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: amoxicillin / sulfonamides / penicillins attending: chief complaint: s/p fall major surgical or invasive procedure: -open reduction internal fixation of right hip -closed reduction of right distal radius with manipulation. -endotracheal intubation -placement of a right internal jugular central venous line history of present illness: ms. is an 87 year old woman with past medical history of htn, glaucoma, oa, and recently diagnosed pancreatic/ ca with ?liver mets who presented s/p unwitnessed fall at her facility. she was found on the ground by her aide complaining of severe right hip pain. in the ed, the patient was found to have low hct 23.6. she was crossmatched 4 units and consented. she was placed in a c-collar and had a ct c-spine. xray showed right hip fracture. she was given iv morphine for pain control. overnight, the patient was transfused 2 units of prbcs. she was unable to answer questions appropriately to pain. she does not remember anything from the fall. the daughter reports that the patient is ambulatory at baseline and relies on her aide for all adls. past medical history: -newly discovered likely pancreatic, ca with liver mets (pt unaware) -htn -glaucoma -oa -?rheum dx -lbp social history: pt lives at , aide helps with all adls. no smoking, etoh, drug use. family history: no history of cancer, ibd, breast cancer, cad, diabetes, rheumatic diseases, asthma. physical exam: (per admitting resident) vitals:t.98.2, bp 150/83, hr 108, rr 16, sat 97% on ra. general: sleeping comfortable, c-collar in place. family requests no distruptions. heent:nc/at, mmm, neck: c-collar in place. lungs: clear to auscultation anteriorly. cv: regular rate and rhythm, normal s1 + s2, +3/6 systolic crescendo/decrescendo murmur loudest in aortic area. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, 1+pitting edema. neuro: unable to assess. pertinent results: admission labs : blood 09:00pm wbc-13.1* hgb-6.9* hct-23.6* plt ct-468* 09:00pm neuts-81.9* lymphs-11.2* monos-3.9 eos-2.8 baso-0.2 09:00pm pt-11.5 ptt-19.5* inr(pt)-1.0 09:00pm glucose-187* urean-29* creat-1.2* na-136 k-4.4 cl-102 hco3-26 angap-12 09:00pm ck(cpk)-49 09:00pm ck-mb-3 ctropnt-0.07* u/a 02:33am color-yellow appear-clear sp -1.015 02:33am blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 02:33am rbc-2 wbc-2 bacteri-none yeast-none epi-<1 02:33am mucous-rare microbiology: , 2 urine cx grew e. coli , 2 urine cx negative , 2 urine cx grew yeast c.diff negative x 2 blood cx negative x 5 (2 pending at d/c) bal respiratory viral cx negative; bal gram stain negative sputum cx (): 3+ gram negative diplococci.; 1+ multiple organisms consistent with oropharyngeal flora.; resp cx grew out yeast (sparse growth) radiology: ct c-spine () -impression: 1. no acute fracture of the cervical spine. 2. minimal anterolisthesis of c4 over c5 and c7 over t1 and minimal retrolisthesis of c5 over c6 of indeterminate age, but could be degenerative. clinical correlation advised. severe osteopenia and degenerative changes. mri is a more sensitive modality to evaluate for ligamentous or spinal cord injury. 3. sub-cm right thyroid nodule. 1.3 x 0.9 cm nodule posterior to the right lobe of the thyroid may represent a parathyroid adenoma versus a thyroid nodule. correlation with thyroid ultrasound on a non-emergent basis suggested. ct head () - impression: no acute intracranial abnormality. hip x-ray () - impression: 1. intertrochanteric-subtrochanteric fracture of the femur extending to the lesser trochanter with varus angulation. 2. severe osteopenia. wrist x-ray () - impression: 1. right wrist -- colles fracture with dorsal angulation of the distal radial articular surface. question acute or subacute. 2. left wrist -- findings essentially representing slac wrist (scapholunate advanced collapse), unlikely to be acute. no acute fracture identified. no chondrocalcinosis. 3. bilateral severe osteopenia and osteoarthritis. cxr () - impression: new left lower lobe atelectasis with pleural effusion could be due to aspiration. early followup chest radiograph recommended. cxr (; at time of micu transfer) - as compared to the previous radiograph, there is no relevant change. borderline size of the cardiac silhouette, moderate retrocardiac atelectasis. presence of minimal left-sided pleural effusion cannot be excluded. no evidence of overhydration. no focal parenchymal opacity suggesting pneumonia. no pneumothorax. cxr (; at time of micu callout) - impression: significant interval improvement in multifocal airspace opacities. echo () - the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2 -1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. discharge labs (): 05:30am blood wbc-16.9* rbc-3.34* hgb-9.3* hct-29.7* mcv-89 mch-27.8 mchc-31.2 rdw-18.1* plt ct-771* 05:30am blood glucose-98 urean-17 creat-0.8 na-141 k-4.2 cl-109* hco3-25 angap-11 05:30am blood alt-36 ast-38 ld(ldh)-332* alkphos-256* totbili-0.7 05:30am blood calcium-8.9 phos-3.3 mg-1.9 05:30am blood crp-37.0* 05:30am blood esr-24* brief hospital course: 87 year old female with recently diagnosed pancreatic/ cancer with liver metastases, hypertension, osteoarthritis who presented on with right hip and wrist fractures after an unwitnessed fall. # unwitnessed fall, right hip and wrist fractures - the patient presented with right hip and wrist fractures after an unwitnessed fall. on arrival to , she received one liter of normal saline and morpine 4 mg iv x 2. ct-c-spine was without fracture. ct head was without acute process. hip xray showed a right intertrochanteric-subtrochanteric fracture of the femur extending to the lesser trochanter with varus angulation. she was admitted to the medical service for further management. she underwent open reduction and internal fixation of right hip fracture and closed reduction or right distal radius fracture. she tolerated the procedure well but had agitation post-operatively which was treated with iv haldol. on pod#1 she was noted to have acute hypoxia, tachypnea and tachycardia. she was ultimately transferred to the micu for further management (see below). while in the micu, she had an echo which showed mild atrial stenosis, mild mitral regurgitation, severe pulmonary artery hypertension, and an ef of 75%. after she was called out to the floor, pt and ot were consulted. at the time of discharge, pt recommendations included transfer training, balance training, and bed mobility. the patient was ultimately discharged to a rehabilitation facility. # hypoxia, respiratory distress - at approximately 2 pm on pod#1 she was noted to have acute hypoxia, tachypnea and tachycardia. she was initially 80% on ra and this improved to low 90s on facemask and high 90s on a non-rebreather. repeat cxr showed no acute cardiopulmonary process. abg on a non-breather was 7.34/34/170. ekg showed sinus tachycardia but no other changes compared to priors. she was transferred to the micu for further management. cta did not show evidence of pulmonary embolism. also, bilateral lower extremity ultrasounds showed no evidence of dvt. while in the micu, the patient was intubated. she was also found to have a pneumonia (in addition to a previously known uti, which was being treated with ciprofloxacin). she was started on vancomycin and cefepime. she was ultimately extubated on . she was called out to the floor on . the patient also had some episodes of delirium / agitation upon transfer to the micu and while she was in the micu. by the time the patient was transferred to the floor, this had improved. sedating medications were avoided after she was called out to the medicine floor. a right internal jugular cvl was also place while the patient was in the micu. this was removed after the patient was called out to the floor. # anemia - on admission, the patient's hematocrit was 23.6 with iron studies notable for low iron and ferritin. it was felt that this could be related to the patient's colonic malignancy (see below). she received three units of prbcs. her hematocrit was trended. she was also kept on pantoprazole. at the time of her call out from the micu on , the patient's hematocrit was stable. after she was called out to the floor, the patient's family requested that she receive no more blood transfusions. # leukocytosis / thrombocytosis - on , as the patient was approaching discharge, she was noted to have rising white blood cell and platelet counts. at that time, she had already completed a 7 day course of vancomycin and cefepime for a pneumonia. her mental status was noted to be improving, and she remained afebrile despite her rising white count. a urinalysis showed bacteriuria; however, two urine cultures grew out yeast alone. she was started on ciprofloxacin again for possible uti, and she was started on fluconazole for the yeast in her urine. her foley was discontinued but restarted secondary to urinary retention. two stool cultures were negative for c.diff. blood cultures also were drawn and did not grow out anything by the time of discharge. a chest x-ray did not show signs of infection. lft's showed elevated ldh and alkaline phosphatase, which could be consistent with her underlying malignancy. this was discussed with the heme/onc fellow, and it was felt that that the patient's leukocytosis and thrombocytosis were consistent with an inflammatory state secondary to her recent pna and uti as well as her mailgnancy. it was discussed with the patient's family that the next step in the workup of her leukocytosis would include bone marrow biopsy. this was not consistent with their goals of care (see below). at the time of discharge, the patient's wbc was trending down. # pancreatic/ cancer - pt had recently been diagnosed with adenocarcinoma of the on biopsy. she has suspicious liver lesions as well as a mass in the head of the pancreas concerning for second primary. at the time of admission, she had not been told yet, as her family wanted to withhold the information until after the holiday. social work and palliative worked with the patient's family throughout her hospitalization. as explained above, the patient had leukocytosis and thrombocytosis towards the end of her hospitalization with a negative infectious work-up. it was discussed with the patient's family that further work-up of this would include a bone marrow biopsy. furthermore, if any abnormalities were found on bone marrow biopsy, treatment of the patient's and pancreatic cancer would need to be addressed first. this was not consistent with the family's goals of care. at the time of discharge, the family's goal of care were to move the patient to a rehab facility, where she could build her strength. telling the patient of her diagnosis can also be addressed during that time. as the patient's disease progresses, the family plans to progress towards hospice care. # hypertension - the patient did have some episodes of hypertension. while in the micu, she was on iv metoprolol qid. this was switched to po metoprolol . after the transition to po metoprolol, the patient's blood pressure was better controlled. # polymyalgia rheumatica - the patient's home regimen of prednisone was not entirely clear. while in the micu, she was on stress doses of steroids. however, after call out to the floor, she was transitioned to a regimen of 5 mg prednisone daily. # of note, a speech and swallow evaluation on recommended nectar thick liquids and pureed foods, with the patient's meds being crushed in puree. repeat speech and swallow done on the day prior to discharge cleared the patient for a regular diet. medications on admission: lorazepam 0.5 mg tab qid aciphex 20mg ibuprofen 800 mg tab oral daily duloxetine 60 mg daily metoprolol tartrate 25 mg tab oral prednisone 5 mg daily ultram 50 mg tab oral qid discharge disposition: extended care facility: of discharge diagnosis: right hip and wrist fractures s/p unwitnessed falls pneumonia urinary tract infection discharge condition: afebrile, hemodynamically stable discharge instructions: you were admitted to the hospital after you had an unwitnessed fall at your facility. you were found to have fractures in both your right hip and your right wrist. you were admitted and taken to the or to repair these fractures. you post-operative course was complicated by respiratory distress, ultimately requiring transfer to the icu and intubation. you were ultimately extubated and transferred back to the medical floor. also, during your hospital course, you were found to have a urinary tract infection as well as a pneumonia. these were treated with antibiotics. we also tried removing your foley catheter but you had difficulty urinating after. this will be removed as possible at your rehab facility. medication changes: -change lorazepam to 0.5 mg at night as needed for anxiety -stop aciphex; start pantoprazole 40 mg twice a day -stop ibuprofen -stop lexapro; start duloxetine 40 mg daily -change metoprolol tartrate to 50 mg twice a day -change prednisone to 5 mg daily -stop ultram the following medications were added: -milk of magnesia 30 ml twice a day as needed for upset stomach -bisacodyl 10 mg po/pr daily as needed for constipation -docusate sodium 100 mg twice a day -enoxaparin sodium 40 mg injection daily -acetaminophen 650 mg every 6 hours as needed for pain -miconazole powder 2% three times a day -fluconazole 200 mg daily (to complete a 7 day course, ending on ) -senna 1 tab twice a day -lidocaine 5% patch daily (apply for 12 hours and then keep off for 12 hours) -amlodipine 5 mg daily please return to the emergency room or call 911 if you experience any further falls, chest pain, shortness of breath, fevers greater than 101.5, severe nausea with inability to tolerate food or liquids by mouth, confusion, or any other concerning symptoms. it was a pleasure taking part in your medical care. followup instructions: you should call your pcp, . , and make a follow-up appointment with her within 2 weeks of discharge. the telephone number for dr. office is . you also need to follow-up with orthopedic surgery in 4 weeks. to set up this appointment, please call at . md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube closed [endoscopic] biopsy of bronchus open reduction of fracture with internal fixation, femur closed reduction of fracture without internal fixation, radius and ulna diagnoses: polymyalgia rheumatica malignant neoplasm of liver, secondary urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia other chronic pulmonary heart diseases unspecified glaucoma pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus malignant neoplasm of head of pancreas osteoarthrosis, unspecified whether generalized or localized, site unspecified fall from other slipping, tripping, or stumbling disorder of bone and cartilage, unspecified other alteration of consciousness closed fracture of intertrochanteric section of neck of femur other closed fractures of distal end of radius (alone) malignant neoplasm of colon, unspecified site 

Answer: The patient is high likely exposed to