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: norvasc / clonidine / cardura attending: chief complaint: syncope followed by seizure activity major surgical or invasive procedure: none history of present illness: this is a 63 yo m with a h/o htn who presents with syncope vs. seizure. he was walking at approx 11:30 am on , on his way home from the office. he had a prodrome of dizziness, lightheadedness,+ blurry vision, confusion, in his words "i felt like i was going to pass out." he then syncopized, bystanders commented that he had jerking movements in his upper extremities. he woke up in handcuffs, being restrained by paramedics and that was all he could remember. he denies bladder or bowel incontinence during the event, but does admit to being confused for a while after the event. he denies feeling nausea, vomiting, chest pain, sob or palpitations prior to event. he denies any prior cardiac hx, did have cardiac cath for chest pain at hosptial 2 years ago. pt fell landing on his nose, causing a laceration of his nose. . on ros, pt denies any hx of mi, angina, doe, orthopnea, recent leg swelling, prior episodes of syncope, prior syncope, new medications, fevers, chills, cough, any recent etoh or drug ingestions. pt does admit to having some heart burn, lasting 10 min, the am prior to his fall. . pt was transported to the ed by ems. in the ed, the pt was noted to be in afib with rvr. his vs t 98.3 hr 138 afib, bp 186/103, rr 18, sao2 100% on 4l n/c. he did report cp earlier today and indigestion this morning for several minutes. his head ct here shows a small right frontal hemorrhagic contusion. he also has a minimally displaced small bl nasal bone fracture. he received diltiazem 10 mg iv x1 and diltiazem 30 mg po x1, diltiazem 20mg iv and diltiazem 40mg po. he also received ntg sl 0.3 mg tablets, tetanus shot, and dilantin 1000 mg load. ekg showed lateral st depressions that resolved with rate control. his c spine was cleared clinically. cardiology will follow pt. plastics closed pts facial lac. past medical history: htn bph substance abuse etoh, cocaine quit 18 years ago per pt anxiety social history: patient is divorced with one son. is healthcare proxy and on vacation in . pt does not want him called. pt lives alone at home. pt is a construction supervisor for . he denies any substance abuse for the past 18 years, because of aa. drug of choice in the past was cocaine, but he was also an alcoholic. denies ever using iv drugs. family history: dad was an alcoholic died of mi at age 51, mother died recently pt unsure of diagnosis. no family hx of sz disorder physical exam: vs: temp: 97.7 bp:167/85 hr: 95 rr:15 o2sat 97% 2l n/c gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, patient noted to have large nasal laceration, with 20 sutures. neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no edema, 2+dp, 2+pt bilat skin: no rashes/no jaundice neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. 2+dtr's-patellar and biceps rectal: not done pertinent results: ekg: axis 0 degrees, afib rate 130, 1mm st depression on v3-v6. repeat ecg showed resolution of st depression with rate of 101. . admission labs . 01:55pm blood wbc-10.7 rbc-4.56* hgb-14.4 hct-40.0 mcv-88 mch-31.5 mchc-35.9* rdw-13.4 plt ct-207 01:55pm blood neuts-70.3* lymphs-20.8 monos-5.1 eos-3.2 baso-0.6 01:55pm blood ptt-23.1 01:55pm blood plt ct-207 09:30pm blood pt-12.5 ptt-23.5 inr(pt)-1.1 09:30pm blood plt ct-229 01:55pm blood glucose-113* urean-17 creat-1.2 na-140 k-3.2* cl-102 hco3-24 angap-17 01:55pm blood ck(cpk)-117 09:30pm blood ck(cpk)-496* 03:05am blood ck(cpk)-511* 01:55pm blood ck-mb-4 01:55pm blood ctropnt-<0.01 09:30pm blood ck-mb-12* mb indx-2.4 ctropnt-<0.01 03:05am blood ck-mb-9 ctropnt-<0.01 01:55pm blood calcium-9.0 phos-1.3* mg-2.1 10:47pm blood %hba1c-5.7 09:30pm blood triglyc-122 hdl-32 chol/hd-4.6 ldlcalc-92 09:30pm blood tsh-1.7 09:30pm blood phenyto-8.2* 09:30pm blood ethanol-neg barbitr-neg 01:55pm blood greenhd-hold other labs . 05:50am blood wbc-9.6 rbc-4.77 hgb-14.9 hct-43.1 mcv-90 mch-31.3 mchc-34.6 rdw-13.5 plt ct-224 05:50am blood glucose-94 urean-19 creat-1.2 na-142 k-4.4 cl-103 hco3-29 angap-14 05:50am blood calcium-9.1 phos-3.4 mg-2.1 10:47pm blood %hba1c-5.7 09:30pm blood triglyc-122 hdl-32 chol/hd-4.6 ldlcalc-92 09:30pm blood tsh-1.7 05:50am blood phenyto-6.8* 09:30pm blood ethanol-neg barbitr-neg . imaging ct sinus 1. minimally displaced fractures of the nasal bone bilaterally. no additional evidence of fracture. 2. maxillary, ethmoid and sphenoid sinus mucosal disease. . ct head wo contrast small, focal area of mixed hypo- and hyperattenuation within the right frontal lobe adjacent to the skull, most consistent with a small hemorrhagic contusion. no significant mass effect. otherwise, no evidence of acute intracranial pathology. . cxr question subtle focal opacity projecting at the lung apex. there is a hypertensive cardiomediastinal configuration . ct head w/o contrast 10:08 am impression: no significant change since the previous study or evidence of progression of edema or worsening mass effect. no hydrocephalus. . shoulder (ap, neutral & axillary) trauma left 10:25 am impression: no fracture or dislocation. degenerative change involving the acromioclavicular joint. . echo : the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . ecg study date of 7:41:32 am sinus bradycardia. within normal limits. compared to tracing #3 there is no significant change. . ecg study date of 7:33:30 pm sinus bradycardia. otherwise, normal tracing. compared to tracing #2 atrial fibrillation is no longer present. . ecg study date of 2:47:28 pm atrial fibrillation with a ventricular response of 101. compared to tracing #1 there is improvement in the minor st segment depressions in the inferolateral leads and the rate is slower. . ecg study date of 1:41:50 pm atrial fibrillation with rapid ventricular response. inferolateral st-t wave changes may be rate-related. no previous tracing available for comparison. . eeg study date of impression: normal eeg in the waking and drowsy states. there were no focal abnormalities or epileptiform features. brief hospital course: mr. is a 63 y/o male w/ prodrome, syncope, question of possible seizure, tranferred to ed found to be hypertensive, in afib w/ rvr, noted to have nasal laceration, small right frontal lobe hemorragic contusion on ct head. patient was evaluated in ed by cardiology, neurosurgery, and plastic surgery. given dilantin load, diltiazem for rate control, w/ decision to hold on aspirin and heparin until pt develops more notable cardiac symptoms or progression of brain contusion ruled out. . #syncope vs. seizure: the ddx is wide but is likely syncope secondary to afib w/ rvr as pt was found to be in this rhythm in ed. pt may have had convulsive syncope. unclear if pt did indeed have seizure. confusion would fit w/ post ictal state, pt did not lose control of bladder or bowel. cardiac arrthymia leading to syncope, very possible given pt was found to be hypokalemic and severely hypophosphotemic in ed, finding that would predispose to arrythmia. these metabolic abnormalities by themselves could have caused the syncope. syncopal event may have also been caused by sinus pause. pt noted to have 4 sec pause in icu, but this may have been caused by large amount of nodal blocking agents given in ed. vasovagal or hypovolemia may have also caused event, but not as likely given history, lack of signs pointing to dehydration. most likely, syncope was from atrial fibrillation given he was found to be newly in afib. per neuro, seizure activity was likely post-syncopal seizure and will not likely recur unless he experiences another syncopal event. he was loaded on phenytoin and discharged with plan to finish 7 total days of phenytoin followed by a taper. he will by mass. state law be unable to drive motor vehicles or operate heavy machinery for at least months and corroborated this understanding. . #.new onset afib w/ rvr: pt denies report of prior afib, . he reverted to sinus rhythm with dilatiazem and atenolol. he continued to be controlled with beta blockage and was discharged on toprol. given he had no heart failure by echo and his score is 1, he was not anticoagulated. tsh was normal. . #head trauma: brain contusion on head ct. repeat ct showed no change. he was started on aspirin. . # cad: osh records show stress protocol , 2mm st depression at peak exercise resolving w/ recovery. lipids were checked showing ldl < 100. + family hx, +tob hx., +male. he was begun on aspirin as above. . #romi: pt unlikely to have mi, given history. atypical epigastric pain lasting for several minutes, occuring several hours prior to syncope. ces negative x three. ekg changes (st depression) resolved with control of rvr. . # chronic renal insufficiency: pt noted to have cr of 1.2 on admit, osh labs from note cr 1.1. . # htn: patient has a long standing of uncontrolled htn. sbp documented as in 180s in ed. osh records show no ras in on angiogram. he was discharged on his home medications with the exception of the toprol as above. . # nose laceration: sutured by plastic surgery. sutures are absorbable. he was instructed to follow up at the post-surgical plastics clinic on the friday after discharge to evaluate fracture after swelling improves. he was given bacitracin to the suture line. . # l shoulder pain: to trauma, full passive and active rom, tylenol for pain, pt does not want opiates, avoid nsaids and asa, given brain contusion. shoulder xray showed no fractures/dislocations but showed degenerative changes of the ac joint. . # code status: full . # communication: sister home , cell hcp is son, away on vacattion medications on admission: lasix 20mg daily avapro 300mg daily atenolol 100mg daily 180mg daily discharge medications: 1. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 2. oxycodone 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. disp:*20 tablet(s)* refills:*0* 3. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical three times a day: until seen by plastic surgery on . disp:*1 tube* refills:*0* 4. toprol xl 200 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 5. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day) for 4 days: through . disp:*10 capsule(s)* refills:*0* 6. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po twice a day for 1 days: take for one day on . disp:*2 capsule(s)* refills:*0* 7. phenytoin sodium extended 100 mg capsule sig: capsule po twice a day for 1 days: for only one day on . disp:*1 capsule(s)* refills:*0* 8. avapro 300 mg tablet sig: one (1) tablet po once a day. 9. aspirin 325 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: atrial fibrillation, paroxysmal syncope post-syncopal convulsion discharge condition: good, in nsr discharge instructions: you were seen at after a fall with loss of consciousness. you also had seizure activity. a head ct showed a brain contusion, which was stable on repeat head ct. you were found to be in a rhythm called atrial fibrillation, which reverted back to a normal rhythm. you also had an echo cardiogram, which showed essentially normal heart function, therefore, you will not need a blood thinner. you should, however, use 325mg of aspirin daily. please do not take excedrin in addition to 325mg tablets of aspirin since excedrin has aspirin in it. . you also had an eeg, which showed normal brain function. because you had a seizure, massachusettes law prohibits you from driving a vehicle for at least 6 months. you should also avoid high places, ladders, roofs, or any place that you may be seriously hurt if you had a seizure. we started you on a medication for seizure prophylaxis called phenytoin. you will complete a total of 7 days, then taper by 100mg per day as per your prescriptions. . please continue using bacitracin on your suture wound 2-3 times per day. your sutures are absorbable and will not need to be removed. please follow up in the plastic and reconstructive surgery clinic as below. . please call your primary care physician or return to the emergency department if you experience shortness of breath, light headedness, loss of consciousness, chest pain, numbness/tingling/weakness in any part of your body, difficulty speaking, facial droop, headache, fever greater than 101.5 degrees f, or any other symptoms that concern you. followup instructions: provider: , md. phone: date/time: 5:00pm. . please follow-up with the plastic and reconstructive surgery clinic next friday . we were unable to get you an appointment at the clinic. please call on monday to schedule the appointment for friday. procedure: suture of laceration of nose diagnoses: hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other convulsions unspecified fall hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypopotassemia chronic kidney disease, unspecified other and unspecified hyperlipidemia anxiety state, unspecified disorders of phosphorus metabolism other chest pain open fracture of nasal bones leukocytosis, unspecified other and unspecified open wound of head without mention of complication pain in joint, shoulder region cerebellar or brain stem contusion without mention of open intracranial wound, with no loss of consciousness other disease of nasal cavity and sinuses 

Answer: The patient is high likely exposed to