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Episode 36 Hepatitis

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Edited by: Todd Fredricks DO MSS

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.

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 35 Inflammatory Bowel Disease

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Produced by: Todd Fredricks DO MSS 

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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

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 34 Irritable Bowel Syndrome

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Produced by: Todd Fredricks DO MSS 

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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.

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 33 Peptic Ulcer Disease

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

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Produced by: Todd Fredricks DO MSS 

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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 32 GERD

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

Outro Music: Comedy Cartoon Funny Background Music by Hitslab

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Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

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

 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 31 Vitamin D

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

Outro Music: Epic Dramatic Cinematic Mover Underscore by Aleksei Bezruchko

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Produced by: Todd Fredricks DO MSS 

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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.

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 30 Testosterone Deficiency

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Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

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. 

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 29 Gestational Diabetes

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Produced by: Todd Fredricks DO MSS 

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

Outro Music: Science Documentary by Lexin Music 

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Produced by: Todd Fredricks DO 

Edited by: Todd Fredricks DO

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.

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 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.

Shoot me any comments or questions @Rotations2ptoh  on X 

Intro/Outro: Night Detective by Amaksi

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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.