Approach to stimulant use, intoxication, and overdose Quiz: Ace Your Exams
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A 34-year-old man comes to the primary care clinic for a 3-month history of a severe rash and skin picking. The patient feels as if bugs are crawling all over his body. There has been no recent exposure to scabies or bed bugs, and there is no past medical or psychiatric history. Documentation available on the electronic health record (EHR) shows multiple emergency department visits for concerns of parasite infestation. Collateral information obtained from the patient’s family reveals that the mother found needles in the patient’s room next to an unknown powder. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 15/min, and blood pressure is 135/85 mmHg. Dermatological exam shows multiple scattered excoriations covering the bilateral upper extremities in various stages of healing that appear self-inflicted. There is severe dental decay and tooth erosion. Mental status exam shows a thin adult with age-appropriate appearance and fair grooming and hygiene. Comprehensive metabolic panel (CMP) and complete blood count (CBC) are normal. The patient declines to complete a urinary drug screen. Which of the following is the most probable cause of the patient’s dermatological findings?
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