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: compazine attending: chief complaint: abdominal pain major surgical or invasive procedure: : open ruptured aaa repair history of present illness: 69 year old female who was transferred from osh for ruptured aaa. patient reports the the pain began 3 hours prior to presentation to osh. pain radiates to left flank. patient reports nausea but no vomiting. patient reported an episode of left arm wearkness/tingling that had resolved. past medical history: past medical history: htn, hypercholesterolemia, right carotid stenosis, subclavian steal syndrome on left past surgical history: c-section, tonsillectomy social history: etoh: denies tob: current smoker with < ppd family history: there is a family history of aaa physical exam: at time of discharge: vs: 98.6 97.9 58 144/60 17 94 ra gen: resting comfortably cv: rrr, nl s1, s2 resp: ctab abd: soft, incision steristrips, dry, intack ext: warm well perfused pulses: r p/d/d/d l p/d/d/d pertinent results: 09:00pm blood wbc-11.8* rbc-3.15* hgb-9.5* hct-28.5* mcv-91 mch-30.2 mchc-33.3 rdw-13.4 plt ct-173 09:00pm blood pt-12.2 ptt-33.4 inr(pt)-1.1 12:51am blood glucose-166* urean-15 creat-0.7 na-147* k-3.2* cl-109* hco3-22 angap-19 12:51am blood alt-21 ast-29 ld(ldh)-234 ck(cpk)-87 alkphos-51 totbili-0.9 12:51am blood ck-mb-3 ctropnt-<0.01 07:53am blood ck-mb-4 ctropnt-<0.01 renal us: indication: 69-year-old with status post aaa repair. please assess arterial flow. technique: -scale and color doppler ultrasound images of the kidneys were obtained. comparison: outside hospital ct of the abdomen and pelvis from . findings: the right kidney measures 10.9 cm without evidence of hydronephrosis, stones, or masses. there is normal arterial flow in the main renal artery or the upper, mid and lower pole renal arteries with resistive indices (ris ranging from 0.64-0.74. the main renal vein is normal on the right side. the left kidney measures 9.5 cm without evidence of hydronephrosis, stones, or suspicious masses. there is a 1.3 cm mid pole partially exophytic cyst. there is no flow to the left kidney including no flow in the main renal artery or the upper, mid, or lower pole renal arteries. the main renal vein also demonstrates no flow. bilateral pleural effusions and small amount of fluid surrounding spleen. the spleen is normal in size measuring 8.2 cm. impression: no flow to or in the left kidney. bilateral pleural effusions. small ascites. : indication: 69-year-old female with left subclavian steal syndrome post-abdominal aortic rupture, evaluate for stroke. comparison: cta head/neck from and outside hospital ct head dated . technique: contiguous non-contrast axial images were obtained through the brain, and reconstructed at 5-mm intervals. findings: there are new watershed infarcts in the left frontal and parietal regions, at the aca/mca and mca/pca boundaries. these have a wedge-shaped morphology with cytotoxic edema involving both and white matter. there is no evidence of hemorrhagic transformation. the ventricles and sulci are prominent, consistent with age-related involutional changes. multiple periventricular and subcortical white matter hypodensities persist, compatible with small vessel ischemic disease. there are dense calcifications in the bilateral cavernous carotid, vertebral, and basilar arteries. midline structures are preserved. there is no evidence of herniation. there is a mucus retention cyst in the left sphenoid sinus. mastoid air cells and middle ear cavities are clear. there is mild cerumen in the left external auditory canal. orbits and intraconal structures are intact. impression: 1. new watershed infarcts in the left frontal and parietal regions. this was called to dr. on at 6:48 p.m. 2. chronic atrophy and microvascular disease. : echocardiogram the left atrium and right atrium are normal in cavity size. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. pulmonary artery hypertension. : mr , mra with out contrast indication: 69-year-old woman with status post urgent aaa repair. assess for cva. comparison: ct head dated . technique: sagittal t1 and axial t1, t2, flair, gradient echo, and diffusion with adc map images were obtained without contrast. findings: scattered and confluent predominantly cortical based areas of restricted diffusion are seen involving the vascular territory of the left superior mca division. bilateral scattered acute infarcts are moreover identified involving the posterior circulation, notably the bilateral medial parietal and occipital lobes. small scattered cortical foci of restricted diffusion in the right frontal lobe are too small to characterize, yet likely represent additional areas of infarct. there is no evidence of hemorrhagic transformation and no mass effect associated with the infarct areas. the cerebral sulci, ventricles, and extra-axial csf-containing spaces have normal size and configuration. flow voids of the major intracranial vessels are preserved. extensive periventricular and deep white matter flair/t2 signal abnormalities are in keeping with sequela of small vessel ischemic disease. the patient is intubated. there is fluid retention within the sphenoid sinus. abnormal t2 hyperintensity is moreover seen within the mastoid air cells. mri head: when compared to the contralateral side, the flow related signal in the left intracranial ica and mca is mildly reduced which may indicate a flow limiting stenosis in the cervical portion of the left ica. in the presence of a right fetal origin, a focal right p1 segment stenosis is not associated with flow reduction in the periphery of the right pca. besides the above mentioned global left sided flow reduction in the anterior circulation, the intracerebral internal carotid, vertebrobasilar and anterior and middle cerebral arteries are patent. there is no evidence of additional stenosis, occlusion, aneurysm, or arteriovenous malformation. impression: 1. acute widespread infarcts involving the bilateral anterior and posterior circulation as detailed above. there is no associated vascular occlusion, no mass effect or hemorrhagic transformation. relative global reduction in flow related enhancement of the left intracranial ica and mca may indicate a flow limiting stenosis in the cervical portion of the left ica. 2. extensive sequela of small vessel ischemic disease. 3. fluid retention in the sphenoid sinus as well as bilateral opacification of the mastoid air cells, likely related to intubation. : urine cx urine culture (final ): enterobacter cloacae complex. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. klebsiella pneumoniae. 10,000-100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae complex | klebsiella pneumoniae | | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- <=16 s 64 i tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s brief hospital course: the patient was admitted to the cardiovascular icu after undergoing emergent open aaa repair on . the patient tolerated the procedure but was transferred to the cvicu in critical condition after having an estimated blood loss of 7500cc, and getting transfused 14 u prbc, 12 u ffp, 2 plt. please see the separate operative note for full details of the procedure. postoperatively the patient was transferred to the cvicu for management of acute respiratory failure and hemodynamic monitoring with strict control. during her stay in the icu a renal us was performed that showed no flow to her left kidney. she was noted on pod 2 to not be movig her right upper extremeity. a ct head was performed that showed subactue left mca/aca and left mca/pca infarcts. neurology was consulted who thought this was mostly like hypotensive in nature and recommend sbp , , statin, mri for further evaluation. on pod 3 an mri/mra were performed (please see results section for full read.) in brief the mri shown left frontal, b/l parietal, b/l occipital area of restricted diffusion. patient was occasionaly becoming tachycardiac for which she was treated with an amiodorone infusion. on pod 4 the patient was extubated. she was begun on diuresis to remove excess fluid. on pod 5 the patient was started on cipro for a uti. patient was started on soft foods, thin liquids at the recommendation of speech/swallow. on pod the patient was keep in the cvicu for occasional periods of tachycardia that required amiodorone administration. on pod 8 the patient was transferred to the vicu. cardiology was consulted for continued trouble with tachycardia. the felt that this was not atrial fibrillation but instead sinus tach with apcs. the recommend anticoagulation with aspiring and lopressor for heart rate control. on pod 9 patient was evaluated by physical therapy who recommend rehab. speech and swallow revaluation removed all restrictions. on pod 10 patient's foley was removed and patient voided without difficulty. at time of discharge on pod 11 patient was tolerating a regular diet, voiding without difficulty, pain was controlled on oral pain medication, patient was able to get out of bed to chair with assistance. patient was discharged to center in . medications on admission: enalapril, 325', hctz 25', metoprolol 100", simvastatin 40', fish oil. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 4. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*45 tablet(s)* refills:*0* 6. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 7. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection three times a day: while non ambulatory. discontinue when patient ambulatory. discharge disposition: extended care facility: - discharge diagnosis: ruptured abdominal aortic anuerysm b/l cva discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: division of vascular and endovascular surgery abdominal aortic aneurysm (aaa) surgery discharge instructions what to expect when you go home: 1. it is normal to feel weak and tired, this will last for 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! 2. it is normal to have incisional and leg swelling: ?????? wear loose fitting pants/clothing (this will be less irritating to incision) ?????? elevate your legs above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. 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 ?????? you should get up every day, get dressed and walk, gradually increasing your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (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 weeks for follow up. what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 101.5f for 24 hours ?????? bleeding from incision ?????? new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: please call dr. office ( to schedule a follow up appointment in 2 weeks. please call dr. office ( to schedule a follow up appointment in weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances resection of vessel with replacement, aorta, abdominal diagnoses: acidosis other iatrogenic hypotension pure hypercholesterolemia tobacco use disorder urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia acute kidney failure, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other specified cardiac dysrhythmias other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation gross hematuria cerebral artery occlusion, unspecified with cerebral infarction abdominal aneurysm, ruptured iatrogenic cerebrovascular infarction or hemorrhage acute respiratory failure following trauma and surgery spastic hemiplegia and hemiparesis affecting nondominant side 

Answer: The patient is high likely exposed to