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: codeine / penicillins / sulfa (sulfonamide antibiotics) / iodine containing agents classifier / ketorolac / tetracycline analogues / erythromycin attending: chief complaint: tranisent bilateral vision loss associated with right upper extremity weakness major surgical or invasive procedure: none history of present illness: per admitting resident: 52 yo rhw who experienced transient loss of vision in both eyes at 1 pm, she stated that she could not see "a glimmer of a shadow in both eyes for 5 minutes." this was followed by sharp pain in her right arm with tingling, and a feeling of weakness, she called 911, and she was taken to . she did not notice weakness in her right leg. she has never had symptoms like this previously. at , she had an mri of the brain and mra of the head and neck, which demonstrated multiple small infarcts and a left carotid artery stenosis. since finding out this news, ms has been tearful. at she received a heparin bolus and heparin gtt at 6.8 cc/hr. she has never had symptoms such as these previously. she felt light headed during her symptoms, and in the er, she developed a dull bifrontal headache. the day prior to these symptoms, she had nausea. otherwise, the rest of her neurological and systemic symptoms review was unremarkable. past medical history: pmh rheumatoid arthritis oa fibromyalgia chronic pain syndrome pe in secondary to the ocp . psh 6 surgeries s/p mva: c6-7 fusion, 3 shoulder surgeries (1 r, 2 l), l tkr tah (for menorrhagia) appendicectomy adenoidectomy tonsillectomy social history: - unemployed - lives alone - divorced - has son, daughter weekends . habits: tobacco - 1ppd x 33 years etoh - denies rec - denies family history: mother - copd father - urothelial ca, cad physical exam: on admission: t-97.8 bp-98/70 hr-92 rr-18 o2sat-98% gen: lying in bed, anxious, poor dentition heent: nc/at, moist oral mucosa neck: no tenderness to palpation, normal rom, supple. left carotid bruit back: no point tenderness or erythema cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender ext: no edema neurologic examination: nih ss:2 1a. level of consciousness: 0 1b. loc questions: 0 1c. loc commands: 0 2. best gaze: 0 3. visual: 0 4. facial palsy: 0 5a. motor arm, left: 0 5b. motor arm, right: 1 6a. motor leg, left: 0 6b. motor leg, right: 1 7. limb ataxia: 0 8. sensory: 0 9. best language: 0 10. dysarthria: 0 11. extinction and inattention: 0 mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive, says dow backwards. speech is fluent with normal comprehension and repetition; naming intact. no dysarthria. intact. registers , recalls in 5 minutes. no right left confusion. no evidence of apraxia or neglect. cranial nerves: pupils equally round and reactive to light, 4 to 2 mm bilaterally. fundoscopy reveals normal optic discs bilaterally. vision corrected with glasses is 20/20 bilaterally. visual fields are full to confrontation. extraocular movements intact bilaterally, no nystagmus. sensation intact v1-v3. facial movement symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor right pronator drift tri wf we fe ff ip h q df pf te tf r +4 +4 5 +4 +4 +4 +4 +4 +4 5 5 5 5 5 l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 sensation: intact to light touch, and vibration throughout. pinprick reduced in the right arm and right leg, more so in the right arm. proprioception reduced in the right fingers, but not in the right foot. no extinction to dss reflexes: +2 and symmetric throughout. right babinski coordination: finger-nose-finger ataxic on the right, heel to shin slower on the right, rams slow and clumsy on the right. gait: narrow based, steady. romberg: positive pertinent results: wbc-12.9* rbc-4.64 hgb-14.0 hct-41.1 mcv-89 mch-30.2 mchc-34.1 rdw-15.6* glucose-89 urea n-3* creat-0.6 sodium-141 potassium-4.0 chloride-108 total co2-24 anion gap-13 sed rate-32* pt-12.9 ptt-44.0* inr(pt)-1.1 ck-mb-notdone ctropnt-<0.01 tsh-1.3 . modifiable risk factors for stroke: triglycer-85 hdl chol-40 ldl(calc)-97 %hba1c-5.8 . imaging: . transthoracic echocardiogram (): the left atrium is normal in size. no thrombus/mass is seen in the body of the left atrium. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion . carotid duplex (): pending . chest x-ray (): impression: no acute intrathoracic process brief hospital course: ms. is a 52 year-old right-handed female smoker with a past medical history including rheumatoid arthritis who presented to with right upper extremity weakness following transient bilateral vision loss. neuroimaging demonstrated multiple occipital lobe and deep white matter infarcts in teh setting of left internal carotid artery stenosis. a heparin drip was started and the patient was transferred to the for further care. she was admitted to the stroke service from , then transfered to surgery. . neuro upon her arrival to the , the heparin drip was continued with a goal ptt of 50 to 70. as an mra performed at demonstrated significant carotid artery stenosis, carotid duplex studies were performed to confirm the finding. the imaging showed carotid artery stenois . cvs a surgery consult was requested to evaluate the utility and feasbility of a carotid endarterectomy. the team recommended cea. she recieved thiss. it was uncomplicated . rheum the pre-existing ra regimen of methotrexate, plaquenil, and folate was continued while the patient was in the hospital. . code full medications on admission: percocet 10/325 mg 1 tab po q6h prn pain + qhs prn pain alprazolam 0.5 mg po q 12h fosamax 70 mg po q wednesday methotrexate 2.5 mg tabs - 6 tabs (15 mg) po q tuesday plaquenil 200 mg po bid folic acid 1 mg po daily ambien 10 mg po qhs . allergies: codeine penicillin sulfa ketorolac tetracycline erythromycin iodine contrast dye discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*6* 2. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. hydroxychloroquine 200 mg tablet sig: one (1) tablet po twice a day. 5. folic acid 1 mg tablet sig: one (1) tablet po once a day. 6. alendronate 70 mg tablet sig: one (1) tablet po qwed (every wednesday). 7. methotrexate sodium 2.5 mg tablet sig: one (1) tablet po once a day: as directed by pcp, not known. 8. glucocom lancets misc sig: one (1) miscellaneous three times a day. disp:*1 glucocom lancets * refills:*2* 9. glucostix test strip sig: one (1) in three times a day. disp:*1 strip* refills:*2* discharge disposition: home discharge diagnosis: carotid artery stenosis discharge condition: stable discharge instructions: division of and endovascular surgery carotid endarterectomy surgery discharge instructions what to expect when you go home: 1. surgical incision: ?????? it is normal to have some swelling and feel a firm ridge along the incision ?????? your incision may be slightly red and raised, it may feel irritated from the staples 2. you may have a sore throat and/or mild hoarseness ?????? try warm tea, throat lozenges or cool/cold beverages 3. you may have a mild headache, especially on the side of your surgery ?????? try ibuprofen, acetaminophen, or your discharge pain medication ?????? if headache worsens, is associated with visual changes or lasts longer than 2 hours- call surgeon??????s office 4. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 5. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? 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: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? no excessive head turning, lifting, pushing or pulling (greater than 5 lbs) until your post op visit ?????? you may shower (no direct spray on incision, let the soapy water run over 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 over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? changes in vision (loss of vision, blurring, double vision, half vision) ?????? slurring of speech or difficulty finding correct words to use ?????? severe headache or worsening headache not controlled by pain medication ?????? a sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg ?????? trouble swallowing, breathing, or talking ?????? temperature greater than 101.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: (nhb) phone: date/time: 11:30 provider: , md phone: date/time: 12:00 procedure: endarterectomy, other vessels of head and neck procedure on single vessel diagnoses: other iatrogenic hypotension tobacco use disorder osteoarthrosis, unspecified whether generalized or localized, site unspecified rheumatoid arthritis personal history of venous thrombosis and embolism knee joint replacement myalgia and myositis, unspecified chronic pain syndrome occlusion and stenosis of carotid artery with cerebral infarction 

Answer: The patient is high likely exposed to