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: patient recorded as having no known allergies to drugs attending: chief complaint: hemoptysis major surgical or invasive procedure: ivc filter placement history of present illness: mr. is a 46 year old man with a hx of stage iv nsclc and remote hodgkin's disease who presented to the ed at an osh with hemoptysis on where he was observed overnight, discharged home, then represented to ed the morning of with recurrent hemoptysis. the patient reports 3 episodes of hemoptysis since 7pm yesterday, each with 1-2 tablespoons of blood. last chemotherapy treatment was which was cycle 1 of /taxol + avastin. . in the ed, initial vitals: 98.5 126 142/106 20 96. he underwent cta which showed bilateral pes with a post-obstructive pna. he received ctx and vancomycin. interventional pulmonology (ip) was called as well as oncology and both recommended iv heparin to treat the pes. the ct also showed a small intraparenchymal hemorrhage in the lung but ip felt it was small and was okay with starting heparin. . on the floor, initial ptt was 48 at 8pm and he received a 1300 unit bolus. five hours latter he developed an additional episode of cough and hemoptysis of approximately cup and he was transferred to the icu for closer monitoring. . on arrival, he reports mild shortness of breath which is unchanged in the past 4 days. he denies fevers or chills. he denies dypnea on exertion, chest pain or palpitations. he denies dizziness or lightheadedness. he has no calf tenderness or swelling. past medical history: hx of hodgkin's disease, stage iia, dx s/p radiation therapy. relapsed in , s/p chemotherapy with alternating doses of mopp and abvd. s/p splenectomy as part of staging laparotomy. stage iv nsclc diagnosed - initially presented w/ dry cough, cp, night sweats . he underwent cxr and ct scan on revealed extensive new thoracic adenopathy centered at the right hilus involving both adjacent and remote nodal stations in the mediastinum with atelectasis, consolidation, and possible mass involving most of the right upper lobe, particularly the anterior segment. a destructive t10 spine lesion with possible invasion of the spinal canal was also noted, and bilateral thyroid nodules were observed. an endobronchial core biopsy of the right upper lobe mass revealed moderately differentiated adenocarcinoma. . the tumor was positive for ck7, focally positive for cdx2 and ck20, and negative for ttf-1, egfr mutation negative. a transbronchial needle aspiration of 4l, level 7, and 4r lymph nodes revealed no suspicious cells. . a pet scan on revealed confluent fdg uptake surrounding the right upper lobe bronchus and right main stem bronchus, felt to be related to an infiltrating mass versus post-bronchoscopy change (suv max 14.1). marked narrowing and irregularity of the right upper lobe bronchus and adjacent pulmonary vessels was noted, suggesting an underlying infiltrative lesion. additional involvement includes a left adrenal nodule, a right mandibular lesion, a distal sternal lesion, the left sacral body, a lytic lesion in the left femoral head, the right lesser trochanter, and destructive lesions of the t10 and l1 vertebral bodies, which demonstrated possible spinal canal extension. an mri of the brain demonstrated no evidence of brain lesions. . on , the patient began palliative chemotherapy with carboplatin, paclitaxel, and bevacizumab social history: the patient is married and has three children, ages 8, 12 and 16. he works for a communications company. he enjoys playing the violin. he has never smoked. he drinks alcohol occasionally. family history: the patient's mother is 75 years old and has diabetes and obesity. his father is 76 years old and is well. the patient's maternal grandmother is 101. of his grandparents have malignancies. the patient's mother has one brother, and the patient's father had two brothers and two sisters, none of whom have a history of cancer. the patient has one brother, age 49, who is well. physical exam: vitals: t:98.6 bp:145/102 p:115 r:18 o2:99% on 2l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: scattered rhonchi at left base, decreased bs at right upper lobe cv: tachy, reg rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 11:15am pt-12.1 ptt-21.4* inr(pt)-1.0 11:15am plt count-363 11:15am neuts-84.9* lymphs-10.8* monos-2.5 eos-1.3 basos-0.5 11:15am wbc-21.0*# rbc-4.74 hgb-12.3* hct-37.5* mcv-79* mch-26.0* mchc-33.0 rdw-15.3 11:15am estgfr-using this 11:15am glucose-118* urea n-12 creat-0.6 sodium-136 potassium-4.5 chloride-99 total co2-25 anion gap-17 11:26am lactate-2.1* k+-4.5 08:28pm urine gr hold-hold 08:28pm urine hours-random 08:45pm ptt-48.8* 08:45pm hct-36.0* images: cta chest: impression: 1. bilateral subsegmental pulmonary emboli. 3. right upper lobe likely post-obstructive pneumonia. 3. multiple spiculated masses in the right lower lobe concerning for malignancy. 4. left lower lobe greater than right lower lobe, and lingular ground-glass opacities may represent pneumonia vs edema vs hemorrhage. . bilaterally le us; impression: no evidence of bilateral lower extremity dvt. . bilaterally le us: impression: thrombus in a left posterior tibial vein. more proximal veins of the left lower extremity and the veins of the right lower extremity are patent. . kub: impression: ivc filter adequately positioned at the level of l2 vertebral body. kub: multiple nonspecific air-filled loops of non-dilated small andlarge bowel are unchanged since . there is no free air. barium swallow: 1. unremarkable esophagram, without evidence of stricture, narrowing or filling defect within the esophagus. 2. mild delayed transit of contrast from the distal esophagus in to the stomach. 3. large right hilar mass is noted on the scout examination, consistent with the known lung carcinoma. : pet: impression: 1. interval improvement in the disease burden in the chest. decrease in the fdg avidity of the multiple mediastinal and hilar lymph nodes. unchanged narrowing of the right upper lobe segmental bronchi with post obstructive changes likely representing pneumonitis. 2. multiple new peripheral ground glass opacities in both lungs predominantly seen in the right lower lobe demonstrate mild fdg uptake, may represent post-radiation changes or an inflammatory/infectious process. 2. interval decrease in the fdg uptake of the diffuse bony metastatic lesions. 3. a single focus of increased fdg uptake in the region of the right pterygoid process is new since prior study. recommended attention to this region in the follow-up studies. tte : suboptimal study. the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are grossly normal (lvef 60%). there is no ventricular septal defect. the right ventricle is poorly visualized. there appears to be some degree of depressed free wall contractility. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic valve leaflets are mildly thickened (?#). the aortic valve is not well seen. there is no aortic valve stenosis. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is no pericardial effusion. : mri t and l spine: impression: limited lumbar spine study demonstrates no obvious change on the sagittal images. l2 and sacral metastases are again noted. : cta chest: final read pending at the time of discharge prelim read: multifocal areas of ggo and consolidation not significantly changed from . extensive hilar and mediastinal adenopathy similar in appearance with marked narrowing of right upper lobe pulmonary segmental artery and bronchi and svc narrowing. multiple filling defects similar in burden, but slightly different locations (and now more proximal) - i.e. less pe in left lower lobe segmental branches, however new, small filling defects in left main pulm artery. bone lesions are similar. brief hospital course: mr. is a 46 year old man with remote h/o hodgkin's lymphoma, s/p splenectomy, with new stage iv nsclc with bone mets s/p 1st round of chemo who presents with hemoptysis, found to have bilateral pes and post-obstructive pneumonia. . hemoptysis: patient underwent lenis to assess for clot, and read was negative for dvts bilaterally. he was initially continued on heparin gtt for b/l pe seen on cta. patient was seen by interventional pulmonology (ip) who had plans for bronchoscopy the next day. however, overnight, patient had further episodes of hemoptysis ~1 cup size. his heparin was stopped given concern for further bleeding. ip urgently bronched patient and observed active bleeding from airways but unable to identify source. pt then taken for rigid bronchoscopy in the or at which time blood was evacuated. bleeding thought to be from mass in right upper lobe. pt then developed recurrent hemoptysis and interventional radiology and radiation oncology were consulted and pt underwent radiation therapy. pt also had ivc filter placed as it was felt that it would not be safe to anticoagulate at that time. pt continued to have tachycardia and fatigue and so a repeat cta was done to evaluate for pe on week 4 of hospitalization. repeat cta final read is pending. however, preliminary read (above) was discussed with family and risks and benefits of anticoagulation considered. pt and family prefer not to proceed with anticoagulation at this time. *****patient plans to reconsider anticoagulation and will discuss this further with dr and dr as an outpatient. if pt decides he would like to try anticoagulation again, he would need to be admitted for heparin gtt with close supervision . # post-obstructive pneumonia - on admission pt felt to have postobstructive pneumonia. his last abx exposure prior to admission was azithromycin . pt recieved a dose of vancomycin/ceftriaxone on admission, then switched to ceftriaxone/levofloxacin, then switched to augmentin and finally to unasyn for the rest of the course. pt reevaluated for postobstructive pna later in his hospital course fuo and recieved ct chest followed by repeat bronch. on bronchoscopy, pt not observed to have post-obstructive pneumonia. . # occasional fevers: pt developed fevers to 100-101 in 3rd week of hospitalization. source could not be identified. pt initially started on vanc/cefepime for potential pulmonary source. pt was evaluated for recurrent pneumonia with both ct chest (which could not exclude pna) and bronch (which did not show any evidence for pneumonia.) given this information vanc/cefepime were discontinued and fever curve remained constant (temps of 98 c occasional spikes to 100 to 101). ct chest did show ggo which could be consistent with fungal pna, cop as well as many other etiologies. ground glass opacities (ggo) were discussed c pt's oncology attg who felt that they could be watched with consideration for pulm f/u in the future (ddx includes cop, resolving pna, opportunistic infection) etc. ua and ucx unremarkable and multiple blood cultures were unrevealing. of note, pt was not neutropenic. low grade fevers thought to represent pes and/or tumor fever. infection of clot thought to be unlikely given negative blood cultures. *****pt will follow up with dr and dr and will have repeat ct chest in several weeks. depending on goals of care, they will consider pulm referral. . # nsclc - recent dx in with lesion on right upper lobe and mets seen on pet scan to a left adrenal nodule, a right mandibular lesion, a distal sternal lesion, the left sacral body, a lytic lesion in the left femoral head, the right lesser trochanter, and destructive lesions of the t10 and l1 vertebral bodies. he was started on palliative chemotherapy with carboplatin, paclitaxel, and bevacizumab. recieved cycle 2 on with /taxol only. pt recieved cycle 3 on with pemitrexed (alimta) and carboplatin. he had a total of 6 radiation tx, after which he refused further radiation esophagitis (goal had been 11). . # leg weakness: pt had worsening lower extremity weakness. differential felt to include progression of known spinal mets versus deconditioning versus increased edema. on week 4 of hospitaliation pt got mri t and l spine, however, pt could only tolerate first part of study. based on limited info, seems same as prior (t10 lesion c mild cord compression). please continue to trend carefully. consider repeat scan if any concern. . #le edema: likely ivc filter. pt noted to have extensive clots bilaterally distal to filter. pt was seen by vascular surgery who recommended conservative management with thigh-high teds. . # elevated lfts: pt has had uptrending lfts. this may be tumor versus chemo. seemed to improve after last chemo dose. could also be portal v thrombosis however, this would not alter the decision to anticoagulate so we did not do ruq ultrasound. hep serologies neg in . *** dr and dr aware and will continue to monitor. . # sinus tachycardia: felt to likely be pes as bedside echo shows evidence of elevated rh pressures without rv dilation. pt had repeat cta chest which was pending at the time of discharge (but family feels they do not want anticoagulation). pt does not have pericardial effusion and pt remained in sinus tach even when afebrile and asleep. pt started on bblocker but he felt that this gave him a depressed mood and it did not slow his hr significantly at dose of metoprolol 12.5tid. . # siadh: pt noted to have siadh likely related to nsclc versus chemo adverse effect. pt responded well to 1.5l fluid restriction, later liberalized to 2l fluid restriction. . # vomiting and dysphagia: temporally related to radiation. gi consulted and felt that given hemoptysis, he is a high risk candidate for an upper endoscopy at this time. pt instead had barium swallow whcih did not show stricture. pt felt to have likely radiation esophagitis, he was started on sodium and baking soda as instructed by rad onc as well as magic mouth wash and symptoms subsided. *** could consider outpt egd if this seems consistent with goals of care. . # gib: pt had guiac positive stool on week 2 of hospitalization and was started on protonix. *** could consider egd/ for further evaluation as outpt if this is within goals of care. . # hematuria: pt noted to have hematuria, which may have been prior foley placement. repeat ua with 1 rbc prior to discharge. . #anemia: has had melena, hemoptysis and chemo during this admission. pt transfused for goal hct >24. . # insomnia: pt experienced insomnia and was started on trazadone and mirtazapine at night. . # prophylaxis: pt initially started on heparin gtt. when heparin gtt discontinued, pt encouraged to use pneumoboot on the leg that did not have a dvt, however, pt refused pneumoboot on multiple occasions. . # goals of care: pt remained full code throughout admission. initially pt and family were certain that they wanted aggressive treatment for his cancer and any potential complications of his cancer. however, as his hospitalization progressed both pt and his wife began to have mixed feelings about the length of his stay and the discomfort he was enduring by being hospitalized far from his family. pt and family aware that his long-term prognosis is poor. given this, they began to refuse certain interventions (further radiation, anticoagulation) that they felt would be uncomfortable for him or that had the potential to keep him hospitalized for longer. goals of care became oriented towards getting him to rehab which is closer to his home. pt and family plan to continue to consider chemotherapy, anticoagulation, radiation, as well as more comfort-oriented measure. they will continue to discuss these with dr and dr as an outpatient. medications on admission: benzonatate 100mg capsules q8h cough combivent 18mcg-103mcg 1 puff ativan q6 prn nausea zofran 8mg q8h prn nausea endocet 5/325mg 1-2 tabs q6prn pain compazine 10mg po q6 prn nausea discharge medications: 1. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). 2. combivent 18-103 mcg/actuation aerosol sig: one (1) inhalation twice a day. 3. lorazepam 1 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea: hold for sedation. 4. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po once a day as needed for nausea. 5. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain: hold for sedation. 6. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 9. lidocaine-diphenhyd--mag- 200-25-400-40 mg/30 ml mouthwash sig: 15-30 ml mucous membrane every six (6) hours as needed for mucositis. 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever: do not give more than 2g in one day. 12. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 13. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 14. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 15. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 16. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 17. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 18. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 3 doses: for post-chemo treatment. 19. critic-aid clear af 2 % ointment sig: one (1) topical twice a day as needed for itching. discharge disposition: extended care facility: hospital rehab discharge diagnosis: primary: hemoptysis bilateral pes dvt post-obstructive pneumonia nsclc discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - requires assistance or aid (walker or cane) (short distances only) activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to the for coughing up blood. you were found to have blood clots in your lung. you were initially started on heparin (an blood thinner) and you coughed more blood. we stopped the blood thinner and temporarily moved you to the intensive care unit for closer follow-up. you were then found to have clots in your leg and you had a filter placed in your vein to prevent any more clots going to your lungs. this resulted in a large amount of swelling in your legs which can you were also treated for pneumonia that was caused by your lung mass. you were continued on your chemotherapy treatment and also recieved a small amount of radiation therapy. followup instructions: please transport pt to the following appointment: provider: , md phone: date/time: 9:30 provider: , md phone: date/time: 9:30 please arrange for pt to see his pcp , within 1 week of discharge md procedure: interruption of the vena cava fiber-optic bronchoscopy fiber-optic bronchoscopy fiber-optic bronchoscopy other lavage of bronchus and trachea injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified anemia, unspecified acute kidney failure, unspecified personal history of other lymphatic and hematopoietic neoplasms other specified cardiac dysrhythmias malignant neoplasm of upper lobe, bronchus or lung encounter for palliative care acute venous embolism and thrombosis of deep vessels of proximal lower extremity hemorrhage of gastrointestinal tract, unspecified other disorders of neurohypophysis hematuria, unspecified other pulmonary embolism and infarction secondary malignant neoplasm of bone and bone marrow insomnia, unspecified late effect of radiation radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other esophagitis nonspecific abnormal results of function study of liver 

Answer: The patient is high likely exposed to