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: heparin agents attending: chief complaint: cold, painful right foot major surgical or invasive procedure: : 1. ultrasound-guided puncture of left common femoral artery. 2. contralateral third order catheterization of the right superficial femoral artery. 3. balloon angioplasty of right femoral to below-knee popliteal bypass graft. 4. stenting of common femoral to below-knee popliteal bypass graft. 5. angiojet thrombectomy of obstructed common femoral artery to below-knee popliteal bypass graft. 6. balloon angioplasty of midportion of right posterior tibial artery. 7. perclose closure of left common femoral arteriotomy. history of present illness: 77m with terminal, stage iv metastatic adenocarcinoma of the lung who has been admitted on multiple occasions over the past few months for medical problems, who presented to the on with a 1 day history of a cold, painful right foot and a history of positive pf4ab after thrombocytopenia earlier this month. pt was just discharged from for back pain on and discharged after rectal bleeding in early . per heme/onc his plavix was never stopped, although the pt is a poor historian and is unable to verify the medications he is taking at home. his lung ca is terminal and he is end stage at this point. he has known metastatic disease of the spine causing severe pain, he denies known brain mets. he lives alone and is a poor historian. he is unable to verbalize the medications he takes daily but does report that his pain regimen of long and short acting morphine are working. he has had intermitent vna services in the past. his last visit was on by multicultural vna. he has a long history of refusing care in the hospital and at home and frequently demands to be discharged from the hospital prior to medical advice. past medical history: 1. stage iv non-small cell lung cancer, on palliative treatment; to spine 2.htn 3. peripheral disease s/p r cia stent and l eia angioplasty and s/p r sfa balloon angioplasty and stent x2 - and right lower extremity claudication status post right common femoral to above knee popliteal graft with ptfe on , . 4. s/p bilateral shoulder displacement. 5. cad s/p mi ' 6. hypercholesterolemia, 7. gi bleed ' 8. gout 9. osteoarthritis 10. herniated l4-5 disc 11. l5-s1 stenosis psh: r cia stent l eia angioplasty r sfa balloon angioplasty and stent x2 r common femoral to above knee popliteal graft with ptfe social history: smoking x 63 years. he smoked less than a pack per day for most of his life and recently smokes only approximately five cigarettes a day. he currently lives alone in . he consumes alcohol on occasion. he previously consumed significant amounts of rum. he has been in the united states for over 20 years. he was born and raised in . he only speaks spanish. he is a retired musician and automobile mechanic. lives alone - has a girlfriend "" who visits daily. he also has a friend/ neighbor who claims to be a nurse, who visits several times per week. poor historian - unable to give clear history of illness, unable to give names/doses of medications. family history: sister (d) throat cancer . denies other ca, cad, disease physical exam: discharge exam: vss, afeb gen: cachetic appearing elderly male, who appears chronically ill. in nad. alert and oriented, x 3. communicates through spanish interpreter but gets easily aggitated when questioned about medical history/medications/home situation cvs: rrr pulm: cta bilat abd: s/nt/nd thin abdomen. ext: right le warm, well perfused, without edema. groin incision is clean/dry/intact. sensory-motor function intact. left le warm, well perfused, without edema or wounds. pulses: right femoral palpable, dp and pt dopplerable left femoral palpable, dp and pt dopplerable pertinent results: 11:00am blood wbc-12.8* rbc-3.41* hgb-9.1* hct-28.0* mcv-82 mch-26.8* mchc-32.6 rdw-21.0* plt ct-530* 04:24pm blood wbc-10.3 rbc-3.29* hgb-8.8* hct-27.6* mcv-84 mch-26.8* mchc-32.0 rdw-21.0* plt ct-530* 11:00am blood neuts-85.1* lymphs-10.1* monos-4.4 eos-0.2 baso-0.2 04:30pm blood wbc-16.1*# rbc-2.91* hgb-7.8* hct-23.8* mcv-82 mch-26.7* mchc-32.7 rdw-21.2* plt ct-406 06:50am blood wbc-17.1* rbc-2.52* hgb-6.9* hct-20.9* mcv-83 mch-27.2 mchc-32.9 rdw-21.3* plt ct-441* 03:12pm blood wbc-21.4* rbc-3.11* hgb-8.3* hct-25.9* mcv-83 mch-26.7* mchc-32.0 rdw-20.6* plt ct-453* 07:40am blood wbc-19.6* rbc-3.10* hgb-8.3* hct-25.6* mcv-83 mch-26.7* mchc-32.3 rdw-19.8* plt ct-422 07:35am blood wbc-20.1* rbc-3.29* hgb-9.0* hct-27.6* mcv-84 mch-27.5 mchc-32.7 rdw-20.1* plt ct-464* 07:35am blood neuts-93.2* lymphs-2.6* monos-3.7 eos-0.3 baso-0.1 07:35am blood hypochr-1+ anisocy-3+ poiklo-2+ macrocy-3+ microcy-2+ polychr-normal ovalocy-1+ burr-2+ pencil-occasional tear dr 1+ 11:00am blood pt-15.8* ptt-23.5 inr(pt)-1.4* 04:24pm blood pt-34.9* ptt-93.6* inr(pt)-3.6* 08:30pm blood pt-40.1* inr(pt)-4.2* 04:30pm blood pt-43.4* ptt-103.4* inr(pt)-4.6* 06:50am blood pt-37.7* ptt-90.3* inr(pt)-3.9* 07:40am blood pt-42.7* ptt-93.7* inr(pt)-4.5* 06:00pm blood pt-32.5* ptt-62.1* inr(pt)-3.3* 12:00am blood pt-26.0* ptt-51.3* inr(pt)-2.5* 07:35am blood pt-19.2* ptt-32.3 inr(pt)-1.8* 11:00am blood glucose-105* urean-19 creat-1.1 na-138 k-3.7 cl-102 hco3-25 angap-15 04:24pm blood glucose-104* urean-17 creat-1.0 na-138 k-4.0 cl-106 hco3-21* angap-15 04:30pm blood glucose-198* urean-13 creat-0.9 na-131* k-3.9 cl-101 hco3-19* angap-15 06:50am blood glucose-159* urean-15 creat-1.0 na-136 k-4.1 cl-104 hco3-23 angap-13 07:35am blood glucose-133* urean-26* na-137 k-4.5 cl-104 hco3-21* angap-17 04:24pm blood calcium-8.0* phos-3.3 mg-1.9 04:30pm blood calcium-7.4* phos-1.8* mg-1.8 06:50am blood calcium-7.8* phos-2.9 mg-2.0 11:00am urine color-yellow appear-clear sp -1.012 11:00am urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg 11:00am urine rbc-* wbc-0-2 bacteri-0 yeast-none epi-0 12:10 pm blood culture blood culture, routine (pending): radiology report ct head w/o contrast study date of 11:44 am medical condition: 77 year old man with c/o left leg numbness, may need heparin to re-vascularize his leg, eval for brain mets reason for this examination: brain mets? contraindications for iv contrast: none. final report ct head without contrast comparison: mr brain, . history: lung mass and left leg numbness. evaluate for metastases. technique: mdct axially acquired images through the brain were obtained. no iv contrast was administered. findings: there is no evidence of acute hemorrhage, large areas of edema, or mass effect. there is normal -white matter differentiation. the ventricles and sulci are mildly prominent, consistent with age-related atrophy. mildly prominent bifrontal extra-axial spaces are also stable, likely also due to atrophy. a stable small hypodensity within the right lentiform nucleus is consistent with a chronic lacunar infarct. there is no evidence of acute major territorial infarct. mild calcifications of the anterior and the posterior circulation are noted. the visualized paranasal sinuses are clear. impression: no evidence of an acute intracranial process. please note that mri would be more sensitive for metastatic disease and acute infarction. radiology report chest (pa & lat) study date of 12:03 pm medical condition: 77 year old man with c/o of cold l leg, to surgery today eval for acute ct process reason for this examination: acute ct process? final report history: 77-year-old male with history of metastatic lung cancer, now with cold left leg for presurgical evaluation. comparison: cta chest dated and chest x-ray dated . findings: pa and lateral views of the chest were obtained. the cardiomediastinal silhouette is stable in appearance with calcifications. atherosclerotic calcifications again noted within the aortic arch. there is stable scarring within the upper lobes, left greater than right with upward retraction of the hila. lung volumes are increased with flattening of the diaphragms consistent with a history of emphysema. no new parenchymal abnormalities are identified in the lungs. there are no pleural effusions or pneumothorax. numerous sclerotic lesions are noted throughout the spine and ribs consistent with the patient's diffuse metastatic osseous deposits. no acute osseous abnormality is identified. impression: 1. no significant interval change with stable pulmonary scarring and retraction of the hila as described above. 2. widespread osseous metastatic deposits. brief hospital course: mr. was admitted to the service with an occluded graft and known heparin induced thrombocytopenia. he was started on an argatroban drip for therapeutic anticoagulation and a dilaudid pca for pain control. he was taken to the endosuite on where he underwent balloon angioplasty of the posterior tibial artery, stent placement at right common femoral artery to below-knee popliteal bypass graft x4, angiojet thrombectomy of right common femoral artery to below-knee popliteal bypass graft. he tolerated the procedure well, remaining hemodynamicaly stable. he was transfered back to the vicu and continued on argatroban. he was started on pletal 100mg as well. on pod 1 he was hemodynamically stable, but refused to have labs drawn or take any oral medications. his friend visited and his oncology social worker, stopped to see him. after discussion, he agreed to take meds and have labs , however, when phelbotomy came he became aggitated and began flailing his arms during his veinapuncture. he refused to have labs after that. we explained that this was not safe given that he was on argatroban. he acknowledged this, but continued to refuse labs for that day. after reviewing his records at length, and discussing the case with palliative care, and social work, it became apparent that this is an ongoing problem on his hospitalizations. on pod 2 he was more cooperative, taking medications and allowing phlebotomy to draw labs. he was started on coumadin, and the argatroban gtt was continued. his dilaudid pca was stopped and he was transitioned to his home regimen of ms contin 100mg q8h with ir morphine 30-60mg q2h prn. his pain was well controlled on this regimen. later that day he went for a plaiative radiation of l1-l3 which he tolerated well. we also contact dr. at this time, who reinforced that the pt has refused home hospice and vna care on multiple occasions and frequently refuses inpatient treatments. he felt mr. was terminal, with only a few months to live and agreed that our goal would be to make him as comfortable and safe as possible. a pt consult was obtained, and on and the pt did ambulate independently. a spanish speaking hospice nurse came to see him, and discussed the availability of home services, and he adamently refused any home care. his girlfriend agreed to stay with him at his house, and a friend agreed to stop by daily to assist as well. in the late pm on pod 3, the pt received a dose of coumadin, and the argatroban gtt was stopped. an inr was then checked 2 hours later, and was therapeutic at 3.3. on the inr was 2.5 in the early am, and had fallen to 1.8 at the 7am draw. the pt was feeling well, pain free, with a well healing groin puncture site. he was quite eager to be discharged. unfortunately his white count had trended up over several days, and was 20 on the morning on pod 4. the pt had been afebrile throughout his stay, and there was no obvoius source of infection. a cxr ruled out pneumonia, and blood cultures were sent to rule out bacteremia. discussion with dr. and dr. resulted in the decision to allow mr. to be discharged home in the care of his friends. is to see his pcp 2 days for a follow up and pt/inr check, and to see dr. in 5 days for a follow up, to include a repeate cbc and f/u on his blood cultures. mr. and his girlfriend are aware of the elevated wbc and know to return immediately should he have a fever, prodcutive cough, drainage from his wound or other concerning symptoms. medications on admission: pt is unclear but per prior d/c summary senna 8.6 mg po bid, docusate sodium 100 mg , atorvastatin 40 mg po daily, clopidogrel 75 mg po daily, aspirin 81 mg po daily (daily), mirtazapine 15 mg po hs, folic acid 1 mg po daily, tamsulosin 0.4 mg 24 hr po hs, metoprolol succinate 50 mg 24 hr daily, nifedipine 30 mg po daily, isosorbide mononitrate 30 mg tablet sustained release 24 hr, polyethylene glycol 3350 17 gram po daily,morphine 100 mg po q8h, morphine 15 mg tablets po q2h, lactulose 10 gram/15 ml po tid, dexamethasone 8 mg , ezetimibe 10 mg daily, acetaminophen 500 mg q8h, lidocaine 5 % adhesive patch, albuterol sulfate 90 mcg/actuation hfa aerosol inhaler, omeprazole 20 mg daily, ondansetron hcl 4 mg q8, dextromethorphan-guaifenesin prn, lorazepam 0.5 mg q8h, megestrol 400 mg/10 ml ten (10) ml po once a day. discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*2* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 7. nifedipine 30 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 8. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 9. dexamethasone 4 mg tablet sig: two (2) tablet po q12h (every 12 hours). 10. acetaminophen 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 11. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheeze. 13. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: ten (10) ml po q 24h (every 24 hours). 14. cilostazol 100 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 15. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 16. morphine 100 mg tablet sustained release sig: one (1) tablet sustained release po q8h (every 8 hours). disp:*30 tablet sustained release(s)* refills:*0* 17. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 18. morphine 30 mg tablet sig: one (1) tablet po q2-3h prn as needed for pain. disp:*30 tablet(s)* refills:*0* 19. coumadin 1 mg tablet sig: three (3) tablet po at bedtime: take at the same time daily. disp:*100 tablet(s)* refills:*2* 20. outpatient work pt/inr to be checked twice per week by dr. , , phone: dx: heparin induced thrombocytopenia with arterial thrombus inr goal: 2.0-3.0 discharge disposition: home discharge diagnosis: right lower extremity ischemia with rest pain and diminished motor and sensory function due to known obstruction of previous bypass graft. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with a cold, painful right foot and found to have occlusion of your right lower extremity bypass graft. you have been found to have an allergy to a medication called "heparin"; this can increase your risk of having blood clots in your blood vessels, like the one you were diagnosed with. we have treated your problem with surgical intervention. you have been started on medication to help thin your blood, this medication is called coumadin. it is very important that you take this medication daily, and follow up with your primary care doctor for frequent blood testing to monitor the medication levels. medications: ?????? take aspirin 81mg once daily ?????? we have started you on two new medications pletal 100mg twice daily and coumadin 3mg once daily ?????? continue all other medications you were taking before surgery except for plavix and omeprazole, you should stop these ?????? you make take prescribed pain medications for any post procedure pain or discomfort what to expect when you go home: it is normal to have slight swelling of the legs: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated ?????? it is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? drink plenty of fluids and eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? when you go home, you may walk and go up and down stairs ?????? you may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? after 1 week, you may resume sexual activity ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate ?????? no driving ?????? keep your f/u appt for work and to follow up with the surgeon what to report to office: ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site sudden, severe bleeding or swelling (groin puncture site) ?????? lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call office . if bleeding does not stop, call 911 for transfer to closest emergency room. your new medication "coumadin or warfrin" requires frequent blood tests. you must have your labs drawn once to twice per week initially and your primary care physician will call you with instructions to adjust your coumadin dose if needed. followup instructions: office visit with dr. , your primary care doctor y . you can walk in to his office between 5am and 12 noon . it is very important that you see him and have your blood checked. name: , address: , , phone: provider: , md phone: date/time: 9:30 location: 9 provider: , md phone: date/time: 10:30 location: () procedure: angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries arteriography of other intra-abdominal arteries insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) other endovascular procedures on other vessels other radiotherapeutic procedure procedure on two vessels insertion of four or more vascular stents diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder gout, unspecified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation old myocardial infarction other complications due to other vascular device, implant, and graft malignant neoplasm of other parts of bronchus or lung accidents occurring in other specified places personal history of noncompliance with medical treatment, presenting hazards to health stricture of artery secondary malignant neoplasm of bone and bone marrow arterial embolism and thrombosis of lower extremity atherosclerosis of native arteries of the extremities with rest pain neoplasm related pain (acute) (chronic) heparin-induced thrombocytopenia (hit) bandemia 

Answer: The patient is high likely exposed to