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: seizure major surgical or invasive procedure: colonoscopy upper endoscopy history of present illness: 79 y/o f with hx of dm, htn, hl and recent rcc s/p nephrectomy in mid presents approx a week after discharge from her post surgical care with decreased appetite, lethargy and altered mental status with seizure in bed witnessed by husband. emergently brought to hospital, stabalized and transferred to . . at she was admitted to the surgery icu and seen by neurology and diagnosed with press syndrome. seizures treated with dilantin. during her hospitalization, she also had worsening renal failure (which began after her nephrectomy), nstemi diagnosed by troponin leak and new hypokinesis, and hct drop with melanotic stools. pt had been started on aspirin, not plavix, by cardiology as a result of her nstemi. . upon transfer, the patient is feeling well. has no complaints. has never experienced chest pain in the recent past, does not endore shortness of breath. had some sob post surgery, but otherwise, no sob, cough, doe, pnd. did have some edema with 10 lb weight gain post surgery as well, but has improved. no dizziness or headache. no abdominal pain, nausea, vomitting. is up in chair without problems, not ambulating on her own yet. past medical history: dm htn hyperlipidemia rcc s/p nephrectomy social history: married with 4 children, nonsmoker, no etoh/illicts family history: non contributory physical exam: pe on discharge: vitals - tc 97.4, tm 99.5, bp 152/60, p 74, r 18, 93% on ra gen - pleasant elderly woman in bed, eating dinner, nad heent - atnc, perrla, eomi, supple neck, no jvd, no bruits cv - rrr, no m,r,g lungs - decreased breath sounds at the bases, otherwise cta b abd - soft, nontender, nondistended, hypoactive but present bowel sounds; l flank incision with steristrips, cdi and healing well ext - warm feet with palpable pulses, no edema; palpable radial pulses, normal capillary refill neuro - a+ox3, cn intact, moving all 4 extremities, strength 5/5 throughout, no focal deficits pertinent results: eeg: findings: abnormality #1: throughout the recording the background rhythm was generally slow and of lower voltage. often, the background included alpha frequencies with a generalized distribution but a possible frontal maximum. abnormality #2: there were additional bursts of generalized slowing and some bursts of relative attenuation of the background in all areas for up to 1.5 seconds or so. hyperventilation: could not be performed. intermittent photic stimulation: could not be performed. sleep: no normal waking or sleeping morphologies were seen. cardiac monitor: showed a generally regular rhythm. impression: markedly abnormal portable eeg due to the widespread suppression and slowing of the background and due to bursts of generalized slowing and bursts of suppressed background activity. these findings indicate a widespread encephalopathy affecting both cortical and subcortical structures. the very regular portions of the background raise the possibility of medication effect. such encephalopathies are often due to metabolic disturbances, infection, medication, or hypoxia, but the etiology cannot be determined from the tracing. nevertheless, there were no areas of prominent focal slowing (although encephalopathies may obscure focal findings), and there were no epileptiform features. mri: findings: brain mri: diffusion images demonstrate no evidence of acute infarct. there is no evidence of mass effect, midline shift or hydrocephalus. mild-to-moderate brain atrophy is seen. there are several hyperintensities seen in the periventricular white matter including some patchy hyperintensities in the subcortical white matter of both frontal and parietal lobes as well as in the left posterior temporal and occipital lobe. following gadolinium, no abnormal enhancement is seen. in addition, subtle signal abnormalities are seen in the region of facial colliculi bilaterally in the pons as well as subtle increased signal is seen in the pons. impression: 1. the patchy flair hyperintensities seen in the subcortical white matter of both frontal and parietal lobes as well as in the left posterior temporal lobe are not typical for small vessel ischemic changes. this finding could represent reversible encephalopathy syndrome. 2. the other periventricular hyperintensities visualized as well as hyperintensities seen in the brainstem could be due to small vessel disease. 3. moderate brain atrophy. 4. no enhancing brain lesions or acute infarcts. mra of the head: the head mra demonstrates normal flow signal in the superior sagittal sinus and transverse sinuses. no evidence of sinus thrombosis is seen. mri: 1. interval complete resolution of the patchy flair-hyperintense foci in bilateral frontal and parietal and left posterior temporal and occipital subcortical white matter, consistent with clinical impression of pres, with no evident sequelae. 2. moderate atrophy and chronic microvascular infarction, largely in bifrontal subcortical white matter, unchanged. 3. no pathologic enhancement. 4. fluid/opacification of right mastoid air cells. echo: the left atrium and right atrium are normal in cavity size. the right atrial pressure is indeterminate. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate regional left ventricular systolic dysfunction with severer hypokinesis of the basal 2/3rds of the anterior septum and anterior walls. the remaining segments contract normally (lvef = 40%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: regional left ventricular systolic dysfunction most c/w cad (mid-lad distribution). aortic valve sclerosis. no definited structural cardiac source of embolism identified. renal us: impression: 1. no hydronephrosis, stones or solid masses seen in the right kidney. 2. tardus parvus waveform of the main right renal artery could suggest a renal artery stenosis but in the absence of the left kidney ultrasound is unable to further characterize. pertinent labs: brief hospital course: 79 y/o f with hx of recent nephrectomy for rcc presents with altered mental status and new onset seizures. likely secondary to pres syndrome. while an inpatient, has worsening arf, found to have nstemi and significant hct drop with melanotic stools. s/p endoscopy and colonoscopy showing severe gastritis. doing well with stable hct. gout is bothering her. . # gi bleed - secondary to gastritis. pt had both a colonoscopy and endoscopy while here in the workup of the bleed. she is to cont protonix po, hct stabalized with no melanotic or bloody stools by the time of discharge. discussion with both cardiologists and gastroeneterologist thought it was fine to start asa for treatment of nstemi discussed below. . # nstemi - patient with troponin leak, twi v1-v3, and new hypokinesis. on baby aspirin and high dose statin. titrated up beta blocker yesterday, hr in 70s and sbps in 130s-140s, could likely increase again this evening after monitoring her on new dose of 400 mg tid of labetolol. cards following. plavix not needed at this time. she should follow up with cards regarding when stress testing and/or cath or other workup is needed. . # pump - patient with decreased ef in setting of nstemi. ef 40%. pt without signs of fluid overload. follow up echo with cards to see permanent pump dysfunction after nstemi. . # htn - htn was initial problem causing the seizure with pres syndrome. she was titrated up on bb over the course of the , be discharged on labetolol. renal was following and there was a question of whether renal artery stenosis was possible, epecially after her recent nephrectomy. it was thought that no stenosis was present and an acei could be added. her bp was well controlled by the time of discharge with goal sbps under 140s. . # gout - had flare in big toes. rheum and podiatry do not inject big toe joints; given low dose dilaudid (was receiving post nephrectomy) and see if pain improves at all. no nsaids or colchicine due to decreased renal function. no steroids due to gastritis. . # seizure - initial presenting symptoms. neuro following along, was on neuro service initially. the seizure was secondary to pres syndrome, on dilantin and titrated according to level; patient only needs to be antisiezure for 10-14 days post seizure. will continue tight bp control. repeat mri done and show resolution of pres changes. . # arf - had arf. treated with fluids due to likely prerenal state. renal followinged. expected her to find new baseline, although likely has some more recovery. electrolytes stable. . # rcc - staples removed, scar well healed. tumor was clear cell renal cell carcinoma, s/p left radical nephrectomy and adrenalectomy, left para aortic lymph node dissection on for 6.1 x 5.9 x 5.0 cm mass in the lower pole of the left kidney and bilateral small adrenal nodules found on mri abdomen . . # dm - on sliding scale. . # respiratory - stable, no problems. . # communication - husband , daughter . . # code - full medications on admission: -atorvastatin 20 mg qhs -timolol 0.5% drops, 1 drop as directed -dorzolamide-timolol 2-0.5% drops 1 drop tid -bimatoprost 0.03% drops q drop qpm -atenolol 50 mg daily -tylenol 1000 mg po q6 hr -dilauded 2 mg, 1-2 tablets po q4 hr prn pain -gemfibrozil 600 mg -lisinopril 30 mg daily -metformin 500 mg -calcium-chjolecalciferol 500 mg-400 u, 2 tablets daily -mvi -hctz 25 mg daily (d/ced prior to admission) -colace 100 mg po bid (d/ced prior to admission) discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 3. labetalol 200 mg tablet sig: four (4) tablet po bid (2 times a day). disp:*240 tablet(s)* refills:*2* 4. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). disp:*30 tablet(s)* refills:*2* 6. metformin 500 mg tablet sig: one (1) tablet po twice a day. 7. bimatoprost 0.03 % drops sig: one (1) drop ophthalmic qhs (): one drop in each eye nightly. 8. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic tid (3 times a day): one drop left eye three times daily. 9. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day): one drop right eye two times daily. 10. hydromorphone 2 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for 5 days. disp:*10 tablet(s)* refills:*0* 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed: for constipation, make sure to take if you are taking the pain pill dilaudid. disp:*30 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: 1. pres syndrome 2. seizure 3. acute renal failure 4. gi bleed 5. gastritis 6. nstemi 7. gout discharge condition: patient stable, sbps in 130s, afebrile, ambulating without difficulties. discharge instructions: you were admitted to the hospital with a seizure. the seizure was related to a syndrome called pres. it was due to very elevated blood pressure. while you were here, you also had a small heart attack. when we started the blood thinners for your heart, you developed a bleed in your stomach that required you to have several transfusions. the gastroenterologists did a colonoscopy and endoscopy showing severe gastritis. that is why you need to continue the medicine called protonix. you can take aspirin. you must be careful to monitor your stools and watch for black tarry stools or bloody stools. your doctor will monitor you blood counts when they see you in the office. you will need to follow up with several different doctors. you should see a cardiologist and have a stress test in the future. you should also follow up with the nephrologists about your kidney function. and finally you should follow up with a neurologist about your seizures. you can stop taking dilantin at home. please return to the hospital for any seizures, headaches, dizziness, chest pain, shortness of breath, abdominal pain, black stools, bloody stools, or any other concerns. feel free to call your doctor with any questions. followup instructions: please follow up with your pcp . tomorrow at 11:30 am. his phone number is . please follow up with cardiology. your doctor will be dr. . the appointment is on at 1pm in building on the seveth floor. the number is (. please follow up with neurology. your doctor will be dr. . your appointment is on at 2:30 pm. they are located in the building level 5. his phone number is (. please follow up with nephrology. you have an appointment with dr. on at 9 am. they are located on level 7. their number is (. please follow up with your urology surgeons. please call them and ask when they would like to see you again. their number is (. procedure: colonoscopy esophagogastroduodenoscopy [egd] with closed biopsy transfusion of packed cells diagnoses: subendocardial infarction, initial episode of care acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified other convulsions chronic kidney disease, unspecified other and unspecified hyperlipidemia cerebral edema unspecified gastritis and gastroduodenitis, with hemorrhage personal history of malignant neoplasm of kidney acquired absence of kidney personal history of surgery to other organs 

Answer: The patient is high likely exposed to