06-25-2007, 05:10 AM
A 53-year-old man who is status post renal transplant 3 years earlier, returns to the clinic for routine
follow up for multiple warts on his hands and feet. Since his last visit 1 month ago he has been using
large amounts of salicylic acid 40% plasters to treat his widespread warts. He tells you in passing that
over the past week he has developed ringing in his ears. He currently takes many medications,
including prednisone, cyclosporine, and lansoprazole. His temperature is 38.3 C (101.0 F), blood
pressure is 110/80 mm Hg, and pulse is 105/min. Physical examination shows approximately 20
verrucous papules on the plantar surface of the feet as well as involvement of multiple fingers on the
hands. The most appropriate next step in the management of this patient is to
A. discontinue cyclosporine
B. discontinue lansoprazole
C. discontinue topical wart therapy
D. refer him for an audiology exam
E. tell him to continue current therapy until he sees an otolaryngologist about this problem
follow up for multiple warts on his hands and feet. Since his last visit 1 month ago he has been using
large amounts of salicylic acid 40% plasters to treat his widespread warts. He tells you in passing that
over the past week he has developed ringing in his ears. He currently takes many medications,
including prednisone, cyclosporine, and lansoprazole. His temperature is 38.3 C (101.0 F), blood
pressure is 110/80 mm Hg, and pulse is 105/min. Physical examination shows approximately 20
verrucous papules on the plantar surface of the feet as well as involvement of multiple fingers on the
hands. The most appropriate next step in the management of this patient is to
A. discontinue cyclosporine
B. discontinue lansoprazole
C. discontinue topical wart therapy
D. refer him for an audiology exam
E. tell him to continue current therapy until he sees an otolaryngologist about this problem