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: penicillins attending: chief complaint: shortness of breath major surgical or invasive procedure: thoracentesis bronchoscopy history of present illness: this is an 81 year old lady with hx copd, cabg-avr (), atrial fibrillation, hypertension and hyperlipidemia who presents with progressive shortness of breath and cough. she reports the symptoms of shortness of breath are chronic and have been worsening for the past year exacerbated by a protracted hospital course in for a cabg-avr. the symptoms over the weekend have worsened and today, she called her daughter who encouraged her to go to the emergency department for evaluation. she denies fevers, chills, nausea, vomiting, gi sx, chest pain. she reports her symptoms are not easily improved with home nebulyzer therapy. she denies sick contacts and reports discharge from rehab in late . she has not been hospitalized or received antibiotics since that time. she has no contact with small children or recent travel. lives alone. no h/o blood clots or cancer history. quit smoking 15-20 years ago. she was given azithromycin 1 month prior for management of her shortness of breath and experienced no improvement. she is on hme oxygen which initially was for just at night but she uses continuously. unclear oxygen requirement. she sleeps with 2 pills, unable to lie flat. denies lower extremity swelling. in the ed, initial vs were: 80 153/71 40 69%. initial labs were significant for wbc na 129, hc03 33, cr 0.6, lactate 1.4 and troponin < 0.01. a cxr demonstrated an extensive right infrahilar opacity and a patchy retrocardiac opacity that was concerning for pneumonia in addition to mild vascular congestion. an ekg showed afib at 89 w/ lateral st depressions. for her tachypnea, the patient was given albuterol and ipratropium nebulyzer therapy x 2 in addition to 125 mg iv methylprednisone. for her possible pneumonia she was started on vancomycin and levofloxacin. given her worsening exam and persistent tachypnea, a trial of bipap was started which the patient ultimately did not tolerate and refused. transfer to the medical icu was initiated when the patient did not improve with initial medical therapy. vitals on tranfer were: vitals 100 156/100 34 100% on 4l. on arrival to the micu, initial vitals were: 110 158/93 19 95% on 2l nc. she was comfortable and reported her breathing was improved since being in the emergency department. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: hyperlipidemia hypertension copd osteopenia pulmonary nodule transaminitis atypical chest pain diverticulosis aortic valve stenosis: avr/single vz cabg (svg-om) by dr. on cabg primary open angle glaucoma multifocal atrial tachycardia transient ischemic attack: (s/p tpa @ nwh after presenting with rle weakness carotid stenosis: (50-69% and stenoses) seizure history atrial fibrillation social history: - tobacco: quit > 15 years ago - alcohol: glass of wine in the evening - illicits: no - housing: lives alone, close with adaughter who live nearby - employment; formerly worked in travel family history: nc physical exam: admission: vitals: 110 158/93 19 95% on 2l general: alert, oriented, breathing through pursed lips. heent: sclera anicteric, mmm, oropharynx clear, eomi neck: supple, jvp not elevated, no lad cv: irregular rate and rhythm. systolic ejection murmur. lungs: inspiratory and expiratory wheeze with prolongued expiratory phase. no crackles. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact discharge: vs: 98-98.6, 100-138/50-79, 60-93, 98-100% 2l o2 general- alert, oriented x 3, lying comfortable in no acute distress heent: sclera anicteric, perrla, eomi, mmm, op clear thorax- decreased breath sounds with scattered bibasilar rhonchi. no wheezes or rales. cv- irregularly irregular rhythm with regular rate, normal s1 and loud s2 with some irregular splitting. no rubs, gallops. no jvd abdomen- soft, non-tender, non-distended w/ normoactive bowel sounds, no organomegaly ms- no evidence of swelling or deformity. good rom present ext- wwp, 2+ pulses in dp bilaterally. no clubbing, cyanosis or edema skin- few ecchymoses noted bilaterally on leg. no ulcers, lesions neuro- cns2-12 grossly intact but decreased hearing to finger rub pertinent results: 06:50pm glucose-122* urea n-13 creat-0.5 sodium-129* potassium-3.8 chloride-88* total co2-33* anion gap-12 06:50pm calcium-9.0 phosphate-3.4 magnesium-1.7 06:00pm lactate-1.4 05:50pm ctropnt-<0.01 05:50pm wbc-9.0 rbc-4.34 hgb-12.8 hct-39.2 mcv-90 mch-29.5 mchc-32.7 rdw-13.6 05:50pm neuts-79.5* lymphs-13.9* monos-4.4 eos-1.5 basos-0.7 05:50pm plt count-294 05:50pm pt-48.7* ptt-42.4* inr(pt)-4.8* 07:30am blood wbc-6.2 rbc-4.11* hgb-12.0 hct-36.9 mcv-90 mch-29.1 mchc-32.5 rdw-13.7 plt ct-198 06:30am blood pt-18.9* ptt-30.4 inr(pt)-1.8* 07:30am blood pt-16.2* ptt-31.6 inr(pt)-1.5* 07:35am blood pt-16.9* inr(pt)-1.6* 07:30am blood pt-26.0* inr(pt)-2.5* 07:30am blood glucose-83 urean-11 creat-0.5 na-134 k-4.1 cl-93* hco3-36* angap-9 03:20pm blood ld(ldh)-261* 06:20am blood probnp-2627* 05:50pm blood ctropnt-<0.01 07:30am blood calcium-8.5 phos-2.9 mg-2.0 05:43am blood osmolal-269* 03:47pm blood type-art po2-87 pco2-55* ph-7.47* caltco2-41* base xs-13 06:00pm blood lactate-1.4 06:41pm urine hours-random na-71 k-47 cl-52 04:30pm pleural wbc-1800* rbc-1050* polys-14* lymphs-39* monos-4* meso-6* macro-37* 04:30pm pleural totprot-2.5 glucose-149 ld(ldh)-115 amylase-11 albumin-1.5 cholest-56 triglyc-9 02:55pm other body fluid polys-96* lymphs-3* monos-0 macro-1* micro: 2:50 pm bronchial washings bronchial wash. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. 10,000-100,000 organisms/ml.. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s legionella culture (preliminary): no legionella isolated. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 2:55 pm bronchoalveolar lavage right middle lobe. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. 10,000-100,000 organisms/ml.. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s legionella culture (preliminary): no legionella isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 3:28 pm pleural fluid gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. 6:00 am urine source: catheter. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. 4:38 pm sputum source: expectorated. **final report ** 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. 9:30 am mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. blood cultures negative x2 reports: ecg study date of 5:48:38 pm atrial fibrillation with a controlled ventricular response. baseline artifact. anteroseptal myocardial infarction of indeterminate age. compared to the previous tracing of , atrial fibrillation has replaced sinus rhythm. otherwise, no diagnostic interim change. chest (portable ap) study date of 6:00 pm findings: the patient is status post coronary artery bypass graft surgery. the heart appears likely at the upper limits of normal size although not optimally assessed. the mediastinal contours are unremarkable. there is a confluent right infrahilar opacity in the right lower lung with kerley b lines and blunting of the right cardiophrenic angle, quite asymmetric. patchy retrocardiac opacity is less specific but an additional focus of pneumonia could be considered versus atelectasis. there is mild background perihilar fullness suggesting pulmonary venous hypertension or slight fluid overload, but not substantial. each costophrenic sulcus is blunted which may suggest pleural effusions. impression: extensive right infrahilar opacity worrisome for pneumonia. follow-up radiographs are recommended to show resolution. patchy retrocardiac opacity, possibly atelectasis or pneumonia. findings also suggestive of mild vascular congestion or fluid overload. portable tte (complete) done at 11:50:28 am final impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. well seated aortic valve bioprosthesis with normal gradient. mild-moderate mitral regurgitation. pulmonary artery hypertension. increased pcwp. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. ct chest w/o contrast study date of 10:00 am findings: moderate right and small left nonhemorrhagic pleural effusions layer posteriorly. in addition to asbestos-related pleural plaques, some calcified, such as the largest adjacent to the right middle lobe, 2:40, and others on both sides of the posterior chest, 2:41, there is a suggestion of even greater pleural thickening in the right posterior pleural sulcus which raises concern for pleural tumor. there is no indication of pulmonary fibrosis. a roughly elliptical opacity in the right middle lobe sitting on an elevated aspect of the right major fissure has both the morphology--short, nodular branching extensions--and also the low attenuation characteristics of mucoid impaction, 15 to 18 , but does not really conform to bronchial branches, 4:147-185 and 601b:19-12. the only other lung lesion is an irregular 4-mm wide nodule in the right middle lobe, 4:166. there is no consolidation. the questionned right lower lobe "infiltrate" was probably a combination of the middle lobe lesion and superimposed, moderate right pleural effusion. motion artifact makes it difficult to say whether mild bronchial wall thickening is present, but there is no substantial bronchiectasis. the only enlarged central lymph node is in the right lower paratracheal station, 13 mm across, 2:27. the caliber of the intrapericardial pulmonary artery, 31 mm, suggests pulmonary arterial hypertension. the patient has had median sternotomy, coronary bypass grafting and aortic valve replacement. moderate cardiomegaly is mostly due to enlarged atria. atherosclerotic calcification is most pronounced at the origin of the left subclavian artery, but is scattered throughout head and neck vessels and the normal size thoracic and abdominal aorta. impression: 1. despite asbestos-related pleural plaques found elsewhere, moderate right pleural effusion and more pronounced pleural thickening in the right lower chest raise concern for malignant mesothelioma or adenocarcinoma in the right pleural space. 2. lesion in right middle lobe could be an atypical mucoid impaction, but endobronchial tumor is a reasonable alternative. pet ct scanning is recommended for evaluation of both lung and pleural lesions. 3. possible pulmonary arterial hypertension. ct chest w/contrast study date of 9:34 am findings: small right and trace left non-hemorrhagic pleural effusions are improved since the prior exam. note is again made of asbestos-related pleural plaques, some of which are calcified. the pulmonary vasculature appears unremarkable. there is atherosclerotic calcification within the thoracic aorta. right main pulmonary artery measures 31 mm, suggesting pulmonary arterial hypertension. cardiomegaly is also noted. right paratracheal lymph nodes are unchanged from the prior exam measuring upto 9mm in short axis diameter. there are multiple areas of mucoid impaction scattered throughout the lungs bilaterally ($eries 4: images 132;135;145;147;149). bronchial wall thickening is noted in the right lower lobe as well. multiple sub-5mm pulmonary nodules (series 603: images 9, 16; 22; 25; 27) are unchanged. an elliptical lesion in the right middle lobe with short nodular branching extensions appears most consistent with mucoid impaction, measuring 19 x 11mm, previously 24 x 10mm at a comparable level. impression: 1. asbestos-related pleural plaques with improved small right pleural effusion and trace left pleural effusion. 2. an elliptical lesion in the right middle lobe with short nodular branching extensions appears most consistent with mucoid impaction, measuring 19 x 11mm, previously 24 x 10mm at a comparable level (size comparisons were requested by the consulting pulmonary team). bronchosocpy with direct visualization should be considered to rule out a smaller stenotic lesion or endobronchial tumor. 3. possible pulmonary arterial hypertension. 4. multiple areas of mucoid impaction scattered throughout the lungs bilaterally as noted above. 5. multiple sub-5mm pulmonary nodules (series 603: images 9, 16; 22; 25; 27) are unchanged. bronchial washings procedure date of diagnosis: bronchial washings: atypical. scattered atypical epithelial cells, cannot exclude reactive changes. numerous neutrophils. brief hospital course: 81f w/ hx of copd, avr-cabg x 1 (svg-om) (), atrial fibrillation, and hypertension who presented with acute on chronic dyspnea and was treated for copd exacerbation, pneumonia and acute on chronic congestive heart failure. # right middle lobe lesion/ mrsa pneumonia/ other etiology: seen initially on chest ct and was comperable following a 7 day course of levofloxacin, chest pt, and diuresis. consider mucus impaction, infection versus neoplastic growth. by bronchoscopy, patient with lots of mucus and friable mucusa. bronchoscopy cultures growing mrsa and patient started on mrsa coverage with vancomycin x1 day and sent out with 2 weeks of linezolid po as well as an additional 2 weeks of levofloxacin. concerning atypical cells found on cytology from washings. patient was instructed to continue chest pt with: - tid nebulized saline with flutter device. - repeat chest ct in 1 month - follow up in clinic after chest ct # pleural effusions: 350ml of amber pleural fluid was drained from the right side and was positive for wbc and rbcs with lymphocyte and macrophage predominance. the fluid's protein and ldh ratios do not meet light's criteria although cholesterol content is > 45mg/dl: likely transudative and is concerning for heart failure or an atypical presentation of malignancy related effusion. given that she had mild vascular congestion on ct and known hx of as and htn, she may have diastolic dysfuntion that is primarily contributing bilaterally to the pleural effusion. it is also concerning for a malignancy due to the pronounced pleural thickening that is concerning for malignant mesothelioma or endobronchial tumor. patient continued on hydrochlorothiazide 25 mg po/ng daily - f/u with pleural fluid cytology/ cell block # dyspnea with 2l o2 nc. treated as a copd exacerbation initially with 5 days of prednisone and a 3 week course of levofloxacin and 2 weeks of linezolid (starting at time of discharge). mrs. dyspnea has improved and is closer to her baseline following inital treatment with predinsone. it is likely that it was multifactorial with a combination of copd exacerbation, pneumonia, and vascular congestion. patient was started on morphine sulfate ir 7.5 mg po/ng q6h:prn dyspnea and continued levofloxacin 750 mg po/ng q48h duration: 22 days day 1 = last day is as well as: - albuterol 0.083% neb soln 1 neb ih - fluticasone-salmeterol diskus (250/50) 1 inh ih (decreased from 500/50) - stop guaifenesin ml po/ng q6h:prn cough - continue ipratropium bromide neb 1 neb ih q6h - continue tiotropium bromide 1 cap ih daily ambulator sat above 90% with walking and 2l nc, although component of deconditioning/ fatigue. # atrial fibrillation: chads2 score: 4. initially presented as peri-operative complication from her avr in and now persistent. she is scheduled for cardioversion week of - . rate controlled with diltiazem and anticoagulation with coumadin. inr supratherapeutic on admission at 4.8 (goal inr ) so coumadin was held while in micu. given initial concern for afib causing pulm edema, tte was performed which showed lvef>55%, mild lvh, mild-mod mr, pah with elevated pcwp>18. she had no palpitations or chest pain. we decreased her dilt to diltiazem extended-release 120 mg po daily. patient was bridged with lovenox, stopped on with inr of 2.6 and discharged on 1mg warfarin daily. # hypertension: continued home hctz, decreased diltiazem as above. # sp cabg avr: cp free on admission with negative cardiac enzymes. no baseline ekg. continued aspirin. # white spots in oropharynx: improved spots on oropharynx are concerning for thrush due to inhaled steroid use. given that spots persists, this is less concerning for food stuck on palate. unroofing of the spots was not attempted on physical exam. she is not known to be immunocompromised systemically. decreasing in size, but persisting. we discharged with 5 more days of nystatin oral suspension 5 ml po tid and instructed patient to rinse mouth after inhaled steroid use # seizure: peri-operative complication of recent avr. continued keppra 50mg er . no evidence of seizure activity during admission. she is scheduled for outpatient mri and eeg in 2 weeks. # glaucoma: pt has a history of glaucoma s/p surgical intervention on the right. - continue latanoprost 0.005% ophth. soln. 1 drop left eye hs - continue timolol maleate 0.5% 1 drop left eye # insomnia: continued trazadone qhs # code status: dnr/dni (confirmed with patient) # transitional: - patient needs follow up with atrius pulmonology in 1 month and ct chest prior to appointment (pending but patient on call back list) - pleural fluid and cell block pending from thoracentesis - atypical cells on bronchial washings, likely reactive but needs follow up ct which is being scheduled. - weekly cbc while on linezolid medications on admission: 1. metoprolol tartrate 25 mg oral tablet 1 tab po bid 2. diltiazem hcl 90 mg oral capsule,extended release 12 hr 1 capsule twice daily 3. warfarin 1 mg oral tablet take 1 tablet (1mg) for 3 days (mwf) and 2 tablets (2mg) for 4 daily or as directed 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) inhalation solution for nebulization use 1 ampule (3ml) every four to six hours as needed 5. fluticasone-salmeterol (advair diskus) 500-50 mcg/dose inhalation disk with device inhale 1 puff twice daily and rinse mouth thoroughly afterward 6. tiotropium bromide (spiriva with handihaler) 18 mcg inhalation capsule, w/inhalation device 1 capsule inhaled daily 7. trazodone 50 mg oral tablet take tablet (25mg) at bedtime as needed for sleep. 8. aspirin ( low-dose aspirin) 81 mg oral tablet, chewable 1 by mouth once daily 9. docusate sodium 100 mg oral capsule take capsules daily as needed; available over the counter 10. levetiracetam (keppra xr) 500 mg oral tablet extended release 24 hr 1 po bid 11. hydrochlorothiazide 25 mg oral tablet take 1 tablet daily 12. latanoprost (xalatan) 0.005 % ophthalmic drops instill 1 drop in left eye at bedtime 13. albuterol sulfate (proair hfa) 90 mcg/actuation inhalation hfa aerosol inhaler inhale 2 puffs four times daily ; rinse mouthpiece at least once per week. 14. timolol maleate (timoptic) 0.5 % ophthalmic drops instill 1 drop in left eye twice daily 15. multivitamin capsule po (multivitamins) 1 tablet daily 16. calcium + d tablet 600-200 po 1 tablet po qd discharge medications: 1. aspirin 81 mg po daily 2. docusate sodium 100 mg po bid 3. fluticasone-salmeterol diskus (250/50) 1 inh ih 4. hydrochlorothiazide 25 mg po daily do not give if sbp < 100 or hr <60 5. latanoprost 0.005% ophth. soln. 1 drop left eye hs 6. levetiracetam 500 mg po bid 7. metoprolol tartrate 25 mg po bid hold for sbp < 100 or hr< 60 8. morphine sulfate ir 7.5 mg po q6h:prn dyspnea hold for sedation, rr<10 9. timolol maleate 0.5% 1 drop left eye 10. tiotropium bromide 1 cap ih daily 11. trazodone 25-50 mg po hs:prn insomnia 12. levofloxacin 750 mg po q24h day 1 = . planned duration until . 13. bisacodyl 10 mg po/pr daily:prn constipation 14. polyethylene glycol 17 g po daily:prn constipation 15. senna 1 tab po bid:prn constipation 16. nystatin oral suspension 5 ml po tid swish and spit. stop on . 17. albuterol 0.083% neb soln 1 neb ih q6h 18. diltiazem extended-release 120 mg po daily 19. warfarin 1 mg po daily16 20. simvastatin 20 mg po daily 21. ipratropium bromide neb 1 neb ih q6h 22. linezolid 600 mg po q12h continue through . 23. albuterol inhaler 2 puff ih q6h:prn dyspnea/wheezing 24. neb nebulized saline tid followed by flutter valve. discharge disposition: extended care facility: - discharge diagnosis: primary: copd exacerbation, acute heart failure, pulmonary effusions secondary: hyperlipidemia, hypertension, primary open angle glaucoma, coronary artery disease, atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was our pleasure to care for you at . you were admitted for shortness of breath and were found to have numerous possible causes. we treated you for an exacerbation of your copd, started you on antibiotics for pneumonia, and removed fluid from your outside your lung. in addition, you underwent a procedure to test the fluid in your lung to see which bacteria was causing the pneumonia to ensure that you are on the correct antibiotics. you are being discharged to rehab on supplemental oxygen. there, you will complete your antibiotics (linezolid and levofloxacin) and should have a weekly blood test (cbc) to make sure that your blood levels remain fine, as linezolid can drop your white blood cell count. you will follow up with your pulmonologist in ~4 weeks including a repeat of the chest ct. at the time of discharge today, there are some studies pending but you can discuss the results at your follow-up appointment. note that today () your inr is therapeutic, but recently it was not. whenever your inr is <2, you should be covered with lovenox injections because of your risk of stroke. you are scheduled to have follow-up with your cardiologist, especially because there are possible plans for an intervention on your abnormal heart rhythm. we made the following changes to your medications: please start levofloxacin until please start linezolid until please decrease simvastatin to 20mg daily, from 40mg daily please decrease fluticasone-salmeterol diskus to 250/50 from 500/50 changed warfarin dose changed diltiazem dose please start a short course of nystatin for thrush (stop on ) please start morphine as needed for pain please start colace, senna, miralax, and bisacodyl as needed for constipation please get your inr checked on please get a cbc checked on and followup instructions: cardiology name: , location: --cardiology address: , , phone: appt: at 8:50am pulmonology ***it is recommended you follow up with a pulmonologist within 4 weeks of discharge. the pulmonary office at is working on an appt for you and will call you at home with the appt. if you dont hear from them by within 2 business days, please call the office directly at to book. procedure: thoracentesis other lavage of bronchus and trachea closed [endoscopic] biopsy of bronchus diagnoses: unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension hyposmolality and/or hyponatremia atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status unspecified glaucoma candidiasis of mouth constipation, unspecified other and unspecified hyperlipidemia disorders of phosphorus metabolism epilepsy, unspecified, without mention of intractable epilepsy do not resuscitate status heart valve replaced by transplant diverticulosis of colon (without mention of hemorrhage) disorder of bone and cartilage, unspecified insomnia, unspecified pleurisy without mention of effusion or current tuberculosis mixed acid-base balance disorder inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation methicillin resistant pneumonia due to staphylococcus aureus solitary pulmonary nodule foreign body in other specified parts bronchus and lung 

Answer: The patient is high likely exposed to