A 21-Year-Old College Student Is Brought to the Emergency Department

A 21-year-old college student is brought to the emergency department by his roommate after he was found carving holes in the walls and ceiling of their dorm room.  The patient is agitated and paces in the examination room.  He says, "I had no choice.  I had to locate and destroy the cameras.  I refuse to answer any questions."  The roommate has known him for the past year and says, "He seemed like a normal guy, but over the past several months he became withdrawn and started acting strange.  He stopped seeing his friends and going to classes, and spent all his time researching government websites.  I was getting annoyed with him because he stopped showering and no longer cleaned the room."  The roommate does not believe the patient has any other medical problems or known psychiatric history.  Temperature is 37.2 C (99 F) , blood pressure is 125/85 mm Hg, pulse is 108/min, and respirations are 16/min.  Examination shows normal pupils, moist mucous membranes, clear lung fields, and tachycardia.  The abdomen is soft and nontender.  Bowel sounds are present.  There is no rebound tenderness or rigidity.  Neurologic examination is within normal limits.  Mental state examination is significant for poor eye contact, blank facial expression, and minimal spontaneous speech production.  Which of the following would be the most useful test in the diagnostic workup of this patient?

A) 24-hour urinary copper and serum ceruloplasmin levels
B) Electroencephalogram
C) MRI of the brain
D) Thyroid function tests
E) Urine toxicology

Correct Answer:

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