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: nsaids attending: chief complaint: mental status changes major surgical or invasive procedure: intubation history of present illness: mr. is a 68m with h/o copd (on 3l home o2), cad, hepatitis b&c, and an fdg avid rll mass concerning for malignancy who presented to the ed from stone rehab on with mental status changes. specifically, it was reported that the patient has been becoming more lethargic over 3 days. the patient's hcp , ) was contact who given a history that the patient has had an increasing number of falls at his rehab facility recently. she does not know the cause of the falls or if there have been complications. further, the patient was recently admitted to hospital on with pna and bacteremia tx'ed with levaquin and course ended . during this hospitalization, he was found to have a lll infiltrate thought to be consistent with pneumonia. he was started on vancomycin and zosyn since he described a history of aspiration and had multiple pulmonary co-morbidities. blood cultures yielded gram positive cocci in clusters that later grew out coagulase negative staph that speciated as staph hominus. he was switched to levofloxacin with end date of . in addition, he had altered mental status on admission, which rapidly improved to his baseline with administration of narcan in the er. he continued on a pain regimen. in addition, echo showed diastolic heart failure (ef 60 %). . in the ed, the patient was unable to provide a history and was noted to be mumbling and unable to state his own name. sats initially in the low 80s on ra and improved to 93% on non rebreather. cxr showed large left sided consolidation on cxr. labs significant for wbc 7.3, hgb 10 (down 11.8), cr 4.9 (baseline cr 0.7). his mental status and oxygenation deteroriated prompting intubation. after intubation, he became hypotensive to 77/40. a cvl was placed in r ij. he was given 5l of fluids and started on vanc/zosyn/levofloxacin. neosenephrine was started. he was transferred to the micu for further management of ? sepsis. he received a total of 5 l ns. . on arrival to the floor, the patient's intial vitals were 98.1 110/54 79. he remained intubated on neosenephrine. he was sedated and unable to provide further history. past medical history: arthritis copd/emphysema chronic pain hep b hep c htn gerd, severe polyneuropathy, swelling of ankles and feet psh - bilat knee replacements, femur (rod put in), chole, hernia repair, hip repair, left hip repair with screws put in, ulnar and radial fx with rod put in chronic pain syndrome cad: reports taking plavix for a plaque in "a heart vessel" that caused a heart attack (not listed on medical hx from dr. in clinic) social history: still smoking cigarettes/day, >40 pack year history denies alcohol & drugs lives in nursing home (stonehedge nsc/rehab) family history: noncontributory physical exam: on admission: vitals: t: 98.1 110/54 79 general: intubated and sedated heent: sclera anicteric, mmm, et tube in place neck: supple, jvp not elevated, r ij cl lungs: decreased breath sounds b/l with rhonci on left cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present gu: foley in place ext: warm, well perfused, 1+ edema edema on discharge: vs: t:98.4 bp:140/83 hr:68(60-70s, sinus) rr:17 o2 sat:96% 3l nc general: alert and oriented, in nad, talking in full sentences heent: sclera anicteric, mmm, hoarse low pitched voice neck: supple, jvp not elevated, r ij without redness/warmth/erythema lungs: decreased bs, scattered wheezes, no ronchi/rales cv: rrr, normal s1 + s2, no m/r/g abdomen: soft, mildly tender in llq, no rebound, non-distended, +bs gu: foley in place ext: wwp, 1+dp/pt pulses bilaterally neuro: a+ox3 pertinent results: on admission: 11:20am blood wbc-7.3 rbc-3.39* hgb-10.0* hct-28.9* mcv-85 mch-29.4 mchc-34.5 rdw-14.1 plt ct-174 11:20am blood pt-12.7 ptt-26.5 inr(pt)-1.1 11:24am blood type-art po2-191* pco2-52* ph-7.32* caltco2-28 base xs-0 comment-green top on discharge: studies: ct chest-1. multifocal opacities with air bronchograms, including complete consolidation/atelectasis of the left lower lobe. differential considerations include pneumonic consolidations or extensive atelectasis. 2. mass in the right lower lobe, compatible with known suspected malignancy. 3. similar slight left adrenal thickening without discrete nodules. ct head. impression: no evidence of an acute intracranial process. scattered periventricular white matter hypodensities, grossly unchanged, which most likely represent sequela of mild chronic small vessel ischemic disease. mr would be significantly more sensitive for detection of intracranial metastases, if clinically indicated. echo. the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. the mitral valve leaflets are not well seen. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. no vegetation seen but cannot exclude (views are suboptimal). brief hospital course: mr. is a 68 y/o male with pmh copd, cad, hepatitis b&c and questionable lung cancer presents with altered mental status and hypercarbic respiratory failure in the setting of pna # pna the patient was recently admitted to hospital on with pna and bacteremia (staph hominus). tx'ed with levaquin and course ended . on he presented to this hospital with ams and lethargy. in the ed, the patient was unable to provide a history and was noted to be mumbling and unable to state his own name. sats initially in the low 80s on ra and improved to 93% on non rebreather. a cxr revealed a lll consolidation in addition to known right sided lung mass. his mental status and oxygenation deteroriated prompting intubation. after intubation, he became hypotensive to 77/40. a cvl was placed in r ij. he was given 5l of fluids and started on vanc/zosyn/levofloxacin. pressors were started. a ct c/a/p showed the left sided consolidation and a right sided mass measuring 30 x 22 mm. he was transferred to the micu where he was slowly weaned from pressors. a tte done showed an ef of 55% and no vegitations although was a suboptimal study. a bronchoscopy was performed and cultures taken which grew mrsa. antibiotics narrowed to just vancomycin. on , the patient passed an sbt and was extubated w/o complications. a picc was placed on , with plan for 14 days of antibiotic therapy to end on the night of . patient back to baseline and doing well on vancomycin. # hypotension the patient was initially normotensive in th ed. following intubation, his bp fell to the 70s/40s and he required pressors. on transfer to the micu, his pressors were able to be weaned off slowly. most likely etiology of hypotension is sedating medications for intubation. vasodilation from sepsis also a possible explanation. over his micu stay, the patient was able to be weaned off of pressors. on transfer to the floor, he was hypertensive and his home anti-hypertensives were gradually added back. he is hemodynamically stable at this point. labetalol 200mg po bid converted to metoprolol 75mg po tid. #atrial fibrillation on the patient was noted to be in afib with rvr. he has no history of afib. the event started immediatly following an sbt and the patient was initiated on a heparin drip. by the afternoon of the patient converted back to sinus while being continued on po dilt. on the patient had another episode of afib with rvr likely agressive diuresis, and again spontaneously converted back to sinus rhythm. on he had a third episode of atrial fibrillation with rvr, and was symptomatic with shortness of breath, diaphoresis, hypertension and ekg changes significant for st depressions in anterolateral leads. with rate control, symptoms improved and st depressions resolved, and patient spontaneously converted. he was titrated to metoprolol 75mg po tid, home dose of amlodipine 5mg po daily. labetalol 200mg po bid discontinued. patient has been in sinus for the past 2-3 days at this point, stable. a discussion of anticoagulation was initiated given patient's chads score of . patient is amenable to starting but he has plans for bx of rll mass in the not to distant future. unable to discuss with pcp directly, so anticoagulation for now held and should be initiated and followed by pcp. to rn in office and heard that his care will be transfered from dr. to dr. sometime in of this year and given the transition, thought it best not to start a complicated drug like coumadin while in the hospital. # acute renal failure the patient presented with a cr of 4.9 which is well above his baseline of ~0.8. his cr dropped rapidly with fluid resusitation indicative of a prerenal etiology. creatinine remained at baseline for the remainder of hospitalization. #lung mass the patient has an fdg avid rll lung noducle suspicious for malignancy. he is being followed by rad-onc here as an outpatient. it appears that he is not presently a surgical candidate and that cyberknife is being considered. biopsy will be done through bronch and egus instead of mediastinoscopy as evaluated by thoracic surgery. patient has followup with dr. at on for plans to biopsy mass. plavix and asa will need to be held prior to biopsy, and should coumadin be started, will need to be held as well. # cad unknown baseline history. last echo at showing normal ef and ? diastolic heart failure. his anti-hypertensives were initially held in the setting of shock but have been slowly added on as above as the patient's vascular tone recovered. patient was continued on aspirin and clopidogrel throughout hospitalization. # copd patient with oxygen-dependent copd. was on qvar while on vent, now transitioned back to home medications. at the time of transfer from the micu, patient was back to home o2 requirement of 3l nc and was stable for the remainder of hospitalization. #. depression/ptsd no active issues. temporarily held all psychoactive and sedating medications while patient was intubated. #transitional issues- - follow-up with pulmonologist regarding rll mass (dr. at ) - follow-up with ent regarding change in voice (appointment made) #full code medications on admission: - lisinopril 40 mg po qhs - doxepin 50 mg po qhs - enlose 10 g/15 mlo 30 ml po qod - slices qhs - lasix 80 mg po qd - omeprazole 40 mg po qd - amlodipine 5 mg po qd - asa 81 mg po qd - citalopram 50 mg po qd - clonazepam 1 mg po qd - docusate 200 mg po qd - loratadine 10 mg po qd - spiriva 1 cap inh qd - vitamin b12 - plavix 75 mg po qd - labetalol 200 mg po bid - advair 250/50 inh - azelastine nasal spray - bupropion sr 200 mg po bid - levofloxacin 750 mg po qd (completed on ) - ms contin 60 mg po bid - neurontin 600 mg po tid - hydromorphone 2 mg po q 4 hr prn pain discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 5. gabapentin 600 mg tablet sig: one (1) tablet po three times a day. 6. citalopram 20 mg tablet sig: 2.5 tablets po daily (daily). 7. bupropion hcl 100 mg tablet extended release sig: two (2) tablet extended release po bid (2 times a day). 8. furosemide 40 mg tablet sig: two (2) tablet po daily (daily). 9. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 10. clonazepam 1 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 12. morphine 30 mg tablet extended release sig: two (2) tablet extended release po q12h (every 12 hours). 13. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 14. vancomycin 500 mg recon soln sig: 2.5 recon solns intravenous q 12h (every 12 hours) for 4 days: to end on pm. 15. doxepin 50 mg capsule sig: one (1) capsule po at bedtime. 16. docusate sodium 100 mg capsule sig: two (2) capsule po daily prn as needed for constipation. 17. loratadine 10 mg tablet sig: one (1) tablet po once a day. 18. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) puff inhalation once a day. 19. advair diskus 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 20. vitamin b-12 oral 21. azelastine nasal discharge disposition: extended care facility: rehabilitation & care center - discharge diagnosis: primary diagnosis: 1. mrsa pneumonia 2. paroxysmal atrial fibrillation secondary diagnosis: 1. copd 2. htn 3. cad 4. hepatitis b 5. hepatitis c 6. right lower lung mass discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. transfers from bed to chair discharge instructions: it was a pleasure taking care of you at the . you presented with pneumonia and have been treated with antibiotics. you will need to continue antibiotic treatment for an addtional 4 days (last day will be ) and have a picc line in place for the infusion during this period. . your hospital stay was also complicated by an irregular heart rhythm called atrial fibrillation. this was treated and some changes have been made to your medications. your heart rhythm is normal and well-controlled at this point. however, with atrial fibrillation, anticoaguation (thinning of your blood) is indicated and should be discussed with your primary care physician. starting this medication, you will need frequent blood labs and you will need to be closely monitored. . the following changes have been made to your medications: --stop labetalol --start metoprolol 75 mg three times a day --start vancomycin 1250mg iv twice a day please take your other medication as previously prescribed. followup instructions: you have the following appointments: **please make an appointment to see your pcp, . () within the next week. department: liver center when: monday at 10:50 am with: , md building: lm campus: west best parking: garage with: dr. location: hospital address: , phone: appointment: thursday 10:45am department: otolaryngology (ent) when: wednesday at 10:15 am with: , m.d. building: lm campus: west best parking: . garage department: radiology when: monday at 2:45 pm with: cat scan building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: hyperpotassemia coronary atherosclerosis of native coronary artery esophageal reflux tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified acute respiratory failure old myocardial infarction rheumatoid arthritis encephalopathy, unspecified unspecified hereditary and idiopathic peripheral neuropathy spinal stenosis, unspecified region knee joint replacement chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta other specified hypotension chronic diastolic heart failure disorder of bone and cartilage, unspecified chronic pain syndrome arthropathy, unspecified, site unspecified other dependence on machines, supplemental oxygen swelling, mass, or lump in chest posttraumatic stress disorder methicillin resistant pneumonia due to staphylococcus aureus 

Answer: The patient is high likely exposed to