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: demerol / aspirin / dilaudid attending: chief complaint: lung mass. major surgical or invasive procedure: lung biopsy on . vertebroplasty history of present illness: 88 year old male with a history of prostate cancer, cva, dm2, cea and transferred to the medicine service for further evaluation of a lung mass. the patient was in his usual state of health until one month prior to admission when he developed upper extremity weakness, right more than left as well as bilateral shoulder pain and a cough. he was admitted to an osh and was found to have a lll infiltrate and was treated for pneumonia and copd flare. he also had a spine mri which demonstrated a t1 compression fracture. the patient was transitioned to rehabilitation. at the rehab facility he continued to have upper extremity weakness and bilateral shoulder pain refractory to conservative measures. mri of his brain showing no significant change from his post-stroke mri per report. his r hand weakness progressed and he was sent from rehab back to the osh where he again had a mri of his c-spine which showed interval progression of the compression fracture with retropulsion of the posterior fragment into the upper thoracic cord. additionally, a soft tissue mass anterior to the vertebral body brought up the possibility of metastatic disease. his psa remained flat at this time and a ct chest showed 2 lll masses along with renal and thyroid cysts. he was started on steroids and sent to for further managment. incidentally, he was restarted on ctx/gentamycin at the osh per family report because he developed fevers but they denied any other infectious symptoms at this time including sob, cough, dysuria, or abdominal pain. he did have mild diarrhea. . at , his films were reviewed by neurosurgery and no cord compression was noted. his thoracic vertebral fracture was thought to be stable and he was fitted for a brace. ip was consulted to perform a percutaneous biopsy of the mass and ct of the chest, abdomen and pelvis were performed. a bone scan and ct head were ordered along with a mri of c5-t4. the patient was transfered to medicine for further work-up of his lung mass once acute neurosurgical issues were excluded. . on interview today, the patient feels generally well. he denies any cp, sob, abdominal pain, nausea, vomiting or headache. he does have some le paresthesias and notes weakness in his r hand that is worse than baseline. his family notes chronically loose bowels but states this has been worse of late and feels that his cognition has slipped over the past month. past medical history: 1. htn 2. prostate ca s/p xrt and since treated w/ lupron and zoladex 3. cva ' w/ residual r sided weakness 4. dm2 5. s/p nephrectomy ~' 6. gib 7. carotid endarterectomy 8. copd 9. shoulder oa 10. glaucoma social history: lives with sons but most recently in rehab. social etoh. quit smoking ~20yrs ago (30-45pk/yrs prior). no drug use. worked for but also spent time in a quarry. no work in construction, demolition, or shipyard. no exposure to chemicals. family history: noncontributory. physical exam: (on admission) 99.3, 126/69, 88, 20, 98%ra gen: wnwd elderly sitting up in chair w/ neck brace in place heent: mmm, o/p clear, eomi, perrla cv: rrr, 3/6 sem at the apex lungs: decreased breath sounds on the l abd: s/nt/nd, +bs, -hsm ext: no peripheral edema neuro: decreased strength on r side w/ worst strength in grip, intact sensation to light touch bilaterally, aao to person and year but not date or location, 0/3 recall immediately and w/ prompting, thought 5 quarters in $1.75, intact heel-to-shin on l but impaired on r, able to name watch/pen and describe what they are used for skin: no rashes (on discharge) 99.1, 130/70, 74, 18, 95% on 2l nc gen: chronically ill appearing male in soft neck collar in place heent: op clear, eomi, mmm cv: rrr, 3/6 sem apex radiating to axilla, heard across precordium resp: sporadic ronchi, decreased breath sounds left abd: soft, nontender, nondistended, normal bowel sounds ext: no edema, able to move ue/le bilaterally pertinent results: at the time of callout from the micu (): . labs: remarkable for wbc 18.3 trending downward, hct 27.9 baseline 32, inr 1.3. . mr thoracic and cervical spine without contrast (): 1. again seen is compression deformity involving the t1 vertebral body. there is no evidence of cord signal abnormality. degenerative changes within the cervical spine result in areas of spinal canal stenosis, as described above. 2. there is left pleural effusion and ill-defined mass in left lower lobe, which is better evaluated on prior ct scans. . bone scan (): no evidence of osseous metastatic disease. focal uptake in the lower neck likely correlates with t1 compression fracture on ct scan. . ct chest/abd/pelvis (): 1. multiple heterogeneously enhancing soft tissue masses within the posterior left lung likely centering within the pleura extending into the lateral chest wall and causing mild bony erosion. a small linear calcification is noted adjacent to the pleura within the dominant mass suggesting possible mesothelioma. additional diagnoses within the differential include primary lung cancer or metastatic lesion from thyroid or renal cell carcinoma. the lesion appears to be amenable to percutaneous biopsy. 2. heterogeneously enhancing middle mediastinal left thyroid lesion. this likely represents a simple goiter but can be further evaluated with ultrasound if clinically indicated. 3. cholelithiasis without evidence of acute cholecystitis. 4. multiple right renal hypoattenuating lesions, some of which are clearly cystic and others which are too small to characterize. 5. diffuse atherosclerotic calcifications. 6. t1 compression fracture with multilevel degenerative changes throughout the spine, including grade 1 anterolisthesis of l5 on s1 and mild posterior disc protrusion of l3-4 intervertebral disc. . bronchial brushings and washings (): negative for malignant cells. . lymph node biopsy (): non-diagnostic, lymph node not sampled, likely reactive lymphocytes. . echo (): the left atrium is elongated. the left ventricular cavity size is normal. left ventricular systolic function is grossly preserved although views are technically suboptimal (ef probably >45%). regional wall motion could not be fully assessed. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets are severely thickened/deformed. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr (): large lower lobe consolidation. this may be due to aspiration, hemorrhage, or pneumonia. . cxr (): increased airspace opacity involving both lungs is new when compared to the previous chest radiograph and ct. the finding represents mild pulmonary edema. previously identified bilateral lower lobe opacities are much less conspicuous on the current exam. deviation of the trachea from the midline to the right attributable to the previously seen enlarged thyroid. . cta (): 1. no pulmonary embolism. 2. new bilateral pleural effusions, moderate on the left and small on the right. 3. consolidation of the majority of the right lower lobe. increased consolidation surrounding the left lower lobe masses. this may be infectious or due to aspiration. 4. no short interval change in the left lower lobe masses previously detailed on the study from five days ago. . tte : the left atrium is elongated. the left ventricular cavity size is normal. left ventricular systolic function is grossly preserved although views are technically suboptimal (ef probably >45%). regional wall motion could not be fully assessed. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets are severely thickened/deformed. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . thyroid ultrasound: 1) very limited study due to overlying brace and patient immobility. thyroid parenchyma not visualized. 2) 4.1-cm mass centered in the expected position of the upper lobe of the left thyroid/supraclavicular region. it is impossible to tell on the current study whether this lesion is exophytic from the left lobe thyroid or represents supraclavicular adenopathy, though the former appears more likely in correlation with the recent cta chest. . noncontrast ct chest: 1. no change in large soft tissue mass in the left lower lobe with extension/invasion into adjacent chest wall, pleural effusion, and infrahilar and mediastinal lymphadenopathy. 2. decreased right pleural effusion and improved right basilar atelectasis/consolidation. . ct head () for mental status changes: 1. no hemorrhage or mass effect. 2. old bilateral basal ganglia and left cerebellar infarcts. . brief hospital course: 1. t1 compression fracture: the patient was initially evaulated by neurosurgery who did not feel that the patient had new weakness or evidence of spinal cord compression. he was fitted for brace which he wore at all times. in an effort to free the patient from the brace and improve his pain, he underwent interventional radiology-vertebroplasty. after that, the patient was able to be changed to a small soft collar, but had very little palliation from the procedure. his mobility is significantly limited and requires significant assistance to get out of bed. at discharge, he could move all extremities at his baseline. radiation oncology was involved and radiated his t1 lesion in a single fraction, with little palliation. tissue biopsy at the time of vertebroplasty was unrevealing. . 2. lll mass: likely primary lung cancer, however, no definitive tissue pathology was obtained despite several attempts including transbronchial biopsy. ddx included thyroid and renal cell cancers, and the patient does have a large thyroid nodule which was unable to be biopsied secondary to his neck fracture constraints. oncology consulted who thought patient was not a chemotherapy candidate given his solitary kidney and poor performance status. radiation oncology consulted, as above. he was not a candidate for radiation to the lung mass. . 3. post obstructive pneumonia: the patient was intermittently febrile throughout the hospitalization and was found to have a postobstructive pneumonia. he was treated with broad spectrum antibiotics for a prolonged course given his inability to clear secretions effectively. chest pt was not able to be done given the constraints of his neck fracture. on the day of discharge, he was febrile to 102 after a long period of being afebrile with a resolving leukocytosis. he was continued on antibiotics at discharge. . 4. atrial fibrillation: the patient developed new onset atrial fibrillation during the hospitalization around the time of his transbronchial biopsy. he was diltiazem refractory and ultimately responded to iv metoprolol. he was maintained on metoprolol orally during the hospitalization. he received a course of amiodarone and coverted to sinus rhythm. he was discharged on 200 mg amiodarone daily in nsr. . 5. hypoxia: the patient was intermittently hypoxic during the initial period of his hospitalization from the large lll mass, post obstructive pneumonia/mucus plugging, paroxysmal atrial fibrillation and intermittent volume overload. he would have a tendency to desaturate overnight, but would respond to increased oxygen and diuresis if overloaded. at discharge, the patient had a much improved requirement of 2 liters by nasal cannula. . 6. left lobe thyroid nodule. incidentally found on chest ct on . normal thyroid function. thyroid ultrasound completed, but limited by the patient's large neck brace and t1 fracture. the decision was made not to pursue further characterization of the thyroid nodule. . 7. anemia of chronic inflammation: stable at his baseline hematocrit of 28-30. . 8. prostate cancer: prior history, on zoladex as outpatient. not continued as inpatient. psa flat despite evidence of metastatic disease. stable as inpatient. . 9. diabetes: home regimen of metformin and glipizide held in the hospital, placed on sliding scale. uncontrolled sugars in the setting of steroids for pain control. titrating lantus based on sliding scale requirement. . 10. pain and palliation: palliative care consulted given that the patient's pain was difficult to control. he was refractory to tylenol but very sensitive to narcotics. he was on several regimens during the hospitalization, but was ultimately discharged on methadone 0.5 mg q8 am and q2 pm. he was also maintained on ritalin for improved mood and energy during the day. he was also pulsed with decadron with improvement in his mood, but not pain. decadron was tapered to 4 mg daily with the plan to taper off as tolerated. . 11. glaucoma: continued home latanoprost . 12. gout: continued home allopurinol. no acute issues. . 13. hypertension: well controlled initially on home regimen, but became difficult to control in the setting of steroids. at discharge, he was stable in 130s/70s on lisinopril and metoprolol. . 14. disposition: the patient had a long and complicated hospital course, ultimately resulting in vertebroplasy for his t1 compression fracture. he was deconditioned and depressed at the time of discharge to hospice. palliative care followed closely in the management of this patient and helped the family cope with the new diagnosis and complications. ultimately it was decided not to pursue aggressive diagnostic and therapeutic measures and the patient was discharged to hospice care. . medications on admission: (on transfer): hsq iss allopurinol 300mg latanoprost 1 drop qhs ctx 1g gentamycin 80mg protonix 40mg iron 325mg propoxyphene-apap prn fa glipizide 5mg . meds (at rehab): lisinopril 20mg glipizide 5mg allopurinol 300mg lasix 40mg asa 325mg metformin 500mg lactulose prn xalatan eye drop qhs naprosyn prn zantac 150mg fa 1mg lidocaine patch to back darvocet prn prednisone taper zoladex 10.8mg q3mo (due this mo) discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. lidocaine hcl 2 % gel sig: one (1) appl mucous membrane prn (as needed). 4. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours). 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): on for 12 hours, off for 12 hours. 8. methylphenidate 5 mg tablet sig: one (1) tablet po bid (2 times a day): at 10 am daily. 9. oxycodone 5 mg tablet sig: 1/2-1 tablet po q3h (every 3 hours) as needed. 10. dexamethasone 4 mg tablet sig: one (1) tablet po daily (daily) for 5 days: please take 4 mg for five days, then 2 mg for five days, then stop. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 12. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 13. methadone 10 mg/5 ml solution sig: 0.5 mg po please give at 8am, 2pm () as needed for prn pain. 14. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 15. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 16. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed. 17. insulin glargine 100 unit/ml solution sig: eighteen (18) units subcutaneous at bedtime. 18. amiodarone 200 mg tablet sig: one (1) tablet po once a day. 19. insulin regular human 300 unit/3 ml insulin pen sig: 0-12 units subcutaneous four times a day: per sliding scale. 20. levofloxacin 500 mg tablet sig: one (1) tablet po once a day. 21. bactrim ds 160-800 mg tablet sig: one (1) tablet po twice a day. 22. flagyl 500 mg tablet sig: one (1) tablet po twice a day. 23. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. discharge disposition: extended care facility: community hospice discharge diagnosis: t1 compression fracture lung mass, likely nsclc shoulder pain hypertension diabetes mellitus prostate cancer cva with residual r weakness s/p nephrectomy gib carotid endarterectomy copd shoulder oa glaucoma discharge condition: stable. on 3l o2, to hospice discharge instructions: discharge to hospice. please return to the ed as needed. followup instructions: as needed. procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung biopsy of lymphatic structure diagnoses: pneumonia, organism unspecified anemia of other chronic disease congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation personal history of malignant neoplasm of prostate other chronic pulmonary heart diseases unspecified glaucoma systolic heart failure, unspecified malignant neoplasm of other parts of bronchus or lung hypoxemia secondary malignant neoplasm of bone and bone marrow ulcer of heel and midfoot pathologic fracture of vertebrae diabetes with unspecified complication, type ii or unspecified type, uncontrolled nontoxic uninodular goiter 

Answer: The patient is high likely exposed to