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: erythromycin base attending: chief complaint: dyspnea major surgical or invasive procedure: picc line placement history of present illness: 66 yof w/ a h/o myasthenia presents with labored breathing. the patient had been at for the past 1 month with pneumonia and copd. she had planned on being transferred to rehab today and had also had a scheduled neurology appointment. while at the neurologist's office she was noted to have labored breathing. she did not feel subjectively short of breath and per her daughter, she had similar breathing for the month. while at the neurologist's office the physician stated that she appeared in no shape to go to rehab and should go to the emergency room. the patient currently denies any sob, chest pain, pleuritic chest pain, hemoptysis or cough. she has been relatively immobile at the hospital, but with assistance can walk with a walker. her husband noticed some pedal edema (bilateral) 3 days ago. per her daughter she has memory deficits and occasional confusion. the patient denies urinary complaints, constipation or diarrhea, nausea / vomiting, no fevers / chills. in the ed, initial vs: t 97 hr 90 bp 128/80 rr 24 o2 sat: 100% on 3l. she underwent a cta of her chest which revealed subsegmental pes. her ekg revealed an ste so a code stemi was called, cardiology fellow evaluated the patient and deemed this not to be a stemi and suggested a cta of her chest. the patient had rec'd asa and plavix load (300mg). vs prior to tranfer hr 92, bp 99/62, rr 28, 96% on 3l. past medical history: 1. myasthenia dx in : primary neurologist in , mild crisis in past marked by visual changes (diplopia) nd generalized weakness, treated with mestinon 60mg tid, prednisone and cellcept. at baseline, uses wheelchair for any extended travel and walks around the home with a walker, adls with support by her husband- primary caretaker 2. stroke, - residual weakness in blle 3. history of lung ca in , s/p chemoradiation, treated by dr. in , ? small cell lung cancer. 4. atrial fibrillation on dig/coumadin 5. hypertension 6. hypercholesterolemia 7. osa 8. gerd 9. chronic low back pain 10. spine surgery, 11. bilateral knee arthroscopy 12. degenerative arthritis 13. cholescystecomy social history: she was discharged from to rehab. has a prior history of heavy smoking. family history: noncontributory physical exam: (per admitting resident) vitals - t: 96.9 bp: 100/48 hr: 94 rr: 26 02 sat: 95% on 3l nc general: nad, aox3 heent: mmm, eomi, perrl, conjunctiva pink, sclera anicteric cardiac: rrr, no m/r/g lung: ctab although decreased breath sounds throughout abdomen: soft, nt, nd, no masses or organomegaly, bs+ ext: wwp, trace bilateral edema there is normal muscle bulk and tone throughout. neck extension is 5-/5, and neck flexion is 5-/5. d b t wf we adm ip q hs df l 4+ 5- 5- 5 5 4 4- 5 4+ 4 r 4+ 4+ 5- 5 5 5- 4- 5- 4+ 4 at time of discharge, vs 97.9 76 hr 70s-80s bp 120/72 rr 20-24 92-95% 2l nc she had decreased bs on pulmonary exam with scant expiratory wheezes and basilar rales. has 1+ pitting edema b/l. patient weak overall related to illness and mg but neuro exam unchanged from admission. pertinent results: admission labs 01:10pm blood wbc-7.9 rbc-4.15* hgb-12.8 hct-38.3 mcv-92 mch-30.9 mchc-33.5 rdw-17.6* plt ct-106*# 01:10pm blood neuts-90.4* lymphs-6.0* monos-3.2 eos-0.1 baso-0.2 01:10pm blood pt-18.3* ptt-20.6* inr(pt)-1.7* 01:10pm blood glucose-177* urean-28* creat-1.1 na-135 k-5.0 cl-91* hco3-32 angap-17 01:15pm blood lactate-2.7* discharge labs 04:59am blood wbc-5.8 rbc-3.42* hgb-11.1* hct-32.3* mcv-95 mch-32.4* mchc-34.3 rdw-18.1* plt ct-122* 04:59am blood pt-19.7* ptt-84.5* inr(pt)-1.8* 04:59am blood glucose-108* urean-17 creat-0.9 na-136 k-4.5 cl-99 hco3-29 angap-13 . 05:25am blood wbc-5.6 rbc-3.21* hgb-10.4* hct-30.4* mcv-95 mch-32.3* mchc-34.1 rdw-18.3* plt ct-127* 05:25am blood pt-21.2* ptt-48.5* inr(pt)-2.0* 05:25am blood glucose-119* urean-18 creat-0.9 na-135 k-4.3 cl-99 hco3-24 angap-16 cardiac enzymes 01:10pm blood ck(cpk)-34 ck-mb-notdone ctropnt-0.04* 08:35pm blood ck(cpk)-53 ck-mb-notdone ctropnt-0.07* 03:15am blood ck(cpk)-25* ck-mb-notdone ctropnt-0.05* probnp-1523* urine studies 03:06am urine color-yellow appear-clear sp -1.039* 03:06am urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg 03:06am urine rbc-8* wbc-2 bacteri-none yeast-rare epi-0 imaging: cxr () - impression: left basilar atelectasis. unchanged cardiomegaly. cta chest () - impression: 1. left lower lobe segmental and subsegmental acute pulmonary embolism. 2. persistent but slightly decreased right infrahilar density now measuring 11 x 13 mm. as mentioned previously, pet-ct is recommended to exclude underlying neoplasm. 3. interval resolution of left upper lobe opacity. left upper lobe 7-mm nodule unchanged from the most recent prior, but new from . follow up chest ct in months is recommended. 4. extensive atherosclerotic disease. 5. multiple new wedge deformities within the thoracic spine. bilateral le lenis - impression: nonocclusive thrombus extending from the distal right common femoral vein into the mid superficial femoral vein and proximal deep femoral vein. echo () - the left atrium is elongated. the right atrium is markedly dilated. the right atrial pressure is indeterminate. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). the right ventricular cavity is moderately dilated with borderline normal free wall function. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a promient fat pad. impression: normal left ventricular size with preserved global and regional systolic and diastolic function. moderately dilated right ventricle with borderline normal free wall function in the setting of abnormal septal motion/position consistent with right ventricular pressure/volume overload. moderate aortic root dilatation. moderate tricuspid regurgitation. moderate pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the pulmonary artery systolic pressures are higher. the other findings are similar brief hospital course: 66 y/o f w/ a h/o myasthenia , copd and recent hospitlization for pna/copd presents from neurologist oupt office for labored breathing found to have pulmonary emboli. # pulmonary emboli: the patient had no history of pe in the past. she was on coumadin for afib and cva but subtherapeutic on admission. she was continued on coumadin, with an increased dose and goal more in the 2.5-3 range. she was also started on a heparin gtt which . she had lower extremity ultrasounds performed which showed nonocclusive thrombus extending from the distal right common femoral vein into the mid superficial femoral vein and proximal deep femoral vein. her clinical status improved, and she was called out to the medicine floor service on the day after her admission. she had an echo performed that did show evidence of right-sided heart strain, consistent with pe (see above for full report) but no evidence of right heart failure and was relatively unchanged from prior. at the time of discharge, her coumadin dose was still being titrated to bring her inr to a therapeutic level. she remained on a heparin gtt to bridge for 24-48 hours. # copd: she had significant wheezing initially and was maintained on standing nebs then transitioned to home regimen advair and tiotropium with albuterol prn. she was on 30 mg of prednisone at the time of admission. she remained on this dose throughout her hospitalization, and a taper was begun at the time of discharge. follow-up was arranged with an outpatient pulmonologist given she did not have a pulmonologist or recent pfts # ?ste in avr on ekg: as stated in the hpi, cardiology fellow evaluated the patient in the ed and deemed this not to be a stemi and suggested a cta of her chest. she had serial cardiac enzymes drawn which were stable. she denied any chest pain on the medicine floor and repeat ekgs were without st elevatoin. . # afib: she was continued on rate control with metoprolol and cardizem. digoxin was initially held but later restarted. metoprolol and cardizem doses were decreased, as pt had bradycardia. heparin gtt and coumadin as above. # arf: improved with hydration to a normal creatinine level. lisinopril was initially held but then restarted when creatinine improved and lasix dose was decreased to 20mg daily. electrolytes and renal function should be repeated in days. # osa: continued on cpap at night. # myasthenia : continued on mestinon and imuran. follow-up arranged with neurologist dr. . # depression: continued on provigil and zoloft. # dm: continued on lantus 20 units and insulin sliding scale. # lll nodule: of note, imaging showed a lll ground glass nodule that should have f/u ct scan in months (see report) and also right infrahilar density which was decresae din size from prior but which recommended outpatient pet scan to determine if possible malignancy given history of lung cancer. medications on admission: advair 500/50 cardizem cd 360mg daily colace 100mg po bid coumadin 5mg daily digoxin 0.25mg daily duonebs qid ferrous sulfate 324mg po daily imuran 150mg po daily k dur 20meq daily lantus sc qhs riss lasix 40mg po daily lopressor 25mg po q8hrs mestinon 60mg po tid mvi daily oscal 1250mg po bid prednisone 30mg daily (plan taper, 30mg po daily until then 20mg daily) prilosec 20mg daily lisinopril 20mg daily modafinil 200mg po daily senna spiriva daily vitamin d 400u zolfot 25mg po daily coumadin 5mg / 7.5mg daily . discharge medications: 1. diltiazem hcl 60 mg tablet sig: one (1) tablet po four times a day. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. warfarin 3 mg tablet sig: three (3) tablet po once a day. 4. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulization inhalation q4h (every 4 hours). 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 7. azathioprine 50 mg tablet sig: three (3) tablet po daily (daily). 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 9. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po every eight (8) hours. 10. multivitamin tablet sig: one (1) tablet po once a day. 11. prednisone 10 mg tablet sig: 1-2 tablets po as directed: please take 2 tablets (20 mg) daily for five days, then 1 tablet (10 mg) daily for 5 days, then stop. 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 13. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 14. modafinil 200 mg tablet sig: one (1) tablet po once a day. 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 16. vitamin d 400 unit tablet sig: two (2) tablet po twice a day. 17. sertraline 25 mg tablet sig: one (1) tablet po once a day. 18. advair diskus 500-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 19. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. 20. lasix 20 mg tablet sig: one (1) tablet po once a day. 21. os-cal 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po twice a day. 22. heparin (porcine) in ns (pf) 1,000 unit/500 ml parenteral solution sig: titrate to ptt 60-80 units intravenous continuous for until inr therapeutic x 48 hours days: please titrate to goal ptt 60-80. would d/c when inr x 48 hours. . 23. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous at bedtime. 24. humalog 100 unit/ml solution sig: 1-12 units subcutaneous every 6-8 hours: per sliding scale. discharge disposition: extended care facility: hospital - discharge diagnosis: primary: - pulmonary embolism - copd exacerbation secondary: - myasthenia - atrial fibrillation discharge condition: mental status: clear and coherent level of consciousness: lethargic but arousable activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were brought to the hospital for difficulty breathing, and were found to have a blood clot in your lung. you were initially admitted to the icu, where you were treated with a heparin drip. since your coumadin levels were below therapeutic, your coumadin dose was titrated to bring your anticoagulation levels within the therapeutic range. you will remain on the heparin drip until your inr (coumadin level) is in a good range for 48 hours. your medications have changed as follows: - change cardizem to 60 mg four times a day - change coumadin to 9 mg daily and your facility will follow your coumadin levels - decrease your metoprolol tartrate to 12.5 mg three times a day - decrease your lasix to 20mg daily - your duonebs were changed to albuterol nebs it was a pleasure taking part in your medical care. followup instructions: please follow-up as below: appointment #1 md: dr specialty: neurology date/ time: at 11am location: , bldg, phone number: appointment #2 md: dr specialty: pulmonology date/ time: at 8:30am location: , , phone number: special instructions for patient: you will have a breathing test first followed by an appt with the doctor you should also arrange a follow-up appointment with a primary care physician if you are discharged from rehab facility md, procedure: venous catheterization, not elsewhere classified diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux pure hypercholesterolemia unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of bronchus and lung obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified other late effects of cerebrovascular disease other diseases of lung, not elsewhere classified acute venous embolism and thrombosis of deep vessels of proximal lower extremity other pulmonary embolism and infarction other disorders of muscle, ligament, and fascia myasthenia gravis without (acute) exacerbation 

Answer: The patient is high likely exposed to