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: no known allergies / adverse drug reactions attending: chief complaint: epigastric pain, incidental aaa identified, transfered from osh for assessment of surgical intervention upon aaa major surgical or invasive procedure: none history of present illness: mr is a 78 yom presented to osh with epigastric pain, shortness of breath, cough and chills, s/p fall on his right chest with ecchymosis, diagnosed osh with possible nstemi (bnp of 1100, tropt of 0.09, 0.13, 0.13), pna, chf with ef of 25%, and aaa (6.7x6.5 cm). at osh ed, he was noted to have ecchymosis on the right chest, unable to lie flat and was hypotensive. he was urgently intubated to perform ct scans of the chest and abdomen. ct scan showed a 6.7x6.5 infrarenal abdominal aortic aneurysm with no suggestion of acute leakage or bleed and bibasilar atelectasis vs airway disease. ecg showed st depression in v2 & v3 and prominent t-waves diffusely, rbbb, 1st degree av block. . at the osh (), patient was treated for pneumonia with zosyn and levaquin. he was intubated for 1 day duration. his cultures were reportedly unremarkable. he was evaluated by cardiology due to his extensive coronary artery disease. on the osh echo, he was noted to have a depressed ef of 20-25% which was noted to be worse than prior reports (at ). patient did have several episodes of acute pulmonary edema that was with increased bb, diuresis, acei, and bipap. he was evaluated by surgery for the newly discovered abdominal aortic aneurysm, which he was recommened to have endovascular repair. he was transferred to for catheterization and management of aaa repair evaluation. . on review of systems, he has a persistent non-productive cough. he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, abdominal pain, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. he denies recent fevers or rigors. he denies exertional buttock or calf pain. all of the other review of systems was negative. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea (sleeps with 1 pillow at night), ankle edema, palpitations, syncope or presyncope. . past medical history: past medical history: 1. cardiac risk factors: -diabetes, +dyslipidemia, +hypertension 2. cardiac history: - congestive heart failure of uncertain type - moderate aortic regurgitation (diagnosed ) - previous admission to for a possible acute cardiac situation of unclear description - cabg: emergency procedure at () - percutaneous coronary interventions: none - pacing/icd: none 3. other past medical history: - obstructive sleep apnea not on cpap - asthma - asbestosis - benign prostatic hypertrophy social history: the patient lives with his wife, per wife patient is full code (per report on d/c summary). he is independent in his activities of daily living. uses a cane or walker to ambulate. currently retired, has previously worked in the shipyard industry. - tobacco history: denies ever smoking. - etoh: none - illicit drugs: none . family history: - he recalled his mother had "trouble with heart" but could not elaborate further. - otherwise, no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. . physical exam: physical examination general: nad. oriented x1-2 confused, tachypnic to the 30's, moderate respiratory distress heent: perrl, eomi. no pallor or cyanosis neck: supple, no jvd chest: bruise over right lower anterior chest, midline sternotomy scar with 2 corresponding sub-centimetre horizontal scars inferiorly. irregular rhythm with impression of extrasystolic beats, heart sounds distant. no m/r/g. no thrills, lifts. no s3 or s4. lungs: diffuse expiratory > inspiratory wheezing and ronchi, bibasilar crackles, prolonged expiratory phase. abdomen: umbilical herniation, soft, ntnd, no peritoneal signs. no hsm or tenderness. abd aortic pulsation positive. extremities: old saphenous vein harvest scar on right medial aspect of leg. no c/c/e. no femoral bruits. distal phalanx of r thumb not present. no peripheral gangrene or amputations. skin: dry, shiny and excoriated skin with patches of erythema bilaterally on forearms. fungal intertriginous eruption with some skin breakage in perineal are and groins, dystrophic nail changes/onychomycosis noted on toes. pulses: right: carotid 2+ femoral 2+ popliteal 4+ wide very prominent !! aneurysm? dp 1+ pt +/- left: carotid 2+ femoral 2+ popliteal 4+ wide very prominent !! aneurysm? dp 1+ pt + /- neuro: normal symmetric gross cn, motor and sensorium function, peripheral fasciculations resolved, cogwheeling in upper limbs right > left. . pertinent results: admission - laboratory data: . 10:01pm urine color-straw appear-clear sp -1.010 10:01pm urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 10:01pm urine rbc-1 wbc-<1 bacteria-few yeast-none epi-0 10:01pm urine hyaline-18* 10:00pm glucose-107* urea n-33* creat-1.2 sodium-141 potassium-3.3 chloride-100 total co2-33* anion gap-11 10:00pm estgfr-using this 10:00pm alt(sgpt)-19 ast(sgot)-24 ck(cpk)-53 alk phos-46 amylase-49 tot bili-0.5 10:00pm lipase-17 10:00pm ck-mb-6 ctropnt-0.17* 10:00pm albumin-3.8 calcium-9.5 phosphate-3.5 magnesium-2.0 cholest-131 10:00pm %hba1c-5.7 eag-117 10:00pm triglycer-101 hdl chol-45 chol/hdl-2.9 ldl(calc)-66 10:00pm wbc-10.3 rbc-3.73* hgb-12.5*# hct-36.4*# mcv-98 mch-33.6* mchc-34.4 rdw-14.1 10:00pm neuts-91.1* lymphs-4.4* monos-4.2 eos-0.2 basos-0.1 10:00pm plt count-154 10:00pm pt-14.1* ptt-33.4 inr(pt)-1.2* . tte : the left atrium is normal in size. the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. there is mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the mid-distal anterior wall, apex, and distal anterior septum (lvef 35-40%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild-moderate focal left ventricular dysfunction c/w cad. mild aortic regurgitation. mild dilatation of the aortic root. . cxr : cardiomegaly and widened mediastinum are unchanged. small-to-moderate bilateral pleural effusions, left greater than right, are stable. there are bilateral extensive pleural plaques. right picc remains in place in standard position. there is mild vascular congestion, minimally increased. bibasilar opacities are consistent with atelectasis. the sternal wires are aligned with unchanged fracture of the first wire. patient is status post cabg. there areno new lung abnormalities or evident pneumothorax. cta : impression: 1. stable appearance of 6.9 cm abdominal aortic aneurysm with no evidence of contained or impending rupture. imaging surveillance is recommended if other intervention is not performed. additionally, there is a right internal iliac aneurysm. 2. 2.0 x0.8 cm cystic lesion within the tail of the pancreas, with a second in the pancreatic head which should be further evaluated with mri on a non-emergent basis, which will also evaluate the renal lesions. 3. gallstones. 4. enlarged bladder, correlate with signs of outlet obstruction. osh workup: date: echocardiogram done : this was a technically difficult study. left ventricular systolic function was normal and there were no obvious wall motion abnormalities. the left atrium is dilated but the other were normal. there was moderate aortic insufficiency and mild mitral regurgitation. there was no pulmonary hypertension. . persantine myoview stress test : the test was negative for symptoms and ekg changes. the myoview perfusion scan showed a moderate sized perfusion defect in the inferior and infra-apical walls. this was a fixed defect but no reversible defects were seen. . cardiac catheterization : there was severe coronary artery disease with obstruction of the left main coronary artery. there was a total obstruction of the left anterior descending, circumflex and right coronary arteries. the lad artery beyond the graft filled poorly from the graft because of severe distal disease. the 2 marginals filled via the graft. the distal artery after its branches also filled via the graft. overall the bypass grafts were normal. the proximal second marginal artery had a significant proximal stenosis after the graft insertion, and could be treated percutaneously if symptoms occurred. carotid ultrasound -mild non-obstructive disease. historical studies: mibi : coronary artery bypass surgery : he had a the vein graft to the lad, a sequential vein graft to 2 marginal branches, and a vein graft to the distal right coronary artery. a calcified aneurysm of the lad was repaired at that time. brief hospital course: mr is a 78 yom who presented to osh with epigastric pain, shortness of breath, cough and chills, s/p fall on his right chest with ecchymosis, at osh found to have elevated trop and bnp, fever, leukocytosis, chf with ef of 25%, and aaa (6.7x6.5 cm), was treated with broad spectrum abx and diureses and transfered here for consideration of surgical intervention for aaa. upon admission to the ccu was found to be in respiratory distress with acute on chronic hypercarbic and hypoxic respiratory failure. his hospital course included treatment for an acute copd exacerbation, pneumonia treatment and treatment of acute pulmonary edema. in this setting, intervention upon the aaa was deferred until after further recovery, and was discussed with the patient and his family. . # copd exacerbation: admitted in repiratory distress with acute on chronic hypercarbia + hypoxia- the main pulmonary process per physical findings and radiology is likely exacerbation of his chronic respiratory disease (a combination of restrictive and obstructive pulmonary disease given h/o asbestosis, sleep apnea, and asthma) perhaps with some contribution from heart failure and resulting pulmonary congestions given pleural effusions and congestion on xray. per fever and leukocytosis at osh though he was also covered with abx for pneumonia, got ceftriaxone, azythro, vanco then transitioned to levofloxacin. in the micu patient was put on bipap with improvement in abg. he was started on standing nebs; continued ipratroprium + started levalbuterol(given ectopy). we also increased home advair to 500/50 (from 250/50). we started prednisone day 1 = (also got iv solumedrol 125mg on the night of admission to the ccu). we continued levofloxacine for a total of 7 days. his blood cultures and urine cultures were negative. on discharge: patient is leaving on a prednisone taper - 30mg for 3 days, 20mg for 3 days, and 10mg for 3 days. will need to continue with use of inhalers - this will need to be adjusted based on patient's respiratory status. patient will need his o2 sat monitored, with o2 therapy to maintain his o2 around 92%. # arrhythmia: per telemetry here has paf with rates to the 130??????s when in fib. asymptomatic with stable hd. we restarted his home carvedilol at 3.125 then uptitrated to 6.25. his chads2 score of 3 but does not appear to be candidate for anticagulation given his poor functional status and evidence of falls (bruise on chest), family understood this. # cad: patient has significant history of cad with question of mi. had modest trop levels to 0.13 in the setting of chf exacerbation , echo here showed focal lv wall hypokinesis consistent with cad , these findings are unchanged from those on mibi in which showed akinesia and severe perfusion defects in lad territory. thus patient is not thought to have had a recent mi. positive trop are likely to leak in the setting of chf exacerbation +/- sepsis. - continued asa 325 mg po daily - continued lisinopril - restarted home carvedilol - continued home simvastatin 80mg daily . # chf: echo here: mild symmetric lvh, lv is top normal/borderline dilated, mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the mid-distal anterior wall, apex, and distal anterior septum (lvef 35-40%). ??????left ventricular dysfunction c/w cad, mild aortic root dilatation (1+) aortic regurgitation is seen. trivial mitral regurgitation, mild phtn. currently is not clinically fluid overloaded. los fluid balance at tramsfer was -1600 - holding home lasix, goal i/o even for now - restarted acei once renal function improved - restarted home carvedilol - salt restrict to na 2g/daily on discharge: continue to monitor i&os - goal net- even daily. can restart home lasix if net positive. monitor creatinine if restarting home lasix. # aaa: infrarenal 7.5 cm newly found, no acute intervention per vasc . also on phys exam susp politeal aneurysms. patient initially transferred here for evaluation of surgical intervention. vascular surgery followed patient daily. currently vascular feels that patient needs to improve functional status prior to surgical intervention. on discharge: once patient is out of rehab he will need to follow up regarding surgical intervention for his large aaa. . # htn: blood pressures currently holding well - continued lisinopril as above - restarted home carvedilol on half home dose 6.25 on dischareg:- hold anti-hypertensives if sbp <100 . # hld: - continued simvastatin 80mg daily for now . # benign prostatic hyperplasia - continued proscar - foley on discharge: trial of void in 2 days. if fails, reinsert foley and consult urology services. transitional issues: #pancreas lesions - on cta - 2.0 x 0.8 cm cystic lesion within the tail of the pancreas, with a second in the pancreatic head which should be further evaluated with mri on a non-emergent basis, which will also evaluate the renal lesions. #aaa - patient will follow up with surgery as outpatient for elective endovascular repair of this aneurysm. surgery will set up all necessary services for pre-op. medications on admission: - aspirin 325 p.o. daily - lisinopril 20 p.o. daily - lasix 20 p.o. daily - carvedilol 6.25 p.o. - simvastatin 80mg daily - advair 250 one inhalation twice daily - prilosec 20 p.o. daily - flonase 50mcg 1 puff in both nostrils - proscar 5mg p.o. daily - trazodone 50 p.o. hs - senokot once daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 3. lasix 20 mg tablet sig: one (1) tablet po once a day. 4. carvedilol 6.25 mg tablet sig: one (1) tablet po twice a day. 5. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 6. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. proscar 5 mg tablet sig: one (1) tablet po once a day. 8. senokot 8.6 mg tablet sig: one (1) tablet po once a day. 9. trazodone 50 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 10. flonase 50 mcg/actuation spray, suspension sig: one (1) nasal twice a day. 11. olanzapine 2.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for agitation. disp:*30 tablet(s)* refills:*0* 12. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for back pain. 13. advair diskus 500-50 mcg/dose disk with device sig: one (1) inhalation twice a day. disp:*1 unit* refills:*0* 14. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for rash area. 15. prednisone 10 mg tablet sig: three (3) tablet po daily (daily): please take 30mg until , then take 20mg until , then take 10mg until then stop. . 16. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: two (2) disk with device inhalation (2 times a day). 17. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours). 18. sodium chloride 0.65 % aerosol, spray sig: sprays nasal daily (daily) as needed for nasal dryness. 19. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) inhalation q4h (). 20. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). discharge disposition: extended care facility: rehabilitation and nursing of discharge diagnosis: primary diagnosis: 1)copd exacerbation 2)abdominal aortic aneurysm secondary diagnosis: - cabg: emergency procedure at () - obstructive sleep apnea not on cpap - asthma - asbestosis - benign prostatic hypertrophy discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were transferred to our facility with trouble breathing, trouble walking, coughing as well as newly-discovered abdominal aortic aneurysm. we have treated your copd-exacerbation, and your breathing has improved. we have also treated you for a possible pneumonia. while in our care you were closely followed by the surgical team, who felt that your aneurysm will be repaired, but not during this admission. the following changes were made to your medications: start olanzapine 2.5 mg tablet one tablet at bedtime as needed for agitation. start tramadol 50 mg one (1) tablet q6h (every 6 hours) as needed for back pain. start advair discus at a new higher dose of 500-50 mcg twice a day start prednisone - take 3 pills for 2 days, 2 pills for 3 days, then 1 pill for 3 days, then stop. start sodium-chloride nasal spray - twice a day as needed start ipratropium-bromide nebulizer treatments every 4 hours as needed for shortness of breath. start levalbuterol nebulizer treatment every 4 hours as needed for shortness of breath. start fluticasone spray twice a day as needed. please hold your lasix until told to restart it by your physician. followup instructions: please set up an appointment with primary care doctor e from the rehab facility. department: vascular surgery when: tuesday at 1 pm with: , md building: lm campus: west best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids acute kidney failure, unspecified atrial fibrillation aortocoronary bypass status other chronic pulmonary heart diseases hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute and chronic respiratory failure chronic obstructive asthma with (acute) exacerbation abdominal aneurysm without mention of rupture acute on chronic systolic heart failure fall from other slipping, tripping, or stumbling asbestosis delirium due to conditions classified elsewhere cyst and pseudocyst of pancreas other nonspecific abnormal serum enzyme levels contusion of chest wall other specified retention of urine mixed acid-base balance disorder dysphagia, oral phase 

Answer: The patient is high likely exposed to