Snapshot A 68-year-old woman is bothered by easy bruising. She recalls that even reaching into her purse can cause bruising along the sides of her arms. These bruises resolve on their own, but they bother her cosmetically. She is otherwise healthy and is not taking any medications. Introduction Non-inflammatory purpura presenting as ecchymotic lesions on sun-damaged skin Also known as actinic purpura or solar purpura Associated with sun exposure anticoagulants corticosteroids Epidemiology Seen in patients > 65 years of age dermal tissue atrophy blood vessel fragility Presentation Symptoms easy bruising with minimal or no trauma heals on its own Physical exam non-palpable, purple bruises fade to brown (hemosiderin deposits) commonly on sun-exposed skin forearms dorsal hands Evaluation Diagnosis made by clinical history and exam Differential Solar lentigo Geriatric abuse Treatment None Prognosis Purpura may resolve after weeks Residual hyperpigmentation (brown color) may remain No other health consequences No indication of severe bleeding elsewhere
QUESTIONS 1 of 1 1 Previous Next (M2.DM.17.4774) A 79-year-old woman with a history of osteoporosis and colon cancer presents to her primary care physician with complaints of bruising on her hands and arms. She states that she initially noticed scattered bruises on the backs of her hands one month prior, which have since slightly enlarged and coalesced into larger areas. She denies recent trauma to her hands and arms and has no family history of bleeding diatheses. Her medications include atorvastatin, zolendronic acid, a calcium supplement, and a daily multivitamin. The patient’s temperature is 98.6°F (37.0°C), pulse is 65/min, blood pressure is 140/75 mmHg, respirations are 12/min, and oxygen saturation is 99% on room air. Physical exam is notable for a thin, elderly woman with prominent kyphosis. Cardiopulmonary exam is unremarkable, capillary refill is 2 seconds, and part of the skin exam shown in Figure A. Laboratory results are below:Serum:Na+: 140 mEq/LCl-: 107 mEq/LK+: 4.5 mEq/LHCO3-: 22 mEq/LUrea nitrogen: 15 mg/dLCreatinine: 0.8 mg/dLGlucose: 104 mg/dLHemoglobin: 12.4 g/dLLeukocyte count: 9,800/mm^3Platelet count: 150,000/mm^3Which of the following is the next best diagnostic step in this patient? QID: 109115 FIGURES: A Type & Select Correct Answer 1 Bleeding time 7% (3/44) 2 Prothrombin time 18% (8/44) 3 Carcinoembryonic antigen (CEA) levels 0% (0/44) 4 Urine porphyrin levels 18% (8/44) 5 No additional diagnostic tests required 57% (25/44) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic