Dr. Healy’s wisdom about a massive problem for American Medicine. I hope you enjoy the discussion as much as I did.

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Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 27 Metabolic Syndrome

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Answers for Episode 26 Obesity

Question 1: Clinical Decision-Making in Obesity Pharmacotherapy

A 45-year-old woman with a BMI of 34 kg/m² and type 2 diabetes has attempted multiple lifestyle interventions with limited success. She is interested in pharmacologic therapy for weight loss. Which of the following medications is most likely to result in the greatest average weight loss?

C. Tirzepatide 15 mg subcutaneous weekly

Question 2: Understanding Lifestyle Intervention Outcomes

Which of the following statements best describes the expected outcome of intensive lifestyle intervention (ILI) for obesity management?

B. ILI leads to an average weight loss of 2–9% at 1 year, with some regain over time.

Question 3: Post-Medication Management Strategy

A 52-year-old man with obesity (BMI 38 kg/m²) has been taking semaglutide 2.4 mg weekly for 12 months and has lost 17% of his initial body weight. He asks if he can stop the medication now that he has reached a “normal” BMI. What is the most appropriate response?

C. Continue the medication, as discontinuation is associated with significant weight regain.
Paper for next week:

 Ebernella Shirin Dason M, Olexandra Koshkina, Crystal Chan, Mara Sobel, Diagnosis and management of polycystic ovarian syndrome, CMAJ 2024 January 29;196:

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 26 Obesity

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Answers for Episode 25 Hyperthyroidism

Question 1: Diagnosis and Pathophysiology

A 35-year-old woman presents with weight loss, palpitations, and heat intolerance. On examination, she has a diffusely enlarged thyroid with a bruit and mild exophthalmos. Laboratory tests reveal suppressed TSH and elevated free T4. Which of the following is the most appropriate next step to confirm the diagnosis?

C. TRAb (TSH receptor antibody) assay

Question 2: Pharmacologic Management

A 42-year-old woman with newly diagnosed Graves’ disease has a free T4 level that is 2.5 times the upper limit of normal. She is not pregnant. Which of the following is the most appropriate initial dose of methimazole?

C. 30–40 mg daily

Question 3: Treatment Complications

A 29-year-old woman with Graves’ disease is started on methimazole. Three weeks later, she presents with fever and sore throat. Which of the following is the most appropriate next step?

B. Order a complete blood count immediately

Paper for next week:

Gracia Fahed, Laurence Aoun, Morgan Bou Zerdan, Sabine Allam, Maroun Bou Zerdan, Youssef Bouferraa and Hazem I. Assi, Metabolic Syndrome: Updates on Pathophysiology and Management in 2021, Int. J. Mol. Sci. 2022, 23, 786

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 25 Hyperthyroidism

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Answers for Episode 24 Hypothyroidism

Question 1: Cardiovascular Comorbidities

A 58-year-old woman with a 10-year history of subclinical hypothyroidism presents for routine follow-up. Her TSH is persistently 6.8 mIU/L. She reports no symptoms. Which of the following best describes her current cardiovascular risk profile according to population-based evidence?

C. She has an increased risk of cardiovascular disease, even in the absence of symptoms

Question 2: Persistent Symptoms Despite LT4

 A 42-year-old man on levothyroxine (LT4) for overt hypothyroidism has normalized TSH but reports persistent fatigue and difficulty losing weight. Labs reveal normal free T4 and T3 levels. What is the most appropriate next step in management?

D. Assess for non-thyroidal causes of symptoms and comorbidities

Question 3: Comorbidity Patterns

Which of the following is most accurately described as a comorbidity that shares a possible genetic or autoimmune pathogenesis with hypothyroidism?

B. Rheumatoid arthritis

Paper for next week:

Susan Z. Yanovski,Jack A. Yanovski, Approach to Obesity Treatment in Primary Care: A Review, JAMA Intern Med. 2024 July 01; 184(7): 818–829.

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 24 Hypothyroidism

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Answers for Episode 23 Type 1 DM

Question 1: Clinical Application of Technology in Older Adults

A 75-year-old man with long-standing Type 1 diabetes is experiencing frequent episodes of severe hypoglycaemia, including nocturnal events. He lives independently with minimal caregiver support. Which of the following interventions is most likely to reduce his risk of hypoglycaemia and improve his quality of life?

C. Initiation of continuous glucose monitoring (CGM) with predictive alerts

Question 2: Understanding Glycaemic Variability

Which of the following best describes the clinical significance of glycaemic variability (GV) in older adults with diabetes?

B. GV is associated with increased risk of cognitive decline, frailty, and mortality

Question 3: Barriers to Technology Use

An 82-year-old woman with Type 1 diabetes, moderate cognitive impairment, and visual deficits is being considered for diabetes technology. Which of the following is the most appropriate next step?

C. Assess cognitive function, dexterity, and social support before initiating technology

Paper for next week:

Sun Y. Lee, Elizabeth N. Pearce, MD, Hyperthyroidism: A Review, JAMA. 2023 October 17; 330(15): 1472–1483.

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 46 Gout

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Answers for Episode 45 Neck Pain 

Question 1

A 35-year-old patient presents with chronic mechanical neck pain lasting 8 months. The physician considers dry needling (DN) as a treatment option. Based on the systematic review and meta-analysis by Aleid et al., which of the following outcomes is MOST likely to show significant improvement after DN compared to control therapy?

B. Pain Pressure Threshold (PPT)

Question 2

In the same meta-analysis, which statement BEST describes the effect of dry needling on cervical range of motion?

B. DN improves flexion and right rotation but not extension or lateral flexions

Question 3

Which of the following is TRUE regarding the overall evidence quality and limitations of the studies included in the meta-analysis?

C. Most studies had high risk of bias and lacked adequate blinding

Paper for Next Week: 

Filipovic T, Filipović A, Nikolic D, Gimigliano F. Stevanov J, Hrkovic M, & Bosanac I, Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment. Journal of Clinical Medicine, 2025, 14(3), 955. 

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 12.1  Thoughts on Vaping

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Papers referenced:

 Avian V.White, David W. Wambui, Lok R. Pokhrel, Risk assessment of inhaled diacetyl from electronic cigarette use among teens and adults, Science of the Total Environment 772 (2021)

 E Andrew L. Pipe and Hassan Mir, E- Cigarettes Reexamined: Product Toxicity, Canadian Journal of Cardiology, Volume 38 2022 

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Episode 23 Type 1 Diabetes Mellitus 

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Intro: Rock Christmas/ Christmas Music by tramp963

Outro: KI Instrumental (Rock Celtic) by Lyrium-2025

Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 22

Question 1: 

A 45-year-old patient presents with polyuria, polydipsia, and unexplained weight loss. Laboratory tests reveal a fasting plasma glucose of 130 mg/dL and an HbA1c of 6.8%. What is the most appropriate diagnosis?

C. Type 2 Diabetes Mellitus

Question 2: 

A 60-year-old patient with Type 2 Diabetes Mellitus has an HbA1c of 8.2% despite being on metformin. The patient has a history of heart failure and chronic kidney disease (CKD). Which of the following medications would be most beneficial for this patient?

C. SGLT2 inhibitor

Question 3: 

A patient with long-standing Type 2 Diabetes Mellitus presents with progressive vision loss, floaters, and flashes of light. Fundoscopic examination reveals microaneurysms, hemorrhages, and neovascularization. What is the most likely diagnosis?

C. Diabetic retinopathy

Paper for next week

Gabriela Brenta & Ulrike Gottwald-Hostalek (2025) Comorbidities of hypothyroidism, Current Medical Research and Opinion, 41:3, 421-429

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 22.1  Elizabeth Beverly PhD, Diabetes Researcher

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Intro/Outro: Night Detective by Amaksi

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Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

Rotations is produced using (and we always accept donations from any gear folks):

Rode Podcaster Pro

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iPhone 6

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iMac

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Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 22 Type 2 Diabetes Mellitus 

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Intro: Rock Christmas/ Christmas Music by tramp963

Outro: KI Instrumental (Rock Malmsteen-Style) by Lyrium-2025

Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 21

1.     A 62-year-old man presents with fever, productive cough, and pleuritic chest pain. Chest X-ray reveals a moderate right-sided pleural effusion. Thoracentesis is performed, and pleural fluid analysis shows:

• pH: 6.95
• Glucose: 32 mg/dL
• LDH: 1,200 IU/L
• Gram stain: negative

Which of the following is the most appropriate next step in management?

 C. Insert a chest tube for drainage

2. A 55-year-old woman is admitted with pneumonia and a suspected pleural effusion. A contrast-enhanced chest CT reveals thickened, enhancing visceral and parietal pleura with a fluid collection measuring 35 mm. Which of the following radiologic signs is most consistent with this finding?

 B. Split pleura sign
 
 3.     A 70-year-old man is diagnosed with hospital-acquired empyema. Pleural fluid culture grows methicillin-resistant Staphylococcus aureus (MRSA). According to recent studies, which of the following statements best describes the prognosis associated with this organism?

 C. It is associated with significantly increased 1-year mortality

 Paper for next week

 Giuseppe Maltese, Sybil A McAuley, Steven Trawley, Alan J Sinclair, Ageing well with diabetes: the role of technology, Diabetologia (2024) 67:2085–2102

 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

 Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

 Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

 Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 21 Pleural Space Infections 

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Intro: Rock Christmas/ Christmas Music by tramp963

Outro: Survival by ikoliks

Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 20

Question 1: Cardiovascular Risk and OSA

 A 58-year-old man with a BMI of 36 kg/m² presents with excessive daytime sleepiness, loud snoring, and witnessed apneas during sleep. His blood pressure remains elevated despite being on three antihypertensive medications. A sleep study reveals an apnea-hypopnea index (AHI) of 38 events/hour and a mean nocturnal oxygen saturation of 76%.Which of the following findings in this patient is most predictive of increased cardiovascular mortality?

 C. Hypoxic burden

Question 2: OSA and Atrial Fibrillation

 A 65-year-old man with a history of paroxysmal atrial fibrillation (AF) undergoes successful catheter ablation. He returns 3 months later with recurrent palpitations. He reports loud snoring and frequent nighttime awakenings. A sleep study confirms moderate OSA.Which of the following interventions is most likely to reduce the recurrence of atrial fibrillation in this patient?

 C. Continuous positive airway pressure (CPAP) therapy
 

Question 3: Stroke and Sleep Apnea

 A 72-year-old woman is admitted for an acute ischemic stroke. She has no prior history of sleep apnea but reports chronic fatigue and poor sleep quality. Her BMI is 29 kg/m². A sleep study performed during rehabilitation reveals an AHI of 22 events/hour. What is the most appropriate next step in managing this patient’s sleep-disordered breathing?

 C. Initiate CPAP therapy
 

Paper for next week

Ewelina Młynarska , Witold Czarnik , Natasza Dzie˙za , Weronika J˛edraszak , Gabriela Majchrowicz  ,Filip Prusinowski , Magdalena Stabrawa  , Jacek Rysz  and Beata Franczyk,  Type 2 DiabetesMellitus: New Pathogenetic Mechanisms,Treatment and the Most Important Complications, Int. J. Mol. Sci. 2025, 26, 1094

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 20 OSA

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Intro: Rock Christmas/ Christmas Music by tramp963

Outro: Whip Afro Dance Hall Music by Prazkhanal

Courtesy of Pixabay for non-commercial educational use 

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 19 

Question 1: Diagnosis and Testing

A 28-year-old woman presents with a 2-year history of nasal congestion, sneezing, and watery eyes that worsen in the spring and fall. She has no known food allergies and denies asthma. Physical exam reveals pale, boggy nasal mucosa and allergic shiners. Which of the following is the most appropriate next step to confirm the diagnosis?

 B. Perform skin prick testing
 
 Question 2: Pharmacologic Management

A 35-year-old man with moderate persistent allergic rhinitis has been using cetirizine daily with minimal relief. He reports nasal congestion and postnasal drip that interfere with sleep. What is the most appropriate next step in management?

 C. Start an intranasal corticosteroid
 
 Question 3: Immunotherapy Indications

A 22-year-old college student with seasonal allergic rhinitis has tried intranasal corticosteroids and oral antihistamines with limited benefit. She is interested in a long-term solution. Which of the following is the most appropriate indication for initiating allergen immunotherapy?

 C. Persistent symptoms despite optimal pharmacologic treatment

Paper for next week

Sean P. F. Foley * and John Scott Parrish, Pleural Space Infections, Life 2023, 13, 376.

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 19 Allergic Rhinitis

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Intro: Rock Christmas/ Christmas Music by tramp963

Outro: Tokyo Café by TVARI

Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 18  

Question 1

A 35-year-old male patient presents with newly diagnosed pulmonary tuberculosis (TB) confirmed to be drug-susceptible (DS-TB). The patient has non-cavitary disease and a low bacillary burden. Based on recent clinical trial evidence and World Health Organization (WHO) guidelines, which of the following treatment regimens is most appropriate for this patient?

 B. 4 months of rifapentine, moxifloxacin, isoniazid, and pyrazinamide
 
 Question 2

A 42-year-old female patient is diagnosed with multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) without fluoroquinolone resistance. The patient has no contraindications to new TB drugs. Based on the most recent WHO recommendations and clinical trial data, which regimen is the preferred treatment option for this patient?

 B. 6 months of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM)

Question 3

A 50-year-old male patient with pre-extensively drug-resistant tuberculosis (pre-XDR TB, defined as MDR/RR-TB with fluoroquinolone resistance) is being considered for a new treatment regimen. The patient has no baseline resistance to bedaquiline or linezolid. Which of the following regimens, supported by recent clinical trial evidence, is most appropriate, and what is a key consideration for its use?

A. 6–9 months of bedaquiline, linezolid, clofazimine, and delamanid; monitor for linezolid-associated toxicity

Paper for next week

Yerem Yeghiazarians, Hani Jneid, Jeremy R. Tietjens, Susan Redline, Devin L. Brown, Nabil El-Sherif, Reena Mehra, Biykem Bozkurt, Chiadi Ericson Ndumele, Virend K. Somers, Obstructive Sleep Apnea and Cardiovascular Disease A Scientific Statement From the American Heart Association, July 20, 2021 Circulation. 2021;144:

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 18.1  Thoughts on TB

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Intro/Outro: Night Detective by Amaksi

 Courtesy of Pixabay under Creative Commons for non-Commercial Educational use only.

Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

Rotations is produced (bot not sponsored) using (and we always accept donations from any gear folks):

Rode Podcasters (Pro and Duo)

MacBook Pro

Rode NT1-A mics

Polsen Studio Headphones

Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

Tama mic stands

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

 Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 18 Tuberculosis

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Intro: Rock Christmas/ Christmas Music by tramp963

Outro: Piano Inspiring by Paul Yudin

Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 17 

Question 1: Antiviral Treatment for Elderly Patient

A 65-year-old man with chronic obstructive pulmonary disease (COPD) presents with a 2-day history of fever, cough, and myalgia. He has been diagnosed with influenza A. Which of the following antivirals is most appropriate for this patient?

 Correct Answer: B. Oseltamivir 

 Question 2: Diagnostic Test for High-Risk Child

A 3-year-old child with asthma has been exposed to influenza and presents with fever, runny nose, and cough. Which diagnostic test is most appropriate for this patient?

Correct Answer: C. RT-PCR 

Question 3: Vaccination Recommendation for Pregnant Patient

A 30-year-old woman at 28 weeks gestation has not received the influenza vaccine. What is the most appropriate recommendation regarding influenza vaccination for this patient?

Correct Answer: C. Administer the inactivated influenza vaccine (IIV) 

Paper for next week

Lana Rosenfield, Paul K. Keith, Jaclyn Quirt, Peter Small, and Anne K. Ellis,

Allergic rhinitis, Allergy, Asthma & Clinical Immunology (2024) 20:74

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 17 Influenza

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 Intro: Rock Christmas/ Christmas Music by tramp963

Outro: Main Title Blockbuster by Mint Music

 Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 16 

Question 1: Diagnosis of Bacterial Acute Rhinosinusitis

A 25-year-old male presents with a 7-day history of nasal congestion, rhinorrhea, and facial pressure. Initially, his symptoms improved after 3 days but then worsened, and he now has a fever of 38.2°C, maxillary sinus tenderness, and purulent nasal discharge. Based on the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 guidelines, what is the most likely diagnosis for this patient?

Answer Choices:
C. Bacterial ARS
 
Question 2: Treatment for Viral Acute Rhinosinusitis

A 30-year-old female with a history of allergic rhinitis presents with a 5-day history of nasal congestion and clear rhinorrhea. She has no fever, no facial pain, and her symptoms have not worsened. What is the most appropriate initial treatment for this patient?

C. Saline nasal irrigation

Question 3: Indication for Antibiotics in Acute Rhinosinusitis

Which of the following scenarios indicates the most appropriate use of antibiotics in acute rhinosinusitis (ARS)?

 B. A 10-day history of facial pain, purulent nasal discharge, and fever of 38.5°C
 
 Paper for next week

 Ilaria Motta, Martin Boeree, Dumitru Chesov, Keertan Dheda, Gunar Günther, Charles Robert Horsburgh Jr., Yousra Kherabi, Christoph Lange, Christian Lienhardt, Helen M. McIlleron, Nicholas I. Paton, Helen R. Stagg, Guy Thwaites, Zarir Udwadia, Reinout Van Crevel, Gustavo E. Vel asquez, Robert J. Wilkinson, Lorenzo Guglielmetti, Clinical Microbiology and Infection, 30 (2024) 1107-1114

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 45 Neck Pain 

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: Through the Ashes by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

Answers for Episode 44 Low Back Pain 

Question 1

A 45-year-old patient presents with chronic midline low back pain that worsens with sitting and forward flexion. MRI shows Modic type 1 changes at L4-L5. Conservative therapy has failed. Which pharmacologic intervention is supported by some evidence for this patient’s condition?

B. Long-term oral antibiotics (amoxicillin ± clavulanic acid)

Question 2

Which of the following statements about provocative discography is TRUE?

C. It involves injecting contrast into the nucleus pulposus under controlled pressure to reproduce concordant pain.

Question 3

Which minimally invasive intervention has moderate evidence supporting its use for refractory discogenic low back pain?

C. Biacuplasty (cooled radiofrequency)

Paper for Next Week: 

L. Punzi, L. Scagnellato, P. Galozzi, C. Baggio, A. Damasco, F. Oliviero, R. Ramonda, Gout: one year in review 2025, Clin Exp Rheumatol 2025; 43: 799-808.

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 16 Common Cold

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Intro: Rock Christmas/ Christmas Music by tramp963

Outro: Rainbow by Mood Mode

Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

“Who Moved my Cheese,” Spencer Johnson, 1998

https://en.wikipedia.org/wiki/Who_Moved_My_Cheese%3F

Questions and Answers from Episode 15 

Question 1: 

 A 32-year-old healthy female presents to your clinic with a 5-day history of cough that started as dry but has become productive of yellow sputum over the past 2 days. She denies fever or shortness of breath. Her vital signs are normal  and her chest examination reveals no crackles or wheezing. There are no current outbreaks of influenza or COVID-19 in the area. What is the most appropriate management for this patient? 

 D. Reassure the patient that antibiotics are not necessary and provide symptomatic relief 

Question 2: 

 A 68-year-old male with a history of COPD and heart failure presents with cough productive of purulent sputum, fever (38.5°C), shortness of breath on exertion, and pleuritic chest pain for 3 days. His vital signs include a heart rate of 102/min, respiratory rate of 24/min, blood pressure of 110/70 mmHg, and oxygen saturation of 92% on room air. Chest examination reveals crackles in the right lower lobe. After evaluation using clinical prediction tools (CURB-65 score of 1), it is determined that he can be managed as an outpatient. What is the most appropriate antibiotic regimen for this patient? 

 D. Amoxicillin-clavulanate plus azithromycin 

Question 3: 

 A 70-year-old male with hypertension and type 2 diabetes presents to your clinic with a 3-day history of fatigue, cough, headache, and loss of smell (anosmia). He has no shortness of breath or chest pain. His vital signs are stable (temperature 37.2°C, heart rate 88/min), and his oxygen saturation is 96% on room air. A rapid antigen test for SARS-CoV-2 is positive. What is the most appropriate treatment for this patient as an outpatient? 

 B. Ritonavir-boosted nirmatrelvir (Paxlovid)
 

Correct Answer: B 

Paper for next week

Timothy M Uyeki, David S Hui, Maria Zambon, David E Wentworth, Arnold S Monto, Influenza, the lancet, Vol 400 August 27, 2022

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

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Episode 15 Treating Respiratory Infections

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 Intro: Rock Christmas/ Christmas Music by tramp963

Outro: You and Me by HitsLab

Courtesy of Pixabay for non-commercial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 14 Bronchitis

Question 1: Diagnosis Scenario 

Question: A 35-year-old healthy patient presents with a two-week history of cough, mild fever (100.2°F), and normal lung auscultation. What is the most appropriate next step in management? 

C) Treat with supportive care and patient education 

Question 2: Treatment Scenario for Children

Question: A 2-year-old child with acute bronchitis has a persistent cough. The parent asks for treatment options. Which is most appropriate? 

B) Administer honey 

 Question 3: Complication and Differential Diagnosis 

Question: A patient with acute bronchitis reports persistent fever after one week of symptoms. What is the most appropriate next step? 

B) Order chest X-ray 

 Paper for next week

 Francesca Jaume, & Meritxell Valls-Mateus, & Joaquim Mullol, Common Cold and Acute Rhinosinusitis: Up-to-Date Management in 2020, Current Allergy and Asthma Reports (2020) 20:28

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 14 Acute Bronchitis

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 Intro: Rock Christmas/ Christmas Music by tramp963

Outro: You Can by Grand Project

Courtesy of Pixabay for non-commericial educational use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

Questions and Answers from Episode 13 Pneumonia

 Question 1:

 A 70-year-old man presents to your clinic with a 3-day history of cough productive of yellow sputum, fever, and shortness of breath. On examination, he appears confused, has a respiratory rate of 24 breaths per minute, blood pressure of 85/50 mm Hg, and diminished breath sounds in the right lower lobe. Chest radiography shows a right lower lobe consolidation. Which of the following is the most appropriate next step in management based on risk stratification? 

• B) Admit to the hospital for intravenous antibiotics 

Question 2:

 A 55-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presents with a 2-day history of fever, productive cough, and dyspnea. Chest radiography confirms right middle lobe consolidation consistent with community-acquired pneumonia. She is hemodynamically stable, and her oxygen saturation is 92% on room air. Which of the following is the most appropriate initial antibiotic regimen? 

• C) Amoxicillin-clavulanate plus azithromycin 

Question 3:

 A 68-year-old man with type 2 diabetes mellitus presents for an annual physical examination. He has no history of pneumonia and is up to date on other vaccinations. He inquires about vaccination to prevent community-acquired pneumonia. Which of the following is the most appropriate recommendation? 

• C) Administer the 20-valent pneumococcal conjugate vaccine (PCV20) alone 

 Paper for next week

Rodrigo Cavallazzi and Julio A. Ramirez, How and when to manage respiratory infections out of hospital, Eur Respir Rev 2022; 31

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. 

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 13 Pneumonia

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Questions and Answers from Episode 12 COPD

Question 1

A 62-year-old male with a 40-pack-year smoking history presents to the primary care clinic complaining of progressive shortness of breath during exercise and a chronic cough productive of sputum for the past 3 years. Spirometry reveals a post-bronchodilator FEV₁/FVC ratio of 0.65 and an FEV₁ of 55% predicted. He reports two episodes of acute worsening of symptoms in the past year requiring oral corticosteroids. According to the GOLD ABCD assessment tool, which group should this patient be classified into?

D. Group D 

Question 2

A 58-year-old female with a confirmed diagnosis of COPD presents for a follow-up visit. She reports persistent dyspnea despite adherence to a long-acting muscarinic antagonist (LAMA). Her blood eosinophil count is 350 cells/mm³, and she experienced one moderate exacerbation in the past 12 months treated with antibiotics. Based on current GOLD guidelines, which of the following is the most appropriate next step in her pharmacological management?

C. Add a long-acting β₂-agonist (LABA) to the LAMA
 
Question 3

A 70-year-old male with severe COPD (FEV₁ 35% predicted) and a history of recurrent respiratory infections is admitted to the hospital with acute respiratory failure. Physical examination reveals cyanosis, a respiratory rate of 28 breaths per minute, and oxygen saturation of 88% on room air. Arterial blood gas analysis shows a PaO₂ of 7.5 kPa and a PaCO₂ of 7.0 kPa. According to the classification of COPD exacerbations, which of the following best describes this patient’s current condition?

C. Severe exacerbation

Paper for Next Week

SCOTT KINKADE, and NATALIE A. LONG, Acute Bronchitis, American Family Physician, October 1, 2016, 94:7 560-565

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 12 COPD

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Questions and Answers from Episode 11 Asthma

Question 1: Diagnosis of Asthma in Patients on Controller Treatment 

Question: A 35-year-old woman presents to your clinic with a history of recurrent wheezing and shortness of breath. She has been using an inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) combination inhaler for the past year. To confirm the diagnosis of asthma, what is the most appropriate test to perform?

• a. Spirometry before and after bronchodilator

Question 2: Treatment for Mild Asthma

Question: A 25-year-old man with mild asthma presents to your clinic. He experiences occasional wheezing and shortness of breath, requiring his short-acting beta-agonist (SABA) inhaler a few times a month. According to the 2022 GINA guidelines, what is the recommended treatment for this patient?

• c. Start as-needed combination ICS-formoterol

Question 3: Assessing Symptom Control and Management

Question: A 40-year-old woman with asthma is on low-dose ICS-LABA as maintenance therapy and uses SABA as needed for symptom relief. She reports using her SABA inhaler on three different days each week. According to GINA guidelines, what should be the next step in her management?

• c. Review her adherence to maintenance medication and inhaler technique

Paper for Next Week

Jason Womack, MD, and Jill Kropa, MD, Community-Acquired Pneumonia in Adults: Rapid Evidence Review, American Family Physician, Vol 105,6 June 2022

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 11 Asthma

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Outro: Armageddon by Grabnd Project

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Questions and Answers from Episode 10 Isolated Distal Deep Vein Thrombosis

Question 1: Management for a Patient with IDDVT Post-Flight

A 45-year-old woman presents with left calf pain and swelling after a recent long-haul flight. Compression ultrasonography reveals a thrombus in the left peroneal vein, with no involvement of the popliteal or femoral veins. She has no other significant medical history and is not on any medications. Which of the following is the most appropriate management for this patient? 

• B. Start rivaroxaban for 3 months.

Question 2: Comparing Clinical Course of IDDVT and Proximal DVT

Which of the following statements is true regarding the clinical course of isolated distal deep vein thrombosis (IDDVT) compared to proximal deep vein thrombosis (DVT)

• C. Mortality rates are lower in IDDVT compared to proximal DVT.

Question 3: Management for Cancer Patient with IDDVT

A 62-year-old man with a history of stage IV lung cancer presents with right calf pain. Compression ultrasonography shows a thrombus in the right tibial vein, with no proximal extension. He is currently undergoing chemotherapy and has no other significant comorbidities. What is the most appropriate management for this patient?

• D. Prescribe extended anticoagulation with LMWH.

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Questions and Answers from Episode 9 Pulmonary Embolism

Question 1: Diagnosis in Non-Pregnant Patients with Elevated D-dimer

 A 45-year-old woman presents to the emergency department with acute onset of chest pain and shortness of breath. She has a history of recent long-haul flight and oral contraceptive use. On examination, she has tachycardia and tachypnea but is normotensive. Her D-dimer level is elevated. Which of the following is the most appropriate next step in management? 

• C. Obtain a computed tomography pulmonary angiography (CTPA). 

Question 2: Treatment for Cancer Patients with Stable PE

 A 65-year-old man with a history of lung cancer is diagnosed with a pulmonary embolism (PE) after presenting with dyspnea and chest pain. He is hemodynamically stable, and his right ventricular function is normal on echocardiogram. Which of the following is the most appropriate initial treatment? 

• B. Low-molecular-weight heparin (LMWH) 

Question 3: Managing Suspected PE in Pregnancy

 A 30-year-old pregnant woman at 28 weeks gestation presents to the emergency department with sudden onset of dyspnea and chest pain. She has no significant past medical history. Her vital signs are stable, and her D-dimer level is elevated. Which of the following is the most appropriate next step in management? 

• A. Perform a ventilation-perfusion (V/Q) scan. 

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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 Intro: Rock Christmas/ Christmas Music by tramp963

Outro: Alone by BoDleasons

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Questions and Answers from Episode 8 Stroke

1. Question: A patient presents with transient ischemic attack (TIA) symptoms that are triggered by physical activity or changes in blood pressure. Which type of stroke is most likely? 

• C. Hemodynamic stroke 

2 Question: A patient with internal carotid artery occlusion (ICAO) undergoes PET imaging. The results show normal CBF, CMRO2, and OEF, but increased CBV in the affected cortical territory, and decreased CVR. According to the stages of hemodynamic failure, this patient is in which stage? 

• B. Stage 1 (Oligemia) 

 3 Question: A patient has been diagnosed with hemodynamic stroke due to internal carotid artery occlusion (ICAO) and is found to have Stage 2 (Misery Perfusion) on PET imaging. Which of the following is the most appropriate treatment approach based on current evidence? 

• C. Medical management with antiplatelets and lipid-lowering agents 

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Outro: Eco Technology by Lexin Music

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Questions and Answers from Episode 7

Question 1: Reperfusion Strategy in STEMI

 A 65-year-old man presents to a rural hospital with a 2-hour history of severe chest pain. His ECG shows ST-segment elevation in the anterior leads, consistent with acute myocardial infarction. The nearest hospital capable of performing primary percutaneous coronary intervention (PCI) is 2 hours away by ambulance. Which of the following is the most appropriate initial treatment for this patient?

 A. Administer intravenous fibrinolytic therapy and arrange for immediate transfer to the PCI-capable hospital.

 Question 2: Revascularization in Multivessel Disease

 A 55-year-old man presents with acute myocardial infarction and is found to have multivessel disease (MVD) on coronary angiography. The culprit lesion is in the left anterior descending (LAD) artery, and there are significant stenoses in the right coronary artery (RCA) and circumflex artery. He undergoes successful primary PCI of the LAD. Which of the following is the most appropriate next step in his management?

 B. Perform staged PCI of the RCA and circumflex artery within the next few weeks.
 
 Question 3: Duration of Dual Antiplatelet Therapy

 A 60-year-old man with a history of acute myocardial infarction undergoes successful primary percutaneous coronary intervention (PCI) with drug-eluting stent placement. He has no other significant medical history. Which of the following is the recommended duration of dual antiplatelet therapy (DAPT) for this patient?

 C. 12 months

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Outro: Fast Chase Music Comedy Action by Omar Faruque

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Questions and Answers from Episode 6

 Question 1

A 62-year-old male with a 40-pack-year smoking history presents with complaints of leg pain during walking that resolves with rest. He is diagnosed with peripheral artery disease (PAD) and undergoes successful endovascular revascularization. Which of the following interventions is MOST likely to reduce both major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in this patient post-procedure?

 C. Rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily
 
 Question 2

A 55-year-old female with peripheral artery disease (PAD) and a low-density lipoprotein (LDL) level of 110 mg/dL is currently on atorvastatin 20 mg daily. Despite this, her LDL remains above the guideline-recommended goal. Which of the following is the MOST appropriate next step in her lipid-lowering therapy according to current guidelines?

A. Increase atorvastatin to 80 mg daily

Question 3

A 68-year-old male with peripheral artery disease (PAD) and intermittent claudication is referred to a supervised exercise therapy (SET) program. Which of the following outcomes is MOST likely to result from his participation in a 12-week SET program?

 B. Improvement in maximal walking distance by up to 300 meters

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 44.1  Medical Malpractice with Johnathan Robe esq. Part 2

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Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 6 PAD

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Questions and Answers from Episodes 4 and 5

Week 4

Question 1: Prevalence of AF in HF

Which of the following statements is true regarding the prevalence of atrial fibrillation (AF) in heart failure (HF) patients?

 b) AF is diagnosed in approximately 44% of patients with acute HF.

Question 2: Catheter Ablation Recommendation

What is the current recommendation for catheter ablation in patients with atrial fibrillation and heart failure?

 c) Class 1 A recommendation for patients with HF with reduced ejection fraction (HFrEF) and end-stage HF.

Question 3: Effect of GDMT on AF

What is the effect of guideline-directed medical therapy (GDMT) for heart failure on the incidence of atrial fibrillations?

 c) Decreases the incidence of AF and progression of atrial myopathy.

Week 5

 Question 1

A 52-year-old male presents to your clinic for a routine health evaluation. He has no history of cardiovascular disease (CVD) but has a family history of premature atherosclerotic cardiovascular disease (ASCVD). His lipid panel reveals an LDL-C of 160 mg/dL, HDL-C of 45 mg/dL, and triglycerides of 180 mg/dL. Using the Pooled Cohort Equation (PCE), his 10-year ASCVD risk is calculated at 8%. According to the 2018 AHA/ACC cholesterol guidelines, which of the following is the most appropriate next step in managing his dyslipidemia?

 C. Evaluate risk-enhancing factors and discuss moderate-intensity statin therapy

Question 2

A 65-year-old female with a history of myocardial infarction 3 years ago is currently on atorvastatin 40 mg daily. Her recent lipid panel shows an LDL-C of 85 mg/dL. She reports no adverse effects from her medication. According to contemporary guidelines discussed in the article, which of the following is the most appropriate management strategy to further reduce her cardiovascular risk?

 C. Add ezetimibe to her regimen to achieve an LDL-C <55 mg/dL

Question 3

A 45-year-old male with type 2 diabetes and hypertension presents for follow-up. His lipid panel shows an LDL-C of 130 mg/dL and triglycerides of 220 mg/dL. He is not currently on lipid-lowering therapy. The article discusses the role of triglycerides in cardiovascular risk management. Based on this, which of the following statements best reflects the current guideline recommendations for managing his triglyceride levels?

 C. Consider triglyceride-lowering therapy if he is on a statin and has established ASCVD

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

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Episode 5 Dyslipidemia

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 Intro: Rock Christmas/ Christmas Music by tramp963 

Outro: Electronic Reggae by Fernando Dias Silva

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Answers to Week 3 Questions

Question 1:

A 65-year-old patient presents with chronic fatigue and shortness of breath. The patient's NT-proBNP level is measured at 1800 ng/L. According to the UK guidelines for chronic heart failure investigation, what is the most appropriate next step in management?

B. Referral within six weeks for a heart failure diagnostic pathway.

Question 2:

Which of the following best describes the primary utility of NT-proBNP testing in the context of heart failure management?

C. It helps in the diagnosis and management of heart failure by indicating cardiac stress.

Question 3:

A patient with suspected chronic heart failure has just had their NT-proBNP tested. The results show levels above 400 ng/L. What does this result primarily indicate?

B. The patient's heart is under stress, possibly due to heart failure.

Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0  is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 4.1  Discipline Empathy and World Intention

Errata: I said "RK21" when referring to the Chernobyl reactor. It is an RBMK reactor and it is ironically, given the discussion, located in Pripyat, Kyiv Oblast, Ukraine.

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Intro/Outro: Night Detective by Amaksi

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Edited by: Todd Fredricks DO MSS

Rotations is produced using (and we always accept donations from any gear folks):

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iMac

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Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

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Music: Intro: Rock Christmas/ Christmas Music by tramp963 

            Outro: The Moment (Inspiring-Life) by Amaksi

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Rotations is produced using (and we always accept donations from any gear folks):

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Rode NT1-A mics

Polsen Studio Headphones

Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

iMac

Tama mic stands

Questions and Answers from Week 2 CAD

Question 1:

A 45-year-old male with a family history of premature coronary artery disease (CAD) in his father (age at onset: 50) and brother (age at onset: 48) presents for a routine health check-up. According to the article, which of the following imaging modalities would be most appropriate for screening this patient for CAD, considering his family history?

Correct Answer: C. Coronary computed tomography angiography (CCTA)

Explanation: The document emphasizes the use of CCTA for examining the extent of coronary plaque, especially non-calcified plaque, in asymptomatic members of families with a history of early CAD. Given the patient's family history, CCTA is suggested as it can help in the early evaluation of coronary atherosclerosis and guide clinical management effectively, as per the article's discussion on screening methods.

Question 2:

Which of the following is NOT listed in the document as a significant factor in the development of coronary artery disease among individuals with a positive family history?

Correct Answer: D. Increased incidence of infectious diseases

Explanation: The document discusses several mechanisms underlying the higher prevalence of CAD in individuals with a family history, including inherited pathologies, genetic predispositions, shared lifestyle and environments, and epigenetics. However, it does not mention an increased incidence of infectious diseases as a factor related to CAD in this context.

Question 3:

A study mentioned in the article demonstrated that family history of CAD increases the risk of coronary events, particularly when considering which of the following aspects of family history?

Correct Answer: B. Age at onset of CAD in the relative

Explanation: The document specifically highlights that the risk of developing CAD is significantly higher among first-degree relatives, particularly when CAD manifests early in relatives. This is confirmed by various studies, including those from the Framingham Heart Study, which noted higher risks when CAD onset was premature in relatives. The age at which relatives developed CAD is thus a crucial factor in risk assessment according to the article.

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