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: glyburide / sulfonylureas attending: chief complaint: r hip pain major surgical or invasive procedure: ct guided right iliac biopsy history of present illness: 64 m w/ pmhx of colon cancer s/p resection w/ colsotomy, esrd, developed abdominal abscess in 20/08. then fell in during a dialysis session, w/ r hip fx w/o surgical correction given abscses at that time, ct scan supported metastatic disease. later a biopsy was performed which demosntrated possible spindle cells. he is being tx to the for further oncology managment by dr. . he states that since his hospital admission in he has been at rehab, and has had rle weakness and been unable to ambulate, he also has had a chronic o2 requirement since . he otherwise has chronic pain in his right hip, and r>l leg weakness, chronic numbness in his lower extremities, is anuric, has an ostomy, no saddle anesthesia. o/w denies cp/f/c/n/v. past medical history: o2 requirement 2.5l since dm ii esrd from post-surgical atn from which pt never recovered - currently on dialysis mwf colon ca chf hyperlipidemia htn gout afib . psh: av fistula for dialysis access l arm colon ca resection with j pouch c post-op chemo/xrt temporary diverting ileostomy subsequently taken down. social history: social history: lives with wife, quit smoking 22 years ago but smoked 3 ppd x ?20 years (60 pack-years), quit etoh 2 years ago (drank on weekends, denies heavy use), denies illicit drug use. family history: family history: mother alive and healthy, father deceased when pt a baby, unknown cause, son healthy, no siblings. physical exam: vs 96.6 70 20 97 58 3lnc gen: nad, pleasant speaking in full sentences, comfortable heent: perrl eomi, op clear, no lad cv: rrr sem iii/vi greatest lusb radiating to axilla chest: crackles left lung fields 1/2 up abd: +bs soft nt/nd ostomy, hemorrhoids, no decub. ext: no c/c/e neuro: aaox3, motor lle , rle , ue symmetric labs: see below pertinent results: 07:55am blood wbc-8.2 rbc-3.57*# hgb-9.7* hct-31.3* mcv-88 mch-27.1 mchc-30.9* rdw-18.5* plt ct-514* 06:45am blood wbc-9.3 rbc-3.48* hgb-9.3* hct-30.4* mcv-87 mch-26.7* mchc-30.5* rdw-17.7* plt ct-539*# 07:55am blood glucose-72 urean-42* creat-3.4*# na-138 k-5.2* cl-93* hco3-29 angap-21* 06:45am blood glucose-86 urean-42* creat-3.6* na-136 k-4.4 cl-95* hco3-27 angap-18 07:55am blood calcium-8.6 phos-5.5* mg-1.7 06:45am blood calcium-8.7 phos-5.8* mg-1.9 07:00am blood caltibc-179* ferritn-1026* trf-138* 07:00am blood cea-4.6* psa-0.4 . bilat hips (ap,lat & ap pelvis) 6:32 pm bilat hips (ap,lat & ap pelvis reason: please eval fracture medical condition: 64 year old man with rectal cancer, s/p r hip fracture in reason for this examination: please eval fracture bilateral hips : clinical information: rectal cancer status post right hip fracture marginally. findings: ap view of the pelvis and two coned down views of the right hip are submitted. comparison is made with the ct of the abdomen and pelvis from which demonstrates a lytic destructive lesion of the right acetabulum. since the prior study, there has been interval progression of the destructive lesion within the right acetabulum and iliac bone. there is now destruction of the acetabular wall with medial migration of the femoral head. there is medial displacement of the acetabular wall into the pelvis. there is a lucency at the femoral head-neck junction which may represent a non-displaced fracture. further evaluation with ct or mri is recommended. evaluation for fine osseous detail is limited by the osteopenia. there are multiple lytic lesions throughout the osseous pelvis and the left femur as well. there is old osseous deformity of the left proximal femur. there is severe degenerative change in the lower lumbar spine. impression: 1) progression of large lytic destructive lesion in the right acetabulum and iliac bone with fracture of the medial acetabular wall with displacement of fracture medially into the pelvis. 2) question non-displaced fracture of the femoral neck at the subcapital region. 3) old fracture deformity of the left proximal femur. further evaluation with ct or mri is recommended. . bilat lower ext veins 10:32 am bilat lower ext veins reason: bilateral leg edema, ?dvt medical condition: 64 year old man with colon cancer, pathalogic fracture of hip, bilateral lower extremity swelling, r>l. reason for this examination: dvt? indication: bilateral lower extremity swelling, right greater than left. comparison: none. bilateral lower extremity venous ultrasound: the right and left common femoral, greater saphenous, superficial femoral, popliteal demonstrate wall- to-wall flow and normal compressibility and response to valsalva and augmentation. wall-to-wall flow is seen in the posterior and tibial veins bilaterally. edema is seen in both legs. impression: no son evidence for dvt; edema. bone scan: whole body images of the skeleton and planar views of the thorax were obtained in anterior and posterior projections. images show focal abnormal uptake of tracer in the right acetabulum and right inferior pubic ramus. increased uptake is seen within the left proximal femur diaphysis associated with bony deformity. additionally there is focal uptake in the bilateral shoulders, right greater than left, as well as the bilateral knees, right greater than left consistent with degenerative changes. focal uptake within the distal ends of the 11th and 7th left ribs is likely secondary to prior trauma. the above described findings are consistent with focal tracer uptake within the known lytic lesion in the right acetabulum as well as within the right inferior pubic ramus, concerning for metastatic disease. the kidneys and urinary bladder are visualized, the normal route of tracer excretion. impression: 1. focal tracer uptake within the known lytic lesion of the right acetabulum and pubic symphysis, concerning for metastatic disease. 2. likely degenerative changes of the bilateral shoulders and knees. ct guided biopsy: procedure/findings: the risks and benefits of the procedure were explained to the patient and informed written consent was obtained. preprocedural timeout was performed confirming the patient's identity and the procedure to be undertaken. the patient was placed in the left lateral decubitus position on the ct scanner. the patient was prepped and draped in the usual sterile fashion. using 10 cc of 1% lidocaine for local anesthesia, under direct ct fluoroscopic guidance, a 14-gauge coaxial needle was inserted into the destructive lytic lesion within the right ilium. subsequently, five core biopsy samples were obtained with a 15-gauge biopsy gun device with the samples were placed in formalin. additionally, one core biopsy sample was placed in cytolite for cytology analysis. patient tolerated the procedure well and there were no immediate post-procedural complications. dry sterile dressing was placed. moderate sedation was provided by administering divided doses of versed and fentanyl throughout the total intraservice time of 10 minutes during which the patient's hemodynamic parameters were continuously monitored. a total dose of 25 mcg of fentanyl and 0.5 mg of versed were administered. the procedure was performed by drs. and dr. , the attending radiologist, present and supervising throughout. impression: technically successful ct-guided core biopsy of right iliac bone lesion biospy: diagnosis: right iliac lytic lesion, biopsy (a): connective tissue, scant fragments of bone and fibrin. no malignancy identified in this specimen ct torso: ct chest with iv contrast: bilateral pleural effusions and associated atelectasis are greater on the right than the left. there is associated volume loss on the right, with segmental collapse. the right lower lobe bronchus remains patent. the trachea and left bronchi are patent to the subsegmental level. the aorta and its branches and the coronary arteries demonstrate heavy calcifications. the heart, aorta, and great vessels are otherwise unremarkable. there is mild thyroid enlargement without a discrete thyroid nodule identified. there is no supraclavicular, axillary, or mediastinal lymphadenopathy. there is a soft tissue mass involving the right rotator cuff muscles and causing erosion into the right humeral head, which demonstrates pathologic fracture. there is no apparent involvement of the glenoid fossa. ct abdomen with iv contrast: a 2.2 x 1.9 cm adrenal nodule (3:57) is low in attenuation and unchanged since prior studies, likely representing an adrenal adenoma. the kidneys are atrophic bilaterally. a 3.9 x 2.2 cm exophytic cyst is identified arising from the interpolar region of the left kidney (3:60a), and a simple renal cyst is identified arising from the inferior pole of the right kidney (3:60a). the liver, spleen, pancreas, right adrenal gland, large bowel, and small bowel are unremarkable. there is no mesenteric or retroperitoneal lymphadenopathy, and no intra-abdominal free air or fluid is identified. the abdominal aorta and its branches are heavily calcified. ct pelvis with iv contrast: the left lower quadrant demonstrates sigmoid colostomy. a rectosigmoid anastomosis site is identified. there is a small amount of calcification in the prostate gland. the rectum and bladder are unremarkable. no pelvic or inguinal lymphadenopathy is identified. there is a 4.4 x 2.1 cm fluid collection anterior to the inferior sacrum and posterior to the rectum (axial 3:107; coronal 7:47). there is diffuse edema and soft tissue enlargement involving the right flank, right psoas muscle, and iliopsoas, with erosion of a soft tissue mass into the right acetabulum and femoral head. although previously involving the right acetabulum, there has been progression of pathologic fracture of the acetabulum as well as femoral head. the left iliopsoas muscle is also enlarged, indicative of a soft tissue mass with pathologic fracture of the left acetabulum and extensive lytic lesions of the left femoral head without definite cortical breakthrough. the origin of the left hamstring muscle is asymetrically enlarged with obliteration of the fat planes at the medial aspect of the posterior thigh (3:130). impression: 1. soft tissue metastases with bony erosion and pathologic fracture involving the right humeral head, right femoral head and acetabulum, and left acetabulum. lytic lesions without definite cortical breakthrough involving left femoral head. 2. bilateral pleural effusions, right greater than left, with associated atelectasis and volume loss. 3. no lymphadenopathy in the chest, abdomen, or pelvis. 4. left adrenal adenoma. 5. bilateral renal cysts. 6. significant atherosclerotic disease involving the aorta and its branches. brief hospital course: 64 m w/ pmhx of rectal cancer presented for evaluation of likely pathologic right hip fracture. the patient had undergone an ir guided needle biopsy of his right iliac crest in order to obtain for diagnosis. the initial examination hsowed predominantly fibrosis with spindle cells, raising the possibiltity that the pathalogic fracture may be from a new primary sarcoma, as opposed to metastatic rectal cancer. the biopsy specimen was sent to and woman's hospital for further examination. on arrival to , pelvis x-ray showed widespread metastatic involvement of the bony pelvis. orthopedics evaluated the patient and found his hip unable to be surgically repaired. they recommended the patient be seen by radiation oncology for treatment of his metastatic disease. however, radiation oncology deferred until pathology on his planned biopsy returned. furthermore, he had previously received radiation therapy at an outside provider and they recommended that if radiation was needed, he should return there as they have his previous mapping. they also recommended the patient get a bone scan in order to find other metastatic sites which may be easily accesible for further biopsy and identification. the bone identified the lesions in the right hip that were suspicious and he underwent a ct guided biopsy of the right ilium by orthopedic oncology on . however, this biopsy show no malignancy. furthermore, and spep and upep were negative. his right hip lesion may be severe bony disease in a patient in a patient on hemodialysis. in discussion with the orthopedic oncologist and his primary oncologist, the decision was made to observe the patient in one month with a repeat ct scan. if his disease has progressed at that time, the orthopedic oncologist will pursue an open biopsy. he will follow up with his primary oncologist, dr. , and the orthopedic oncologist, dr. . he should also be evaluated by his nephrologist to evaluate his metabolic status in regards to his bone health. his pain was controlled with oxycontin . on , after receiving more extensive iv fluids prior to his bonescan, the patient developed respiratory distress and subsequent hypercarbic respiratory failure. he was transferred to the medical icu. he was briefly placed on non-invasive ventilation and emergently dialyzed to remove fluid. the previous day, his long acting oxycontin was also increased from 20mg to 40mg . it is felt that both the volume overload and the increase in his narcotics contributed to his respiratory failure. he continued to have fluid removed by hd and improved. he presented with a chronic oxygen requirement of approximately 2.5l. he was using 3l nc at the time of discharge and this may continue to be weened as more fluid is removed at hemodialysis at it is felt that the cause of his oxygen requirement is continued volume overload. . # esrd- on hd mwf- continued on nephrocaps and calcium acetate. he will continue on an oral fluid restriction as outlined above. . # afib- he was continued on his home doses of amiodarone, metoprolol, and diltiazem with good effect. his lfts and tfts were normal here. the patient may benefit from pfts as an outpatient. . # ischemic cardiomyopathy: continued on asa, metoprolol, and statin with fluid removal at hemodialysis . # gout - continued renally-dosed allopurinol . # dm- continued humalog iss . # depression- continued home celexa . # ppx: cont ppi, sc heparin . # fen: renal diet as tolerated, monitor lytes . # code: full code (confirmed with wife on transfer) medications on admission: oxycontin 20mg oxycodone 10mg q4hr prn nephrocaps prilosec 20mg daily crestor 5mg daily diltiazem 30mg qid amiodraone 200mg daily metoprolol 100mg daily asa 325 daily allopurinol 100mg daily citalopram 40mg daily lorazepam 1mg po q6hr prn iss discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 5. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 7. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 8. hydrocortisone acetate 1 % ointment sig: one (1) appl rectal (2 times a day). 9. diltiazem hcl 30 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for sbp<100, hr<60. 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day): hold for sbp<100, hr<60. 11. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 14. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 15. oxycodone 5 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed. 16. ibuprofen 800 mg tablet sig: one (1) tablet po q8h (every 8 hours). 17. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 18. oxycodone 20 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q8h (every 8 hours). 19. insulin lispro 100 unit/ml solution sig: see sliding scale subcutaneous asdir (as directed). discharge disposition: extended care facility: health care center discharge diagnosis: rectal carcinoma pathologic hip fracture end stage renal disease on hemodialysis diabetes type 2 hyperlipidemia hypertension gout atrial fibrillation discharge condition: all vital signs stable discharge instructions: you were admitted to the hospital for evaluation of your hip fracture. you had a biopsy done which showed no cancer. you will follow up with dr. and dr. for further observation. if the problem has progressed, dr. would consider an open biopsy. your hip problem may be from severe osteooporosis caused by your dialysis. you should discuss this with your kidney doctor. you also have accumulated more fluid which will continue to be taken off at dialysis. . please continue to take your medications as prescribed. . please follow up as described below. . please call your doctor or return to the hospital if you experience any worrisome symptoms. followup instructions: please call dr. office at ( to schedule a follow up appointment towards the end of . provider: xray (scc 2) phone: date/time: 9:40 provider: , md phone: date/time: 10:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube hemodialysis biopsy of bone, other bones diagnoses: end stage renal disease congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled gout, unspecified atrial fibrillation other specified forms of chronic ischemic heart disease acute respiratory failure chronic systolic heart failure personal history of malignant neoplasm of large intestine secondary malignant neoplasm of bone and bone marrow pathologic fracture of neck of femur 

Answer: The patient is high likely exposed to