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: morphine attending: chief complaint: ams major surgical or invasive procedure: endotracheal intubation history of present illness: this is a 75yo f pmhx l mca stroke with residual dysarthria / aphasia / partial r hemiplegia, af on coumadin, dm, htn, hld, who initally presented with lethargy to an osh. per patient's family, they had found her increasingly lethargic that am, and "looked sweaty". at osh, there was concern for whether or not neurologic exam findings were acute or chronic (family was not there to clarify), so patient was transferred to for further management. . at , intial vital signs were 97.2 70 159/93 18 99%nrb. exam was significant for alterred mental status, neuro exam significant for dysarthria, partial r hemiplegia (family arrived at this point and reported these were all chronic, no new deficits). nchct did not demonstrate any acute changes. ekg w/o prior for comparison, demonstrating qwaves. labs were significant for wbc 9.5, hct 38.1, cr 0.7, trop 7.66, ua w 1wbc, no bacteria. cxr w/o acute process. patient denied cp, sob, cough, fever. . given ams and initial concern for cva, patient was evaluated by neurology who felt that given lack of new findings on exam and imaging, it was unlikely that patient was having a stroke, but that close neuro monitoring in an icu was recommended. . given elevated troponin, cardiology was consulted, who felt that cause of troponin elevation was unclear given ecg without signs of acute ischemia/infarct in a patient without chest pain; they felt that potential causes could include demand ischemia afib vs neurogenic myocardial mediated by catecholamines. patient was admitted to micu for further monitoring vital signs prior to transfer were 96.5 110 114/81 2l98%3lnc. patient was comfortable, and on ros had back pain but no chest pain, dyspnea, headache, fever, abdominal pain, or extremity pain. this was limited by her dysarthria and expressive aphasia. past medical history: - - l mca stroke with residual dysarthria / aphasia / partial r hemiplegia - af on coumadin - dm - htn - hld - gerd social history: not tobacco, etoh, or illicits. currently residing in a nursing home s/p l mca stroke. mobilizes with wheelchair, needs assistance for transfers and adls. family history: strokes (mother, multiple), htn (multiple family members) physical exam: admission exam: vitals: t: 36.2 bp: 116/78 (symmetric bilaterally) p: 100 r: 18 o2: 94% general: somnolent but rouses to voice, oriented x1, dysarthric, no acute distress heent: sclera anicteric, mucous membranes dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irrregular rate and tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: 1+ pulses, no clubbing, cyanosis or edema neuro: cn: ii - l hemianopia, perrla 5->3 mm iii, vi, vi - eomi v - sensation intact to light touch vii - r facial weakness viii - hearing intact bilaterally ix, x - palate elevates symmetrically - scm strength xii - tongue midline strength - l normal strength throughout, r significantly reduced sensation - l normal throughout, r diminished guaic negative discharge exam: ******************* patient afebrile, rr at 14. did not complete full exam as pt was cmo at discharge. pertinent results: admission labs: 04:42pm blood wbc-9.5 rbc-4.53 hgb-12.6 hct-38.1 mcv-84 mch-27.9 mchc-33.1 rdw-16.2* plt ct-264 04:42pm blood neuts-88.9* lymphs-7.1* monos-2.9 eos-0.6 baso-0.5 04:42pm blood pt-19.4* ptt-26.0 inr(pt)-1.8* 04:42pm blood glucose-201* urean-31* creat-0.7 na-139 k-4.6 cl-105 hco3-24 angap-15 04:42pm blood ck(cpk)-1095* 04:42pm blood lipase-35 04:42pm blood ck-mb-64* mb indx-5.8 ctropnt-7.66* 05:00am blood calcium-10.2 phos-2.6* mg-1.8 cholest-137 05:00am blood %hba1c-6.5* eag-140* 05:00am blood triglyc-60 hdl-60 chol/hd-2.3 ldlcalc-65 04:50pm blood cortsol-28.8* 11:07pm blood type- temp-36.2 po2-18* pco2-56* ph-7.35 caltco2-32* base xs-2 11:07pm blood lactate-2.2* ce trend: 04:42pm blood ck-mb-64* mb indx-5.8 ctropnt-7.66* 10:45pm blood ck-mb-36* ctropnt-3.29* 05:00am blood ck-mb-20* mb indx-4.2 ctropnt-3.42* 11:05am blood ck-mb-13* mb indx-3.8 ctropnt-2.94* 04:50pm blood ck-mb-10 mb indx-3.5 ctropnt-2.66* 03:37am blood ck-mb-8 ctropnt-1.72* discharge labs: we did not do labs on discharge as pt was made cmo. imaging: cxr: mild chf ct head: there is a moderate sized hypodense area in the right occipital lobe parasagittal in location, ( se 2, im 15-18) involving the cortex and adjacent white matter with effacement/ indistinct appearance of the right occipital , representing an acute infarct in the right pca territory. d/w dr. by dr. on at 2.35pm. cllinical team is aware of the findings earlier. cta head and neck: head and neck cta: occlusion of the distal right posterior cerebral artery, compatible with distribution of infarction. otherwise, the remaining arteries are patent with no evidence of stenosis. no evidence of aneurysm formation. impression: 1. extension of the previously described right posterior cerebellar artery infarction now including the right occipital and right temporal lobe. 2. new area of infarction involving the right cerebellar hemisphere. 3. occlusion of the distal right posterior cerebellar artery compatible with the distribution of infarction. 4. no evidence of herniation or midline shift. eeg impression: this is a markedly abnormal record. it shows significant loss of background frequencies suggestive of either multifocal disease or significant encephalopathic component. there are paroxysmal epileptiform features seen independently in the left central and over the right central temporal region. the activity in the right is occasionally very rhythmic suggesting a brief electrographic seizure. these occurred perhaps 30-40 times during the course of the record and usually lasted 10-20 seconds in duration. there is no clinical accompaniment with these events. the cardiac monitor, in addition, is abnormal. nchct impression: 1. technically limited study due to artifacts from monitoring devices on the scalp. evaluation of inferior cerebellar hemispheres is particularly limited. 2. evolving infarcts in the right pca and sca territories. no evidence of new intracranial abnormalities. eeg impression: this 24-hour recording is most compatible with a moderately severe to severe diffuse encephalopathy with multifocal features suggesting both an encephalopathy and underlying structural pathology. the left frontal central region seems to be one area of independent abnormality, as well as the more posterior aspects of the right hemisphere. there were no sustained events that appear to be compatible with electrographic seizures and it should be noted that the record does wax and wane throughout the course of the 24-hour recording session. eeg impression: this eeg gives evidence for marked encephalopathic disorder manifest by marked suppression of normal background rhythms, suppressive bursts with periods of one to four seconds of flatline eeg, and high voltage triphasic waves that are seen synchronously. additionally, at least two areas appear abnormal independently in that there is delta and sharp slow activity in the left frontal region and independently seen over the right hemisphere with some excessive delta noted over the right posterior quadrant. in comparison to the prior day, the eeg appears to be slightly worse in terms of the degree of encephalopathy. eeg impression: this eeg continues to give evidence for a moderately severe to severe encephalopathic disorder likely metabolic in origin. there are also superimposed some structural features in the left frontal and the posterior quadrant on the right. in addition, the heart rhythm is abnormal and seemed, for some reason, to show a change in the qrs appearance at about 00:12 in the morning. ct abd/pelv w/o contrast impression: 1. large hematoma within the right thigh, which is not completely visualized on this scan. 2. right renal calculi. 3. diverticula without evidence of diverticulitis. 4. calcified fibroids within the uterus. cxr : impression: no change from prior. brief hospital course: 76 yo w h/o past l mca stroke (residual r hemiplegia, nonfluent aphasia, dysarthria), af on anticoagulation, dm2, likely prior mi p/w lethargy and nausea/vomiting/abdominal pain and found to have a r pca and r cerebellar acute infarction accompanied by cardiac ischemia (trop 7.6) and subsequent generalized seizure activity. hospitalization c/b uti and acute anemia. acute cerebral infarction - her initial presentation was with lethargy in the setting of nausea, diaphoresis, vomiting, abdominal pain and left arm/back pain with high troponins suggestive of acute cardiac ischemia; when examined at the bedside with the family, they felt that she did not have new neurologic deficits, and the patient denied new neurologic symptoms initially. however, over the span of an hour she was noted to have a left homonymous hemianopia and poorer command following and sensory neglect. given her inr of 1.8 and unclear deficits, she was not a candidate for intravenous tpa and was not clinically stable enough for a cta head/neck or ctp head (vomited in the ct scanner). the next day as she continued to be lethargic, she was found to have a r pca stroke and r cerebellar hemisphere stroke. this stroke had a small amount of hemorrhagic conversion. she was rescanned multiple times in subsequent days during periods of waxing and mental status. her blood pressure was maintained with an sbp > 120, sometimes requiring fluid boluses. her infarction size did not appear to change, but she developed several other medical complications. an mri could not be obtained due to her pacemaker. seizure - the patient on showed periods of broad, generalized waves suggestive of seizure activity for which she was started on levetiracetam 1000 , but on subsequent consultation epilepsy felt that this activity might represent primarily encephalopathy with triphasic waves rather than seizures. there were multifocal discharges, but these did not propagate. a repeat eeg on revealed diffuse encephalopathy without seizures. nstemi vs. stress/takutsubo cardiomyopathy - the patient had nausea, diaphoresis, vomiting, and abdominal pain with left arm/back pain consistent with cardiac ischemia, likely nstemi versus stress cardiomyopathy. cardiology was consulted and suspected that the troponin leak, which downtrended since admission, was likely due to demand ischemia from af with rvr versus takutsubo cardiomyopathy for which she has a depressed ef of 20-25%. she treated with aspirin, heparin infusion, metoprolol, and amiodarone. atrial fibrillation - the patient has a history of persistent af and reportedly was on propafenone. she was transitioned to amiodarone as an alternative. her hr occasionally would rise to the 120s-130s and required further beta blockade with metoprolol. urinary tract infection - the patient on was found to have >100,000 gnr in her foul-smelling urine with low-grade fevers, a suggestive ua, and worsening mental status suggestive of a uti. the urine culture was later resulted as contaminated, but treatment was continued due to high clinical suspicion for uti. respiratory failure/pneumonia - on , the patient's respiratory status decompensated such that she required intubation. she had a high fever of 105.6 at the time, raising suspicion for a pulmonary infection. her prior antibiotic treatment for uti was extended to vancomycin and piperacillin-tazobactam. she was continued on broad spectrum antibiotics but required pressors and continuous ivf to maintain her bp and warming blankets as her temperature dropped. no organism was identified and the family declined bronchoscopy. goals of care - multiple discussions took place with the patient's children (two daughters, and , and one son, wherein they decided to make the patient dnr but not dni given her worsening clinical status and diminishing chances of meaningful recovery. on , given the patient's multisystem dysfunction and lack of significant interactivity, the family decided to make the patient cmo. palliative care was consulted for assistance with counseling and offering hospice services. she was extubated at approximately 7:30 pm on . she remained comfortable throughout the rest of her stay and was discharged to hospice on . medications on admission: - senna - miralax - propafenone 150mg tid - omeprazole 20mg daily - metformin 500mg - colace - biscodyl - asa 81mg daily - milk of magnesia - cholecalciferol 800 units daily - sertraline 50mg daily - simvastatin 10mg daily - cranberry extract - gabapentin 600mg qhs - vitmain b12 1000mcg daily - coumadin 5mg discharge medications: 1. hydromorphone 3 mg suppository sig: suppositorys rectal q3h (every 3 hours) as needed for agitation. 2. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for standing. 3. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: five (5) mg po q4h (every 4 hours). discharge disposition: extended care facility: rehab & nursing center - discharge diagnosis: primary: right pca and r cerebellar infarct secondary: atrial fibrillation, past l mca stroke, dm, hx of mi discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: dear ms. , you were admitted to the hospital because you had a stroke and heart damage. your course was complicated by a uti and persistently depressed level of consciousness. while here, your family decided to make you comfort measures only, which was done in an effort to make you comfortable. you were then able to be sent to hospice. we stopped all of your home medications and started you on the following medications: 1) dilaudid 3-6mg per rectum as needed for agitation. 2) tylenol 650mg every 6 hours. 3) morphine concentrated oral solution 5mg every 4 hours. if you have any questions about your care please consult your hospice doctor. it was a pleasure taking care of you on this hospitalization. followup instructions: you will be followed by your hospice team at your hospice facility. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other diagnostic procedures on lung or bronchus diagnoses: pneumonia, organism unspecified other primary cardiomyopathies subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified toxic encephalopathy unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes intracerebral hemorrhage other and unspecified hyperlipidemia acute respiratory failure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants late effects of cerebrovascular disease, hemiplegia affecting unspecified side cardiac pacemaker in situ nontraumatic hematoma of soft tissue encounter for palliative care cerebral embolism with cerebral infarction acute systolic heart failure do not resuscitate status late effects of cerebrovascular disease, aphasia homonymous bilateral field defects late effects of cerebrovascular disease, dysarthria 

Answer: The patient is high likely exposed to