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: lipitor / ativan attending: chief complaint: altered mental status major surgical or invasive procedure: egd history of present illness: pt is a y/o male w/h/o dementia (a&ox2 at baseline), chronic afib, cad s/p single-vessel cabg in , and pseudogout who is sent in from his pcps office w/ acute mental status changes in the setting of worsening productive cough and hypoxia. his two daughters found him quite confused last night and this morning in his independent apartment at . when they went to see him this afternoon he was in his pajamas, confused and agitated beyond his baseline. over the past few days, they had noted that he had developed a cough with a small amount of sputum production. of note he recently had an episode of pseudogout, which was treated by his rheumatologist, dr. , at the with colchicine. in dr. office he was found to be hypoxic on presentation (91% ra), with a productive cough, and diminished mental status (a&ox1). in the ed initial vitals: 98, hr 97, bp 110/55, rr 16, o2sat 91% ra and work-up was initiated with cxr, head ct, u/a, chemistry and cbc. ekg was interpretted as afib, lad, ni, no s/o ischemia and unchanged from prior. labs were impressive for an inr of 18.0 and hct drop from 43 in to 25 today. on further history taking it was discovered that the patient's inr hasn't been checked "in months." rectal exam revealed guaiac positive melanotic stool in the vault. he was ordered for 4 units of ffp, 2 units of blood and 10mg of iv vitamin k and gi was consulted. he only received 1 unit of ffp prior to transfer. a head ct was checked and ich was r/o'd. given his elevated wbc, he was given ceftriaxone and azithromycin. on the floor he is without complaint, though nauseated in rapid afib. past medical history: 1. hypertension. 2. hyperlipidemia. 3. coronary heart disease. 4. atrial fibrillation. 5. memory loss or early dementia. 6. spinal stenosis. 7. pseudogout. 8. status post laparoscopic cholecystectomy. social history: the patient is a retired civil engineer. he has 3 children. he quit tobacco in the 70's (30 pack years) and denies drugs. social history is significant for the absence of current tobacco use. there is no history of alcohol abuse, though patient has one drink per night. family history: there is no family history of premature coronary artery disease or sudden death. mother died at 95 of stroke and father lived to 91. physical exam: admission exam: vitals: t: bp:92/55 p:112 r:22 o2:100% general: alert, no acute distress, very hard of hearing heent: pale conjunctiva, dry mm, oropharynx clear with dentures neck: supple, jvp below clavicle, bounding carotids, no lad lungs: diffuse rhonchi, no obvious crackles cv: irregular, tachycardic, ?flow murmur s2s2 abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: diffuse psoriasis discharge exam: vs: tm 97.4, 100-135/50-, 72-90, 92-97% ra general: elderly male resting comfortably in bed, nad, very hard of hearing lungs: ctab, no wheezes/crackles/rhonchi cv: irregularly irregular, no r/m/g appreciated abdomen: +bs, soft, nt/nd ext: warm, well perfused, 1+ edema of lower extremities pertinent results: admission labs: 05:25pm blood wbc-22.1*# rbc-2.60*# hgb-8.4*# hct-25.0*# mcv-96 mch-32.4* mchc-33.7 rdw-14.6 plt ct-360 05:25pm blood pt-141.6* ptt-50.5* inr(pt)-18.0* 05:25pm blood glucose-232* urean-72* creat-1.4* na-139 k-4.5 cl-103 hco3-21* angap-20 11:27pm blood calcium-8.3* phos-4.3# mg-2.3 egd: impression: erythema in the gastroesophageal junction otherwise normal egd to third part of the duodenum recommendations: the findings do not account for the symptoms. consideration should be given to repeat colonoscopy. will need to discuss with patient and faimly. additional notes: the attending was present for the entire procedure. final diagnoses are listed in the impression section above. estimated blood loss = zero. no specimens were taken for pathology colonoscopy: grade 3 internal and external hemmorhoids diverticulosis of whole colon polyps in the distal descending colon polyp at 35 cm in the sigmoid sent for biopsy, endoclip place otherwise normal discharge labs: 06:33am blood wbc-14.1* rbc-2.88* hgb-9.1* hct-27.3* mcv-95 mch-31.4 mchc-33.2 rdw-18.8* plt ct-242 06:33am blood pt-14.2* ptt-27.7 inr(pt)-1.2* 06:33am blood glucose-104* urean-38* creat-1.3* na-138 k-4.1 cl-106 hco3-20* angap-16 brief hospital course: m on coumadin for afib coming in with greatly supertherapeutic inr, ams, hypoxia, and gi bleeding with hct drop. diagnoses: # gib: he presented with a supratherapeutic inr of 18 and was given 3 units of ffp with improvement in his inr to 1.6. spontaneous gastritis in the setting of the coagulopathy was the most likely source. egd was performed and he did not show any signs of active bleeding or oozing. colonoscopy was performed and showed diverticulosis and two polyps the largest of which was removed. he received 2 units of prbcs with an appropriate bump in his hematocrit. his bumex, lisinopril, metoprolol, aspirin, and warfarin were initially held. he was restarted on a diet and tolerated food. an iv ppi was initially started and then he was transitioned to po. his metoprolol was restarted but his bumex and lisinopril were held due to low blood pressure. # ams: thought to be secondary to acute illness in the setting of a gib coupled with sundowning. frequent orientation was helpful, and small doses of antipsychotics. # hypoxia: he had mild hypoxia in the setting of a white count and dry cough. his chest x-ray was unremarkable, however he did have unilateral crackles. he was treated for a cap with azithromycin initially but this treatment was stopped later in his hospitalization. exact etiology was not determined. # coagulopathy: this may be secondary to a drug-drug interaction between his coumadin and colchicine. more likely this was either patient error administering his own medication or the fact that he gets his inr checked relatively infrequently (monthly) he was aggressively corrected. his colchicine was discontinued after discussion with his rheumatologist. # afib: his metoprolol was initially held but he had several episodes of afib with rvr. he was treated with 5 mg iv metoprolol with resolution of these episodes. his metoprolol was restarted and was titrated up to 25 mg tid. this was converted to metoprolol succinate on discharge. his warfarin was planned to be restarted the day after discharge. he was also planned to take enoxaparin unitl his inr was therapeutic. # cad: aspirin held during coagulopathy. transitional issues: anticoagulation: mr warfarin was held in the setting of his gib and elevated inr. his inr at discharge was 1.2. his warfarin will need to be restarted and his dose will need to be titrated up to his goal inr of . while he is subtherapeutic he should be treated with enoxaparin which should be renally dosed. aspirin held at discharge. decision about re-starting aspirin can be addressed as outpatient once hct known to be stable with therapeutic inr. follow-up: patient needs a follow up appointment with dr. after discharge from the rehabilitation facility. medications on admission: medications: bumetanide - 0.5 mg tablet daily donepezil - 10 mg tablet daily lisinopril - 5 mg tablet daily meclizine - 25 mg tablet as needed for vertigo attack memantine - 10 mg tablet metoprolol succinate - 50 mg tablet extended release 24 hr simvastatin - 20 mg tablet tablet(s) by mouth warfarin medications - otc aspirin - (prescribed by other provider) - 81 mg tablet ferrous sulfate - 325 mg (65 mg) tablet - 1 (one) tablet(s) by mouth once a day multivitamin-minerals-lutein - tablet - 2 (two) tablet(s) by mouth once a day discharge medications: 1. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 2. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical daily (daily) as needed for rash. 3. memantine 5 mg tablet sig: two (2) tablet po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 6. olanzapine 2.5 mg tablet sig: one (1) tablet po daily prn as needed for agitation. 7. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 8. metoprolol succinate 25 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. 9. outpatient lab work please check cbc thursday please check inr saturday please fax results to : name: , md address: ,ste 1b, , phone: fax: email: 10. warfarin 2 mg tablet sig: one (1) tablet po once a day: please start on thursday, . 11. enoxaparin 100 mg/ml syringe sig: one (1) 90 subcutaneous once a day for until inr 2-3 days: please start thursday . 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid prn as needed for constipation. discharge disposition: extended care facility: - discharge diagnosis: gastrointestinal bleed altered mental status discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were admitted to the hospital with changes in your mental status. while you were here we also discovered that you had a bleed in your gi tract and that your warfarin level was very high. initially you were admitted to the intensive care unit but you were then transferred to the floor because you were stable. you underwent an upper and lower bowel endoscopy. the upper endoscopy did not show evidence of bleeding. the lower endoscopy showed a small growth that may have caused the bleeding. this growth was removed. we also stopped the warfarin to bring your level back to normal which helped stop the bleeding. we also started a medication pantoprazole which decreases the acid in your stomach which may also help stop bleeding. you will need to restart the warfarin thursday . because the warfarin was stopped you will need to take a medicine called enoxaparin for a couple days before the warfarin will be effective again. we also stopped your bumetanide and lisinopril because your blood pressure was low. medication changes summary: please start warfarin 2mg per day on thursday please start enoxaparin 90mg daily (renal dosing) please start ferrous sulfate (iron) 300mg twice a day please start pantoprazole 40 mg twice a day please stop bumetanide please stop lisinopril please increase metoprolol succinate to 75mg daily please continue all other medications thank you for allowing us to participate in your care. we wish you a speedy recovery. followup instructions: department: gerontology when: friday at 2:30 pm with: , md building: lm bldg () campus: west best parking: garage procedure: other endoscopy of small intestine endoscopic polypectomy of large intestine diagnoses: abnormal coagulation profile anemia, unspecified congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of tobacco use other persistent mental disorders due to conditions classified elsewhere chronic systolic heart failure long-term (current) use of anticoagulants unspecified gastritis and gastroduodenitis, with hemorrhage rash and other nonspecific skin eruption hypoxemia anticoagulants causing adverse effects in therapeutic use benign neoplasm of colon other disorders of calcium metabolism chondrocalcinosis, unspecified, site unspecified diverticulosis of colon (without mention of hemorrhage) internal hemorrhoids without mention of complication external hemorrhoids without mention of complication 

Answer: The patient is high likely exposed to