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Episode 73 Depression

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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.

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Episode 72 Rosacea

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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.

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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.