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: history of present illness: the patient is a 67 year-old man with a history of metastatic gastric carcinoma who was recently started on hospice care and then presented to the emergency department on with severe left hip pain and inability to ambulate. the onset of these symptoms were precipitated by a fall from a chair four hours prior to admission. while in the emergency department the patient continued to complain of excruciating pain. an x-ray of his left hip demonstrated a left femoral neck fracture with displacement. past medical history: 1. metastatic gastric carcinoma diagnosed approximately one year ago. 2. status post partial gastrectomy. 3. chronic obstructive pulmonary disease. 4. history of deep venous thrombosis. 5. history of coronary artery disease. allergies: penicillin and aspirin. medications: 1. fentanyl patch 50 micrograms transdermal q 72 hours. 2. hydromorphone 4 mg po prn pain. 3. pantoprazole 40 mg po q.d. 4. metoclopramide 10 mg po prn nausea. 5. warfarin 2 mg po q.h.s. 6. diltiazem 60 mg po q.i.d. 7. compazine 5 to 10 mg po q 6 hours prn. 8. cosopt eye drops one drop to each eye q.d. social history: the patient denies current alcohol or tobacco use, although he reportedly has a significant smoking history. he is married and he lives at home with his wife. family history: noncontributory. physical examination: the patient's temperature was 99.8 degrees. blood pressure 128/54. heart rate 91. respirations 20. oxygen saturation 97% on 6 liters face mask. in general, the patient was calm, however, he was clearly short of breath and in obvious pain. on heent examination his pupils were equally round and reactive to light and accommodation. his extraocular movements intact. his oral mucosa were dry. his neck was supple. there was no jvd. no carotid bruits. no adenopathy. his heart was a regular rate and rhythm. there was normal s1 and s2 heart sounds and there were no murmurs, rubs or gallops. he had decreased breath sounds at the bases with mild crackles and wheezes bilaterally. his abdomen was soft, nontender, nondistended. there were active bowel sounds and there was no palpable hepatosplenomegaly. neurological examination he was alert and oriented times three. he had decreased strength in his left lower extremity, because of pain, and his sensory examination was grossly intact. he had no peripheral edema and he had 2+ dorsalis pedis pulses bilaterally. initial laboratory evaluation: the patient's white blood cell was 16, hematocrit 20.2, platelets 739. his pt was 13.7, ptt 28.6 and inr 1.3. initial serum chemistries demonstrated a sodium of 129, potassium 4.5, chloride 93, bicarbonate 22, bun 40, creatinine 1.5, glucose 135. initial arterial blood gas demonstrated a ph of 7.37, pco2 74, pao2 of 46 on 6 liters by face mask. his serum lactate was 1.1. hospital course: although the patient had recently been initiated on hospice care, the decision was made for the patient to undergo a left hemiarthroplasty for repair of his left femoral neck fracture, given that this procedure would give the patient the best chance of early ambulation with full weight bearing. however, given his reported history of coronary artery disease, a cardiology consult was obtained for clearance prior to this operative procedure. the cardiology service felt that the patient was asymptomatic from a cardiovascular standpoint at a low functional level. they felt that his baseline dyspnea on exertion was likely secondary to his chronic obstructive pulmonary disease. they felt that given his recent cardiac catheterization in , which demonstrated normal coronaries and an absence of symptoms, the patient was unlikely to have a flow limiting coronary artery disease. they recommended changing his diltiazem to a beta blocker perioperatively. this adjustment was made. given his significant anemia on presentation to the , the patient was also transfused 3 units of packed red blood cells prior to the operative procedure. the patient went to the operating room on for his left hemiarthroplasty. although this procedure was uncomplicated from an orthopedics point of view, while in the operating room the patient reportedly dropped his oxygen saturation to 75 to 80%. airway suctioning done at that time reportedly demonstrated copious amounts of coffee ground emesis. a repeat chest x-ray done following the procedure demonstrated diffuse, patchy opacification of the right middle and lower lobes consistent with an aspiration pneumonia. given the appearance of this chest x-ray and the patient's history of chronic obstructive pulmonary disease, he was deemed to be a poor candidate for weaning off of mechanical ventilation and was therefore transferred to the micu for continued monitoring. the remainder of the hospital course by systems: 1. respiratory failure: as noted above the patient aspirated coffee ground emesis (likely gastric contents given his history of gastric cancer) during his left hemiarthroplasty and was therefore intubated for further airway protection. he initially required frequent suctioning of coffee ground emesis, but he gradually required less and less suctioning following his successful extubation on . by the time of discharge from the hospital the patient was requiring minimal self suctioning of tannish secretions. a repeat chest x-ray done on demonstrated marked interval improvements in his right middle lobe and right lower lobe atelectatic changes. there was also evidence of patchy left lower lobe consolidation and a right perihilar consolidation possibly consistent with a multifocal aspiration pneumonia. on physical examination, however, his lungs were clear to auscultation bilaterally and the patient was maintaining good oxygen saturation on room air. he was continued on his baseline chronic obstructive pulmonary disease medications (fluticasone, salmeterol, and combivent inhalers). he was also started on clindamycin 600 mg intravenous q 8 hours following his orthopedic procedure for empiric coverage of his aspiration pneumonia. this medication was changed to an oral formulation prior to his discharge from the hospital. overall, at the time of discharge from the hospital the patient's respiratory status was markedly improved and appeared to be at its baseline. 2. gastric cancer: the patient has a known metastatic gastric cancer and was recently begun on hospice care. his gastric cancer was the presumed source of his coffee ground emesis. although his hematocrit was found to be 20 on admission he was subsequently transfused a total of 4 units of packed red blood cells throughout the admission and his hematocrit subsequently increased to 32. at the time of discharge the patient's hematocrit was stable at approximately 27.5. he was continued on pantoprazole 40 mg intravenous q 12 hours given his coffee ground emesis. plans were discussed with the patient and his wife for transfer and reinitiation of hospice care following his discharge from the hospital. 3. left femoral neck fracture: at the time of discharge the patient was postoperative day number four following a left hemiarthroplasty for his left femoral neck fracture. he began working with physical therapy on , the physical therapist recommended inpatient rehabilitation with transition to home hospice care following discharge from the hospital. although he continued to experience left hip and knee pain, the patient began transferring from bed to chair with the assistance of the physical therapist. although the patient ideally would have been resumed on anticoagulative therapy with warfarin following his orthopedic procedure, given that he was having continued coffee ground emesis presumably from his gastric cancer, the patient was not restarted on anticoagulative medications following his orthopedic procedure. he was instead maintained on sequential compression devices of his bilateral lower extremities for deep venous thrombosis prophylaxis. at the time of discharge, however, the patient no longer had coffee ground emesis and he was therefore restarted on heparin 5000 units subq b.i.d. for deep venous thrombosis prophylaxis. 4. cardiovascular: the patient had a transient episode of hypotension while on a propofol drip while he was still intubated. this episode spontaneously resolved and did not recur once off of the propofol drip. he remained hemodynamically stable throughout the remainder of his admission. although he had previously taken diltiazem 60 mg po q.i.d. for a history of hypertension the patient was not hypertensive during this admission and this medication was not restarted. plans were made to reinitiate this medication following his discharge from the hospital. 5. neurological: the patient continued to complain of abdominal pain as well as left hip and knee pain postoperatively. his fentanyl patch was therefore increased to 75 micrograms q 72 hours and the patient was initiated on intravenous morphine 1 to 2 mg q one hours prn as needed for pain. the patient achieved adequate pain control with this regimen. 6. renal: the patient's bun and creatinine remained stable throughout the admission. his creatinine decreased to 0.5 at the time of discharge from the hospital, indicating that he likely had a component of acute renal failure at the time of his presentation to the hospital. this acute renal failure was most likely secondary to hypovolemia. 7. fen: the patient was maintained on maintenance intravenous fluids throughout this hospitalization given his relatively poor po intake. his electrolytes were repleted as needed. he was started on a clear liquid diet on the day prior to discharge, however, the patient did not have significant po intake during this hospitalization. 8. infectious disease: the patient had a presumed aspiration pneumonia as noted above. his white blood cell count gradually decreased throughout his hospitalization and he remained afebrile. he was continued on clindamycin as noted above. discharge condition: stable. discharge placement: the patient was discharged to a rehabilitation nursing facility for further physical therapy to increase his strength and gait mobility. the plan was for subsequent discharge to home hospice following this rehabilitation stay. discharge diagnoses: 1. displaced left femoral neck fracture status post left hemiarthroplasty. 2. metastatic gastric cancer status post partial gastrectomy. 3. chronic obstructive pulmonary disease. 4. history of deep venous thrombosis. 5. hypertension. 6. aspiration pneumonia. discharge medications: 1. fentanyl patch 75 micrograms q 72 hours. 2. combivent inhaler two puffs b.i.d. 3. fluticasone inhaler three puffs b.i.d. 4. salmeterol inhaler two puffs b.i.d. 5. clindamycin 300 mg po q.i.d. 6. pantoprazole 40 mg po b.i.d. 9. brimonidine drops to each eye q 8 hours. 10. dorzolamide drops to each eye q.d. 11. morphine sulfate 1 to 2 mg intravenous q one hour prn pain. the patient was instructed to follow up with dr. as necessary for further follow up of his metastatic gastric carcinoma. he was also given a telephone number for the clinic to follow up with them as directed for further management of his left hemiarthroplasty following his left femoral neck fracture. , m.d. dictated by: medquist36 procedure: partial hip replacement diagnoses: coronary atherosclerosis of native coronary artery acute kidney failure, unspecified pneumonitis due to inhalation of food or vomitus other emphysema other malignant neoplasm without specification of site closed fracture of unspecified part of neck of femur malignant neoplasm of stomach, unspecified site 

Answer: The patient is high likely exposed to