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: penicillins / metoprolol attending: chief complaint: left hip fracture major surgical or invasive procedure: open reduction internal fixation of left femoral neck fracture history of present illness: hpi: briefly, this is a 71 yo m with a history of cad s/p cabgx4, vascular dementia, esrd on hd, prior tias, and recent postive stress test, who was transferred to after sustaining a l femoral neck fx after a mechanical fall. ed workup normal except for hip fx and ekg showing sinus brady with first degree av block and inferolateral abnormalities. intention for or to fix hip, but in light of recent stress results demonstrating reversible inferolateral changes, needs clearance from cardiac standpoint before or. . this morning, he complains of pain in his left hip and some minor discomfort in his lower back. otherwise, he feels well, and denies cp and sob. . review of systems: (+) per hpi, + orthopnea (2 pillows, 6-8 months), + chronic lbp (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations, pnd, peripheral edema. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no dysuria. denied arthralgias or myalgias. past medical history: -cad s/p cabg, ) -positive stress test for reversible defects in lateral and posterolateral walls, -lv diastolic dysfunction -htn, labile -hyperlipidemia -esrd, on hd since , mwf -anemia, secondary to esrd, baseline hematocrit low 30s -hypertensive encephalopathy -vascular dementia -subcortical wmd w/ brain atrophy -sleep apnea -osteoarthritis -spinal stenosis -peripheral neuropathy -depression -gerd -bph -nephrolithiasis social history: -married with one son, one daughter -lives with wife in -independent in adls, including ambulation -tobacco: quit smoking 20 years ago, smoked approx 3 cigarettes/day for 20-30 years. -alcohol: none -illicits: none family history: his mother died of a stroke at age 87, dad had brain surgery for a tumor and died as a result of it. one sister has disease at 71, and one sister had a massive mi and passed away in her 60's. physical exam: admission exam: vitals: t 97.7 bp 131/92 hr 77 rr 20 o2 96/ra general: nad, awake, talkative heent: sclera anicteric, dmm, oropharynx clear neck: supple, no jvd, no lad, * l carotid bruit. chest: lungs ctab, 4-5 cm purple ecchymosis just superior to left nipple cv: rrr, no mrg abdomen: surgical scars consistent with history; soft, nd/nt, no hsm, +bs gu: foley in place, draining yellow urine ext: warm, well-perfused, non-palpable distal pulses, no edema or ulcers msk: able to flex and abduct l thigh to 30 deg w/ mild pain. severe ttp at l hip. neuro: aox3, grossly intact, moving all extremities discharge exam: pertinent results: admission labs: 10:05pm blood wbc-6.7 rbc-3.65* hgb-10.6* hct-34.7* mcv-95 mch-28.9 mchc-30.4* rdw-20.2* plt ct-244 10:05pm blood pt-18.2* ptt-26.8 inr(pt)-1.6* 10:05pm blood glucose-87 urean-28* creat-5.7*# na-142 k-3.8 cl-103 hco3-24 angap-19 10:05pm blood ck(cpk)-41* 10:05pm blood ck-mb-3 ctropnt-0.05* 10:05pm blood calcium-8.7 phos-4.8* mg-2.3 discharge labs: 07:30am blood wbc-5.3 rbc-3.23* hgb-9.4* hct-31.0* mcv-96 mch-29.2 mchc-30.4* rdw-21.5* plt ct-176 07:30am blood pt-18.2* ptt-27.7 inr(pt)-1.6* 07:30am blood glucose-101* urean-32* creat-5.3*# na-134 k-3.6 cl-91* hco3-33* angap-14 07:30am blood calcium-8.9 phos-3.4 mg-2.0 cardiac labs: 10:05pm blood ck-mb-3 ctropnt-0.05* 08:50am blood ctropnt-0.04* 10:10am blood ctropnt-0.08* 06:02pm blood ck-mb-5 ctropnt-0.11* 10:45pm blood ck-mb-4 ctropnt-0.12* relevant heme: 11:00pm blood lactate-2.9* 09:49pm blood lactate-1.9 09:49pm blood type- ph-7.28* 10:17am blood type-art po2-70* pco2-46* ph-7.40 caltco2-30 base xs-2 chemistries: alt ast ld(ldh) ck(cpk) alkphos amylase totbili 15:00 326* 1604* 1222* 136* 0.4 07:30 38 212* 324* 112 0.5 studies: ecg study date of 9:54:18 pm sinus rhythm. occasional premature atrial contractions. left ventricular hypertrophy. inferolateral st-t wave changes most likely related to left ventricular hypertrophy. compared to the previous tracing of there is no significant diagnostic change. ct head w/o contrast study date of 8:54 pm impression: no acute intracranial process. hip unilat min 2 views left study date of 9:14 pm impression: fracture of the femoral neck with lateral angulation of the femoral head with respect to the femoral neck with possible impaction of the femoral head. findings less convincing on cross-table lateral films. if there is concern for femoral neck fracture, cross-section imaging may be obtained for confirmation. recommend physical examination and clinical correlation. chest (single view) study date of 3:56 pm findings: in comparison with the study of , there is continued substantial enlargement of the cardiac silhouette with atelectatic changes in the retrocardiac area. there has been the development of moderate interstitial edema. lung scan study date of interpretation: ventilation images obtained with tc-m aerosol in 8 views demonstrate heterogeneous distribution of tracer bilaterally, compatible with airways disease. perfusion images in the same 8 views show heterogeneous tracer distribution, with a defect in the superior segment of the right lower lobe (best seen on the rpo projection), with a peripheral rim of preserved tracer, and a matching ventilation defect. additionally, a small perfusion defect in the medial left upper lung (best seen on the lpo projection) has a matching ventilation defect. there are no mis-matched perfusion defects. chest x-ray shows cardiac enlargement, without pleural effusion or consolidation. the above findings are consistent with a low likelihood of pulmonary embolus. impression: low likelihood of pulmonary embolus. airways disease. brief hospital course: mr. is a 71 yo m with a history of cad s/p cabgx4, vascular dementia, esrd on hd, prior tias, and recent postive stress test, who was transferred to after sustaining a l femoral neck fx after a mechanical fall. . active issues: . #hip: mr. was admitted for repair of a left femoral neck fracture that was diagnosed at an osh. given his abnormal cardiac stress test results at the beginning of novemeber, demonstrating a reversible inferolateral abnormality, he was evaluted by the cardiology service. they felt that he was stable for surgery and did not require revascularization prior, but recommended low-dose metoprolol (6/25 mg iv bid) for risk reduction. he underwent orif of his left femoral neck fracture on hd #2. he did well in the immediate post-operative period, but overnight into hd #3 (pod#1) he developed a new oxygen requirement of 3l nasal cannula. he had crackles bilaterally throughout his lungs. given his history, there was a concern for a cardiac cause of this change, namely acs or chf secondary to fluid overload. repeat ekg was negative, cxr did not demonstrate any evidence of fluid overload or acute process, and an abg only demonstrated hypoxemia. shortly after the return of these studies, he triggered for hypotension, with a systolic blood pressure in the 60s. he was managed per protocol, but given ongoing hypotension, he was transferred to the medical intensive care unit for further management. - follow-up with orthopedics in 2 months - discharge to rehab with physical therapy #hypotension: due to pt's hypotension he was admitted to micu. his hypotension was believed to be due to the metoprolol he received as patient is known to be very sensitive to this medication and is now listed as an allergy. bp responded with ivf. lft's were elevated after his hypotension and led to shock liver. lft's trended back down shortly there after with improved perfusion and no other intervention. pt stabilized and transferred back to the floor. on the floor his blood pressure remained in the 100-120s systolic and he was able to be taken off the supplemental oxygen. #hypoxia: at baseline, the patient has no oxygen requirement. he has a 30 pack year smoking history and also has a recent stress that showed a decreased ef. given his hip fracture, immobilization, hypoxia and hypotension, pe was a serious consideration. v/q scan was negative. he likely was hypoxic in the setting of being mildly fluid overloaded on his chronic lung disease as well as post op atelectasis. he was taken off supplemental o2 as he improved, and he was 93-95% on room air. an echocardiogram was not done. he will be seen by dr. as an outpatient. cardiology did not feel as though he needed and echo inpatient. #rash: he developed a rash between the or and micu. possible causes were chlorhexadine bath for the or, antibiotics during surgery, and metoprolol. all possible offending agents were stopped around the same time. at time of dischargethe rash was improving. #cad: the patient has long-standing cad, with a history of a four-vessel cabg in and a recent abnormal stress test. given the need for surgery, we held his plavix, but continued his home aggrenox and statin. cardiology risk stratified him. we also started him on metoprolol in advance of surgery (as described ), which was subsequently stopped. he will be seen by dr. as an outpatient for his abnormal stress test. -continue plavix -continue aggrenox -continue statin . #end stage renal disease: he has long-standing esrd secondary to htn, and is on hd with access via an av fistula. while in the hospital, he continued his home monday-wednesday-friday schedule of hd, with supervision by the renal team. we also continued him on his home cinacalcet and nephrocaps, and added sevelamer. #diastolic and systolic dysfunction: see above workup given o2 requirement. inactive issues: #anemia: he has long-standing anemia, secondary to his esrd. his hematocrit at admission was 34. we monitored his hematocrit regularly, which stayed at or around baseline throughout his hospitalization. we therefore considered him stable for discharge from this standpoint. #hypertension: he has a history of labile htn. his blood pressures were in the 130s on admission, so we did not initiate any therapy. as explained above, he was triggered for hypotension, with further management by the micu. #spinal stenosis: he suffers from chronic lower back pain secondary to spinal stenosis. we treated him with a lidocaine patch, consistent with his outpatient regimen. his pain was well-controlled, so we considered him stable for discharge from this standpoint. #depression: he has long-standing depression, so we continued him on his home citalopram and are discharging him with the same medication. #peripheral neuropathy: he has long-standing peripheral neuropathy, so we continued him on his home gabapentin and are discharging him with the same medication. #benign prostatic hypertrophy: he is on tamulosin at home, but given that a foley catheter was placed on admission given his poor ambulation, we held his tamulosin. he was without complaints related to this condition. because of his hypotension this medication was held at time of discharge. he also makes very little urine in the setting of his esrd. #gerd: he has long-standing gerd, so we continued him on his home pantoprazole and are discharging him with the same medication and is on ppi at home. transfer of care: mr. was discharged to a rehab center for physical therapy of his hip. he has follow-up with orthopedics in 2 months and the cardiology clinic will contact him with an appointment. there are no tests pending at time of discharge. medications on admission: -simvastatin 40 mg tablet one daily -plavix 75 mg tablet one daily on hold -aggrenox 200/25 mg capsule one capsule -sevelamer 800 mg tablet tid with meals -cinacalcet 30 mg tablet one daily -nephrocaps daily -lidoderm patch -gabapentin 300 mg capsule one daily -citalopram 40 mg tablet two daily -pantoprazole 40 mg daily -tamsulosin 0.4 mg capsule one daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. dipyridamole-aspirin 200-25 mg cap, multiphasic release 12 hr sig: one (1) cap po bid (2 times a day). 6. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). capsule(s) 7. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 8. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 9. citalopram 40 mg tablet sig: two (2) tablet po once a day. 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day): until ambulatory. 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 12. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 13. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 15. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 16. oxycodone 5 mg tablet sig: 1-2 tablets po q 8h (every 8 hours) as needed for pain. 17. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 18. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) grams po daily (daily). discharge disposition: extended care facility: nursing home discharge diagnosis: primary: left femoral neck fracture secondary: coronary artery disease end stage renal disease hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , it was our pleasure caring for you at . you were admitted after a fall for treatment of your left hip fracture. you underwent surgery to repair your hip. you were also seen by our cardiology service regarding your recent abnormal stress test results, and they felt that catheterization was not required before your procedure. we also continued you on your regular hemodialysis schedule while you were here. you had a period of low blood pressure and low oxygen and required a few days of monitoring in the icu. you were stable and managed back on the general medicine floor prior to discharge. your low oxygen was in the setting of having extra fluid on your lungs, and small breaths after surgery. the following changes were made to your medications: -stopped flomax -started bowel regimen with docusate, senna, bisacodyl, and miralax -started heparin injections to prevent blood clots -started sevelamer for your kidneys -started lidocaine patches for pain -started oxycodone for pain -started sarna lotion for itchy rash followup instructions: name: , location: - cardiac services address: , 7, , phone: * from dr. office will call you to make an appointment. you should be seen within 2 weeks. call the number above if you dont hear from in 2 business days. department: orthopedics when: tuesday at 12:40 pm with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: tuesday at 1 pm with: , np building: campus: east best parking: garage procedure: hemodialysis open reduction of fracture with internal fixation, femur diagnoses: other iatrogenic hypotension anemia in chronic kidney disease end stage renal disease obstructive sleep apnea (adult)(pediatric) renal dialysis status esophageal reflux congestive heart failure, unspecified acute and subacute necrosis of liver coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status unspecified fall depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation osteoarthrosis, unspecified whether generalized or localized, site unspecified other respiratory complications rash and other nonspecific skin eruption other antihypertensive agents causing adverse effects in therapeutic use personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits personal history of urinary calculi unspecified hereditary and idiopathic peripheral neuropathy combined systolic and diastolic heart failure, unspecified vascular dementia, uncomplicated cerebral atherosclerosis spinal stenosis, lumbar region, without neurogenic claudication other closed transcervical fracture of neck of femur 

Answer: The patient is high likely exposed to