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: latex / metformin attending: chief complaint: sah major surgical or invasive procedure: : cerebral angiogram w/coiling of the r pcomm aneurysm : peg placement : r evd placement history of present illness: hpi: patient is a 73-year-old right-handed-woman with known aneurysms s/p coiling of nine months ago at here after being found down per her son. history obtained per son, who is also her hcp. he reports that she had undergoing head imaging for ?stroke symptoms and found to have two intracranial aneurysms and had one coiled 9 months ago at but the other one was too small to intervene. she had tia symptoms afterwards but no lasting deficit. her outpatient neurologist is dr. at . she was doing well and actually played cards with the son last night. this afternoon, he went to check on her and found her on the floor faced down with vomit on the floor. when he turned her over, she was responsive and verbal but was not ambulating well hence emt was called. in the ed, head ct showed bilateral, extensive sah and coiling artifact of l mca distribution. past medical history: 1. aneurysms - as above 2. hx of lung cancer s/p chemotherapy 9 years ago 3. hx of throat cancer s/p radiation therapy 18 years ago 4. hx of breast cancer s/p lumpectomy 5 years ago 5. htn 6. dm 7. gerd 8. hld social history: lives alone and ambulates with a cane. retired production line supervisor for ford. quit smoking 20 years ago. son, () is hcp and she is full code. family history: brother and nephew also have aneurysms. physical exam: on admission: physical exam: o:t: 97.1 bp: 179/90 hr:99 r: 16 o2sats: 100% nrb gen: has a nrb - appears comfortable. lungs: clear anteriorly cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. no c/c/e. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, hospital () but thinks its . language: speech fluent and intact repetition. naming intact. no dysarthria. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3 to 2mm bilaterally. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. ix, x: palatal elevation symmetrical. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. no abnormal movements, tremors. mild pronation of rue. strength full power throughout except for mild r deltoid and bilateral ip weakness. sensation: intact to light touch, cold and vibration. reflexes: b t br pa ac right 2 1 2 1 0 left 2 1 2 1 0 toes upgoing bilaterally coordination: normal ftf gait: deferred. on discharge: a&o to self and hospital mae to commands pertinent results: cta head: impression: 1. extensive bilateral subarachnoid hemorrhage involving the sulci, interhemispheric fissure and sylvian fissures. component of intraventricular hemorrhage involving the frontal of the left lateral ventricle and the third ventricle. 2. areas of outpouching at the origin of the right posterior communicating artery and left posterior communicating artery, possibly representing aneurysms. would recommend catheter angiography to further evaluate for the presence of intracranial aneurysms. 3. streak artifact from the coil pack in the left mca on its evaluation at this level. unable to determine if there is filling of the prior aneurysm in this location due to artifacts. cta chest: impression: 1. no evidence of pulmonary embolism, aortic dissection or acute aortic injury. 2. status post right upper lobectomy and left lower lobe wedge resection. focal opacities along the left lower lobe suture line and periphery of the right lower lobe are likely areas of scarring. peripheral opacity in the right lower lobe with a linear geographic border is likely due to post-radiation changes. correlation of these findings with prior imaging, however, is recommended. 3. diffusely enlarged thyroid gland for which clinical correlation is recommended. ct : impression: 1. no evidence of prevertebral soft tissue swelling or acute fracture. 2. extra-axial, extra-dural circumferential hyperdensity within the spinal canal at the level of c3-c4 vertebral bodies may be due epidural or subdural hematoma at this level. mri is recommended for further evaluation if not contraindicated. 3. diffusely enlarged thyroid gland. 4. right carotid artery stent with probable post treatment and post radiation changes as noted above. mri : findings: there is no evidence of hemorrhage in the cervical spine. there is multilevel degenerative joint disease. at the level of c3 and c4, there is protrusion of the disc, with flattening of the cord and narrowing of the canal. there is elevation of the posterior longitudinal ligament with widening of the epidural space at this level. at the level of c4 and c5, there is a disc protrusion with flattening of the cord, but no canal narrowing at this level. at the level of c5 and c6, there is bilateral neural foraminal narrowing due to uncovertebral osteophytes. there is also narrowing of the canal by intervertebral osteophytes at this level. there is retrolisthesis of c5 on c6, as seen on prior study and likely due to degenerative changes. there is a nodular cyst in the left lobe of the thyroid gland. impression: 1. no evidence of intraspinal hemorrhage. 2. multilevel degenerative changes as outlined above with disc protrusion and narrowing of the canal at the level of c3-c4 and c5-c6 as well as bilateral neural foraminal narrowing at the level of c5-c6. 3. nodular cyst in the left lobe of the thyroid. would consider ultrasound if not already completed. head ct: 1. extensive bilateral subarachnoid hemorrhage involving the sulci and sylvian fissures unchanged from prior study. intraventricular hemorrhage in the third ventricle as well as the occipital horns of the lateral ventricles, likely from redistribution from subarachnoid hemorrhage. 2. hydrocephalus, with the left lateral ventricle being asymmetrically enlarged when compared to the right but unchanged from prior study. 3. streak artifact from the coil pack in the left mca aneurysm as well as from the new coil in the right posterior communicating artery aneurysm. unable to determine if there is filling of the prior aneurysms in these locations due to artifact. head ct: impression: study is severely limited by motion artifact, with: 1. enlargement of the ventricles bilaterally consistent with progressive hydrocephalus. 2. stable bilateral subarachnoid and intraventricular hemorrhage when compared to prior study. 3. coil packs in the left mca and right posterior communicating artery with streak artifact at those locations. head cta: impression: 1. evolution of the subarachnoid hemorrhage along bilateral cortical sulci and sylvian fissures. there is decrease in the amount of intraventricular hemorrhage. 2. asymmetric dilatation of bilateral lateral ventricles, left being dilated more than right. 3. streak artifact from coil pack in left mca and right posterior communicating artery. it is difficult to determine if there is filling of the prior aneurysm in these locations due to the streak artifact from the coil pack. 4. no evidence of new aneurysm/ vasospasm. rue us: impression: no evidence of right upper extremity dvt. head cta: head cta: the intracranial internal carotid and vertebral arteries, and their major branches, are patent. allowing for streak artifact from the above-described coil packs, no change in caliber of the intracranial vessels is seen to suggest vasospasm. evaluation for residual filling of the previously coiled aneurysms is limited by streak artifact. extensive calcification of the cavernous and supraclinoid internal carotid arteries is again seen bilaterally. fetal configuration of the right posterior cerebral artery is again noted. impression: 1. unchanged extensive subarachnoid hemorrhage. 2. unchanged intraventricular hemorrhage and ventricular dilatation. 3. no evidence of vasospasm. lenis: impression: no evidence of dvt. cxr: impression: right approach picc in standard position within the mid svc. stable nodular opacity since ct examination from . : impression: right picc line is ending into the svc. since , no significant interval changes are seen in bilateral lungs. lungs remain low volume and the vascular congestion is persisting. there are no lung opacities of concern for pneumonia. heart size is normal. no pleural effusion or pneumothorax. abdomen xray: there is a nonspecific bowel gas pattern with no evidence of obstruction. multiple drains and catheters are visualized overlying the abdomen and pelvis. no evidence of overt free air. evaluation for free air is limited due to supine position. cxr: there are new opacities in the left lower lobe. this could represent aspiration. cardiomediastinal contours are unchanged. the patient is status post right upper lobectomy. there are low lung volumes. right picc remains in standard position. there is no pneumothorax or pleural effusion. mild vascular congestion is unchanged . cxr: an et tube is present, tip at the level of the clavicular heads, approximately 7 cm above the carina. a right-sided picc line is present -- the tip is not optimally visualized but appears to overlie the upper svc. : ct head: impression: 1. unchanged distribution and volume of subarachnoid hemorrhage. 2. decreased size of bilateral lateral intraventricular hemorrhages, though there appears to be subtle increase in ventricular dilatation of the lateral, third, and fourth ventricles. 3. no new intraparenchymal process. attending note: the temporal horns are not significantly changed. the apparent prominence of lateral ventricules since previous study may be related to differences in angulation. however, follow up recommended. ct head: impression: placement of a right frontal ventricular drain with the tip in the upper third ventricle through the foramen of . no significant change in ventricular size is seen. no new hemorrhage is identified. chest (portable ap) as compared to the previous radiograph, there is no relevant change. lung volumes have minimally decreased, potentially caused by changed respiratory pressures. the size of the cardiac silhouette is slightly larger than on the previous image. minimal fluid overload is present, but there is no evidence of new focal parenchymal opacity suggesting pneumonia. in unchanged manner, a small parenchymal opacity projecting over the left costophrenic sinus is present. lenis impression: no dvt head ct stable appearance of ventricle size. cxr the endotracheal tube has been removed. there is a right-sided central venous catheter with distal lead tip in the mid svc. cardiac size is within normal limits. there is coarsening of the bronchovascular markings; however, there are no signs of overt pulmonary edema. there is no focal consolidation. there is possibly a small effusion on the right base. brief hospital course: 73f who was admitted to the neuro icu under neurosurgery after she presented to the er with a sah and history of aneurysms. she was started on nimodipine and dilantin. a ct was done to r/o any fractures as she was found down- the ct noted some blood at c3-4, there was a question whether this was extension of the sah or a separate hemorrhage. a mri was recommended but unable to obtain until confirmation of coil brand/make from is obtained. on , the info was obtained and the patient had an mr which excluded a spinal hematoma. she went to angio and a pcomm aneurysm was discovered and coiled without difficulty. she returned to the icu and her exam remained stable. her sbp was allowed to autoregulate 100-200. on , she was noted to be more lethargic and confused. a ct head was obtained which showed interval increase in her vent size, but because has brain atrophy, she can accommodate increase in size of ventricles, no evd was place. exam improved over the course of the day. dilantin level corrected was found to be 10 and a bolus was given. also, her systolic bp was seen into the 210s, she was given 25mg of metoprolol which helped resolved her htn. on , patient was destating in the am with weak cough and secretions. a chest x-ray was done, which showed no change from previous scan. she was placed on venti mask on 50%fio2. on examination, patient eo to voice, follows commands and was maes. her ivf were decreased by half to 50cc/hr and cta was done which showed no vasospasm. on , there was a wbc increase w/low grade fevers and a cxr showed possible rll consolidation vs atelectasis. started on vanco/ cefepime. on , she remained febrile and antibiotics were continued. a picc line was placed. on she had rue edema and an us was negative for dvt. on , cta showed no evidence of vasospasm. on , her neurological exam remained stable. she still required tent mask at 70% and frequent suctioning. medicine was consulted for transfer but the frequency of suctioning and amount of o2 therapy was not floor suitable. on , her respiratory status improved as she was weaned down to 3l nasal cannula and did not need suction for many hours. she had one desat overnight to 90% once. her neuro exam remained stable thus transfer orders were written for the step down unit. patient was stable in the step down unit from to . on she was taken to the operating roomm for peg placement. on the morning of , patient was found to be in respiratory distress with tachycardia, tachypnia and difficulty managing upper airway secreations. an abg on ra revealed a pao2 of 44. micu was consulted for a possible transfer but they declined and patient was transferred to the sicu. shortly after transfer to the icu patient was intubated for respiratrory failure. ct head was obtained on and demonstrated slight enlargement of the ventricles and so a right frontal evd was placed. post procedure imaging demonstrated the evd catheter to be within the right lateral ventricle, no hemorrhage. on . patient was slightly more lethargic, but followed commands in all 4 extremities. icp remained stable. on , exam stable, evd was clamped. icps were within normal range and a bronch was done by the icu for evaluation of airway. cultures have been negative to date. there was no cuff leak so the patient remained intubated. on , the patient remained stable, her evd remained clamped, and icps remained stable. there was concern that a trach placement would be needed and the conversation was started with the family. on , a repeat head ct was stable and her evd was removed without difficulty. she remained in the icu for further care and monitoring. on she remained stable and she was transferred to the sdu. she was seen by the speech and swallow team and she failed a video swallow. she remained strict npo with peg tube feedings. on she was transferred to the floor in stable condition. on she was seen by the geriatrics team for blood pressure control and further pulmonary management after her pna. she was started on lisinopril per there recommendations as well as nystatin for treatment of thrush. on , patient remained stable and was discharged to rehab. medications on admission: 1. simvastatin 80mg daily 2. metoprolol 50mg 3. omeprazole 20mg daily 4. mvi 5. ca2+ 6. oxycodone prn 7. armidex 8. humulin 16/11 9. 2l oxygen at bedtime discharge medications: 1. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing . 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime). 5. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 6. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for fever. 7. aspirin 300 mg suppository sig: one (1) suppository rectal daily (daily). 8. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 9. insulin regular human 100 unit/ml solution sig: one (1) units injection as directed. 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for bp>160. 11. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: six (6) puff inhalation q6h (every 6 hours) as needed for wheeze. 13. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 14. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 15. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 16. morphine sulfate 1-2 mg iv q4h:prn pain hold for rr < 12 discharge disposition: extended care facility: hospital - discharge diagnosis: subarachnoid hemorrhage intraventricular hemorrhage hap resipiratory failure protien/calorie malnutrition hydrocephalus discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: angiogram with embolization and/or stent placement medications: ?????? take aspirin 325mg (enteric coated) once daily.***** ?????? continue all other medications you were taking before surgery, unless otherwise directed ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort. what activities you can and cannot do: ?????? when you go home, you may walk and go up and down stairs. ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal). ?????? after 1 week, you may resume sexual activity. ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate. ?????? no driving until you are no longer taking pain medications 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 ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site *sudden, severe bleeding or swelling (groin puncture site) lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call our office. if bleeding does not stop, call 911 for transfer to closest emergency room! followup instructions: please follow-up with dr. in 4 weeks with mri/mra () protocol. please see your pcp for nodular cyst in the left lobe of the thyroid. you require an ultrasound of the thyroid. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances other lavage of bronchus and trachea percutaneous [endoscopic] gastrostomy [peg] arteriography of cerebral arteries intravascular imaging of intrathoracic vessels arterial catheterization endovascular embolization or occlusion of vessel(s) of head or neck using bare coils diagnoses: pneumonia, organism unspecified obstructive hydrocephalus esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition personal history of malignant neoplasm of bronchus and lung personal history of malignant neoplasm of breast subarachnoid hemorrhage candidiasis of mouth other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of insulin cervical spondylosis without myelopathy personal history of malignant neoplasm of other and unspecified oral cavity and pharynx swelling of limb cerebral degeneration, unspecified 

Answer: The patient is high likely exposed to