GIM Q110

An 81-year-old woman is evaluated for bruising. For the past few years, she has noticed dark red patches appearing intermittently on the forearms without trauma or other triggers. They are not painful and resolve without treatment. History includes hypertension, for which she takes hydrochlorothiazide. On physical examination, vital signs, including blood pressure, are normal. Skin is dry, and skin findings on the forearm are shown.

Which of the following is the most appropriate next step in management?

A Complete blood count

B Discontinue hydrochlorothiazide

C Skin biopsy

D Topical triamcinolone

E Reassurance

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