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: headache, syncope major surgical or invasive procedure: coiling of aca and evd placement history of present illness: neurosurgery hpi 64 m who was filling up his gas tank this morning when he developed a sudden onset severe headache and loss of consciousness. pt was transported to an osh where a ct showed sah. pt was med-flighted to . sbp has been 190-200. gcs on arrival 13 (-1 for confusion, -1 for eye opening). . . hpi taken on transfer to medicine service re non neurosurgical issues mr is a 64 year old man who is transferred to us from the neurosurgery service after a long hospital course after a subarachnoid hemorrhage that came as a massive headache and loc while engaged in daily activities. an aneurysm was found to have burst, and was coiled. neurologically he has been improving well post-operatively. . in medical terms his course has been somewhat complicated with hypertension and urinary retention figuring as prominent issues which remain; post-op ileus and urinary tract infection were earlier issues. he was considerably fluid-loaded during the earlier part of his admission. he notes that his abdomen and pelvis felt swollen and taut, and that his abdomen felt "like a basketball that was inflated to too high a pressure" likely secondary to ileus. he feels that this is considerably better now. he does say that he constantly feels thirsty and that his mouth feels dry. . an echo during his admission showed >55% lvef with some diastolic dysfunction. in reviewing his pre-admission history, mr that he has had very little medical care in the past few years and thus has not had any formal diagnosis of cardiovascular disease, but also denies any history of headaches, palpitations, syncope, chest pain, chest tightness, or notable dyspnea on exertion. he does note that over the last six months or so he began to notice some swelling in his feet at the end of his work shift, considerably more than prior. . he says that he began noticing some urinary hesitancy and retention about six months prior to admission; he says that when seeing commercials on tv asking "hard to get started?" he thought, "i should get this checked out" medically, but did not. he says that he sometimes had to stand over the toilet for a while to get started, and that he sometimes did feel as if there was urine left, although not so much that he felt like he had to go right back to the urinal. he denies urinary discomfort or pain with urination and denies hematuria. . he denies any problems with defecation and denies noticing small-caliber stool or blood in his stool or melena. . currently he feels fairly well. he has a foley in place and this is not causing him discomfort. past medical history: tonsillectomy at age 7. generally avoids medical visits. social history: has worked multiple jobs in the past, but for the past 6 years has worked as a postal worker loading and sorting priority mail packages. in the past was an english teacher, then was in sales, then ran his own painting business, and during a winter in which he was not getting painting jobs decided to work for the postal service. . he was a smoker from his teen years until about a month before his admission. before his admission he drank drinks a week. he denies any other drug use. . he is married and lives with his wife; they have three daughters in their 20s, all out of the home, two in college and one graduated. family history: father had htn, died at 91, 92 of "old age" (died on toilet after long period of weakness/decline starting several years before) mother died in her 80s, was hospitalized much of her life for schizophrenia 1 sister, age 69; htn, arthritis physical exam: o: t: 96.0 bp: 199/88 hr: 35-60 rr15 o2sats 99 ra gen: lethargic, arousable, appears comfortable heent: pupils: 1.5mm to 1mm symmetrical, eomi. neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: cooperative with exam, lethargic, arousable, oriented to person, hospital and year. must be reminded of hospital name, repeatedly thinks it is normal affect. language: speech slowed . cranial nerves: i: not tested ii: pupils equally round and reactive to light, to mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. . motor: normal bulk and tone bilaterally. no abnormal movements, tremors. strength full power 4-5/5 throughout. no pronator drift . toes downgoing bilaterally. . physical exam on transfer to medicine service t 99 tmax 101.5 at 5:30 am bp 170/98, range 134-178/68-98 hr 96 (90-103) rr 18 o2 96% ra fsbs 122 (123, 136 prior) . gen: thin man, watching red sox game on tv, in nad, engages examiner easily heent: oropharynx clear. anicteric, non-injected conjunctivae. cn exam negative for abnormalities or asymmetries in detail except slight l facial droop (as seen prior). tongue and mucus membrane appears dry. pulmonary: poor air movement, faint lung sounds at r base; good air movement elsewhere; no egophony cardiac: rrr, no m/r/g abdominal: somewhat distended but not taut; soft; non-tender; no organomegaly appreciated extremities: no edema. warm and well-perfused. distal pulses +/+. skin: morbilliform rash extending bilaterally and evenly from thighs with medial predominance, extending to hips, lower torso; also on arms. neurologic: motor exam: strength intact and muscle tone wnl w knee elevation, feet dorsiflexion and plantarflexion; grip. . pertinent results: . kub : again noted are multiple dilated loops of small bowel. contrast from prior administration is seen throughout the colon into the sigmoid and rectum. the degree of distention is probably unchanged compared with the previous examination. nasogastric tube is in place, but the side ports projecting below the expected location of ge junction. impression: dilated loops of small bowel and air-filled colon, probably unchanged in degree compared to the prior study of . . kub :oral contrast is again demonstrated within the colon with evacuation of a small amount of contrast between the two studies particularly in the region of the proximal descending colon and sigmoid region. dilated, air-filled loops of small bowel are again demonstrated not substantially changed since the prior study. examination was not tailored for evaluating for free intraperitoneal air. additional upright or lateral decubitus view would be recommended if free air is suspected clinically. nasogastric tube has been removed in the interval. . kub : no short interval change in gaseous distention to small or large bowel more suggestive of an ileus. distal contrast has passed. . echocardiogram measurements: left atrium - long axis dimension: *4.4 cm (nl <= 4.0 cm) left atrium - four chamber length: 5.0 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.7 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.3 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.1 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 2.9 cm left ventricle - fractional shortening: 0.43 (nl >= 0.29) left ventricle - ejection fraction: >= 55% (nl >=55%) aorta - valve level: *3.7 cm (nl <= 3.6 cm) aorta - ascending: *3.5 cm (nl <= 3.4 cm) aorta - arch: 2.6 cm (nl <= 3.0 cm) aortic valve - peak velocity: 1.3 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 1.0 m/sec mitral valve - a wave: 1.1 m/sec mitral valve - e/a ratio: 0.91 mitral valve - e wave deceleration time: 195 msec tr gradient (+ ra = pasp): *37 mm hg (nl <= 25 mm hg) pulmonic valve - peak velocity: 0.8 m/sec (nl <= 1.0 m/s) interpretation: findings: left atrium: mild la enlargement. right atrium/interatrial septum: normal ra size. left ventricle: mild symmetric lvh with normal cavity size and regional/global systolic function (lvef>55%). transmitral doppler and tvi c/w grade i (mild) lv diastolic dysfunction. no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: mildly dilated aortic sinus. mildly dilated ascending aorta. normal aortic arch diameter. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. conclusions: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. 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 (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: symmetric lvh with preserved global and regional biventricular systolic function. mild diastolic lv dysfunction. mild mitral regurgitation. moderate pulmonary hypertension. electronically signed by , md on 13:24. ====================================== ct abd/pelvis medical condition: 64 year old man with an area of spasm vs tortuous colon at rectosigmoid jxn on sigmoidoscopy. reason for this examination: r/o extrinsic compression of colon, intraabdominal mass contraindications for iv contrast: none. addendum: these findings were conveyed to by at approximately 4:45 p.m. on . indication: 64-year-old man with an area of spasm versus tortuous colon at the rectosigmoid junction on sigmoidoscopy; rule out extrinsic compression and intra-abdominal mass. comparisons: none. technique: mdct images from the lung bases through the ischial tuberosities were obtained with intravenous and oral contrast in the portal venous phase of enhancement. multiplanar reformations were essential to interpretation. lower chest: there are small bilateral pleural effusions with adjacent atelectasis. abdomen: there are numerous hepatic hypodensities in both lobes, the majority of which are too small to characterize. the largest lies in segment iii and measures 17 x 22 mm and is compatible with a cyst. the gallbladder is present. the spleen, pancreas, and adrenal glands are within normal limits. there is mild bilateral hydronephrosis and mild right hydroureter secondary to a massively enlarged urinary bladder, which contains a locule of air which is believed to be iatrogenic. there is marked stranding surrounding the left renal pelvis, believed to be related to forniceal rupture. the abdominal aorta demonstrates a normal caliber, with extensive atheromatous calcification which extends into the common iliac arteries. there is no pathologic lymph node enlargement. there is diffuse regular-appearing low-attenuation wall thickening involving the majority of the ileal loops. the jejunal loops appear unremarkable. the colon also appears grossly unremarkable. the rectum is within normal limits. the massively distended urinary bladder is compressing the sigmoid colon. the prostate gland appears unremarkable. there is no pathologic lymph node enlargement. a small fat-containing left inguinal hernia is present. there is diffuse stranding of the subcutaneous fat, compatible with anasarca. osseous structures: no suspicious lytic or blastic lesions are identified. there are degenerative changes at multiple levels in the spine. impression: 1. extrinsic compression of the sigmoid colon by massively distended urinary bladder. 2. bilateral hydronephrosis with left renal forniceal rupture secondary to massively distended bladder. 3. ileal wall thickening, with an appearance most suggestive of a mural hemorrhage. edema, infection and cellular infiltration would be less likely diagnostic considerations. 4. small bilateral pleural effusions with adjacent atelectasis. 5. multiple renal hypodensities, some of which cannot be definitively characterized, but may represent cysts. the study and the report were reviewed by the staff radiologist. dr. dr. approved: sat 7:24 am ============================================ radiology preliminary report chest (pa & lat) 4:29 pm chest (pa & lat) reason: ?resolution of rll opacity medical condition: 64 year old man with ?resolving edema vs ongoing slight rll infiltrate of pna, pls compare to prior cxrs and prior ct to eval whether infiltrate vs resolving edema more likely--thanks reason for this examination: ?resolution of rll opacity indication: 64-year-old man with resolving edema versus ongoing right lower lobe infiltrate. comparison: multiple studies, the most recent dated , . findings: the cardiac silhouette remains enlarged. interval improvement in the right lower lobe opacity likely represent atelectasis and pleural effusion. the lungs are hyperinflated consistent with emphysema. small left pleural effusion. there is no evidence of pneumothorax. the osseous structures are unchanged. impression: interval improvement in the right lung base opacity. dr. dr. dr. ======================================== 10:00am wbc-15.7* rbc-4.68 hgb-15.3 hct-44.2 mcv-94 mch-32.8* mchc-34.7 rdw-12.7 10:00am neuts-90.6* bands-0 lymphs-7.0* monos-1.5* eos-0.4 basos-0.4 10:00am hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 10:00am plt smr-normal plt count-250 10:00am pt-12.3 ptt-22.1 inr(pt)-1.1 . 09:03pm type-art po2-201* pco2-36 ph-7.39 total co2-23 base xs--2 . 10:00am glucose-172* urea n-12 creat-1.0 sodium-138 potassium-4.3 chloride-101 total co2-29 anion gap-12 10:00am ck(cpk)-76 10:00am ctropnt-<0.01 10:00am ck-mb-notdone 10:00am calcium-9.2 phosphate-2.7 magnesium-2.3 brief hospital course: the patient was admitted for a sah and an aneurysm on . . neuro: pod2 became agitated at night, pulled at evd. f/u head ct revealed evd still in good place ending in the frontal of the r lateral ventricle, still draining csf. . tcd performed showed early vasospasm. repeat tcd on showed no vasospasm. cta showed no change besides the coil. repeat tcd on showed mild/moderate vasospasm. pt removed evd on , head ct showed unchanged hemorrhage. 3pm experienced transient episode of acute onset l blurred vision. head ct showed minimally increased sah r post parietal lobe, otherwise unchanged study. blurred vision stopped after this study was performed, and he has had no visual complaints since. angiogram on showed s/p coiling; no residual aneurysm filling; no evidence of vasospasm. tcd on showed no vasospasm. he was evaluated by psychiatry several times during the end of the admission with no suggestion of psychiatric disturbance, suicidal ideation, or altered mental status. several serial screening mmses by medicine service also confirmed this. . cardiac: cvl placed pod2. nicardipine gtt to keep sbp 140-160. chf appearing cxr on for which lasix was given. his bp was elevated to 190s/100s on , medicine was consulted and recommended metoprolol and lisinopril. as he was transferred to medicine service he continued to have occasional bps peaking to 190, more often in 160s, 170s. increased metoprolol and lisinopril, added amlodipine. no symptoms of hypertension. though control has improved this will need longer-term follow up as an outpatient. . pulmonary: extubated pod1. tolerated extubation well and continues to ventilate well. he had a chest angiogram on which showed no aneurysm. he had some pleural effusions and pulmonary edema when transferred to medicine which were gradually clearing, though he still had scattered crackles on exam when discharged. at one point () there was the appearance of a rll consolidation and he was started on empiric therapy for hospital-acquired pneumonia (zosyn+vancomycin); however he had a follow-up x-ray two days later that showed complete resolution of the opacity, suggesting that it was much more likely to have been resolving edema. antibiotics were withdrawn. . x-ray suggested emphysema as well. . metabolic: the patient did have hyponatremia for several days in early but that resolved on its own. he did not require fluid restriction or sodium tablets. . gi: on , imaging of the abdomen showed distention, dilated loops of bowel. gen was consulted and they recommended bowel rest and ngt for an ileus. on he had a gastrograffin enema which showed no colonic obstruction. he had multiple kubs as well which showed dilated bowel but did not become worse over time. on the patient had a bowel movement. he had a rectal tube placed and had numerous bowel movements while in place. on gi allowed patient to have a regular diet once again. a stool sample on was positive for vre, which per id, is incidental finding, no abx is needed. was stooling regularly by discharge, abdominal distension reduced considerably. . gu: the patient had a uti while in house and completed a course of cipro for it, as below. . urinary: his foley was d/ced on , but he had bladder retention on and foley was re-inserted. had been on haldol and benadryl earlier in the admission during his neurosurgical recovery, medicine svc discontinued this for concern re contribution to urinary retention. several trials were unsuccessful, the last of which was after three days on tamsulosin, and in which bladder scan showed >900cc of retained urine after 8 hours without the foley. notably patient did not perceive that his bladder was full at this volume. also of note, his psa while here was 8.4 although his prostate was "unremarkable" via a pelvic ct. . he is scheduled for followup with a urologist in his area. . id uti discovered on - culture results finalized. given that this is an atypical uti, he was given a course of cipro 500" x 7 days. he remained afebrile while on this abx. csf gs neg, csf cx neg. brief course of empiric abx for possible hap, ultimately much more likely to have been pulm edema, as above. . endocrine he did have some high blood sugars during the admission, with several slightly above 150. not clear whether he might be pre-diabetic. would likely benefit from close outpatient follow-up to rule this out. . dermatologic morbilliform rash and distribution classic for drug reaction. no indication of ---no mucosal involvement.. dilantin was most likely suspect, was on this, rash often appears in this form, timing can be delayed. given that pt was on no medicines prior, potentially any medicine he has been on here could be a suspect. for symptoms, benadryl was given prn, but because may contribute to urinary retention was pulled as symptoms improved. second, pt had flushing rash while vancomycin was given, even w/2 hour infusion; likely classic "red man" though not directly seen by medicine mds, vanco was stopped soon as described above. getting ranitidine and sarna lotion. rash improving considerably on discharge. . additionally patient has several notable large nevi, elevated and dark but with well-delineated borders; and one large clear round growth just superior to his l clavicle. these should be followed up by a dermatologist. . overall health maintenance mr has not been to a doctor in some time and will likely benefit from a number of preventive interventions. an appointment with an area pcp was made for his discharge. . medications on admission: none discharge medications: 1. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. disp:*10 suppository(s)* refills:*0* 2. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day). disp:*1 tube* refills:*2* 3. metoprolol tartrate 50 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* 4. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*30 capsule, sust. release 24 hr(s)* refills:*2* 5. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*0* 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for itching. disp:*60 tablet(s)* refills:*0* 8. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. disp:*120 tablet(s)* refills:*0* discharge disposition: home with service facility: home services discharge diagnosis: primary: subarachnoid hemorrhage secondary to anterior cerebral aneurysm hypertension urinary retention secondary to bph drug rash secondary: impaired fasting glucose diastolic congestive heart failure - acute on chronic ileus discharge condition: neurologically stable. stable vital signs. ambulating without assist. tolerating oral medications and nutrition. discharge instructions: discharge instructions for craniotomy/head injury ?????? have a family member check your incision daily for signs of infection ?????? take your pain medicine as prescribed ?????? exercise should be limited to walking; no lifting, straining, excessive bending ?????? you may wash your hair only after sutures and/or staples have been removed ?????? you may shower before this time with assistance and use of a shower cap ?????? increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, ibuprofen etc. ?????? if you have been prescribed an anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing as ordered ?????? clearance to drive and return to work will be addressed at your post-operative office visit call your surgeon immediately if you experience any of the following: ?????? new onset of tremors or seizures ?????? any confusion or change in mental status ?????? any numbness, tingling, weakness in your extremities ?????? pain or headache that is continually increasing or not relieved by pain medication ?????? any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? fever greater than or equal to 101?????? f procedure: spinal tap incision of lung parenteral infusion of concentrated nutritional substances flexible sigmoidoscopy endovascular (total) embolization or occlusion of head and neck vessels diagnoses: congestive heart failure, unspecified unspecified essential hypertension subarachnoid hemorrhage hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) paralytic ileus acute diastolic heart failure 

Answer: The patient is high likely exposed to