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: rv thrombus seen on echo major surgical or invasive procedure: none history of present illness: 41yom with h/o stage iv l tonsillar small cell ca who was admitted to last friday after he lost consciousness for "two seconds" and had a fall and hurt his l shoulder. he deneis any cp, palpitations, dizziness, post-ictal period, b/b incontinence, tongue biting, and knew where he was immediately after regaining consciousness. he endorses that he has been dehydrated and has had poor po due to loss of appetite, such that he was actually going to be admitted for j tube placement when this event occurred. . at lgh he was 98.1 p104 18 107/67 98%ra. he had several ekg's which were tachycardic and show s1q3t3 but no acute st changes. admitted to telemetry unit and ruled out for mi by enzymes and had normal ekg on admission. through admission they felt it was less likely that he had a seizure. he was given ivf's. he then developed nsvt on day #2, review of the strips shows 5-8 beat runs, and was started on amiodarone gtt, changed to po dose today. he then had an echo showing large thrombus in rv and is transferred to for further management/intervention. . vitals on transfer: 97.9 118/81 81 18. labs on d/c na 133, k 4.4, co2 28, bun/cr 9/0.52, bnp 177. his hct was stable in the mid 30's, wbc's elevated up to 14, and thrombocytopenic in the low 100's. dilantin level low and he was loaded. he had a ct c-spine concerning for metastases (see report below) and a left shoulder plain film concerning for mets (see below). . ros is as above, including anorexia, wt loss (225 --> 140 now), chronic constipation and vomiting, dehydration. chronic l shoulder pain. . no cp, palpitations, doe, leg swelling, dizziness. past medical history: 1. cardiac risk factors: pt denies 2. cardiac history: pt denies 3. other past medical history: - rv thrombus seen on echo - s/p j tube placement - left tonsillar small cell carcinoma, stage 4, bt1, n3m0 --> with vocal cord paralysis and weight loss, with some regurgitation and aspiration - tumor surrouding l internal carotid and inter.... base (unclear osh report) - headaches, seizures due to tumor, last seizure and on dilatin at home. social history: lives at home with fiance and daughter (? fiance's daughter?) -tobacco history: long history of smoking ppd x20yrs, quit last friday -etoh: rare -illicit drugs: none . family history: htn brother with "tumor in the back of the head, the same type as mine" no sudden cardiac death, no arrythmias . physical exam: 97.6 85 126/93 21 90-93% on ra thin, hoarse sounding man in no distress, conversant, appears fatigued but able to appropriately relate his history. eomi, sclera normal. jvd not elevated. ctab no w/c/r/r but diffuse poor air movement rrr, with fixed split s2, heart sounds best heard at busb's, and possible, very faint diastolic murmur best at busb's. radial pulses palpable, dp's not abd with staples midline, appears c/d/i, non-erythematous, non-infected. j tube noted, well placed, no oozing. abd is nt nd. no ble edema noted cn 2-12 noted, no facial droop or dysarthria noted but voice sounds hoarse. unable to turn his neck to the l without pain, and is also weak. lue is hypotonic and unable to spontaneously move his lue proximal muscles or shoulder shrug, but does have distal hand grip that is weaker compared to r. his rue proximal and distal muscles are normal tone and strength. ble's proximal and distal muscles are normal strength and sensation. pertinent results: 05:23pm blood wbc-13.6* rbc-4.29* hgb-13.6* hct-40.7 mcv-95 mch-31.6 mchc-33.3 rdw-15.7* plt ct-92* 05:23pm blood pt-14.3* ptt-28.9 inr(pt)-1.2* 05:23pm blood glucose-110* urean-11 creat-0.5 na-134 k-4.4 cl-97 hco3-29 angap-12 05:23pm blood calcium-9.2 phos-3.1 mg-2.0 05:23pm blood phenyto-<0.6 brief hospital course: mr is a 41yom with stage iv l tonsillar small cell cancer, h/o seizures, who was admitted to lgh for syncopal episode of unclear etiology and through workup was found to have rv thrombus vs tumor, who is transferred to for further management. . 1. rv thrombus vs tumor: patient underwent gated ct chest that was revealing for likely thrombus in rv, pe, and pulmonary infarcts. lenis were negative for dvts bilaterally. he was initially treated with heparin gtt and then transitioned to lovenox. ct surgery evaluated patient. patient remained hemodynamically stable and so thrombolytics and surgery was not pursued. patient expressed that he wanted to go home and did not want to stay in the hospital. his outpatient oncologists was contact who stated that patient was a candidate for palliative chemotherapy and confirmed that he has progressive malignancy with poor response to chemo/radiation. patient was discharged with lovenox. - patient will need repeat echocardiogram within 3 weeks. - continue lovenox . 2. syncopal episode: likely related to rv thrombus and pe. amiodarone, which wsas started at osh for nsvt was stopped. patient had 3-4 beats of nsvt on telemetry but otherwise no arrythmia. a head ct was done and was negative for metastasis. her outpt oncologist confirmed that mri head did not show evidence of metastasis. . 3. stage iv tonsillar small cell carcinoma: diagnosed about a year ago and is s/p chemo and radiation finished in , no surgery. already metastatic. discussed with dr. at lgh; patient candidate for palliative chemotherapy and is also undergoing evaluation for surgical intervention of skull based met for palliation. . 4. nutrition: s/p j tube placement due to persistent n/v and decreased po intake, likely due to the malignancy, although further w/u for this is not noted in osh reports. patient tolerating tube feeds in house. . . 5. leukocytosis: likely related to pe, stress rx to thrombus. no evidence of infection. . 6. thrombocytopenia: no clear etiology. osh was 104 and is high 90's here. ddx including drug effect (heparin, does not appear pt received abx at osh), metastases to bm. no evidence of bleeding or unstable hct. unlikely to be hit; could be related to consumption secondary to underlying clot. he does have repeat labs two days following discharge for repeat plt check which will be faxed to dr office. . 7. dilantin was continued for his seizure history. . 8. left shoulder pain: concerning lesions on x-ray for metastasis; will require further outpatient follow up. . 9. pain control - mr is being sent home with a small supply of dilaudid in addition to lyrica, methadone, desipramine, and flexeril. medications on admission: home medications: 1. temazepam 15mg qhs 2. fioricept 1-2 tabs q6 prn headache 3. methadone 5mg 4. gabapentin 300 mg tid --> pt states now switched to lyrica 5. flexeril 10 mg tid 6. dilatin 100 tid --> was increased to 200 mg at lgh 7. reglan 10mg tid 8. prednisone 20 mg --> pt states outside onc started him on this last wednesday 9. desipramine 25 mg daily 10. ativan 1 mg tid 11. compazine 10 mg q6prn . discharge medications: 1. fioricept two tabs q6 prn 2. tylenol 3. amiodarone 200 daily 4. atenolol 25 daily 5. coumadin 2.5 daily 6. flexeril 10 q8 7. noripramine 25 hs 8. benadryl 25 iv q6 prn itching 9. colace 10. heparin gtt 11. dilaudid pca 0.2mg lockout 10 mins with iv breakthrough 12. lactulose prn constipation 13. ativan 1mg po q8 prn 14. magnesium oxide 400 15. methadone 10 16. reglan 10 iv q6 prn 17. narcan prn, part of pca protocol 18. nicotine patch 19. zofran 4mg iv prn 20. protonix 40 mg daily 21. dilantin 200 mg po bid 22. prednisone 20 mg 23. lyrica 100 . discharge medications: 1. methadone 10 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 2. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 3. enoxaparin 60 mg/0.6 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). disp:*60 syringes* refills:*2* 4. outpatient lab work please check cbc and fax results to dr. 5. desipramine 25 mg tablet sig: one (1) tablet po hs (at bedtime). 6. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day) as needed for constipation. disp:*600 cc* refills:*0* 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 9. prednisone 20 mg tablet sig: one (1) tablet po bid (2 times a day). 10. pregabalin 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*0* 11. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 12. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for headache. 13. cyclobenzaprine 10 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for pain. 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 15. phenytoin 100 mg/4 ml suspension sig: two hundred (200) mg po twice a day. disp:*500 cc* refills:*2* 16. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 17. dilaudid 2 mg tablet sig: 1-2 tablets po every six (6) hours for 7 days. disp:*56 tablet(s)* refills:*0* 18. lactulose 10 gram/15 ml solution sig: ten (10) mg po twice a day as needed for constipation. disp:*900 cc* refills:*0* discharge disposition: home with service facility: hospice discharge diagnosis: rv thrombus pe squamous cell metastastic lesion to base of skull discharge condition: a&ox3 discharge instructions: you were transfered to the bdimc because of a clot seen in your heart at . while you were here we did a ct scan that showed clots in your lungs and a clot in your heart. we have treated you with lovenox, a blood thinner. your loss of consciousness was likely secondary to this clot. we did a ct scan of your head that did not show any intracranial metastasis, but did show the metastasis to the base of your skull which is old. you will need to follow up with dr. your oncologist as an outpatient. he will need to repeat an echocardiogram to monitor the clot in your heart. your platelets were low, likely from the clot and possibly from medications you have received. your vna nurse a platelet count and dr. will follow up on this. the following changes were made to your medications: 1. start lovenox: this is an injection that you will give to yourself twice daily. it is a blood thinner that was started for your clots. 2. increase methadone from 5mg to 10mg twice daily. this was increased at lgh. this will help control your pain related to cancer. 3. increase lyrica from 75mg to 100mg, also increased at lgh, to better control your pain. 4. start dilaudid as needed for pain. this is a very sedating medication. take only as directed. this should not be taken with alcohol or while driving. you will need to discuss with dr. your long term pain management. 5. start senna, colace, bisacodyl, and lactulose as needed for constipation. these are stool softners to be started since your pain medications can cause constipation. 6. increased dilantin from 100mg three times a day to 200mg twice a day, for seizures. you should not be driving since you have had an active seizure within the past six months. 7. start omeprazole daily. you are on several sedating medications (dilaudid, ativan, methadone). you should take this as directed, not with alcohol or while operating a motor vehicle. since you have had a recent seizure, prior to this hospitalization, you should not be driving. you should follow up with your oncologist as directed below. followup instructions: please follow up with dr. on tuesday at 9:30 am at . he will need to repeat an echocardiogram and follow up on your platelets. procedure: enteral infusion of concentrated nutritional substances diagnoses: thrombocytopenia, unspecified personal history of tobacco use other specified cardiac dysrhythmias epilepsy, unspecified, without mention of intractable epilepsy syncope and collapse other pulmonary embolism and infarction secondary malignant neoplasm of bone and bone marrow personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health leukocytosis, unspecified neoplasm related pain (acute) (chronic) other severe protein-calorie malnutrition other ill-defined heart diseases malignant neoplasm of tonsil 

Answer: The patient is high likely exposed to