AFP Clinical Answers

Tinnitus, HIV Infection, Joint Hypermobility Disorders, Drug-Resistant Epilepsy, Cancer Pain


Am Fam Physician. 2021 Dec ;104(6):566.

What are indications for referral to audiology in patients with tinnitus?

According to guidelines from the American Academy of Otolaryngology-Head and Neck Surgery, patients should be referred for audiologic examination within four weeks if tinnitus is chronic (i.e., lasting six months or longer), bothersome, unilateral, or associated with hearing changes. Patients presenting with tinnitus associated with sudden sensorineural hearing loss should have urgent audiometry because this requires urgent treatment.

What is the appropriate initial management for patients with HIV infection?

Combination antiretroviral therapy should be initiated as soon as possible after HIV diagnosis. If the CD4 count is less than 200 cells per μL, initiate prophylaxis against Pneumocystis jiroveci. If the CD4 count is less than 100 cells per μL and Toxoplasma antibodies are positive, initiate prophylaxis against Toxoplasma gondii. Administer vaccines according to the standard adult vaccination schedule, avoiding live vaccines if the CD4 count is less than 200 cells per μL.

How should joint hypermobility disorders be diagnosed?

Suspect hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders in patients with joint hypermobility and associated symptoms such as joint pain or dislocations, typical skin findings, arthralgias, recurrent hernias, marfanoid habitus, or family history of Ehlers-Danlos syndrome. Assess joint hypermobility in patients suspected of having hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders with a Beighton hypermobility score and a validated five-part questionnaire.

Are ketogenic diets effective at reducing seizure frequency in patients with drug-resistant epilepsy?

In children with drug-resistant epilepsy, a ketogenic diet decreases the risk of seizures by 50% after three to four months (number needed to treat



Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections


May 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article