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: patient recorded as having no known allergies to drugs attending: chief complaint: coffee ground emesis, abdominal distention major surgical or invasive procedure: egd history of present illness: history of present illness: 87-year-old male with pmh s/f afib, htn, gerd, dm-ii, and obesity who presents now as transfer from for evaluation of orhtostatic hypotension, intermittent dizziness x 4 days, nausea and emesis. he had had some nausea for the last 3-4 days and vomited yesterday once after lunch that seemed to be more like a regurgitation, no blood was noted. he also complained of some constipation which was confirmed on a kub done yesterday at rehab. it was negative for any free air or air-fluid levels. his stool was guaiac negative and he remained distended despite a large bm and an enema. he had an episode this morning of coffee ground emesis and was found to be orthostatic there (160/70, 93 lying; 160/90, 100 sitting, 110/60, 110 standing). he was transferred to . in the ed, initial vs were: t: 98.3 p: 94 bp: 157/52 r: 20 o2 sat: 98% on 2l. labs including a t&s were drawn and sent, he had an ekg, cxr, kub, and an ngt was placed with heme + lavage. gi was consulted and they are planning to take him for egd in the morning. on the floor, the patient has the ngt in place, not complaining of any pain. denies cp or sob/palpitations. he has occasional heartburn relieved by antacids, none now. he is otherwise comfortable. review of sytems: (+) per hpi: in addition, has also had a 10lb weight gain since and a dry cough (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denied shortness of breath. denied chest pain or tightness, palpitations. no dysuria. denied arthralgias or myalgias. past medical history: s/p r tha (also pelvic fracture at that time with intraperitoneal bleed) hypertension. atrial fibrillation with rvr, spontaneous conversion to nsr . type 2 diabetes, 10y duration, recently started insulin hyperlipidemia. obesity chronic gait instability -peripheral neuropathy? thrombocytopenia. prev anemia. monoclonal paraproteinemia igm followed by hematology. gerd chronic prostatitis/bph. right proximal humerus fracture. horseshoe kidney. s/p bilateral cataract removal. depression. commonuted proximal humerus fracture 6th rib fracture social history: patient previously lived alone in his own home with the support of one of his daughters but was brought to nursing home in of this year s/p two falls--a pelvic fracture 1.5 years ago and a r humerus fracture. retired car salesman. smoked 2-3 packs a day for 30 years, quit 20 years ago. used to drink alcohol in moderation but currently does not drink. he uses a wheelchair at baseline and can only walk short distances with assistance. family history: mother died aged 32y hysterectomy; father died 81y paget's disease; daughters in good health physical exam: physical exam on admission: vitals: t:98.4 bp:142/74 p:93 r:20 o2:92% ra, 98% on 2l, weight 210lb general: nad, answers questions appropriately, easily arousable heent: sclera anicteric, perrl, eom intact, mmm, oropharynx clear, ngt in place with small amount of dark brown/red drainage neck: supple, no jvd lungs: ctab, no wheezes, rales, ronchi cv: rrr, normal s1 + s2, no m/c/r abdomen: bs present, markedly distended, no ttp, rebound, or guarding, but is somewhat tympanitic ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: ecchymoses on r hand, no rash neuro: a+ox2 (uncertain of place, thought it was ), cnii-xii intact, strength 5/5 and equal, sensation intact, dtrs 1+ and equal - patellar difficult to assees as pt. in bed. ftn slow. no focal defecits pertinent results: initial labs: 10:17pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 10:17pm urine rbc-84* wbc-8* bacteria-none yeast-none epi-<1 02:55pm pt-12.9 ptt-27.7 inr(pt)-1.1 11:03am lactate-2.6* 11:00am glucose-287* urea n-19 creat-0.9 sodium-139 potassium-4.1 chloride-101 total co2-24 anion gap-18 11:00am wbc-13.7* rbc-4.03* hgb-13.0* hct-39.0* mcv-97 mch-32.4* mchc-33.5 rdw-13.1 11:00am neuts-91.7* lymphs-4.8* monos-3.3 eos-0.1 basos-0.2 kub: dictation concerning for ileus or sbo with dilated loops of small bowel to 4.2cm. ct abdomen with iv contrast: there are trace bilateral pleural effusions, and subsegmental atelectasis. mitral annulus calcification is seen. a nasogastric tube has been placed, with the tip terminating in the stomach. there is cholelithiasis, with no evidence of cholecystitis. the liver, spleen, and adrenal glands are unremarkable. the pancreas demonstrates fatty replacement. there is a horseshoe kidney. the large bowel and small bowel are unremarkable, with no evidence of obstruction. oral contrast has reached the transverse colon, and there is stool and air in the rectum. there are no abnormally dilated loops of bowel or unusual gas or fluid collection in the abdomen. egd : diffuse erosion, friability, erythema and congestion, pale mucosa in the whole esophagus compatible with severe erosive esophagitis with unknown etiology (biopsy, biopsy). erythema in the stomach. otherwise normal egd to third part of the duodenum ct angiography: no evidence for pulmonary embolism or acute aortic syndrome. small, right greater than left, pleural effusions with associated atelectasis. mild centrilobular emphysema brief hospital course: this is an 87 yo man with multiple medical problems (afib, htn, gerd, , and obesity, and others) presenting with a 1-day history of coffee ground emesis, intermittent dizziness, nausea and vomiting, and abdominal distention that had begun about days ago. 1. gi bleed: patient presented with abdominal distention, constipation, nausea and vomiting of coffee ground emesis. ng lavage in emergency department was positive and patient was started on iv ppi. aggrenox was stopped. egd on showed severe esophagitis with diffuse continuous erosion, friability, erythema and congestion. the mucosa was pale with contact bleeding. biopsies and viral cultures were sent. the patient remained hemodynamically stable, requiring no transfusions although stool remained heme-occult positive (to be expected given slow transit time through colon). patient should continue taking sulfacrate and protonix and avoid nsaids after discharge. 2. abdominal distention: patient presented with increasing abdominal distention associated with nausea and vomiting of coffee ground emesis. initially there was concern over a small bowel obstruction so an ng tube was placed and patient was made npo. surgery consult recommended ct scan with oral contrast which demonstrated no obstruction. bedside disimpaction was attempted with limited success. patient retained ability to pass gas although did have some burping. throughout the hospital course, the patient had ongoing difficulties with constipation despite an aggressive bowel regimen, including enemas, lactulose and milk of magnesia. drugs that slow transit through gi system were limited and pt/ ot saw patient to increase patient mobilization. by time of discharge, patient was having multiple loose stools. 4. hypoxia/ respiratory distress: patient had a new oxygen requirement of 2l nc upon admission from baseline of 94- 96% on room air as per nursing home notes. upon his return from the egd, the patient became tachycardic and went into rapid atrial fibrillation with worsening hypoxia. he was triggered, iv access obtained, and he was given diltiazem 10mg x 2 with improvement of hr from 140s to 110s. he was requiring 4lnc and 50% shovel mask to sat >94%. patient was transferred to the icu for closer monitoring. initially there was concern for possible aspiration pneumonia (started on empiric vancomycin and zosyn) given recent vomiting as well as a pulmonary embolism, given relative immobility. a ct angiogram was done which showed small bilateral pleural effusions with associated atelectasis with no evidence of pe or lung consolidation. empriic antibiotic therapy was stopped. hypoxia was felt to be multifactorial: low tidal volumes with abdominal distention and pleural effusion, volume overload/pulmonary edema in setting of afib with rvr and dchf, and possible copd flair. patient was diuresed with 20 mg lasix iv prn with goal net fluid balance of -1.0 liters/ day. a foley catheter was placed and serial cxr were obtained for closer monitoring of fluid status. patient was transferred back to floor once repiratory status improved. diuresis was continued and patient started on prednisone and azithromycin for possible copd exaccerbation. at time of discharge, patient had symptomatically improved. he was saturating 93% on 3 liters nasal cannula. 5. atrial fibrillation: patient had remote history of atrial fibrillation that had converted spontaneously to normal sinus rhthym in . at time of admission, patient was on aggrenox only as longterm anticoagulation secondary to history of stroke. he had an episode of atrial fibrillation with rapid ventricular response following his egd. patient remained hemodynamically stable, with systolic blood pressure in 120s but did develop a new oxygen requirement requiring care in the icu (see above in hypoxia). heart rate stabilized on diltiazem 60 mg every 6 hrs which was eventually titrated up to 90mg every 6 hrs. patient was maintained on telemetry for the duration of hospitalization and did not have any recurrent episodes of atrial fibrillation. however, as patient likely has paroxysmal atrial fibrillation, long term anticoagulation should be considered as an outpatient given his high chads score. 6. benign prostatic hypertrophy: upon hospitalization, all of patient's home medications were stopped. a foley was placed during hospital stay to facilitate accurate measurement of fluid balance. when foley was discontinued, patient complained of urinary hesitancy and frequency although he retained the ability to void. home medications of finasteride and terazosin were restarted. 7. diabetes mellitus: patient initally on metformin as an outpatient. this was stopped on admission due to a slightly elevated lactate level of 1.7. patient was normoglycemic with the addition of sliding scale insulin. however, when prednisone was started, he developped transient hyperglycemia requiring the administration of nph. this was discontinued at time of discharge as patient would be tapered off steriods in another 3 days. restarted on metformin with instructions to perform glucose checks four times a day. according to patient's wishes, code status was recorded as dnr/ dni during hospitalization. patient's daughter (cell phone number () was very involved in patient's care medications on admission: aggrenox 25mg-200mg (asa 25mg/dipyridamole) since tia 1 cap po cholecalcilferol (vitamin d3) 1000 unit daily po metformin hcl 500 mg po finasteride 5 mg daily po terazosin hcl 5mg qhs po diltiazem cd 120 mg daily po simvastatin 20 mg qpm po psllium seed 1 scoop po erythromycin opthalamic ointment qhs lids acetaminophen 650mg po discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day) as needed for esophagitis. 4. azithromycin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 7. bisacodyl 5 mg tablet sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 8. magnesium hydroxide 400 mg/5 ml suspension sig: fifteen (15) ml po every six (6) hours as needed for constipation. 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. 10. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. 11. diltiazem hcl 90 mg tablet sig: one (1) tablet po q6h (every 6 hours). 12. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 13. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) injection tid (3 times a day). 14. prednisone 10 mg tablet sig: see below tablet po see below for 3 days: day 1: take 3 tabs day 2: take 2 tabs day 3: take 1 tab. 15. metformin 500 mg tablet sig: one (1) tablet po twice a day. 16. terazosin 5 mg capsule sig: one (1) capsule po at bedtime. 17. finasteride 5 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: upper gi bleed pulmonary edema atrial fibrillation secondary: constipation abdominal distention discharge condition: stable discharge instructions: you were admitted to the hospital with abdominal distention, nausea, and bloody vomit. on , you had an endoscopy of your upper gastrointestinal tract which showed erosion and inflammation in your esophagus that was likely the cause of your bleeding. biopsies were taken. you were started on a proton pump inhibitor and sulfacrate, two medicines which should prevent this problem from coming back. we also stopped your blood thinning medication, aggrenox that you were on to prevent recurrent stroke. you should talk to your doctor about starting this medicine again. during your hospitalization you developped a heart arrhythmia called atrial fibrillation which required closer observation in the intensive care unit. we started you on diltiazem, a medicine which slowed your heart and your heart beat returned to a normal rhythm. because you have had this arrhythmia several times, you should talk to your doctor about starting another blood thinner (coumadin) to prevent complications from this problem. also developed difficulty breathing, likely from extra fluid on your lungs as well as an exacerbation of your chronic lung disease. we treated you with oxygen, diuresis, steriods and inhalers. you breathing improved and at the time of discharge, you were breathing comfortably on 3 l of oxygen by nasal cannula. you also had significant problems with in the hospital, requiring several medications to have a bowel movement. at the rehab center you can stop these medications as long as you are not constipated. please make the following changes to your medication: 1. start sucralfate 1 gm by mouth 4 times daily 2. protonix 40 mg by mouth twice daily 3. prednisone taper (30, 20, 10 mg) by mouth for 3 days 4. azithromycin 250 mg by mouth for 2 days 5. stop aggrenox you should call your doctor immediately or return to the hospital if you should develop any fever, chills, abdominal pain, nausea, vomiting, diarrhea, chest pain, shortness of breath, or any other symptoms that concern you. followup instructions: you need to follow up with your doctor within 1-3 days of your discharge. procedure: insertion of other (naso-)gastric tube esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: anemia, unspecified esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypopotassemia constipation, unspecified other and unspecified hyperlipidemia acute respiratory failure personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hypoxemia obesity, unspecified hematemesis hemorrhage of gastrointestinal tract, unspecified pulmonary congestion and hypostasis flatulence, eructation, and gas pain leukocytosis, unspecified other esophagitis 

Answer: The patient is high likely exposed to