Not only to give a shit, or a fuck... but to actually give two shits and a fuck.
Usually used as an expression of sarcasm when you couldn't give any less than you already don't.
Joe: Hey man, check this out, I upgraded my character to Scroto on the game...
Dave: Wow... I could give two shits and a fuck about that... no... really... go swallow a knife and die.
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