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 / vioxx / penicillins / cellcept / ceftriaxone / ferrlecit / sulfa (sulfonamide antibiotics) attending: chief complaint: hemoptysis major surgical or invasive procedure: left bronchial artery embolization under fluoroscopy right internal jugular line placement, repositioning, and removal ivc filter placement intubation and mechanical ventilation history of present illness: 37f with history of lupus, lupus nephritis with esrd on peritoneal dialysis on transplant list, hx of pe/antiphopholipid antibody on coumadin, mitral regurg, presents with 4-6 month history of cough, worse in the morning, one week of trace blood, now producing bright red blood over last couple days. patient states that the amount of blood she has been coughing has been increasing and is now almost hourly, aprroximately 1 teaspoon bright red blood. patient states that the cough produced primarily yellow sputum until it turned to blood. patient denies any other symptoms such as dizziness or lightheadedness. she denies any changes in her bms, including consistency, frequency, and color. patient visited pcp on , and a cxr was negative. her was also noted to be subtherapeutic and she took an extra day of 10 mg warfarin as instructed. . initial vitals in the ed were: 108 138/95 18 100% ra. her hct was 29.6, her baseline is unclear but appears to be low 30s. inr was 4.4. a cta was done for concern of pe which showed: 1. left lower lobe consolidation with large amount of secretions/fluid within the left lower lobe segmental bronchi. 2. centrilobular nodules and ground glass opacities throughout both lungs, compatible with chronic collagen vascular disease, progressed since . ground glass opacities could also represent hemorrhage. 3. chronic left lower segmental pulmonary arterial pe, unchanged since . no new acute pe detected to the subsegmental levels. she was initially admitted to medicine but then transferred to the icu. . on arrival to the micu initial vitals were: 110 163/96 20 95%ra. she is breathing comfortably but complains of pain in her chest. her ekg was reviewed which did not show changes from her prior. she also complains of a ha that she says she occasionally recieves toradol. she has had emesis in the ed that looked dark/possibly coffee ground but currently denies nausea. past medical history: # lupus rash # herpes simplex i - , white lesions on the tongue and buccal mucosa # axillary adenopathy - , biopsied -> reactive lymph node # osteopenia - , l spine tscore -2.40, fem neck -1.91, tot hip -1.41 # hypercholesterolemia - # lung abscess - # pulmonary emboli (pe) - # angioedema vs anasarca - , associated with 2 grand mal seizures, required intubation for massive facial/laryngeal swelling # pleural effusions - s/p pleurodesis in nephrotic syndrome # lupus nephritis / nephrotic syndrome - , renal bx showed focal proliferative class iii # gerd / gastric ulcer - , seen on barium swallow # recurrent pneumonia - , possibly from aspirations, most recent # antiphospholipid antibody syndrome (aps) - , requiring anticoagulation to inr of 2 to 3 # breast masses - , bilateral, largest right upper outer quadrant 4/3 cm # thrombotic thrombocytopenic purpura (ttp) - , s/p plasmapheresis # inflammatory eye mass - , s/p excision of mass, lupus # gonorrhea - , disseminated gonococcus # abnormal pap smear - , subsequent paps x 2 normal # systemic lupus erythematosus (sle) - , followed by dr. # raynaud's syndrome # stroke - hemiparalysis # asthma - no problems for several years social history: married with three children, born in , , and . lives in . went to . worked as an accountant until health declined in early . no tobacco, ethanol or drug use. family history: mother with ms with sarcoid discoid lupus physical exam: admission exam vital signs: 110 163/96 20 95%ra. gen: uncomfortable appearing but no acute distress. heent: nc/at. anicteric sclerae. moist mucous membranes. op clear. neck: supple. resp: absent breath sounds entire l lung fields, r lung firels cta cv: tachycardic, regular rhythym. normal s1 and s2. sm at apexno m/g/r. abd: +bs. soft. nt/nd. no rebound or guarding. no hepatosplenomegaly. ext: warm and well-perfused. radial and dp pulses 2+ bilaterally. neuro: a+ox3. perrl. eomi, with no nystagmus. face symmetric. . discharge exam vs t 98.0 hr 128 (regular) bp 102/76 rr 22 o2 100/ra gen thin young woman resting in bed, somnolence but easily roused, nad ncat mmm eomi op clear lungs ctab, prominent breath sounds, no wheeze no l dullness cv tachycardic at regular rate, nl s1 s2 no mumur abd full but nondistended and nontender, soft ext no edema, warm and dry pertinent results: admission labs 07:30am wbc-7.9# rbc-3.19* hgb-9.2* hct-29.6* mcv-93 mch-28.8 mchc-31.0 rdw-16.9* 07:30am neuts-64.1 lymphs-24.2 monos-4.4 eos-6.4* basos-0.8 07:30am plt count-376# 07:30am glucose-96 urea n-58* creat-13.0*# sodium-142 potassium-4.0 chloride-99 total co2-24 anion gap-23* 07:30am pt-45.1* ptt-46.9* inr(pt)-4.4* . other pertinent labs 05:04pm blood -positive * titer-1:160 dsdna-positive * 04:57am blood dsdna-negative 11:44am blood sm antibody-3.6 pos (<1.0 neg ai) 05:04pm blood anca-negative b 04:57am blood dsdna-negative 07:00pm blood lupus anticoagulant-pos 05:13am anticardiolipin igg-5.5(neg) anticardiolipin igm-5.6(neg) 05:04pm blood -positive * titer-1:160 dsdna-positive (1:10) 05:13am blood beta-2-glycoprotein 1 antibodies igg-pnd 07:30am blood c3-109 c4-44* 04:57am blood c3-87* c4-29 03:36am blood c3-104 c4-30 . discharge labs 03:12am blood wbc-14.2* rbc-3.89* hgb-11.5* hct-35.9* mcv-92 mch-29.5 mchc-31.9 rdw-15.9* plt ct-488* 03:12am blood pt-13.2* ptt-31.8 inr(pt)-1.2* 03:12am blood glucose-90 urean-77* creat-12.1* na-136 k-4.1 cl-94* hco3-25 angap-21* 03:12am blood calcium-10.1 phos-6.4* mg-2.4 . micro blood culture -pending blood culture -pending bronchoalveolar lavage gram stain-final; respiratory culture-preliminary; acid fast smear-final; acid fast culture-preliminary; fungal culture-preliminary; potassium hydroxide preparation-final urine culture-final blood culture -pending blood culture -pending peritoneal fluid gram stain-final; fluid culture-preliminary; anaerobic culture-preliminary sputum gram stain-final; respiratory culture-final dialysis fluid gram stain-final; fluid culture-final stool c. difficile dna amplification assay-final blood culture -final blood culture -final sputum gram stain-final; respiratory culture-final inpatient bronchoalveolar lavage gram stain-final; respiratory culture-final; acid fast smear-final; acid fast culture-preliminary; fungal culture-preliminary; potassium hydroxide preparation-final . cta chest the lung apices are excluded from this examination, which was optimized for assessment of the pulmonary vasculature. coarse calcifications within the breasts are new on the left (2:33), and slightly increased in size on the right (2:24), in comparison to the examination. no distinct mass is seen, although the breast tissue is diffusely dense. there is no axillary or mediastinal lymphadenopathy. the heart size is top normal. there is no pericardial effusion. the aorta is normal in caliber and patent. there is no dissection. the main pulmonary arteries are normal in caliber. there is a chronic pulmonary embolus within the left lower segmental pulmonary artery (3:57), which is present since the ct examination. no superimposed acute pulmonary embolus is detected to the subsegmental levels. endobronchial secretions are seen within the left lower lobe segmental bronchus (3:54), extending into the left lower lobe, where there is a moderate-sized consolidation (3:86) filling a previously-seen large air collection from . there are neighboring areas of tree-in- and ground-glass opacities (3:72). ground-glass and tree-in- opacities are also seen throughout both lungs, slightly worse at the lower zones (right lower lobe 3:104, right middle lobe 3:109, right upper lobe 3:49, lingula 3:95), distributed along a centrilobular pattern, with associated mild bronchiectasis, all progressed since . there is no pleural effusion. mild pleural thickening along the left lower lobe (3:78) has slightly progressed since . moderate intraabdominal ascites is present. osseous structures: there is no bony lesion concerning for infection or neoplasm. impression: 1. left lower lobe consolidation with large amount of secretions/fluid within the left lower lobe segmental bronchi. a small air-filled space within the left lower lobe seen on the ct examination is now filled with fluid and/or blood. findings could represent hemorrhage secondary to collagen vascular disease. infection and abscess also have the same appearance on ct. 2. centrilobular nodules and ground glass opacities throughout both lungs, with a basilar predominance, with associated mild bronchiectasis, compatible with chronic collagen vascular disease, progressed since . there is no advanced fibrosis. superimposed infection cannot be excluded by imaging alone. ground glass opacities could also represent hemorrhage. 3. chronic left lower segmental pulmonary arterial pe, unchanged since . no new acute pe detected to the subsegmental levels. . cxr chest, single ap portable view suspect background hyperinflation. superimposed on this, the heart is not enlarged. the left hemidiaphragm is elevated. there is patchy dense opacity at the left base, increased compared with . blunting of the left costophrenic angle suggests a small effusion. smudgy densities scattered in the right and ? left upper lung are compatible with ground glass oapcities seen on chest cta obtained earlier the same day. there is minimal biapical pleural scarring. note is made of calcification along the bronchial walls, an unusual finding in an individual of this age. a large (13 mm) coarse calcification overlying the right lung lies within the right breast. minimal superior endplate scalloping is noted in several mid/upper thoracic vertebral bodies. impression: irregular dense opacity at left base, increased compared with , associated with an elevated left hemidiaphragm. differential diagnosis includes alveolar processes such as infection and hemorrhage. . ct abd/pelvis abdomen: there is atelectasis at the left base with a small left pleural effusion. centrilobular nodules and ground-glass opacities at the right base remain unchanged from cta chest performed yesterday. lack of intravenous contrast limits evaluation of the solid abdominal viscera. the liver, spleen, adrenal glands and pancreas demonstrate a grossly unremarkable unenhanced appearance. the kidneys are small in size. there is vicarious excretion of contrast within the gallbladder from contrast ct performed yesterday. nonenlarged retroperitoneal lymph nodes are visualized. there is no adenopathy. the abdominal aorta is normal in caliber with atherosclerotic calcifications noted predominantly infrarenally. a peritoneal dialysis catheter is present, looped in the right mid abdomen entering from the left. there is a moderate amount of ascites, which measures higher than simple fluid in hounsfield units. there is no evidence of retroperitoneal hematoma. pelvis: the bladder, uterus and rectum are within normal limits. ascites is redemonstrated within the pelvis. there are no dilated or thick-walled loops of bowel. there is no inguinal or pelvic adenopathy. osseous structures: mild degenerative changes are present in the right hip and sacroiliac joints. a sclerotic 9-mm lesion in the left iliac bone appears nonaggressive and is essentially unchanged from suggesting a benign lesion. impression: 1. moderate ascites. given the fluid withdrawn from the peritoneal dialysis catheter is nonhemorrhagic, and the patient underwent a contrast-enhanced ct yesterday, this is likely increased in density from the contrast administration. no evidence of retroperitoneal hematoma. 2. vicarious excretion of contrast in the gallbladder consistent with stated history of chronic kidney disease. 3. left basilar disease is poorly evaluated on this examination. centrilobular nodules and ground-glass opacities are redemonstrated consistent with known chronic collagen vascular disease. again, superimposed infection cannot be excluded by imaging. . fluoroscopic-guided embolization l bronchial artery findings: 1. existing right ij temporary triple-lumen catheter was seen with the tip in the axillary vein. this was successfully repositioned/replaced with the new catheter tip positioned in the distal svc. 2. angiography demonstrated dilated tortuous left bronchial artery, supplying the left lung and specifically, the left lower lobe. some filling of an adjacent pulmonary artery was seen at the end of the angiography suggesting microvascular shunting. 3. no contributor was identified from the left bronchial artery anywhere in its course to an anterior spinal artery. 4. during selective microcatheterization of the left bronchial artery, a small amount of contrast extravasation was noted in the mediastinum from the proximal portion of the artery. subsequent aortic angiography demonstrated no contrast extravasation from the aorta or evidence of aortic dissection. 5. following this, 5 french was again used to select the ostium of the left bronchial artery. from this location, particle embolization with 300-500 micron embospheres was performed to good slowing of flow and angiographic result. impression: 1. successful particle embolization in the left bronchial artery, as described above. 2. successful replacement and repositioning of non-tunneled right internal jugular vein triple lumen catheter, with the tip now in distal svc. the line is ready to use. . ct chest findings: airways and lungs: since , high-density consolidation in the left lower lobe sparing only a portion of the superior segment has increased and new in posterior basal segment of the right lower lobe. preexisting left lower lobe cavity is obscured by this large consolidation. in addition, diffuse ground-glass opacities without septal thickening in both lungs (left side more than right), are also new since . keeping with clinical history, these are highly suggestive of multifocal pulmonary hemorrhage, most pronounced in the left lower lobe. thin rim of hyperdensity along the posterior pleural space in the left lower lobe is probably due to the dissection of the blood from the consolidation. mediastinum: thyroid gland is normal. endotracheal tube tip lies 3 cm above the carina. there are no pathologically enlarged, mediastinal, supraclavicular or axillary lymph nodes. heart is normal size, and thin rim of pericardial fluid is likely reactive. coronary artery calcification is minimal. abdomen: the study is not designed for assessment of subdiaphragmatic pathology; however, limited views were remarkable for moderate ascites with an attenuation value ranging between 19 to 35, suggesting complex fluid, unchanged since . bones: there is no bone lesion concerning for malignancy or infection. impression: 1. ct features are concerning for progressive multifocal pulmonary hemorrhage, most pronounced in left lower lobe. 2. left lower lobe bronchial tree occlusion is likely from aspirated blood. 3. moderate ascites with attenuation ranging between 19 to 35 is probably complex fluid, unchanged since . . cxr findings: as compared to the previous radiograph, there is substantial improvement with substantially improved ventilation of the left lung. only at the left lung base, areas of atelectasis with subsequent elevation of the left hemidiaphragm persists. two new tubular structures project over the left hemithorax. there is no evidence of pneumothorax. the monitoring and support devices are overall constant. constant appearance of the right lung. . lenis findings: there is normal phasicity within the common femoral veins bilaterally. the visualized vessels are patent and compressible with normal waveforms and augmentation. no thrombus identified. impression: no evidence of dvt within the lower extremities bilaterally. . tte conclusions the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size is normal. with normal free wall contractility. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are elongated. there is no mitral valve prolapse. an eccentric, posteriorly directed jet of moderate (2+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. impression: poor image quality (patient difficult to position and unable to cooperate). preserved regional and global left ventricular systolic function. based on limited views, right ventricular cavity size and function are probably normal. pulmonary pressures were undetermined. compared with the prior study dated (images reviewed), left ventricular function is more vigorous. other findings are probably similar although current suboptimal image quality precludes definite comparison. brief hospital course: 37f with sle c/b lupus nephritis, w/esrd on pd & bilateral pe on chronic coumadin p/w hemoptysis & hypoxic respiratory failure, found to have l bronchial artery bleed. # hemoptysis on admission pt was hd stable, not hypoxia, and without airway compromise. she did have significant hct drop, from 29.6 to 20.8 within 24h of admission. pt is on chonic coumadin for hx bilateral pe 11y ago; inr was elevated to 4.4 on admission. explanation for acute bleed not entirely clear - initial ddx included infection (pna vs abscess) in setting of elevated inr most likely; diffuse alveolar hemorrhage also possible, & rheumatology consult also suggested possible pulmonary vasculitis. no new pe seen on cta. she initially received antibiotics for possible pulmonary infection (vanc/levo/flagyl, subsequently narrowed to levo/flagyl). on hd3, underwent ct-guided pulmonary angiography for question source of bleed and possible bleeding into mediastinum. bleed localized to l bronchial artery, which was embolized. solumedrol started for possible vasculitis. hct stabilized and uptrended thereafter. there was discussion of possible pulmonary wedge biopsy for purpose of solidifying a tissue diagnosis to guide possible immunosuppression but this was decided against after risk/benefit analysis. discharge hct 35.9. sent home w/steroid taper to be further managed in rheumatology follow-up next week. . # hypoxic respiratory failure pt developed respiratory failure while in the icu, w/increasing o2 requirement. cxr showed significant left-sided infiltrate, most likely from l bronchial arterial bleed (as discussed above). pt developed progressive respiratory distress requiring supplemental o2. she was intubated on hd4 for rigid bronchoscopy and was difficult to extubate, first because of persistent l-sided infiltrate (blood) and volume overload (retained >5l over 3-4d from pd), then because she developed ventilator associated pneumonia (vap). she was already on levo/flagyl at the time (coverage for possible pulmonary infection as precipitant for hemoptysis, discussed above); aztreonam/vancomycin added briefly for vap coverage. on repeat bronchoscopy on hd9, large mucous plug removed from lul bronchus. pt's respiratory status improved quickly thereafter, and she was successfully extubated the following morning. weaned to ra within several hours, o2 sat in high 90s/ra for >48h thereafter. . #chronic pe/anticoagulation hx indication for anticoagulation was revisited during this admission given hemoptysis and supratherapeutic inr on admission. no acute pe on cta. was consulted and agreed w/continuing to hold anticoagulation. ivc filter placed. review of omr records revealed that anticoagulation was started in during hospitalization for lung abscess; large bilateral pes were revealed on cta done for unexplained persistent sinus tachycardia. she has been on anticoagulation since. omr also include diagnosis of antiphospholipid antibody syndrome in ob/gyn notes (based upon 3 miscarriages and hx cva age 14) but rheumatology notes/records show autoantibody panel not c/w this diagnosis ( positive 1:320, anti-ro/la positive, lupus anticoagulant negative x2, *anticardiolipin negative*. rheumatology and hematology were consulted here for assistance with re-evaluation of pt's indication for chronic anticoagulation and plan to resume anticoagulation. repeat serologies sent - lupus anticoagulation now *positive*, anticardiolipin again negative, b2glycoprotein ab pending at time of discharge. discharge anticoagulation plan as follows: - ivc filter to be removed in ~1 week (ir aware, procedure scheduled for ) - resume warfarin after ivc filter removed, with f/u inr checks at clinic overseen by pcp . . require re-hospitalization to restart warfarin, tbd by pcp and /pulm in outpatient follow-up - pcp, , rheum and pulmonary follow-up appointments arranged - situation discussed with rheumatologist dr. who will review paper records for any osh coagulopathy studies sent prior to initiation of coumadin in and share info w/dr. . # sinus tachycardia pt's hr was 100 on admission and trended 100-140 during her hospital status. always sinus tachycardia on ekg and telemetry. given hx pe, she had bilateral lenis and a tte to evaluate any right heart strain. both were wnl. no cta was obtained because a) pt had an ivc filter placed on admission so low-likelihood and b) no anticoagulation would have been restarted as an inpatient given recent life-threatening bleed. # hx esrd on pd renal failure chronic, lupus nephritis. underwent pd throughout hospital stay. initially there was some difficulty evacuating entire content of pd dwells, and pt became volume overloaded. renal consult service followed closely and guided modifications to pd solution. pt was euvolemic on pd for 4 days prior to discharge. . # hx sle diagnosed in and followed by dr. . complicated by nephritis, & recurrent pleural effusions, w/additional ocular and skin manifestations. plaquenil was continued while pt able to take pos; held while intubated & restarted thereafter. rheumatology consult service followed, suggested possibility that lupus vasculitis or other vasculitis might have contributed to her hemoptysis (see above) and recommended initiation of iv steroids. steroid taper to be further managed by rheumatologist in follow-up. . # hx htn recently stopped lisinopril for concern of exacerbation of her cough. bp meds held on admission given concern for bleeding. used prn iv labetolol to control bps while intubated. after extubation, pt's bp ran . # hx migraine headaches takes amitriptyline at home at night. amitriptyline + prn tylenol while here. . # hx gerd continued ranitidine. pt did have some nausea and po intolerance but was able to take small-volume pos prior to discharge. . transitional issues 1. anticoagulation discharge anticoagulation plan as follows: - ivc filter to be removed in ~1 week (ir aware, procedure scheduled for ) - resume warfarin after ivc filter removed, with f/u inr checks at clinic overseen by pcp . . require re-hospitalization to restart warfarin, tbd by pcp and /pulm in outpatient follow-up - pcp, , rheum and pulmonary follow-up appointments arranged - situation discussed with rheumatologist dr. who will review paper records for any osh coagulopathy studies sent prior to initiation of coumadin in and share info w/dr. - warning signs for cva and dvt/pe reviewed with pt and family prior to discharge, recommend careful follow-up neuro and pulmonary exams. 2. steroid taper - to be managed by outpatient rheumatologist 3. need for ongoing home physical therapy - pt thought to need intense rehabilitation but refused pt, will need follow-up evaluation by pcp and likely ongoing home pt medications on admission: amitriptyline - 25 mg tablet qhs b complex-vitamin c-folic acid calcitriol 0.25 mcg capsule six times weekly codeine-guaifenesin tsp(s) prn cough darbepoetin alfa in polysorbat - 60 mcg/0.3 ml syringe -q2weeks gentamicin - 0.1 % cream - apply to exit site as directed hydroxychloroquine - 200 mg tablet - 1 tablet(s) by mouth one by mouth every day, two by mouth every other day lisinopril - 40 mg tablet - one tablet(s) by mouth once a day -recently stopped for concern of contributing to chroninc cough ranitidine hcl - 150 mg tablet - sevelamer carbonate 800 mg tablet - 3 tablet tid valacyclovir - 500 mg tablet - one tablet(s) by mouth x 1 dose as needed for cold sore outbreak as soon as you have symptoms warfarin - alternating 7.5 mg and 10 mg discharge medications: 1. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) capsule po once a day. 3. calcitriol 0.25 mcg capsule sig: one (1) capsule po 6x/week. 4. aranesp (polysorbate) 60 mcg/0.3 ml syringe sig: one (1) injection injection q2weeks. 5. gentamicin 0.1 % cream sig: one (1) topical once a day: apply to exit site as directed. 6. hydroxychloroquine 200 mg tablet sig: as directed tablet po once a day: 200 mg (1 tab) and 400 mg (2 tabs) on alternating days. 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 8. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 9. valacyclovir 500 mg tablet sig: one (1) tablet po x1: take 1 tablet immediately as needed for cold sore outbreak as soon as you have symptoms. 10. phenol 1.4 % aerosol, spray sig: one (1) spray mucous membrane q6h (every 6 hours) as needed for throat pain. disp:*qs * refills:*0* 11. prednisone 10 mg tablet sig: as directed tablet po once a day: take 4 tabs (40 mg) saturday morning, then 3 tabs (30 mg) every morning until further instructions from your rheumatologist. disp:*50 tablet(s)* refills:*1* 12. ativan 0.5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for anxiety or nausea for 30 doses. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: caregroup vna discharge diagnosis: left bronchial artery bleed ventilator-associated pneumonia end-stage renal disease, peritoneal dialysis-dependent history of pulmonary embolism 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: dear mrs. , you were admitted to the hospital with a life-threatening bleed into your left lung. your inr was >4 so we stopped coumadin. you underwent a procedure to localize and cauterize the source of the bleed: a left bronchial artery. you required intubation to help you breathe as the blood in your left lung resolved. you had multiple bronchoscopies to remove blood clots and mucous plugs. you were followed closely by rheumatologists who recommended steroids to dampen any possible lupus vasculitis, which could have caused the bleed. you also developed ventilator-associated pneumonia and were treated with antibiotics. your pcp . will continue to manage your coumadin. for now, do not take coumadin. we will recommend restarting coumadin in approximately 1 week, after ivc filter removal, but the final decision will be made by dr. in cooperation with your hematologist and rheumatologist. please see below for a list of warning signs. please pay special attention to any difficulty breathing, chest pain including discomfort with breathing, leg or calf pain or swelling. also be aware of warning signs for stroke including sudden weakness or numbness, difficulty speaking, and change in vision. we recommended rehabilitation because you were very weak after 10 days in bed in the hospital. physical therapy did not think you were safe to go home. however, you refused to go to rehab. we made the following changes to your medications: stop coumadin stop lisinopril (recently discontinued by your pcp) stop guaifenesin stop losartan, please discuss resuming this medication with your pcp and nephrologist start chloroseptic spray for throat discomfort, every 6 hours as-needed start prednisone taper, 40 mg saturday then 30 mg daily until you see your rheumatologist, who will give further tapering instructions. start ativan 0.5 mg up to every 8 hours for anxiety or nausea for 10 days. please do not drink while taking this medication. followup instructions: please arrive 1 hour early for this to get your blood drawn: department: when: at 11:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: rheumatology when: wednesday at 4:30 pm with: , md building: lm bldg () campus: west best parking: garage department: west clinic when: thursday at 11:30 am with: , m.d. building: de building ( complex) campus: west best parking: garage this is your to remove your ivc filter. it is very important that you keep this and arrive early. department: radiology care unit when: friday at 7:00 am building: de building ( complex) campus: west best parking: garage department: hematology name: dr. when: dr. office is working on a follow up for 9-15 days after your hospital discharge. if you have not heard from the office in 2 business days please call the office number listed below. location: division of hemostasis and thrombosis address: , e/tcc-9, , phone: department: pulmonary function lab when: thursday at 1:40 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: thursday at 2:00 pm with: rn/dr. pulmonology building: sc clinical ctr campus: east best parking: garage md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more interruption of the vena cava enteral infusion of concentrated nutritional substances other bronchoscopy other lavage of bronchus and trachea closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus aortography peritoneal dialysis other endovascular procedures on other vessels endoscopic excision or destruction of lesion or tissue of bronchus phlebography of pulmonary veins using contrast material central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: chronic glomerulonephritis in diseases classified elsewhere systemic lupus erythematosus end stage renal disease renal dialysis status mitral valve disorders acute posthemorrhagic anemia pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease constipation, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure primary hypercoagulable state awaiting organ transplant status ventilator associated pneumonia accidents occurring in residential institution bronchiectasis without acute exacerbation migraine, unspecified, without mention of intractable migraine without mention of status migrainosus raynaud's syndrome arteritis, unspecified foreign body in main bronchus inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation personal history of pulmonary embolism hemoptysis, unspecified 

Answer: The patient is high likely exposed to