Review Question - QID 109716

A 62-year-old man presents to his primary care physician for a regular checkup. The patient worked as a farmer his entire life but recently retired. Since then, he has been sailing the world. He endorses a recent 7-pound weight loss which he attributes to his sailing activities. Otherwise, the patient has no other complaints and feels that he is doing well. The patient has a medical history of hypertension. His current medications include atorvastatin, lisinopril, and aspirin. The patient smokes cigarettes and drinks alcohol occasionally. His temperature is 98.7°F (37°C), blood pressure is 132/85 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, you note an elderly man in no current distress. Abdominal exam reveals mild epigastric bruising which the patient attributes to sailing. Musculoskeletal exam demonstrates crepitus of the patient's hips. Dermatologic exam reveals the finding in Figure A which the patient has not noticed before, as well as diffuse minor bruises which the patient attributes to his recreational activities. The patient's gait is stable, and he demonstrates 5/5 strength in his upper and lower extremities. Which of the following is the most likely underlying diagnosis?