Taking It on the Chin by DeMarco, Woods and Stephens

Part IV—The Emergency Room

Dr. Umphasea, an African doctor on a six-month rotation in the U.S., is attending at the Emergency Room. He notices that Mr. Gower’s jaw is firmly closed and his neck and lip muscles are contracted.

“I have seen cases like this before in my home country. I have a simple test to confirm my diagnosis. Mrs. Gower, has your husband eaten recently?”

Mrs. Gower shakes her head, “No.”

The doctor places a wooden tongue depressor through Mr. Gower’s clenched teeth and onto the back of his throat. Mr. Gower reacts, but does not open his mouth to regurgitate.

“When did you last have a tetanus shot?”

His wife interjects, “He hates needles, doctors, and dentists.”

The doctor smiles, “I don’t blame you. We need to take some blood to do an antibody titer. We’ll also culture the wound in your mouth, but I don’t know whether we’ll find anything there. Your chart says that you have no allergies. Is that correct?”

Mr. Gower nods his head yes.

The doctor continues, “Because I’ll probably give you penicillin.”

Questions

1. What is the normal response to someone placing a tongue depressor on the back of your throat?
2. Why didn’t Mr. Gower open his mouth with the tongue depressor test?
3. What does this tell you about the action potential activity in Mr. Gower’s motor neurons to his jaw (and neck) muscles?
4. Go back to your answer to Question 6 in the last part of the case. Do the results of the tongue depressor test support one of the two answers?
5. What does the antibody titer tell the physician?
6. Does this explain his fever?
7. Why is penicillin prescribed for Mr. Gower’s condition?
8. How did Mr. Gower initially become infected?
9. Do you wish to change or modify your diagnosis of Mr. Gower’s problem?

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