4th September 2020

A 15-year-old girl is reviewed in paediatric clinic, due to her parents’ concern over her recent weight loss

A 15-year-old girl is reviewed in paediatric clinic, due to her parents’ concern over her recent weight loss. She is weighed at 41.1kg, which results in a BMI of 16.5, meaning she is severely underweight. The patient declines to give a history, but her parents report that she refuses to leave her bedroom for mealtimes, and has become obsessive over her weight, weighing herself on the bathroom scales several times a day. On general examination, she is pale and visibly underweight. Multiple abrasions are noted across the backs of the knuckles of her left hand.

Which of the following physical signs is being described in the above case? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.