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: penicillins attending: chief complaint: s/p fall with facial fractures and right sided subdural hematoma major surgical or invasive procedure: peg placement upper endscopy history of present illness: ms. is an 83 year old woman with late stage parkinson's disease who fell at home today sustaining facial fractures and r subdural hematoma. her husband reports he was at home with his wife today and found it odd she did not hang the phone back onto the receiever following a conversation with her daughter in the living room. while placing the phone on the receiver he heard a thud in the kitchen and found his wife on the floor. she was conscious, able to speak and follow commands. copious hemorrhage from her face and nares. was taken to , found to have sdh and facial fractures. transferred to for further care. the patient is unable to provide a reliable history of events. she denies any headache. she denies any weakness numbness or tingling. she does not provide a reliable ros. per husband and daughter, no recent f/c or ns. no cough, no sob, no cp. no diarrhea. no n/v. she does have intermittent dysphagia chronically. chronic urinary incontinence. no bowel incontinence. past medical history: parkinson's disease- cared for by dr. at . urinary incontinence osteoporosis compression spine fractures eczema/psoriasis social history: former telephone operator who lives at home and uses a cane to walk. husband does cooking and cleaning. pt requires some assist with bathing and dressing. quit tobacco 30 years ago with 10 pack year history. no current etoh use. family history: noncontributory physical exam: vitals t 98.7, hr 78, bp 160/70, r 16, 100% 2lnc gen- on ed gurney with hard collar, facial trauma, attends only briefly to examiner. heent: right facial hematoma, anicteric sclera. neck: in c collar, attempted to clear following review of ct scan and pt report mid-c-spine pain with head rotation. hard collar was replaced. cv- rrr, no mrg pulm- cta b abd- soft, nt, nd, bs+ extrem- no cce, warm, well perfused. neurologic exam: ms- she is unable to describe where she is. unable to choose from a list of places. her speech is fluent, "i'm doing okay doctor, i'm fine." she does not answer questions appropriately. + inattention. follows few appendicular commands intermittently. cn- perrl 3-->2mm bilat, r eye edematous and difficult to visualize. gaze appears conjugate. lateral versions intact. would not cooperate with inferior or superior gaze. r facial edema/hematoma resulting in asymmetry. she is able to smile with reasonable symmetry. sensation is intact to lt. palate elevates symmetrically. motor- no pronator drift. l > right cogwheel rigidity. + resting tremor. holds arms and legs antigravity to command. sensory- intact to light touch. difficult to reliably assess given inattention. plantar response was extensor bilaterally reflexes: 2+ symmetric at , tri, brachirad, patellars 3+, abent ankle jerks. gait: deferred on discharge: aox2,perrl, spontaneous movement in all extremties, intermittant commands(pt pertinent results: cardiology report ecg study date of 4:59:18 pm sinus rhythm. baseline artifact. no previous tracing available for comparison. read by: , k. intervals axes rate pr qrs qt/qtc p qrs t 80 178 90 366/401 63 -10 43 , f 83 radiology report ct head w/o contrast study date of 4:57 pm , eu 4:57 pm ct head w/o contrast clip # reason: eval for fx, bleed medical condition: 83 year old woman with fall ?lefort fracture, sdh vs. epidural reason for this examination: eval for fx, bleed contraindications for iv contrast: none. wet read: gwp tue 8:19 pm r likely sdh no significant shift complex facial fractures final report indication: 82-year-old woman with fall, query subdural hematoma versus epidural. comparison: . technique: non-contrast head ct. findings: there is a 7-mm wide crescentic extra-axial hyperdense collection layering over the right cerebral convexity, compatible with an acute subdural hematoma. there is no significant shift of midline structures. there is no mass effect or edema. ventricles, sulci, and cisterns are similar to prior. basal cisterns are preserved. periventricular white matter hypodensity is likely the sequela of chronic small vessel ischemic disease. there is a left frontal cephalohematoma with subcutaneous gas seen (series 2, image 18). there are comminuted fractures of the right lamina papyracea and floor of the right orbit, with extensive subcutaneous and retroorbital gas, proptosis, and periorbital hematoma. a depressed fracture fragement from the orbital floor fracture is seen within the right maxillary sinus, but without entrapment of the inferior rectus muscle. comminuted fractures of both nasal bones, as well as the anterior, medial, posterior, and lateral walls of the right maxillary sinus are present. the frontal process of the right zygoma also demonstrates comminuted fractures.the left maxillary sinus also demonstrates comminuted fractures of the lateral and medial walls. minimally displaced fractures of the medial and lateral plates of the pterygoid processes bilaterally are fractured. both orbits remain intact. for further details, see the ct of the facial bones. high- attenuation fluid is seen in both maxillary and ethmoid sinuses consistent with hemorrhage. impression: 1. right subdural hematoma layering over the right cerebral convexity without midline shift. 2. extensive complex facial fractures. refer to the ct facial bones. 3. right frontal subgaleal hematoma. , f 83 radiology report ct c-spine w/o contrast study date of 7:03 pm , eu 7:03 pm ct c-spine w/o contrast clip # reason: fall, ? fx medical condition: 83 year old woman with fall reason for this examination: eval for fracture contraindications for iv contrast: none. final report indication: fall. comparison: none available. technique: mdct axial images were obtained from the base of the skull through t1 without intravenous contrast. multiplanar reformats were derived. findings: there is no acute fracture of the cervical spine. exaggerated lordosis of the cervical spine is present, without subluxation. the atlantodental and craniocervical junctions are normal. the central canal is patent. there is prominence of the soft tissues in the nasopharynx posteriorly (series 200b, image 31). otherwise, prevertebral tissues are unremarkable. the dens appears normal. lateral masses of c1 well seated on c2. there is - apical scarring within the lungs. calcification of the cervical carotid arteries bilaterally is present. multiple facial fractures are redemonstrated, better characterized on concurrent facial bone ct. impression: 1. no acute fracture or subluxation of the cervical spine. 2. prominence of posterior nasopharyngeal tissues. recommend direct visualization. 3. -apical scarring. the study and the report were reviewed by the staff radiologist. , f 83 radiology report ct abdomen w/contrast study date of 7:11 pm , eu 7:11 pm ct chest w/contrast; ct abdomen w/contrast; ct pelvis w/contrast clip # reason: fall, ? injuries. field of view: 36 contrast: optiray amt: 130 medical condition: 83 year old woman with fall reason for this examination: eval for chest trauma contraindications for iv contrast: none. wet read: gwp tue 8:26 pm mult t l spine compression deformities distended bladder w/foley balloon inflated in urethra / vagina final report indication: fall. comparison: none available. technique: multiple mdct axial images were obtained from the base of the neck through the proximal thighs after the uneventful administration of 130 cc of optiray intravenously. enteric contrast was not administered. multiplanar reformats were derived. ct of the chest with intravenous contrast: the thyroid enhances homogenously. there is no axillary or mediastinal lymphadenopathy. the pulmonary artery is normal in caliber. the aorta is normal. the heart is normal in size. there is no pericardial effusion. there are coronary artery calcifications. there is a moderate-sized hiatal hernia. central airways are patent to the level of subsegmental bronchi. there is no pulmonary mass, pleural effusion or pneumothorax. ct of the abdomen with intravenous contrast: the liver, gallbladder, and spleen appear normal. the pancreas is atrophic. the kidneys symmetrically take up and excrete contrast without hydronephrosis. a subcentimeter renal hypodensities are too small to characterize and likely represent benign cysts. the adrenals are unremarkable. abdominal loops of bowel are unremarkable. there is no abdominal free air, free fluid, or pathologic lymphadenopathy. the abdominal aorta is normal in caliber and contour but demonstrates prolific atherosclerotic calcifications. ct of the pelvis with contrast: the bladder is distended. a foley is malpositioned with the balloon abnormally inflated in the urethra. the uterus and adnexa are unremarkable. there is no pelvic free air or free fluid, or pathologic lymphadenopathy. musculoskeletal: there is no suspicious osteolytic or osteoblastic lesion. there is vertebra plana at t9 and mild compression deformities at l1 and l4. there is mild anterolisthesis of l5 on s1. impression: 1. malpositioned foley balloon catheter in the urethra. 2. multiple thoracolumbar compression deformities. grade 1 anterolisthesis of l5 on s1. these are age indeterminate. correlate clinically. 3. moderate sized hiatal hernia. 4. coronary artery calcifications. 5. bilateral renal hypodensities, possibly renal cysts. , f 83 radiology report ct chest w/contrast study date of 7:11 pm , eu 7:11 pm ct chest w/contrast; ct abdomen w/contrast; ct pelvis w/contrast clip # reason: fall, ? injuries. field of view: 36 contrast: optiray amt: 130 medical condition: 83 year old woman with fall reason for this examination: eval for chest trauma contraindications for iv contrast: none. wet read: gwp tue 8:26 pm mult t l spine compression deformities distended bladder w/foley balloon inflated in urethra / vagina final report indication: fall. comparison: none available. technique: multiple mdct axial images were obtained from the base of the neck through the proximal thighs after the uneventful administration of 130 cc of optiray intravenously. enteric contrast was not administered. multiplanar reformats were derived. ct of the chest with intravenous contrast: the thyroid enhances homogenously. there is no axillary or mediastinal lymphadenopathy. the pulmonary artery is normal in caliber. the aorta is normal. the heart is normal in size. there is no pericardial effusion. there are coronary artery calcifications. there is a moderate-sized hiatal hernia. central airways are patent to the level of subsegmental bronchi. there is no pulmonary mass, pleural effusion or pneumothorax. ct of the abdomen with intravenous contrast: the liver, gallbladder, and spleen appear normal. the pancreas is atrophic. the kidneys symmetrically take up and excrete contrast without hydronephrosis. a subcentimeter renal hypodensities are too small to characterize and likely represent benign cysts. the adrenals are unremarkable. abdominal loops of bowel are unremarkable. there is no abdominal free air, free fluid, or pathologic lymphadenopathy. the abdominal aorta is normal in caliber and contour but demonstrates prolific atherosclerotic calcifications. ct of the pelvis with contrast: the bladder is distended. a foley is malpositioned with the balloon abnormally inflated in the urethra. the uterus and adnexa are unremarkable. there is no pelvic free air or free fluid, or pathologic lymphadenopathy. musculoskeletal: there is no suspicious osteolytic or osteoblastic lesion. there is vertebra plana at t9 and mild compression deformities at l1 and l4. there is mild anterolisthesis of l5 on s1. impression: 1. malpositioned foley balloon catheter in the urethra. 2. multiple thoracolumbar compression deformities. grade 1 anterolisthesis of l5 on s1. these are age indeterminate. correlate clinically. 3. moderate sized hiatal hernia. 4. coronary artery calcifications. 5. bilateral renal hypodensities, possibly renal cysts. , f 83 radiology report ct head w/o contrast study date of 3:57 am , m. nsurg sicu-a 3:57 am ct head w/o contrast clip # reason: please eval for interval change. pls do at 0500 on medical condition: 83 year old woman with 83 year old woman with sdh and facial fx reason for this examination: please eval for interval change. pls do at 0500 on contraindications for iv contrast: none. final report indication: 83-year-old woman with subdural hematoma and facial fractures. please evaluate for interval change. comparison: multiple head cts, most recent of , performed approximately 11 hours prior. technique: mdct-acquired axial images were obtained of the head without contrast. findings: no interval change when compared to study performed 11 hours prior. again seen are bilateral acute on chronic subdural hematomas, which remain stable. acute subdural hematoma seen over the right temporoparietal lobe measures 6 mm and is unchanged. no areas of intracranial hemorrhage, large areas of edema are seen. there is no new mass effect. high-density material within the maxillary sinuses bilaterally, consistent with blood, are unchanged. impression: no change in acute on chronic subdural hematomas. no new areas of intracranial hemorrhage. the study and the report were reviewed by the staff radiologist. , f 83 radiology report portable abdomen study date of 12:59 pm , m. nsurg sicu-a 12:59 pm portable abdomen; -59 distinct procedural servic clip # reason: ng tube placement medical condition: 83 year old woman with stroke. ng tube placement reason for this examination: ng tube placement provisional findings impression: 2:41 pm in correct placement of ng tube. final report indication: 83-year-old woman with stroke, status post ng tube placement. evaluate for ng tube placement. comparison: ct chest, abdomen and pelvis with contrast . technique: portable abdominal radiograph. findings: ng tube is noted, with sideport above the level of the diaphragm likely within the lumen of the stomach in this patient with hiatal hernia noted on previous ct. compression fracture noted at vertebral body t9. a mild compression deformity is also noted at l1-l4 as previously noted on ct dated . costochondral calcifications are noted. colon is noted to be filled with stool and gas. impression: side port of ng tube above the diaphragm, likely in the lumen of the stomach in patient with known hiatal hernia. , f 83 radiology report ct head w/o contrast study date of 11:23 am , m. nsurg fa11 11:23 am ct head w/o contrast clip # reason: 202 medical condition: 83 year old woman with right sdh reason for this examination: less responsive? worseing bleed contraindications for iv contrast: none. provisional findings impression: jxrl sun 1:27 pm unchanged bilateral subdural collections, with high-density material, consistent with blood on the right. small amount of intraventricular blood is less prominent than on the study from two days prior. no hydrocephalus. final report history: 83-year-old woman with right subdural hematoma and decreased responsiveness. comparison: non-contrast head ct . technique: non-contrast head ct was obtained. findings: there is no significant change in the right subdural collection, with has a mixture of more acute hyperdense blood and chronic hypodense blood. the hypodense left subdural collection has slightly decreased in size. hyperdense subdural blood along the posterior falx and along the tentorium is unchanged. a small amount of blood in the occipital of the left lateral ventricle is slightly decreased in density. there is no shift of normally midline structures. moderate ventricular prominence is unchanged since , likely related to cerebral atrophy high-density material within the maxillary sinuses bilaterally, consistent with blood is unchanged. known maxillary sinus and nasal bone fractures are partially visualized. there is a nasogastric tube. impression: the hypodense left subdural collection has slightly decreased in size. the mixed-density right subdural collection is unchanged. posterior parafalcine subdural hematoma is unchanged. expected evolution of intraventricular hemorrhage. , f 83 radiology report c-spine non trauma flex & ext only study date of 9:53 am , m. nsurg fa11 9:53 am c-spine non trauma flex & ext clip # reason: 83 year old woman s/p fall with r sdh and facial bone fx, pl medical condition: 83 year old woman s/p fall with r sdh and facial bone fx, please call , manual manipulation required for flexion and extension, team member will need to be present. reason for this examination: 83 year old woman s/p fall with r sdh and facial bone fx, please call , manual manipulation required for flexion and extension, team member will need to be present. final report history: 83-year-old female with fall, declining mental status. c-spine, two views with flexion and extension. cervical spine is visualized to the level of the c7-t1 disc. there is minimal cervical motion observed between the flexion and extension views. an ng tube is seen in the esophagus. the vertebral bodies are normal in height and alignment. there is diffuse demineralization. there is a mild anterior vertebral spurring at multiple levels. there are no fractures or dislocations. the prevertebral soft tissues appear normal. the visualized portions of the lungs appear normal. , f 83 radiology report video oropharyngeal swallow study date of 9:24 am , m. nsurg fa11 9:24 am video oropharyngeal swallow clip # reason: evaluate for aspiration medical condition: 83 year old woman with sdh reason for this examination: evaluate for aspiration final report indication: 83-year-old woman with subdural hematoma, evaluate for aspiration. technique: this study was performed in conjunction with speech and swallow pathologist. a limited oral and pharyngeal swallowing videofluoroscopy was performed. nectar thick liquid, two tablespoon and pureed consistency barium, one tablespoon were administered. following administration of nectar- thick liquid, there was significant prolongation of the oral transit time with immediate penetration and aspiration. following this one tablespoon of pureed consistency barium was administered which also demonstrated immediate penetration and aspiration. the patient was unable to clear the pharyngeal residue. there was inability to consistently trigger a second swallow or cough. at this point the study was aborted. impression: penetration and aspiration with nectar-thick and pureed consistencies of barium. please refer to the full speech and swallow pathologist's note for recommendations. brief hospital course: ms was admitted to the neurosurgery service for icu close neurological monitoring due to her subdural and facial fractures. she had a trauma consult and was found to to have multiple facial fractures including pterygoid processes, floor of the right orbit, both maxillary sinuses, right lamina papyracea, right zygoma, bilateral nasal bones, and nasal septum. no muscular entrapment is seen within the right orbital floor fracture. she also had extensive right periorbital hematoma and subcutaneous gas, with extension of gas retroorbitally. the right globe is proptotic, but remains intact. she was noted to have a triponin leak of 0.05 for which a beta bloker was added. plastic surgery recommended clindamycin for 5 days and a soft diet. follow up head cts were stable size of subdural hematoma. she was transferred to step down unit on . physical therapy and occupational therapy felt she was appropriate for acute rehab. her mentation improved on a daily basis and she began to speak and follow simple commands. she had a video swallow on which showed some aspiration. the patient had a flex/extension x-ray of the cervical spine on which was negative for fracture or malalignment. therefore her collar was removed. she had a repeat video swallow evaluation on because she was able to have different positioning after the collar was removed. the evaluation showed continued aspiration. on she had a peg placed. following the peg placement she had approx 200-250cc of melanotic stool. gasteroenterology was consulted to assess for etiology of bleeding and recommendations. she was then scoped by gi and duodenal ulcers x2 were noted and cauterized. she was maintained on a ppi, with stable hct. on , she was discharged to an appropriate rehab facility, and given instructions for follow up in 6 weeks with a non-contrast head ct. medications on admission: carbidopa-levodopa - 25 mg-100 mg tablet - two tablets at 10 am and 6 pm and 1 tablet at 2 pm and 10pm tablet(s) by mouth as above clonazepam - 0.5 mg tablet - 1 tablet(s) by mouth at bedtime gabapentin - (prescribed by other provider) - 300 mg capsule - one capsule(s) by mouth three times a day oxybutynin chloride - (prescribed by other provider) - 5 mg tablet - one tablet(s) by mouth daily discharge medications: 1. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg iv q12h 3. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po q12h (every 12 hours). 4. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po qid (4 times a day): at 8am and 8pm please give two tabs / at 12 noon and 4 pm give 1 tab only. 5. hydralazine 10 mg iv q6h:prn spb >160 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. clonazepam 0.5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 11. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: right frontal subdural hematoma gi bleed acute blood loss anemia extensive facial fractures including involvement of both pterygoid processes, floor of the right orbit, both maxillary sinuses, right lamina papyracea, right zygoma, bilateral nasal bones, and nasal septum. no muscular entrapment is seen within the right orbital floor fracture. discharge condition: neurologically stable discharge instructions: ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, or ibuprofen etc. *you have been prescribed keppra for seizure prophylaxsis. this does not require blood work for monitoring. please continue to take this until you are seen in follow up in 6 weeks. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion, lethargy 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. ?????? new onset of the loss of function, or decrease of function on one whole side of your body. followup instructions: follow up with dr in 6 weeks with a head ct, call for an appointment. please call dr. in the clinic in 4 weeks at if you have dark tarry bowel movements or bright red blood in your bowel movements you should call the clinic immediately or go to the nearest emergency room. ** please note: your h.pylori test was negative (serology study) follow up as planned with dr . your daughter is to email dr in two weeks time procedure: enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] endoscopic control of gastric or duodenal bleeding linear repair of laceration of eyelid or eyebrow diagnoses: acute posthemorrhagic anemia unspecified protein-calorie malnutrition diaphragmatic hernia without mention of obstruction or gangrene open wound of forehead, without mention of complication osteoporosis, unspecified dementia in conditions classified elsewhere without behavioral disturbance chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness fall from other slipping, tripping, or stumbling other psoriasis closed fracture of malar and maxillary bones closed fracture of orbital floor (blow-out) other nonspecific abnormal serum enzyme levels dementia with lewy bodies closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness closed fracture of nasal bones other specified open wounds of ocular adnexa dysphagia, oropharyngeal phase contact dermatitis and other eczema, unspecified cause contusion of eyeball personal history of pathologic fracture functional urinary incontinence 

Answer: The patient is high likely exposed to