A 42-Year-Old Man Comes to the Emergency Department Due to Worsening

A 42-year-old man comes to the emergency department due to worsening jaw pain and stiffness.  His symptoms began 2 days ago and have limited his ability to eat.  Today the patient also developed painful stiffness in his neck.  He has had no fever, chills, headache, focal weakness, or numbness.  The patient is a farmer in rural Pennsylvania and sustained a wooden splinter injury to his forearm while working in a barn a week ago.  He has no chronic medical conditions but has not had medical care for many years.  On examination, the patient is not able to open his mouth.  The muscles of the neck are tense, and neck range of motion is impaired.  Which of the following is the best approach to establishing diagnosis in this patient?

A) Anaerobic blood culture
B) Cerebrospinal fluid analysis
C) Clinical diagnosis only
D) Serum toxin assay
E) Several sets of antibody titers

Correct Answer:

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