Dora is 57-year old woman who visits her family clinic. Dor.docx

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Dora is 57-year old woman who visits her family clinic. Dora complains of a persistent, dry cough that she's had for about two months. She does not have a fever. She cannot recall when or where she initially caught the cough and denies any noticeable connection to the cough to any time of day or the environment. Dora's clinician, Charlene, considers Dora's persistent, dry cough and lack of fever. She rules out rhinovirus, since Dora's cough has lasted well over that usual two- week period. She questions and learns Dora's coughing spells occur randomly throughout the day, and Dora denies any noticeable association with an allergen. Dora denies any travel, or anything else remarkable around the time she noticed the cough. Charlene takes a look at Dora's vaccine record and notices that it's been 12 years since Dora's last Tdap booster. Pertussis springs to Charlene's mind. Though Dora does not have a whoop" sound in her cough, a disease hallmark of pertussis heard as one audibly gasps for air, Charlene remembers attending a lecture where she learned most cases of pertussis seen clinically lack the "whoop." Charlene thinks through the differential diagnosis. She rules out allergies, reflux, chemical exposure and asthma from Dora's history, and tuberculosis, fungal ball, congestive heart failure and cancer from an X-ray. Charlene prescribes a Z-
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pack for Dora and orders a blood draw to test for pertussis. She also orders a Tdap booster shot. Division of Consolidated Lab Services laboratory technician Carl performs a serology test called an ELISA from the blood specimen. The test is positive, meaning Dora has antibodies in her blood specific to B. pertussis. Carl notifies Charlene as well as the Centers for Disease Control (CDC) of the positive result. About a
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