Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: pneumococcal vaccine attending: chief complaint: hemoptysis major surgical or invasive procedure: s/p bronchial artery embolization history of present illness: 79-year-old male with history of nsclc s/p chemotherapy and radiation in with local recurrence diagnosed who developed hemoptysis and was transferred for bronchial artery embolization. . the patient was doing well until a couple months ago. at that time he developed intermittent hemoptysis. this was scant and intermittent until day ago. at that time he noted increased hemoptysis totaling a couple teaspoons and he presented to on . he was noted to have hct of 28, had bronchoscopy with 90% obstructing mass in proximal right bronchus at the orifice of rml and rll. per note, the mass was fungating and polypoid. electrocautery coagulation was done with reduction of the amount of bleeding. he has evidence of mets to rml and rll. he was transferred to for bronchial artery embolization. . at his hct was noted to be 28.2. he was breathing comfortably with 4l nc. he was monitored on floor until procedure. he underwent a right bronchial artery embolization (330-550 microns) which was uncomplicated. after the procedure the patient was transferred from angio table to stretcher and developed tachypnea to 40s, desaturation to low 80s on 2l nc and significant work of breathing. he was switched to 8l simple face mask with saturation to 90. 15l nrb with saturation to 95. he was given 1mg morphine and albuterol treatment with some ease in breathing. cxr was done with no apparent change from prior description (although no comparison cxr). abg of 7.42/47/23 with sao2 of 95%. over the next 5-10 minutes the patient became more comfortable and patient no longer in respiratory distress. nrb was weaned to simple face mask. request was made to have patient observed in micu overnight. . upon transfer, initial vitals were: bp 154/65, hr 115, rr 35, sao2 94% on 50% fm. the patient denies pain, fevers, chills, nausea, vomiting, diaphoresis, diarrhea, constipation. he endorses intermittent shortness of breath and notes he occassionally has productive cough, sometimes with blood clots. past medical history: 1. stage iiib nsclc, s/p radiation and chemotherapy in . cancer was originally in distal trachea near right bronchus. patient in was noted to have local recurrence during an admission for pneumonia. patient was started late on palliative chemo with gemcitabine and has had five cycles. 2. copd 3. h/o seizures secondary to brain injury 4. hyperlipidemia 5. h/o pseudomonas pneumonia social history: widower, quit smoking in , denies etoh. family history: noncontributory. physical exam: vitals: t 99.5, bp 135/61, hr 108, rr 26, sao2 97% 40% fm general: alert, oriented, cachectic, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated lungs: decreased breath sounds throughout, more decreased in rll and rml. anterior exam only. no crackles or wheezes appreciated. cardiovascular: decreased heart sounds, difficult to assess. rr, tachycardia. no murmurs or rubs. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, cyanosis or edema, mild clubbing, no hematoma/bruit at groin. pertinent results: labs: 04:53pm blood wbc-7.4 rbc-3.34* hgb-10.0* hct-29.1* mcv-87 mch-29.8 mchc-34.2 rdw-20.0* plt ct-209 05:11pm blood wbc-15.5*# rbc-3.20* hgb-9.3* hct-28.0* mcv-88 mch-29.1 mchc-33.3 rdw-20.4* plt ct-341 04:15am blood wbc-13.3* rbc-2.98* hgb-8.9* hct-26.1* mcv-88 mch-29.7 mchc-33.9 rdw-20.0* plt ct-669* 04:00am blood wbc-11.0 rbc-2.84* hgb-8.2* hct-24.7* mcv-87 mch-28.9 mchc-33.3 rdw-19.6* plt ct-890* 04:32am blood wbc-10.3 rbc-2.68* hgb-8.0* hct-23.0* mcv-86 mch-29.9 mchc-34.8 rdw-19.9* plt ct-901* 03:59am blood wbc-11.5* rbc-3.15* hgb-9.0* hct-27.1* mcv-86 mch-28.7 mchc-33.2 rdw-19.5* plt ct-1208* 04:53pm blood glucose-105* urean-15 creat-0.6 na-136 k-3.5 cl-99 hco3-29 angap-12 04:46am blood glucose-127* urean-21* creat-0.9 na-132* k-4.0 cl-99 hco3-25 angap-12 04:00am blood glucose-147* urean-12 creat-0.7 na-129* k-4.1 cl-95* hco3-31 angap-7* 04:32am blood glucose-159* urean-11 creat-0.6 na-132* k-4.2 cl-96 hco3-31 angap-9 03:59am blood glucose-132* urean-9 creat-0.7 na-127* k-4.6 cl-91* hco3-32 angap-9 04:54pm blood pt-13.7* ptt-26.4 inr(pt)-1.2* 04:32am blood pt-16.2* ptt-37.9* inr(pt)-1.4* 04:53pm blood calcium-8.2* phos-2.5* mg-2.2 03:59am blood calcium-8.1* phos-2.4* mg-2.1 11:16pm blood type-art po2-23* pco2-47* ph-7.42 caltco2-32* base xs-3 12:45am blood type- temp-37.8 po2-43* pco2-46* ph-7.39 caltco2-29 base xs-1 intubat-not intuba 04:15am blood vanco-17.0 . blood cx pending, blood cx earlier in admission negative urine cx: negative . 8:31 pm sputum source: expectorated. gram stain (final ): <10 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited. . cxr : findings: right middle and lower lobe post-obstructive combination of collapse and consolidation with volume loss and rightward shift of midline structures is unchanged. increased opacity within the right upper lobe and the entire left lung reflects vascular congestion and mild-to-moderate pulmonary edema. cardiac silhouette is significantly obscured. there is no pneumothorax or left effusion. impression: mild-to-moderate pulmonary edema within the left lung and right upper lobe with unchanged right pleural effusion and post-obstructive atelectasis and consolidation of the right middle and lower lobes. . lenis : findings: grayscale, color and doppler images were obtained of bilateral common femoral, superficial femoral, popliteal and tibial veins. there is normal flow, compression and augmentation seen in all the vessels. impression: no evidence of deep vein thrombosis in either leg. . ct chest with contrast : ct of the chest with contrast: no pathologically enlarged supraclavicular, or axillary lymph nodes are present. a small 8-mm left hilar node seen. there is loss of the normal fat plane along the right mediastinal surface with 2 inferior paraesophageal nodes measuring 6 and 10 mm in short axis (2:29). volume loss is noted involving the right lung with paramediastinal fibrosis seen bilaterally, but predominantly on the right in the upper lobe which is poorly enhancing. some aerosolized secretions are noted within the distal trachea extending into the proximal main stem bronchi on the right with complete occlusion of the bronchus intermedius and proximal segmental branches of the right middle and right lower lobe by soft tissue mass. the right upper lobe bronchus has some secretions within its origin but is patent distally. the overall size of the right hilar mass is difficult to delineate in conjunction with the surrounding post-obstructive collapse of a large portion of the right lower lobe with the vasculature remaining patent and coursing through the atelectatic lung. some scattered centrilobular nodules are noted within the right upper lobe in conjunction with regions of bronchiolectasis and bronchial/bronchiole wall thickening (4:64). the aerated portions of the right middle and right lower lobe display bronchiectasis, interstitial septal thickening and surrounding ground-glass opacities. mild thickening is noted along the pleural surface of the right major and minor fissures. mild enhancement is noted along the right pleural surface in conjunction with a moderate-sized pleural effusion with fissural components. the left lung displays some apical scarring and paramediastinal fibrotic changes as well as a tubular 4 x 6-mm nodule within the lingula (4:95), without any other suspicious pulmonary nodules. underlying traction bronchiectasis is noted adjacent to the post-radiation changes with the remaining airways appearing otherwise unremarkable. moderate background centrilobular emphysema is better appreciated within the more normal-appearing left lung. mild-to-moderate atherosclerotic calcification is noted involving the aortic arch, ascending/descending aorta, and coronary arteries. atherosclerotic calcification is also noted involving the aortic valve. incidentally noted is independent takeoff of the left vertebral artery from the aortic arch. included portions of the upper abdomen display a few scattered small cardiophrenic lymph nodes. no suspicious masses within the liver, spleen, kidneys, pancreas, or visualized bowel. both adrenal glands appear hypertrophied more prominent on the left side. bone windows: no malignant-appearing osseous lesions are noted. impression: 1. poorly defined mass in the region of the right hilum with complete opacification of the bronchus intermedius and proximal segmental branches of the right middle and right lower lobe bronchi. the right upper lobe bronchus is opacified at its orifice but likely with fluid which is present within the distal right mainstem bronchus. there are extensive post-obstructive and post radiation changes involving the right lung with resultant volume loss. lymphangitic spread of disease is not excluded. 2. moderate-sized right pleural effusion with pleural enhancement suggesting complex fluid. effusion surrounds the large portion of the right lower lobe with fissural components. left lobe contains single lingular nodule and mild post-radiation changes note: please note assessment for superimposed pneumonia, pulmonary hemorrhage, or worsening post-obstructive changes is not possible in the absence of any prior exams available for our review. s/p embolization: procedure: 1. right common femoral arterial access. 2. aortogram. 3. bronchial artery embolization. details: after explaining the risks, benefits, and alternatives to the procedure, a written informed consent was obtained. the patient was brought to the angiographic suite and placed supine on the table. a timeout and huddle was performed per protocol. the right groin was prepped and draped in a sterile fashion. under continuous fluoroscopic and palpatory guidance, the right common femoral artery access was obtained using a micropuncture system, which was then exchanged for a 5 french vascular sheath, the sidearm of which was connected to a continuous heparin flush. a 5 french pigtail catheter was then advanced into the aorta over wire and aortogram was performed. next, multiple different catheters over the wire were tried to cannulate the common bronchial trunk arising from the aorta. due to the tortuous and acute orientation of the origin of the common bronchial trunk, the cannulation and advancement of the catheter was difficult. however, with extreme care, a renegade catheter over an angled glidewire was advanced further into the common bronchial trunk. arteriograms were performed to confirm the location. further advancement of the catheter over the glidewire was not possible due to the extreme tortuous anatomy of the vessels. hence, it was decided to perform embolization from this location. 300-500 micron embospheres were then used to embolize with intermittent saline flushes. care was taken to avoid anyreflux. intermittent hand angiograms were performed to rule out filling of the anterior spinal artery. further embolization was stopped when stagnancy in antegrade flow was noted. the catheter and the wires were then removed followed by the vascular sheath and manual pressure held over the arterial puncture site for about 15 minutes until good hemostasis was achieved. findings: 1. aortogram performed demonstrating common bronchial trunk. the right bronchial artery is relatively hypertrophied as compared to the left. no active extravasation is noted. 2. no contribution to the anterior spinal artery from the bronchial arteries is noted. impression: successful embosphere embolization of the common bronchial trunk with preferential flow into the right bronchial artery. far distal embolization selectively into the right bronchial artery was not possible at this stage due to the difficult angle of origin and tortuousity. brief hospital course: this is a 79-year-old male with history of nsclc s/p chemo and xrt in now with local recurrence who developed hemoptysis and s/p right bronchial artery embolization who developed hypoxic respiratory distress. . # hypoxic respiratory distress: the patient developed hypoxemic respiratory distress after being turned on right side after procedure. the differential is broad and includes airway obstruction from tumor, mucous plugging, intermittent bronchospasm, and pulmonary embolus. the most likely etiology of the original hypoxia was secondary to airway obstruction from tumor or from mucous plugging causing temporary shunt physiology. this is likely because it occurred after patient was turned on right side, was temporary, and relieved by coughing. interval cxrs showed worsening opacifiation of his right lung suggesting complete tumor or mucous occlusion of his bronchus versus a post obstructive pneumonia process. he was started and continued on iv vanocmycin (day 1 was ) and cefepime (day 1 was ) as all cultures remained negative. he then spiked a fever and flagyl was started on . the plan is for a total of a 14 day course of all antibiotics. the patient was given nebulizations to ease any possible bronchospastic response. no peripheral signs of dvt, including negative lenis although pt is mildly tachycardic and pe was not entirely excluded as cta was not done with pe protocal. however, cancer and pna can explain his oxygen requirement and anticoagulation treatment would be risky given recent arterial access, embolization, and hemoptysis. he generally requires 4-5l of oxygen to maintain sats in the low 90s (has h/o hypercarbia and copd) with intermittent needs for facemask ventilation in the setting of coughing fits. he was started on morphine 5mg po prn sob. he regularly self suctions. he also has a lot of anxiety which he receives lorazepam 0.5mg po as needed. he is also on standing tylenol to suppress fever. . # goals of care: the patient wanted a second opinion from oncology here at . oncology consult was called and his previous oncology records were obtained from dr. and dr. . oncology suggested a possible 3rd line of chemotherapy, but the patient said that he would want to "get better" before trying it. palliative care was also consulted and his code status was changed to dnr/dni. the patient expressed his wishes to die at home, but the family was not able to organize 24 hour home care and preferred that the patient be discharged to a to complete his iv antibiotics course before making a decision about how to approach his care at home. he has a follow up appointment with thoracic oncology on at 10:30 to discuss further chemo options. there were discussions abbout home with hospice but that is not being implemented at this time. . # hemoptysis: the patient has stable hematocrit and is s/p bronchial artery embolization. the procedure went very well, but he desatted to the 80s after the procedure when he layed on his right side as he was being transferred to the stretcher. his desaturation improved on nonrebreather, resolved within hours with weaning to nasal cannula, and was likely ssecondary to mucous plugging. lenis were checked and were negative for any dvt. he only had minimal hemoptysis after the procedure and once or twice in the week following. his heparin sc was stopped and should remain off given risk of bleeding. his hct did trend down to 23 from 29 on admission and was 27 on discharged without transfusion. . # metastatic nsclc: the patient is undergoing palliative chemotherapy with gemcitabine. will hold on further chemo for now pending oncology input. see goals of care section above. . # hypothyroidism: continued levothyroxine . # hyperlipidemia: continued statin . #. constipation: pt had constipation while here that he did not report to us initially. he moved his bowels on senna, colace, and miralax. he should be monitored for constipation. . # h/o seizures secondary to brain injury: continue home phenytoin. . # hypophosphatemia: he repeatedly had a low phos while in hospital. he should have his phos monitored regularly. . #.hyponatremia: is siadh also likely a hypovolemic component given decreased pos. trend hyponatremia. . # thrombocytosis: likely secondary to suboptimally tx post obstructive pneumonia . # insomnia in setting of respiratory issues: pt does well on trazodone 25mg qhs. . # code: dnr/dni as outlined above medications on admission: simvastatin 20mg daily levothyroixine 75mcg daily dilantin 100mg qid phenobarb 60mg daily albuterol neb q4hrs prn spiriva 18mcg daily temazapam 30mg qhs discharge medications: 1. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 2. levothyroxine 75 mcg capsule sig: one (1) capsule po daily (daily). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob. 4. phenobarbital 60 mg tablet sig: one (1) tablet po once a day. 5. phenytoin 100 mg/4 ml suspension sig: two hundred (200) mg po twice a day. 6. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 7. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours): day 1 was for total of 14 day course last day . 8. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety, discomfort: hold for sedation. 9. lidocaine hcl 2 % solution sig: twenty (20) ml mucous membrane tid (3 times a day) as needed for sore throat. 10. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 13. morphine concentrate 20 mg/ml solution sig: five (5) mg po q4h (every 4 hours) as needed for shortness of breath. 14. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours). 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nose. 16. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po daily (daily) as needed for constipation. 17. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day: hold for loose stool. 18. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 19. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 20. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 21. cefepime 2 g iv q12h day 1= 22. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous q 12h (every 12 hours): day 1 total 14 day course last day . 23. outpatient lab work chem 10, cbc daily for 1st 3 days and then at discretion of md at facility 24. pneumoboots discharge disposition: extended care facility: the highlands discharge diagnosis: primary diagnosis: 1. stage iiib nsclc, s/p radiation and chemotherapy in . cancer was originally in distal trachea near right bronchus. patient in was noted to have local recurrence during an admission for pneumonia. patient was started late on palliative chemo with gemcitabine and has had five cycles. 2. s/p bronchial artery embolization 3. post obstructive pna 4. copd . seondary diagnosis: 1. h/o seizures secondary to brain injury 2. hyperlipidemia 3. h/o pseudomonas pneumonia discharge condition: a & o x3, able to get up to chair with assistance but does not have oxygen reserve to do more, on 4-5l of oxygen to maintain o2 sats 89-92% occasionally needs fase mask for short periods discharge instructions: you were admitted for bronchial artery embolization and then had an increased oxygen requirement. your lung cancer is worse and has taken over almost the entire part of your right lung. in addition you developed fever and have a post obstructive pna and you are on cefepime, flagyl, and vancomycin which you will take for 14 days. you also were started on morphine and you are on ipratropium and albuterol nebs. you saw oncology here and you have a follow up appointment with dr. on . followup instructions: thoracic oncology is working on an appointment for you later this month. please call ( 1-2 days after discharge to find out the time appointment. procedure: injection or infusion of other therapeutic or prophylactic substance arteriography of other intrathoracic vessels aortography diagnoses: pneumonia, organism unspecified unspecified acquired hypothyroidism atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation anxiety state, unspecified cachexia malignant neoplasm of other parts of bronchus or lung epilepsy, unspecified, without mention of intractable epilepsy other disorders of neurohypophysis personal history of irradiation, presenting hazards to health foreign body in respiratory tree, unspecified inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation late effect of intracranial injury without mention of skull fracture late effects of injury, undetermined whether accidentally or purposely inflicted 

Answer: The patient is high likely exposed to