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Episode 27 Metabolic Syndrome

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

Outro Music: Ki Instrumental Celtic Rock 357740 by Lyrium-2025

Courtesy of Pixabay under Creative Commons non-commercial use.

 Produced by: Todd Fredricks DO 

Edited by: Todd Fredricks DO

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:

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 26 Obesity

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

Outro Music: Tree of Life by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO 

Edited by: Todd Fredricks DO

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

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 25 Hyperthyroidism

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

Outro Music: Blockbuster Trailer

Courtesy of Pixabay under non-commercial creative commons use

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

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.

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 24 Hypothyroidism

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

Outro Music: KI Instrumental Classic-Waltz by Lyrium-2025 Siggi Würtz 

Courtesy of Pixabay under non-commercial creative commons 

Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

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.

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 12.1  Thoughts on Vaping

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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

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.

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 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

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

Rode Podcaster Pro

Rode NT1-A mics

Polsen Studio Headphones

Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

iMac

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 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.