An 85-year-old patient comes in accompanied by his son and daughter-in-law. The son has a hostile attitude and treats the patient poorly. The patient appears withdrawn and quiet, has bruises on his arms, has rheumatoid arthritis, and is taking adalimumab and aspirin. Which of the following bruising causes is most likely related to the patient's medication?

Correct answer: D. Increased bleeding tendency from aspirin

• A. Vitamin C deficiency (scurvy) can cause perifollicular hemorrhages but is not related to adalimumab or aspirin.
• B. Periodontal disease is a known risk of certain medications but is unrelated to arm bruising.
• C. Amyloidosis can occur in chronic rheumatoid arthritis but is not caused by adalimumab or aspirin, and it does not typically cause bruising of the arms as a first sign.
• D. CORRECT — Aspirin irreversibly inhibits platelet cyclooxygenase (COX-1), impairing thromboxane A2 production and platelet aggregation. Elderly patients on aspirin bruise easily from minor trauma, which is an important consideration when evaluating whether bruises are truly suspicious for abuse.