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: bactrim ds attending: chief complaint: dyspnea major surgical or invasive procedure: thoracentesis bronchoscopy with biopsy history of present illness: this is an 85-year old gentleman with 6 months of dyspnea and recent diagnosis of likely right upper lung primary cancer with diffuse mets, and recent thoracentesis diagnostic on the right, who is presenting with worsening dyspnea 24 hours after a thoracentesis. he has a 15 pack year smoking history (quit 20 years ago) presenting with worsening shortness of breath and cough for the past few months. he explains that he has had worsening dyspnea with exertion for the past few months which has now progressed to shortness of breath even at rest. he has also noticed a worsening cough during this time. no hemoptysis but occassionally lightly brown tinged sputum. he denies any chest pain, fevers or chills. he reports a mild lost of weight and with decreased appetite over the past few months. a chest x-ray on showed two large pulmonary masses in the right upper lobe (6.7 x 5.9 and 3.9 x 2.6 cm) as well as several additional nodular opacities in both lower lobes. a subsequent ct showed stage iv lung cancer with right upper lobe primary, satellite nodules, bibasilar metastases, and bilateral effusions right greater than left. he was seen by ip on who performed a right-sided ultrasound guided thoracentesis removing 1250 cc of fluid. he initially felt better however in the last few days he started having worsening shortness of breath and difficulty lying flat. no chest pain and no fever. on arrival to the ed his initial vs were 97.8 140/52 60 24 sat 92% on room air. a chest x-ray showed worsening pleural effusions. he was sent for a cta to rule out a pe. he was given 1l ns prior to the cta. per report during the cta, while lying flat and receiving the contrast, he became more acutely short of breath with increasingly labored breathing, tachypneic to 30, and desaturating to 86% on 3l nc. expiratory wheezes and crackles bilaterally were appreciated. he was given duonebs, 40mg iv lasix, and started on a nitro drip at 0.42 mcg/kg/min. 1 sl ntg was also given. an ekg showed atrial flutter with 4:1 conduction but no ischemic changes. he was subsequently saturating 80% on fm and so was started on bipap, a foley was placed, and he was admitted to the icu. vital signs at the time of transfer were hr 57 bp 135/55 80% on fm, 99%/bipap. on arrival to the micu the patient appeared to be in no acute distress and was breathing comfortably with sats of 93% on 5l nc. past medical history: diabetes mellitus type 2 hypertension hypercholesteremia difficulty with swallowing coronary artery disease congestive heart failure peripheral vascular disease chronic venous insufficiency in the legs urinary incontinence gout osteoarthritis chronic kidney disease retinal detachment past surgical history: s/p right hernia repair s/p cataract removal s/p thyroid adenoma excision s/p turp s/p tonsilectomy repair of zenker's diverticulm social history: tobacco: 15 pack years, quit 20 years ago alcohol: none and none in the past occupation: lives with son, daughter and wife. retired doctor l surgery. family history: no lung cancer or congenital lung diseases father: died of old age (70s) but had a history of a colectomy of unknown reason mother: deceased age 57 unknown reasons. physical exam: admission physical exam vitals: 85 145/106 rr 23 sat 93%/5l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: diminished breath sounds on right, bibasilar crackles left > right, no wheeze, dullness to percussion over right upper fields abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: foley in place ext: 1+ edema, warm, well perfused, 2+ pulses, no clubbingm or cyanosis neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. discharge physical exam vs: afebrile, o2 sat 90-93% on room air at rest; 88% on room air while ambulating, weight 171# gen: nad chest: symmetric breath sounds, but with bibasilar rales cv: rrr pertinent results: admission labs 04:53am blood wbc-8.0 rbc-4.48* hgb-12.0* hct-40.2 mcv-90 mch-26.9* mchc-29.9* rdw-15.7* plt ct-226 04:53am blood neuts-76.3* lymphs-10.9* monos-5.5 eos-6.9* baso-0.5 04:53am blood pt-11.1 ptt-32.8 inr(pt)-1.0 04:53am blood glucose-141* urean-32* creat-1.3* na-139 k-4.8 cl-104 hco3-25 angap-15 04:53am blood probnp-2434* 04:53am blood ctropnt-0.02* 12:43pm blood ck-mb-2 ctropnt-<0.01 04:15pm blood ck-mb-2 ctropnt-0.01 12:43pm blood ck(cpk)-25* 04:15pm blood ck(cpk)-31* 04:15pm blood calcium-8.2* phos-3.6 mg-2.1 08:37am blood lactate-0.8 discharge labs 09:18am blood wbc-8.8 rbc-4.39* hgb-12.1* hct-38.9* mcv-89 mch-27.5 mchc-31.0 rdw-16.2* plt ct-215 09:18am blood glucose-158* urean-45* creat-1.5* na-137 k-3.9 cl-100 hco3-28 angap-13 09:18am blood calcium-8.7 phos-3.3 mg-2.1 microbiology blood culture: no growth imaging ecg: atrial flutter with 4:1 block or this may be consistent with atrial tachycardia with 4:1 block. non-specific septal and inferior st-t wave changes. compared to the previous tracing of findings are similar chest (pa & lat): known right upper lobe lung mass, and multiple bibasilar pulmonary nodules, redemonstrated. chf. mild increase in the moderate right pleural effusion, and stable left pleural effusion. cta chest w&w/o c&recons, non-coronary: metastatic lung cancer, with a right upper lobe primary mass and multiple satellite metastatic nodules in both lungs, not significantly changed since the earlier study of . moderate right and small left pleural effusion, have slightly enlarged since , especially given the fact that the patient underwent a right thoracentesis in the interim. increasing bibasilar atelectasis. no acute pulmonary embolism or thoracic aortic pathology. ct head w/o contrast: no acute intracranial pathology. moderate-to-severe involutional changes and small vessel ischemic disease. no evidence of metastatic disease. please note that a non-enhanced mri study would be more sensitive for metastatic disease. tte: the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). the diameters of aorta at the sinus, ascending and arch levels are normal. the descending thoracic aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. moderatemitral regurgitation. mild pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the severity of mitral regurgitation has increased. clinical implications: the patient has moderate mitral regurgitation. based on acc/aha valvular heart disease guidelines, a follow-up echocardiogram is suggested in 1 year. chest (portable ap): there continues to be a large opacity overlying the right upper lung which is the known mass. lung volumes are otherwise low. there is a right-sided pleural effusion as well as a more focal area which correlates to the multiple masses on the chest ct from one day prior. cardiomediastinal silhouette is stable in size. brief hospital course: 85 year old retired dentist presenting with worsening shortness of breath and right sided pleural effusion in the setting of likely new malignancy. #. recurrent pleural effusion and acute on chronic dchf exacerbation: pt appeared to volume overload in the setting of a worsening pleural effusion. moderate right pleural effusions persisted despite recent thoracentesis prior to this admission. pleural fluid was negative for malignant cells. breathing dramatically improved with diuresis. pt ruled out for mi via enzymes. he was restarted on home lasix 40. repeat echo (last ) showed lvef 55% and was largely unchanged other than that the severity of mitral regurgitation increased. he was transferred to the floor, and underwent ip guided thoracentesis of 900cc fluid with placement of pleural catheter to gravity drainage. fluid studies as above and indicate transudate (still possible with malignant effusions) he will receive continued diuresis with oral lasix and transition to iv lasix if he has continued hypoxia. patient and family advised to weigh patient daily. pt cr bumped to 1.9 and came down to 1.5 following the folding of lasix for a day and then decreasing back to his home dose of 40mg daily. # adencocarcinoma of the lung: pleural fluid was negative for malignant cells, but ct was suggestive of metastatic disease. he underwent bronchoscopic lung biopsy on with lymph node bx confirming adenoca. assumed to be lung primary. brushing still pending on discharge. clinic appointment to be arranged as outpatient. patient will ask pcp for assistance if he has not heard from clinic by the time of his first follow-up visit with pcp. chronic issues: #. hypertension: bp initially controlled in icu with a nitro drip. losartan was stopped because he was normotensive on a metoprolol, hydralazine, ace-i. his amlodipine dose was reduced. #. dm: insulin sliding scale #. hypothyroidism: no tsh in records here. continued home dose and defer to outpatient for further management. transitional issues: goals of care discussion was had with patient, family and attendings. the patient and family are aware that he has lung cancer and that it will likely be the cause of his death. he states that he is not interested in pursuing any type of care that would be too invasive or involved including surgery, chemotherapy, or radiation. he is open to speaking to an oncologist regarding his prognosis and treatment options. the option for hospice care was introduced to the patient and that he should ask his pcp to help him get more information regarding this type of care if it fits his stated goals of care. the patient's goals of care are most consistent with dnr/dni and he and his family agreed. medications on admission: lasix 40mg po bid hydralazine 25mg po qid allopurinol 200mg po daily amlodipine 10mg po daily losartan 50mg po daily levothyroxine 100mcg po daily nitroglycerin 6.5mg er po tid metoprolol 25mg po bid quinapril 40mg po daily simvastatin 20mg daily aspirin 325mg daily fluticasone 50mcg spray 1 nasally each daily vitamin d3 vitamin b12 tylenol #3 ferrous sulfate 325mg daily guiafenesin hexavitamin humalin r sliding scale nph insulin 20 units qam 26 units qhs discharge medications: 1. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. quinapril 20 mg tablet sig: two (2) tablet po daily (daily). 4. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 6. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 7. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 8. furosemide 40 mg tablet sig: one (1) tablet po once a day: this dose is reduced from 40 mg twice daily. 9. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily): this is reduced from 10 mg daily. 10. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 11. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 12. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 13. nph insulin human recomb 100 unit/ml suspension sig: ten (10) units subcutaneous twice a day: previously 20 units in the morning and 26 units in the evening. 14. oxygen diagnosis: lung cancer, icd-9 code: 162.9 2-3 liters continuous pulse dose for portability. discharge disposition: home with service facility: discharge diagnosis: - lung cancer, adenocarcinoma - pleural effusion - acute on chronic diastolic chf - diabetes type 2 controlled, uncomplicated - acute kidney injury 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: you were hospitalized due to shortness of breath from pleural effusions and chf along with masses in the chest that on preliminary report appear to be adenocarcinoma. you had drainage of pleural fluid and a bronchoscopic biopsy. other instructions: it is important to weight yourself each day. your discharge weight was 171-pounds. if you should gain more than 3 pounds from that weight, you are likely reaccumulating fluid in your chest and may need to have your diuretic doses increased. please call your doctor if you have more than 3 pound weight gain (or loss). it is helpful to minimize sodium (salt) intake to minimize fluid retention or reaccumulation. you may want to also explore the option of enrolling in hospice care services at your next appointment with your primary care physician . medication changes: 1. dose reduction: amlodipine (norvasc) 5 mg daily (previously 10 mg daily) 2. dose reduction: furosemide (lasix) 40 mg daily (previously 40 mg twice daily) 3. dose reduction: nph insulin 10 units twice daily (previously 20 units in the morning and 26 units in the evening) 4. stop: losartan followup instructions: department: gerontology when: thursday at 9:30 am with: , md building: lm campus: west best parking: garage procedure: insertion of intercostal catheter for drainage thoracentesis closed endoscopic biopsy of lung diagnoses: mitral valve disorders unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified acute on chronic diastolic heart failure personal history of tobacco use chronic kidney disease, unspecified malignant neoplasm of upper lobe, bronchus or lung long-term (current) use of insulin postsurgical hypothyroidism 

Answer: The patient is high likely exposed to