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 69 year old female with no significant past medical history who presented to hospital with acute onset of respiratory distress. the patient had been noticing an enlarging neck mass for the past three to four years. as hospital notes, the patient noticed increasing phlegm production two days prior to admission and increasing shortness of breath. she was being evaluated by otorhinolaryngology as an outpatient and sent to hospital for head/neck/chest computerized tomography scan. while in the waiting room the patient had an acute onset of respiratory distress requiring intubation and was admitted to the hospital intensive care unit. because the outside hospital was unable to provide radiation, the patient was transferred to the . 100 cc of necrotic material was aspirated from the left neck mass which by report is consistent with squamous cell carcinoma. computerized tomography scan of the neck/chest revealed a 7 by 7 cm left-sided neck mass with deviation of the trachea to the right and compression of the trachea around the endotracheal tube. no obvious tumor was seen in the chest computerized tomography scan. past medical history: none. allergies: no known drug allergies. medications: medications as an outpatient, none. medications on transfer were heparin subcutaneously, morphine and ativan prn. family history: non-contributory social history: the patient lives with one son and her grandson. she quit tobacco 30 years ago and smoked less than half a pack per day for a few years. she denies alcohol use. she works at and was working prior to her otorhinolaryngology visit. before that she worked for 14 years at a stride-rite factory gluing soles to bottom of shoes. laboratory data: laboratory studies at an outside hospital revealed sodium 138, potassium 3.9, chloride 101, bicarbonate 31, bun 7, creatinine .8, glucose 128, white blood cell count 8.2, hematocrit 32.9, platelets 300, ldh 228. arterial blood gases, pressor support ventilation of 10 and 5 is 7.54, 27, and greater than 250. physical examination: on physical examination vital signs were 100.2, heartrate 98, blood pressure 141/93, respiratory rate 14 and oxygen saturations 100%. in general the patient is an elderly female in no apparent distress, awake, and answering questions. head, eyes, ears, nose and throat, extraocular muscles intact. pupils, equal and reactive to light and accommodation. large left-sided neck mass, nontender, approximately 8 by 8 cm. small 1 cm area of ecchymosis around the biopsy site. heart, normal s1 and s2, no murmurs, rubs or gallops. lungs clear to auscultation bilaterally. abdomen obese, soft, nontender, positive bowel sounds. extremities, no cyanosis, clubbing or edema. radiographs: chest x-ray from outside hospital, large left neck mass with questionable mediastinal lymphadenopathy, endotracheal tube at carina. chest computerized tomography scan without contrast, large neck mass, 7 by 7 in diameter, left trachea shifted to right, trachea compressed around endotracheal tube. computerized tomography scan of chest revealed multiple anterior mediastinal lymph nodes and para-aortic tracheal compression with deviation to the right, no parenchymal lung lesions are seen, small left pleural effusion. hospital course: this is a 69 year old female with left-sided neck mass consistent with squamous cell carcinoma, most likely of esophageal origin, causing airway compromise, intubated for airway protection. 1. left-sided neck mass - on arrival to , the patient was evaluated by radiation medical oncology and otorhinolaryngology. it was felt given the size of the mass that extubation could not be done safely without further securing the airway. the patient had a computerized tomography scan of the neck and chest with contrast and an magnetic resonance imaging scan of the chest which revealed the following. computerized tomography scan of the head revealed no evidence of intracranial metastatic disease. computerized tomography scan of the chest showed a large neck mass which tracks along the posterior wall of the trachea into the thoracic inlet, measuring 7 by 11 cm, multiple enlarged mediastinal lymph nodes and a small lower thoracic vertebral body hemangioma. the magnetic resonance imaging scan of the neck with gadolinium showed redemonstration of an enormous neck mass with probable infiltration in the region of the left carotid sheath and other signs of spread. in light of these findings, the patient was scheduled for operating room placement of a tracheostomy. the patient was sent to the operating room on , hospital day #9. in the operating room the procedure was noted to be very difficult and a tracheoesophageal fistula was found. the patient's trachea was dissected to the fifth tracheal ring and an endotracheal tube was placed instead of a stable tracheostomy tube, given the difficulty of the procedure. on hospital day #10, the patient had an open gastrostomy tube placed and a port-a-cath placed by general surgery. a panendoscopy was done at the time of her tracheostomy placement on hospital day #10 which showed diffuse tumor in both the trachea and the esophagus. multiple biopsies were done of the esophagus and it was felt at this time that the tumor was originating from the cervical esophagus, although this could not be definitely confirmed. on the day after gastrostomy tube and port-a-cath placement, extensive discussions were taken with the family. interventional pulmonology was consulted for possible stenting of the esophageal tracheal fistula, however, given the location it was felt that no stent could be placed in either the esophagus or the trachea at this time. given the poor prognosis with the extent of disease, complicated by the tracheoesophageal fistula, the decision on whether to pursue radiation and chemotherapy was in question. the patient met with both radiation oncology and medical oncology and was told about the risks and benefits of treatment. given the fistula, it was thought that radiation and chemotherapy, while possibly able to provide some local control of tumor extension, would only worsen the fistula and cause neutropenia increasing infection risk. the patient decided that she wanted to not pursue chemotherapy and radiation therapy and would want to go home with home hospice care. the patient was also made do-not-resuscitate at this time. given the unusual nature of the patient's tracheostomy tube, a customized tracheostomy was ordered and is currently enroute to the hospital. the patient is to have a more permanent airway placed on wednesday, . if the patient is able to tolerate the patient and her airway remains stable, she should be able to be discharged home with maximal home services. during this hospitalization palliative care was consulted to aid in placement and home services. they are currently following the patient and have already provided some possible resources for the patient. 2. tracheobronchitis - on hospital day #2 the patient had a bronchoscopy to evaluate for any intrinsic compression of airways by the neck mass. airways appeared patent below the endotracheal tube, however, numerous secretions were seen. bal later grew out staphylococcus aureus which was pansensitive. the patient completed a ten-day course of levaquin and clindamycin which was later added after the tracheal esophageal fistula was found. currently, the patient has occasional secretions and lowgrade temperatures, however, secretions overall have decreased this admission and the patient's cough has not increased. we will try to observe the patient off of antibiotics but anticipate that she may continue to have lowgrade fevers due to her tracheoesophageal fistula and extent of tumor burden. 3. urinary tract infection - the patient had an urinary tract infection during this admission which was escherichia coli pansensitive. the patient was treated with levaquin, and subsequent cultures have remained negative. the foley catheter was discontinued on hospital day #19. 4. thrush - it was noted that the patient has several plaques on her tongue and was started on nystatin swish and swallow which will have to continue while at home. 5. constipation - it was noted that the patient had multiple episodes of constipation in the setting of roxicet narcotic use for incisional pain. this has resolved with an adequate bowel regimen. 6. physical therapy - the patient was evaluated by physical therapy who felt that the patient may be able to be discharged home with maximal services. the patient has been ambulating without complications. 7. respiratory status - the patient was initially on vent support, however, this was slowly weaned during her hospital course and she is currently on a t-piece 24 hours a day without any necessary vent support. she should be able to go home with a similar apparatus. she no longer needs any vent support. 8. tubes, lines and drains - the patient has had her foley catheter discontinued. she has a port-a-cath which has been deaccessed and has a percutaneous endoscopic gastrostomy tube. she is currently receiving tube feeds 24 hours a day at 60 cc/hr. 9. code status - the patient is currently do-not-resuscitate. discharge diagnosis: 1. stage 4 cervical esophageal cancer 2. airway compromise, status post tracheostomy 3. tracheobronchitis 4. urinary tract infection 5. thrush 6. constipation an addendum will be added to this dictation summary with the rest of the hospital course. this dictation cover the timeframe from to . disposition will be determined at a later date. the patient will follow up with her primary care physician, . who is . dr., 12-981 dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other permanent tracheostomy temporary tracheostomy closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma insertion of totally implantable vascular access device [vad] other gastrostomy aspiration of other soft tissue aspiration of other soft tissue diagnoses: urinary tract infection, site not specified other pulmonary insufficiency, not elsewhere classified candidiasis of mouth other constipation acute bronchitis secondary and unspecified malignant neoplasm of intrathoracic lymph nodes malignant neoplasm of other specified part of esophagus secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck tracheoesophageal fistula 

Answer: The patient is high likely exposed to