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: vancomycin weakness major surgical or invasive procedure: picc line placement history of present illness: events / history of presenting illness: 84 yo male with h/o htn, cads/p cabg was in his usoh until 48 hours ago when he started feeling weak and having dizziness. was seen at and found to have hr in the 30s with a junctional rhythm on ekg. was given atropine, and his hr improved to 40. found to have new onset renal failure cr 3.6 and hyperkalemia (5.7) and was given ca, dextrose, bicarb, insulin, kayexalate and transferred to . . in the ed here, his hr was in the 40s and he felt better. no cp, no sob, no lightheadedness. sbp 140s. hr in upper 40s and lower 50s, was given glucagon w/ gi upset but w/o improvement in hr. ekg here w/ ? slow atrial fibrillation. patient usually receives lopressor 12.5 9 a.m. and cardizem 240mg xr 9 a.m. . the patient denies a change in urination, itchiness, but has had trouble sleeping recently. also complains of sinus congestion and ha for the last few weeks and a week of a nonproductive cough. . past medical history: 1. cad s/p cabg () 2. hypertension 3. hyperlipidemia 4. anemia - for the last year, had a transfuion in , baseline in the low 30's 5. diverticulitis s/p partial colectomy 6. mass on the kindey and lung - found last ; no current workup, as workup would be too invasive 7. chronic diarrhea 8. emphysema 9. history of bowel obstructions 10. s/p cholecystecomy 11. s/p two hernia repairs cardiac risk factors: dyslipidemia, hypertension . cardiac history: cabg, in anatomy as follows: 3 vessel disease . outpatient medications: 1. cardizm xr 240 mg daily 2. zestril 40 mg daily 3. metoprolol succinate 12.5 mg daily 4. norvasc xr 10 mg daily 5. asa 81 mg daily 6. zocor 20 mg daily 7. omeprazole 20 mg daily 8. trental zr 400 mg tid 9. ativan 0.5 mg prn 10. temazepam 30 - 45 mg qhs 11. zyrtec 1 tab daily 12. nasonex 2 sprays q nostril daily 13. eye drops for runny eyes 14. miralax once daily 15. b12 shot once monthly . allergies: nkda . social and family history: social history is significant for the a 125 pack year history; quit 8-10 years ago. there is no history of alcohol abuse. there is no family history of premature coronary artery disease or sudden death, however several family members have had . . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. he sleeps with one pillow. . physical examination: vs - t 97.6 bp 162/52 p 54 r 20 sat 98% on 3 l gen: thin, elderly male lying in bed in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. op clear. neck: supple with jvp of 8 cm. cv: midline well-healed scar present; regular and bradycardic, normal s1, s2. no m/r/g. 2 + radial pulses. chest: wheezing present left > rt; crackles present bilaterally at the bases. audible wheezing at baseline. respirations unlabored, no retractions. abd: + bs, distended with gas. no hepatosplenomegaly present. ext: no c/c/e. skin: thin skin throughout . medical decision making ekg - hr 50, irregular, telemetry demonstrated: bradycardia 2d-echocardiogram performed on demonstrated: ef 40-45%, mild to moderate regional left ventricular systolic dysfunction with inferior/inferolateral/inferior akinesis. . laboratory data: na 14 k 4.9 cl 109 bicarb 24 bun 69 cr 3.6 glu 155 wbc 8.7 hct 30.0 plt 201 (83.8% n, 11.6% l) pt 12.9 ptt 25.8 inr 1.1 troponin 0.02 ct abdomen: - cystic renal cell carcinoma left kidney, likely high-grade papillary type. this has grown since . - multiple left lower lobe nodules (in the lungs) are new since . though the largest has an appearance concerning for metastasis, this would be unlikely to have grown to 1 cm in this short interval and this may represent a small airways infection or aspiration as is evident in the right middle lobe. . cxr mild interstital fluid overload without evidence of pna or pleural effusion. . assessment and plan: 84 yo male with pmh of cad s/p cabg, htn, and renal and pulmonary masses who presents with arf and a juntional bradycardia. . #. cad - patient is s/p cabg, currently without chest pain. - continue asa, statin. - are holding b-blocker due to bradycardia. . #. pump - patient has some signs of volume overload - crackles halfway up his chest and interstial fluid on cxr. will monitor and watch his i/os as he is in renal failure and may become volume overloaded. - we will continue bp control with norvasc, but are holding metoprolol and diltiazem as he is bradycardic. can consider starting hydralazine if further bp control is needed. . #. rhythm - patient is currently in a juntional escape rhythm likely due to his arf as diltiazem is renally cleared and may be accumulating causing av block. - continue to monitor on telemetry - hold his b-blocker and diltiazem . #. acute renal failure - differential includes prerenal vs intrarenal vs postrenal. unlikey to be prerenal as there is no history to suggest volume depletion. as for postrenal, he has a history of rcc which could have metastasized or he may have bph which could have caused obstruction. intrarenal causes included extension of his rcc, intrinsic golmerular disease, or interstitial disease. - renal us to rule out obstruction - f/u urinary electrolytes and electrolytes - f/u ua amd ucx - consider ct abd/ pelvis to evaluate renal mass . # kidney/ lung masses - last ct abd was in - consider ct abd/ pelvis to evaluate renal mass . # wheezing - patient has crackles and interstial fluid on cxr - albuterol nebs prn - will monitor respiratory status . # hx of diarrhea and bowel obstruction - continue home ppi, ranitidine and miralax. - as the patient is very gassy, will give simethicone prn . # sinus problems - continue zyrtec and nasonex . #. fen: follow and replete electrolytes. cardiac diet. no ivf at present. . #. access: piv . #. ppx: sqh, bowel regimen. . #. code: full . #. dispo: pending resolution of his junctional rhythm and diagnosis of the cause of his arf . past medical history: cad s/p mi and cabg hx recurrent partial small bowel obstructions htn diverticulitis s/p ccy s/p sigmoid colectomy dengue fever and malaria in wwii small bowel obstruction in colonoscopy with one polyp removed egd with gastritis social history: wife died within the 2 months prior to admission. notes decreased appetite and endorses depression symptoms. one daughter lives nearby and is very involved but is also recently married and has failing in-laws, so is spread thin. currently lives alone but daughter frequently in the home. h/o smoking, but has quit. no etoh. family history: nc physical exam: vs - 100.4 95 123/60 16 100% on ac 0.7 500 16 5 gen: thin, elderly male. intubated. opens eyes and responds to commands correctly. heent: ncat. sclera anicteric. perrl, eomi. op clear. neck: jvp 8cm. supple. no thyroid enlargement. cv: well-healed midline scar; regular and bradycardic, normal s1, s2. no m/r/g. chest: faint crackles at bases but essentially clear anteriorly. abd: og tube in place. + bs, soft, nt, nd. ext: no c/c/e. hand grip intact b/l. tracks and makes eye contact. pertinent results: 03:30am pt-12.9 ptt-25.8 inr(pt)-1.1 03:30am neuts-83.8* lymphs-11.6* monos-3.4 eos-1.0 basos-0.2 03:30am wbc-8.7# rbc-3.23* hgb-9.6* hct-30.0* mcv-93 mch-29.7 mchc-32.0 rdw-14.6 . renal u.s. study date of 12:52 pm 1. bilateral hypoechoic renal lesions, not meeting son criteria for simple cyst. in setting of the suspicious left renal mass previously described on ct, further characterization of these lesions with mr is recommended. 2. the left renal superior pole mass highly suspicious for pappillary rcc, seen on ct, was not demonstrated today. in discussion with referring physician . no interim intervention was undertaken due to decision to pursue non-invasive management approach. in view of which, this mass could have been obscured by the rib shadows in that region and mr evaluation is recommended. . cardiology report ecg study date of 6:19:00 am sinus rhythm with ventricular premature beats including a slow triplet. consider left atrial abnormality. left ventricular hypertrophy. st-t wave abnormalities. since the previous tracing of the rate has slowed. also, the rate of the ventricular ectopy has slowed. consider left atrial abnormality. . chest (portable ap) study date of 3:06 am moderate right pleural effusion layers posteriorly, obscuring detail in the right lung but interstitial edema is still present. consolidation is unchanged at the left base since , either atelectasis or pneumonia. heart size is top normal. there is no pneumothorax. . brief hospital course: summary: patient is an 84m with a hx of htn and cad s/p cabg who p/w weakness and dizziness. he was found to have renal and pulmonary masses of unknown significance and also found to have bradycardia and renal failture. he ultimately underwent intubation for hypoxic respoiratory failure due to a combination of nstemi and aspiration pneumonia. he was successfully extubated and improved, thus he was transferred to the floor on . he was briefly cmo in the micu, but was made dni/dnr prior to transfer to the floor. he was on 40-50% facemask upon transfer. he improved to nc 4l on the floor and was stable with improving pulmonary exam until on , he developed hypercarbic respiratory failure likely due to mucous plugging and/or aspiration with blood ph 7.08 and co2 74. he was sent back to the micu to receive cpap, which he did not tolerate. however, he improved without cpap and has been transitioned back to 4l nc with last abg on showing ph 7.26. he was initially started on vanc/cefepime/flagyl, then the flagyl was discontinued. he currently feels well with no sob, cp, abdominal pain or any other complaints. his current code status remains dnr/dni with comfort centered care: cont antibiotics, bp control, but no escalation of care. as his respiratory function was improving, he was discharged to home with nursing services and hospice care. he completed his course of antibiotics, which was abridged from a 10 day course to a 9 day course (last dose on day of d/c). . # hypercapneic respiratory failure: this was thought to be secondary to witnessed aspiration and either pneumonitis or pna. he was started on aspiration and hospital acquired pna antibiotics. his sputum gs and culture were contaminated however. swallow also recommended soft diet with surveillance while eating. his respiratory function improved and he was satting 93% on 2l at time of d/c. . # nstemi: patient had many pvcs on telemetry but no evidence of a second infarction. we continued aspirin, beta blocker, and statin but held the ace-i b/c of his arf. we initially held amlodipine because the patient was bradycardic but restarted it for better bp control. . # bradycardia: cause of original admission. hr was initially in 30s due to junctional rhythm and b-blocker, ccb. his bradycardia resolved and his hr remained in the 60s. amlodipine was restarted but diltiazem was held. . # acute renal failure: cre 2.9 on admission, down to 1.5 at time of discharge, with a baseline of 1.0 - 1.2. his arf is likely hypoperfusion, probably from bradycardia and/or hypotension after nstemi. his renal function improved with ivf. a renal u/s showed no hydronephrosis/post-renal obstruction from mass, but did identify a lesion suspcious for rcc. the family has chosen not to pursue further w/u. . # hypertension: patient was hypertensive upon transfer to floor but improved control with metoprolol. we restarted amlodipine at the time of d/c. . # hypernatremia: patient was hypernatremic to 147 but improved with free water intake and d5w fluid infusion. sodium was corrected slowly. . # kidney and lung masses: had ct abd in (showed cystic renal cell carcinoma left kidney, left lower lobe nodules largest measures 1 cm). the patient and family do not want further w/u, however. . # anemia: patient's baseline hematocrit is low 30s, and he likely has anemia of chronic disease. we are not working this up further at this time. . # acute decompensated systolic heart failure: with ef 25-30%. previous ef 40%. patient currently appears euvolemic. tolerated ivfs for treatment of arf which largely resolved. an ace-i may be restarted in the future as the patient's renal fxn improves. . # sleep/agitation: patient was given olanzapine qhs for sleep and prn haldol 0.25 for agitation. family members helped with frequent orientation. patient tolerated olanzapine and was weaned off of his home temazepam. he also was given trazadone at night to sleep. however, at time of d/c, he requested a script for his temazepam, which was restarted. . #. fen: cardiac diet, crushed meds, soft solids w/ thin liquids, and one-to-one supervision w/ meds. we repleted lytes prn and d/c'd his foley. . #. access: a picc was placed during his hospital stay and removed at time of d/c. . #. code: dnr/i, not cmo, but no escalation in care. note that patient did not tolerate cpap when we transferred him to the micu for resp distress. the family spoke with (palliative care) and the decision was made to discharge the patient home with hospice care. . # communication: during the hospital stay, we contact the patient's sister ) at to inform her of respiratory arrest and intubation; she is the patient's hcp. medications on admission: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 3. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po tid (3 times a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. zyrtec oral 6. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 7. temazepam oral 8. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed. 9. nasonex 50 mcg/actuation spray, non-aerosol sig: one (1) spray nasal once a day. 10. vitamin b-12 injection 11. ativan 0.5 mg tablet oral discharge medications: 1. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po tid (3 times a day). disp:*90 tablet sustained release(s)* refills:*2* 2. zyrtec oral 3. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed. 4. nasonex 50 mcg/actuation spray, non-aerosol sig: one (1) spray nasal once a day. 5. vitamin b-12 injection 6. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. disp:*60 tablet(s)* refills:*1* 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day) as needed for constipation. disp:*3000 mg* refills:*2* 9. acetaminophen 160 mg/5 ml solution sig: twenty (20) ml po q6h (every 6 hours) as needed for fever/pain. disp:*300 ml* refills:*0* 10. lidocaine hcl 2 % gel sig: one (1) appl mucous membrane asdir (as directed). disp:*30 appl* refills:*2* 11. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*240 puff* refills:*2* 14. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). disp:*360 puffs* refills:*2* 15. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. disp:*30 tablet(s)* refills:*0* 16. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)) as needed for sleep. disp:*30 tablet, rapid dissolve(s)* refills:*0* 17. home supplemental oxygen at 3 to 4 liters 18. haloperidol 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for agitation. disp:*30 tablet(s)* refills:*2* 19. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 20. home physical therapy please assist in developing strength and endurance 21. morphine concentrate 20 mg/ml solution sig: 5-20 mg po q2h as needed for pain or shortness of breath. disp:*30 ml* refills:*0* 22. temazepam 15 mg capsule sig: one (1) capsule po at bedtime. disp:*30 capsule(s)* refills:*2* 23. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: primary 1. non-st elevation myocardial infarction 2. acute renal failure 3. junctional bradycardia secondary to medication acculmulation in the setting of acute renal failure . secondary 1. cad s/p cabg () 2. hypertension 3. hyperlipidemia 4. anemia - for the last year, had a transfuion in , baseline in the low 30's 5. diverticulitis s/p partial colectomy 6. mass on the kindey and lung - found last ; no current workup, as workup would be too invasive 7. chronic diarrhea 8. emphysema 9. history of bowel obstructions 10. s/p cholecystecomy 11. s/p two hernia repairs discharge condition: stable discharge instructions: you were admitted to the hospital due to a slow heart rate accompanied by acute renal failure. you slow heart rate was found to be due to accumulation of the diltiazem secondary to your renal failure. you were also found to have suffered a heart attack and you developed pneumonia. we treated you with antibiotics and other drugs. . we changed several of your medications. please see the medications sheet for specific medications and doses. . please contact your primary care physician if you have chest pain, shortness of breath, fevers, chills, or any other concerns. followup instructions: please schedule an appointment with your primary care doctor in the next one to two weeks: pcp: , . . no follow-up with oncology department for incidental lung and kidney findings per family's request. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: hyperpotassemia anemia of other chronic disease subendocardial infarction, initial episode of care anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status malignant neoplasm of kidney, except pelvis other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus old myocardial infarction other emphysema other diseases of lung, not elsewhere classified other postprocedural status diarrhea encounter for palliative care acute on chronic systolic heart failure other abnormal blood chemistry foreign body accidentally entering other orifice foreign body in larynx other accidents coronary vasodilators causing adverse effects in therapeutic use other disease of nasal cavity and sinuses elbow, forearm, and wrist injury 

Answer: The patient is high likely exposed to