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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

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

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

Shoot me any comments or questions @Rotation2ptoh on X

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

Outro Music: Flying Through the Valley an Epical Trailer

Courtesy of Pixabay under Creative Commons non-commercial use.

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.

Send us a text

Episode 29 Gestational Diabetes

Shoot me any comments or questions @Rotation2ptoh on X

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

Outro Music: Modern Classical Inspirational Cinematic Motivational Music

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS

Edited by: Todd Fredricks DO MSS

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.