Rotations 2.0

Todd Fredricks DO MSS
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A weekly discussion of medicine and science trends between people far too old to be trying something this new.

  1. 23시간 전

    Rotations 2.0 Episode 73 Depression

    Send us Fan Mail Episode 73 Depression Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Path to Bright 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 72 Rosacea  QUESTION 1  A 44-year-old woman presents to an outpatient clinic for recurrent facial “flare-ups” for the past 18 months. She reports episodes triggered by exercise and hot beverages with a burning sensation across the cheeks. On examination, there are scattered inflammatory papules and pustules over the central face with visible telangiectasia. There is no persistent baseline erythema at today’s visit. She denies vision changes. Which additional finding, if present, would be considered independently diagnostic of rosacea in the updated phenotype-basedclassification system? C. Phymatous changes QUESTION 2  A 39-year-old man is diagnosed with rosacea. He has moderate-to-severe disease (IGA 3) with both persistent facial erythema and numerous inflammatory papules/pustules. He requests a regimen that targets both redness and inflammatory lesions. His medical history is unremarkable. Based on evidence summarized in the article, which regimen best aligns with a randomized, double-blind, vehicle-controlled trial evaluating a combination approach for patients who have both erythema and inflammatory lesions?  B. Brimonidine 0.33% AM + ivermectin 1% PM QUESTION 3 A 58-year-old patient presents with severe papulopustular rosacea (IGA 4) with extensive inflammatory lesions and frequent flushing. He has been adherent to topical therapy. He is started on topical ivermectin 1% cream, but he wants an evidence-based approach that improves the probability of clearing lesions more completely. Which additional therapy is best supported by the phase IIIb/IV trial summarized in the article for improving outcomes in severe rosaceacompared with topical ivermectin alone? D. Doxycycline 40 mg modified release Paper for Next week: Mishra, Aneesh K., and Anuj R. Varma. "A Comprehensive Review of the Generalized Anxiety Disorder." Cureus 15, no. 9 (September 28, 2023): e46115.  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.

    47분

  2. 6월 29일

    Rotations 2.0 Episode 72 Rosacea

    Send us Fan Mail Episode 72 Rosacea Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Heartwide 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 71 Squamous Cell Carcinoma  Question 1  A 68‑year‑old patient presents to a family medicine clinic with a scaly, tender, hyperkeratotic plaque on the helix of the ear that has enlarged over 2 months. Shave biopsy confirms cutaneous squamous cell carcinoma (cSCC). The pathology report additionally notes tumor cells tracking along a nerve. The patient is otherwise healthy. Which is the most appropriate next step in management? C. Arrange urgent dermatology (and/or head & neck) referral for high‑risk cSCC management planning Question 2  A researcher examines the tumor microenvironment of cSCC and finds abundant regulatory T cells (Tregs)associated with high extracellular adenosine, which suppresses local anti‑tumor immunity. The researcher asks how these Tregs generate adenosine in the extracellular space. Which mechanism best explains the increased extracellular adenosine production? C. Tregs express ectoenzymes CD39 and CD73 that metabolize extracellular ATP → adenosine Question 3  A 79‑year‑old patient has locally advanced cSCC that is not amenable to curative surgery or radiation therapy. The oncology consultant recommends first‑line systemic therapy with a PD‑1 immune checkpoint inhibitor per evidence summarized in the review. Which regimen matches a PD‑1–targeted treatment dosing schedule described in the article? B. Cemiplimab 350 mg IV every 3 weeks Rosa, Ilenia, Lorenzo Pio Padula, Francesco Semeraro, Carlotta Marrangone, Antonio Inserra, Luisa De Risio, and Marta Boffa, et al. “Endocannabinoids, Depression, and Treatment Resistance: Perspectives on Effective Therapeutic Interventions.” Psychiatry Research 352 (2025): 116697. 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.

    43분

  3. 6월 22일

    Rotations 2.0 Episode 71 Squamous Cell Carcinoma

    Send us Fan Mail Episode 71 Squamous Cell Carcinoma Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Fragile Beauty 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 70 Basal Cell Carcinoma  Question 1  A 72-year-old patient presents with a 0.8-cm pearly papule with telangiectasias on the nasal ala that intermittently bleeds. A shave biopsy confirms basal cell carcinoma. Which risk category best applies to this lesion based on NCCN high-risk features summarized in the article? B. High-risk basal cell carcinoma Question 2  A 66-year-old patient has metastatic basal cell carcinoma (mBCC) and is started on vismodegib, a Hedgehog pathway inhibitor. Which of the following best matches the outcomes reported in the article from the ERIVANCE BCC trial for patients with mBCC? C. ORR 48%, median PFS 9.5 months, OS ~33 months Question 3  A patient with advanced BCC has progressed after a Hedgehog pathway inhibitor and is being considered for chemotherapy. According to the article, which regimen corresponds to a retrospective study reporting a partial response rate of 43% and median PFS of 6 months in advanced BCC? D. Cisplatin 50 mg/m² IV on days 1 and 8 + cyclophosphamide 600 mg/m² IV  van Zuuren, Esther J., Bernd W. M. Arents, Mirelle M. D. van der Linden, Sofieke Vermeulen, Zbys Fedorowicz, and Jerry Tan. “Rosacea: New Concepts in Classification and Treatment.” American Journal of Clinical Dermatology 22 (2021): 457–465. https://doi.org/10.1007/s40257-021-00595-7.  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.

    39분

  4. 6월 15일

    Rotations 2.0 Episode 70 Basal Cell Carcinoma

    Send us Fan Mail Episode 70 Basal Cell Carcinoma Shoot me any comments or questions @Rotation2ptoh  on X  Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Rock Got That Heat This Action by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS EADO Staging reference: https://www.ejcancer.com/article/S0959-8049%2823%2900356-8/fulltext Answers for Episode 69 Melanoma  Question 1: Pathology and Prognosis A 56‑year‑old man presents with a changing pigmented lesion on his upper back. An excisional biopsy is performed. Pathology reveals a superficial spreading melanoma with a Breslow thickness of 0.7 mm, no ulceration, and no dermal mitoses. There is pagetoid spread of atypical melanocytes within the epidermis. Which pathologic feature is considered the single most important prognostic factor and is used directly to determine the tumor (T) category in melanoma staging? C. Breslow thickness Question 2: Surgical Staging and Management A 63‑year‑old woman is diagnosed with a cutaneous melanoma on her lower leg. Pathology shows a Breslow thickness of 1.4 mm with no clinical evidence of lymphadenopathy. Imaging studies are unremarkable. Which of the following is the most appropriate next step in management for accurate pathological staging? D. Sentinel lymph node biopsy Question 3: Systemic Therapy and Emerging Treatments A 48‑year‑old man with resected stage IIC melanoma is being evaluated for adjuvant therapy. His tumor is BRAF wild‑type. He has no contraindications to immunotherapy. Based on recent clinical trial evidence discussed in the article, which class of medications has been shown to reduce recurrence risk in patients with high‑risk stage II melanoma? D. PD‑1 immune checkpoint inhibitors Anderson, Ronald, Nomzamo M. Mkhize, Mahlatse M. C. Kgokolo, Helen C. Steel, Theresa M. Rossouw, Lindsay Anderson, and Bernardo L. Rapoport. 2025. “Current and Emerging Insights into the Causes, Immunopathogenesis, and Treatment of Cutaneous Squamous Cell Carcinoma.” Cancers 17 (10): 1702. https://doi.org/10.3390/cancers17101702.   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.

    45분

  5. 6월 8일

    Rotations 2.0 Episode 69 Melanoma

    Send us Fan Mail Episode 69 Melanoma Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Time for Two 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 68.1 Fungal Skin Infections Question 1 A 34‑year‑old man presents with a 6‑month history of pruritic, annular plaques on the groin and inner thighs. He has been treated multiple times with over‑the‑counter antifungal–corticosteroid combination creams with minimal improvement. Physical examination reveals erythematous plaques with indistinct borders and no central clearing. Which of the following best explains the patient’s current presentation? C. Steroid‑modified dermatophyte infection (tinea incognito) A multicenter molecular study cited in the article examined 351 cases of dermatophytosis in India. Which of the following findings was most strongly associated with the recent epidemic‑like increase in treatment‑resistant cutaneous fungal infections? C. Emergence of Trichophyton indotineae with squalene epoxidase gene mutations Question 3 A 68‑year‑old woman with diabetes presents with thickened, yellow‑brown toenails involving the great toe and second toe. She has no concurrent rash on the feet or hands. Initial KOH testing is positive for fungal hyphae. Which diagnostic approach is most appropriate to confirm the suspected etiology and guide management? C. Repeated fungal cultures to evaluate for non‑dermatophyte mold infection Sergi, Maria Chiara, Francesca Ambrogio, Mario Della Mura, Joana Sorino, and Gerardo Cazzato. “Basal Cell Carcinoma: An Old Friend with Multiple Faces.” Cancers 17, no. 6 (2025): 993. https://doi.org/10.3390/cancers17060993. 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.

    43분

  6. 6월 1일

    Rotations 2.0 Episode 68.1 Fungal Skin Infections

    Send us Fan Mail Episode 68.1 Fungal Skin Infections Shoot me any comments or questions @Rotation2ptoh  on X  Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Motivational 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 68 Impetigo and Staph Scalded Skin Syndrome Question 1 A 3 year old child presents with fever, irritability, and widespread tender erythematous patches that rapidly evolve into fragile bullae. Gentle lateral pressure on the skin causes the superficial epidermis to shear off. Cultures taken from the bullae show no bacterial growth. Which of the following best explains the pathophysiology of this child’s condition? D. Hematogenous spread of exfoliative toxins targeting desmoglein 1 Question 2 A newborn develops flaccid bullae in well demarcated clusters on the trunk and diaper area. The bullae rupture easily, leaving behind a narrow rim of scale and thin brown crust. Bacterial cultures of the lesional fluid grow Staphylococcus aureus. Which of the following additional findings would most help distinguish this condition from staphylococcal scalded skin syndrome? C. Presence of viable bacteria within the bullae Question 3  A hospitalized adult with severe renal disease presents with widespread blistering, fever, and erythema. Blood cultures grow Staphylococcus aureus. The care team initiates IV oxacillin, but the patient fails to improve. Local antibiograms show high regional MRSA prevalence. According to current evidence summarized in the article, which of the following is the most appropriate next step in management? D. Switch to IV vancomycin Caraviello, Camila, Gianluca Nazzaro, Gianluca Tavoletti, Francesca Boggio, Nerina Denaro, Giulia Murgia, Emanuela Passoni, Valentina Benzecry Mancin, and Angelo Valerio Marzano. “Melanoma Skin Cancer: A Comprehensive Review of Current Knowledge.” Cancers17, no. 17 (2025): 2920.  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.

    41분

  7. 5월 25일

    Rotations 2.0 Episode 68 Impetigo and Staph Scalded Skin Syndrome

    Send us Fan Mail Episode 68 Impetigo and Staph Scalded Skin Syndrome Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Got That Heat 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 67 Urticaria Q1. Diagnosis — hairdresser with immediate wheals A 28‑year‑old hairdresser develops intensely pruritic wheals on her hands and forearms within minutes of mixing bleaching powder at work. Symptoms resolve within several hours after leaving the salon. She denies prior episodes of anaphylaxis. Which of the following is the most appropriate initial diagnostic test? B. Skin prick testing (SPT) with ammonium persulfate using appropriate positive/negative controls Q2.  A 36‑year‑old operating room nurse has IgE‑mediated contact urticaria to natural rubber latex confirmed by positive SPT. Despite attempts to substitute gloves, occasional exposures still occur, leading to immediate pruritic wheals on the hands and wrists. She has never required epinephrine. Which of the following is the best initial pharmacologic strategy to reduce symptoms when complete avoidance is not feasible? A. Begin a second‑generation H1‑antihistamine and titrate up to four times the licensed daily dose as needed Q3.  A 24‑year‑old woman applies a new facial moisturizer and experiences burning and erythema within 15 minutes, with occasional small wheals limited to the application area. Ingredient review reveals benzoic acid. Which feature most strongly supports a diagnosis of non‑immunologic contact urticaria (NI‑CoU) rather than I‑CoU? D. Reactions can occur on first exposure and are dose‑dependent Paper for Next Week: Chanyachailert, Pattriya, Charussri Leeyaphan, and Sumanas Bunyaratavej. “Cutaneous Fungal Infections Caused by Dermatophytes and Non‑Dermatophytes: An Updated Comprehensive Review of Epidemiology, Clinical Presentations, and Diagnostic Testing.” Journal of Fungi 9, no. 6 (2023): 669. 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.

    29분

  8. 5월 18일

    Rotations 2.0 Episode 67 Urticaria

    Send us Fan Mail Episode 67 Urticaria Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Pure Energy 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 66  Contact Dermatitis Question 1 A 34‑year‑old hairdresser reports intensely pruritic, erythematous, and edematous lesions with vesiculation at the dorsal hands that begin within a few hours after she contacts a known workplace chemical at sites previously affected in the past. Which immunologic mechanism best explains the rapid onset of her local reaction? C. Activation of epidermal CD8+ tissue‑resident memory (TRM) cells that rapidly produce IFN‑γ and IL‑17 and drive neutrophil recruitment.  Question 2 Which of the following experimental findings would most directly support a pathogenic role for neutrophils in rapid‑onset allergic contact dermatitis in a mouse model? A.    Depletion of neutrophils prior to allergen challenge markedly reduces the early (24 h) skin swelling and histologic neutrophil infiltrate.  Question 3 A researcher proposes a clinical trial to prevent rapid‑onset ACD flares by blocking neutrophil chemotaxis. Which therapeutic target discussed in the article is most appropriate for this strategy, and what practical limitation did the authors highlight for its use in real‑world rapid flares? A. Target CXCR2 to inhibit neutrophil recruitment; limitation — need for near‑immediate administration after allergen re‑exposure to prevent extravasation.  Paper for Next Week: Brazel, Morgan, Anand Desai, Abhirup Are, and Kiran Motaparthi. “Staphylococcal Scalded Skin Syndrome and Bullous Impetigo.” Medicina 57, no. 11 (2021): 1157. 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.

    44분
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A weekly discussion of medicine and science trends between people far too old to be trying something this new.

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    Todd Fredricks DO MSS
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    2025년 - 2026년
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    86
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