On physical examination of a 16 year old female patient, you notice partial erosion of her tooth enamel and callus formation on the posterior aspect of the knuckles of her hand. This is indicative of:

  • Self-induced vomiting and she likely has bulimia nervosa

  • A genetic disorder and her siblings should also be tested

  • Self-mutilation and correlates with anxiety

  • A connective tissue disorder and she should be referred to dermatology