Question: Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do? Conclude that these are lesions she has had for a long time.

Question: Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do? Conclude that these are lesions she has had for a long time.

Ms. Whiting is a 68-year-old female has flat red and purple lesions.

Answer:
These lesions are most likely ecchymoses, which are bruises that occur when blood vessels are damaged and leak blood into the surrounding tissues. Ecchymoses can be caused by a variety of factors, including trauma, medications, and underlying medical conditions.

In this case, it is likely that the ecchymoses are due to trauma, as they are located on the ulnar aspect of the forearms, which is a common site for injury. However, it is also possible that they are due to underlying medical conditions or medications. If the lesions are tender, this may be indicative of inflammation, which could be due to a number of conditions.

Further questioning of Ms. Whiting is warranted to determine the cause of the ecchymoses. If they are due to trauma, no further treatment may be necessary. However, if they are due to underlying medical conditions or medications, further investigation and treatment may be necessary.
Wait for her to mention them before asking further questions.