Rosh Psychiatry Board Practice Exam

A 19-year-old man presents with intermittent symptoms and an unusual odor. What is a likely physical exam finding due to substance abuse?

1. Severe tooth decay with gingivitis

2. Skin abscesses

3. Erythematous streaks on the antecubital fossa

4. Erythematous rash about the mouth

The correct answer is: Erythematous rash about the mouth

The physical exam finding of an erythematous rash about the mouth is consistent with certain types of substance abuse, particularly inhalants or substances that may cause localized irritation or reaction after application near the oral area. For instance, inhalants can lead to mucosal irritation and allergic reactions resulting in redness and inflammation around the mouth. This is particularly relevant when substances are consumed or abused through oral routes or when individuals may inadvertently expose their facial skin to irritants while using them. In contrast, other options highlight various consequences of substance abuse: severe tooth decay and gingivitis typically stem from neglect related to oral hygiene and the effects of certain substances like methamphetamines; skin abscesses are common in intravenous drug users, especially with non-sterile injecting practices; and erythematous streaks on the antecubital fossa are associated with intravenous drug use but specifically surface signs of infection or trauma. Each of these findings suggests different substance abuse patterns or health consequences, but the rash around the mouth points to a direct irritation often tied to specific substances and their misuse characteristics.