Rotations 2.0

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Episode 44 Low Back Pain  

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

Outro Music: Vision of Tomorrow 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 43 Rheumatoid Arthritis 

Question 1: Pathogenesis and Risk Factors

A 45-year-old woman with a family history of rheumatoid arthritis (RA) presents with fatigue and intermittent joint stiffness. Laboratory testing reveals the presence of anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF), but no clinical synovitis is observed. Which of the following best describes the current understanding of the pathogenesis of RA in this patient?

C. Autoantibodies may originate in mucosal tissues and spread systemically

Question 2: Imaging and Early Detection

A 38-year-old man with anti-CCP positivity and musculoskeletal symptoms undergoes ultrasound imaging, which reveals subclinical synovitis. According to recent studies, what is the clinical significance of this finding?

B. Subclinical synovitis is a strong predictor of imminent inflammatory arthritis

Question 3: Pharmacologic Prevention of RA

A clinical trial evaluates the use of abatacept in patients with undifferentiated arthritis and positive anti-CCP antibodies. Participants receive weekly subcutaneous injections of 125 mg abatacept for six months. What was the primary outcome of this intervention according to the ADJUST trial?

B. Abatacept reduced RA development and structural damage

Paper for Next Week: 

Abdulsalam M. Aleid, et al. Dry needling for mechanical neck pain: A systematic review and meta-analysis of randomized controlled trials, Surgical Neurology International, 2025, 16 (44)

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 43.1  Johnathan Robe esq. Part 1

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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  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 43 Rheumatoid Arthritis

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

Outro Music: Upbeat Yacht Club Fashion House Lounge 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 42 Osteoarthritis 

Question 1: Epidemiology and Risk Factors

A 52-year-old woman presents with early-onset knee pain. She has a BMI of 32 and a history of asthma. Based on recent epidemiological data, which of the following is most likely associated with an increased risk of developing osteoarthritis?

C. Atopic disease

Question 2: Hand OA Treatment

A 60-year-old patient with inflammatory hand osteoarthritis is being considered for disease-modifying therapy. Which of the following treatments showed statistically significant pain reduction in a randomized controlled trial?

C. Methotrexate 20 mg/week

Question 3: Knee OA Therapy

A clinical trial is evaluating novel therapies for knee osteoarthritis. Which of the following interventions showed no significant difference in pain or function compared to corticosteroid injection over 12 months?

B. Umbilical cord-derived mesenchymal stromal cells

Paper for Next Week: 

Wouter K. M. van Os et al. Update of Evidence-Based Interventional Pain Medicine According to Clinical Diagnoses: Discogenic Low Back Pain, Pain Practice, 2025; 25

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 42.1  Intro to Medical Malpractice

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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  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 42 Osteoarthritis

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

Outro Music: Hard Rock to Drive to Survive Adrenaline Sport 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 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.

 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 41 Hemorrhoids

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

Outro Music: Mellow Future Bass (Bounce on it) 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 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

 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 40 Diarrhea

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

Outro Music: Endless Universe (Dreamy Summer) by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

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

Outro Music: A Comedy Funny (Dream Lullaby) 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 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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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: Breaking Free 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 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.

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 37 Gallstones

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

Outro Music: Abstract Future Bass Pursuit by Qubesounds

Courtesy of Pixabay under Creative Commons non-commercial use.

 Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

 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.

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.