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.

https://www.aafp.org/afp/2021/0601/p663.html

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.

https://www.aafp.org/afp/2021/0401/p407.html

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.

https://www.aafp.org/afp/2021/0415/p481.html

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

 

 

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