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: ranitidine / prilosec / aciphex / paxil / celexa / prozac / zoloft / cimetidine / zestril / lasix / atenolol / cozaar / celebrex / reglan / norvasc / nexium / carafate / metoprolol / doxycycline / hydrochlorothiazide / triamterene attending: chief complaint: transfer for bilateral pulmonary embolism major surgical or invasive procedure: none history of present illness: 67 y/o f with pmhx of esophageal dysmotility and raynauds who presented to an osh with fatigue x 3wks found to have nstemi and hypoxia. at the osh ce were positive (cpk 95 ck mb 10.3 trop i 0.68 ). she was loaded with plavix, given asa, ativan, lopressor, nitro paste and started on a heparin gtt (7500 bolus, 1450 u/hr). the ecg at the osh showed sinus tachycardia. she was transferred to for further care. in the ed, initial vs were: t 98.7 p 103 bp 130/75 rr 24 o2 sat 89 ra. she underwent a cta to eval for pe, given hypoxia and tachycardia which revealed bilateral large pe's. the ecg here showed sinus tach with non-specific twf. she received 1l ns and the heparin gtt was continued. 3 weeks ago the pt. received cortisone injections for back pain. since that time she has not felt well. she has experienced flushing and "elevated bp. last tuesday she had cp and took sl ntg and asa with good result. she went to hospital, where ecg and ce were nromal per pt. she was sent home but still had cp and doe while climbing stairs. she also reports palpitations. she again had chest pain this last saturday and presented to . ce were normal and the ecg was normal. she underwent protocol on sunday which did not show any ischemic changes. her symptoms were thought to be due to gi issues. she underwent an endoscopy on . per the pt. her 02 sat after the procedure was 89% on ra. that night, she had a pre-syncopal event at home and felt "she was dying." ems was called and she presented to hospital as above. . current vitals in ed 113/52, 98, 94% 3.5l, rr 20 . review of sytems: she reports right calf pain since sunday. she has felt unwell for the past 3 weeks. + uri symptoms- productive cough. poor appetite for 3 weeks. 17lbs weight loss over 3 weeks. cp, palps, doe, sob, fatigue as in hpi. denies f/c/ns. no diarrhea, abd pain, n/v, hemetemasis, brbpr. past medical history: hypertension raynauds esophageal dysmotility syndrome fibromyalgia arthritic symptoms social history: she is married, does not smoke cigarettes or drink alcohol. 2 children. family history: son with h/o 2 pe's (has a pai-1 mutation). 2 sisters with clotting hx (1- dvt, 1- ?retinial thromobosis). brother- mi at 68. 2 brothers with ca (esophageal ca, lymphoma) physical exam: vitals: t: 96.6 bp: 124/67 p: 98 r: 18 o2: 94% on 3l general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bilateral rales at bases l>r cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. slight right calf tenderness pertinent results: labs: trop-t: 0.15 ck: 106 mb: 10 mbi: 9.4 . 137 102 11 bs 144 agap=18 --------------- 4.4 21 0.7 . wbc 12.2 hgb 14.3 hct 40.5 plts 241 n:76.4 l:19.9 m:2.6 e:0.7 bas:0.3 . pt: 13.0 ptt: 22.9 inr: 1.1 . images: cta prelim- large bilateral pe's, small hiatal hernia, thyroid nodule. recommend ultrasound on non-emergent basis stable left lower lobe pulmonary nodule. ett interpretation: this 67 yo woman with uncontrolled htn was referred for evaluation of chest pain. the patient performed 7 minutes of protocol ~3.8 mets and stopped for an exaggerated bp response and fatigue. this represents a limited exercise tolerance. the patient presented with 3/10 left upper chest "pressure", however before exercise, she denied this symptom. no other symptoms were reported throughout the procedure. in the presence of baseline non-specific st-t waves, there were no significant changes at peak exercise. rhythm was sinus without ectopy. heart rate response to exercise was appropriate. impression: limited exercise tolerance. exaggerated resting and exercise bp. non-anginal symptom with no significant ekg changes from baseline. . ekg: rate 108 nsr, normal axis, q waves in iii, avf (new since ), low voltage in pre-cordial leads indication: 67-year-old female with shortness of breath since endoscopy yesterday with troponin bump at outside hospital. evaluate for pulmonary embolus. comparison: . technique: non-contrast and contrast-enhanced mdct acquired axial images of the chest from the thoracic inlet to the upper abdomen. multiplanar reformatted images were obtained. findings: large filling defects in the bilateral main pulmonary arteries extending into the segmental branches are compatible with pulmonary embolus. the thoracic aorta maintains a normal caliber and contour. the main pulnoary artery diameter equals that of the aorta, indicating dialation. the heart size is normal. there is dilatation of the right ventricle compared to the left with rv/lv ratio of 54:38 = 1.4 (normal 0.9) indicating right ventricular strain. there is no pleural or pericardial effusion. the lungs show diffuse hypoventilatory change . 12 mm pulmonary nodule in the left lung base which is unchanged since the . the airways are patent to the subsegmental level however there is collapse of the airway on these apparent expiratory images suggestive of tracheobronchomalacia. there is no mediastinal or axillary lymphadenopathy. the visualized upper abdomen is notable for a 2- cm cyst in the interpolar region of the right kidney. hypodense nodules are identified in each lobe of the thyroid for which further evaluation with ultrasound is recommended on a non-emergent basis. a small hiatal hernia is present. the bones show no lesions worrisome for osseous metastases. impression: 1. large bilateral pes with evidence of right ventricular strain. 2. stable left lower lobe pulmonary nodule. 3. bilateral hypodense nodule in the thyroid gland for which further evaluation with ultrasound is recommended on a non-emergent basis. 4. small hiatal hernia. 5. collapse of the airways on apparent expiratory images is suggestive of underlying tracheobronchoalmalacia. study: bilateral lower extremity veins ultrasound. indication: bilateral pulmonary embolism and lower extremity pain. findings: grayscale, color and pulse doppler son was performed on bilateral common femoral, superficial femoral and popliteal veins. normal flow, compression, augmentation and waveforms are demonstrated. no intraluminal thrombus detected. impression: no lower extremity dvt identified. provisional findings impression: fri 9:35 am slightly limited examination of the lower common iliac seen secondary to patient body habitus. no definite evidence of intraluminal thrombus within the visualized venous system of the abdomen and pelvis. 2.3 cm right renal lesion, not completely characterized. followup characterization by ultrasound or mri is advised. pfi audit # 1 7:49 pm slightly limited examination of the lower common iliac seen secondary to patient body habitus. no definite evidence of intraluminal thrombus within the visualized venous system of the abdomen and pelvis. right renal lesion, definitely demonstrate to be a cyst by ct. followup characterization by ultrasound or mri is advised. preliminary report !! pfi !! slightly limited examination of the lower common iliac seen secondary to patient body habitus. no definite evidence of intraluminal thrombus within the visualized venous system of the abdomen and pelvis. 2.3 cm right renal lesion, not completely characterized. followup characterization by ultrasound or mri is advised. . findings left atrium: normal la size. right atrium/interatrial septum: mildly dilated ra. increased ivc diameter (>2.1cm) with <35% decrease during respiration (estimated ra pressure (10-20mmhg). left ventricle: normal lv wall thickness, cavity size, and global systolic function (lvef>55%). no resting lvot gradient. right ventricle: markedly dilated rv cavity. severe global rv free wall hypokinesis. abnormal septal motion/position consistent with rv pressure/volume overload. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. short (<140ms) transmitral e-wave decel time. tricuspid valve: normal tricuspid valve leaflets. moderate tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: the patient appears to be in sinus rhythm. resting tachycardia (hr>100bpm). conclusions the left atrium is normal in size. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. 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 mildly thickened. moderate tricuspid regurgitation is seen. there is moderate to severe pulmonary artery systolic hypertension (given elevated ra pressures). there is no pericardial effusion. impression: dilated and hypokinetic right ventricle. preserved global and regional left ventricular systolic function. moderate to severe pulmonary hypertension. moderate pulmonary hypertension. brief hospital course: (1) bilateral pulmonary embolisms: while in the micu she was treated with hep gtt and started on warfarin. her o2 sats gradually improved and her tachycardia resolved. she was transitioned to lovenox and coumadin. daily inr's were checked with a goal of . at discharge her inr was 2.3 and she did not require further bridging with lovenox. she will continue lifelong coumadin treatment. her inr will be checked at local lab and the results will be faxed to her pcp who will titrate her coumadin dosing as appropriate. -with strong fh of clots and no strong initiating factor for pe, we were concerned for a genetic hypercoagulability work-up. we sent hypercoagulability studies including factor v leiden, prothrombin mutation analysis, plasminogen activator inhibitor-1 activity, homocysteine, anti-cardiolipin, lupus anticoagulant. some of these tests are still pending and will be followed up by her primary care physician. (2) right heart failure: she had severe rv failure as well as moderate pulmonary hypertension. this is likely the result of the pe's causing increased stress on the right ventricle. initially it was thought that she had had an nstemi, however, the troponin leak was likely secondary to dilation of rv and nstemi medications, including plavix, were discontinued. she will have a follow up appointment in the department of cardiology for a repeat echo to monitor her recovery. she was started on an ace-i for cardiac protection as well as for slightly elevated bps (140s), however she developed a cough and thus was switched to . (3) sinus tachycardia: likely secondary to pe's. responded well to ivf boluses. (4) renal cysts? : ct revealed renal lesion that was suspicious for more than just a simple cyst. as per radiology recommendations, performed renal ultrasound to evaluate lesion which confirmed that this was just a simple cyst. (5) esophageal dysmotility: with reynauld's, there was a question of whether the patient could have scleroderma which may have contributed to hypercoagulability as well. labs were sent to evaluate for scleroderma and are pending at time of discharge. she was continued on her home management for esophageal dysphagia and her pcp will follow up the results of the scleroderma labs. (6) htn: stable throughout admit. (7) weight loss: 14-17 lb weight loss during last 3 weeks. had a pan-ct scan for malignancy given the pes. this was negative. patient is up to date on all cancer screening except her yearly mammogram which she missed because her husband was . breast exam was wnl, however the patient will need to schedule a mammogram to be performed after she is discharged from the hospital. she is aware of this and will do this upon discharge. (8) thyroid nodules: patient had ct scan that showed thyroid nodules. it is recommended that she follow up with a thyroid ultrasound to characterize these nodules. her pcp will arrange for this after discharge. medications on admission: alprazolam prevacid discharge medications: 1. outpatient lab work please have inr check 2 days after discharge and again 2 days later. please have results faxed to dr. (fax: ). she will adjust the dose of your blood thinner, warfarin, accordingly. 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 3. alprazolam 0.25 mg tablet : one (1) tablet po tid (3 times a day) as needed. 4. enoxaparin 100 mg/ml syringe : one (1) injection subcutaneous q12h (every 12 hours). disp:*10 injection* refills:*2* 5. warfarin 5 mg tablet : one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 6. valsartan 80 mg tablet : one (1) tablet po daily (daily) as needed for htn. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna, discharge diagnosis: bilateral pulmonary emboli discharge condition: the patient was afebrile, hemodynamically stable, and not requiring oxygen prior to discharge. discharge instructions: you were admitted to the hospital with blood clots in your lungs. we think you got these clots because you have a gene that makes your blood thicker than normal. you were treated with a blood thinner (warfarin) and will need to stay on this blood thinner for the rest of your life. you will need to have your blood drawn to monitor the levels of this medication. many other medications can change the levels of the blood thinner so if you start a new medication you will need to let your pcp know so that they can change the dose of your blood thinner. also, when you had your ct scan we found some nodules in your thyroid gland. this is a common finding and usually benign, however, we would like you to have a followup thyroid ultrasound to make sure. medication changes: start: warfarin 5mg by mouth daily start: valsartan 80mg by mouth daily please come back to the hospital or call your doctor if you have fainting, headaches, vision changes, difficulty speaking, shortness of breath, chest pain, palpitations, bloody or black stools, weakness of your arms or legs, pain in your legs or any other concerning symptoms. followup instructions: please follow up with the cardiologist, dr. (), on wednesday at 9am. he is located on the of the building at hospital. he will review the ultrasound of your heart and give you appointments for another ultrasound to monitor your heart's recovery. please follow up with your primary care doctor, , () on at 1:45. she will check your warfarin level and adjust your dose accordingly. please have your blood drawn to check your warfarin levels 2 days after discharge using the prescription we have provided for you. please have the lab fax these results to dr. office (). she will call you to tell you how much of the blood thinner (warfarin) to take after she gets these results. procedure: venous catheterization, not elsewhere classified diagnoses: esophageal reflux congestive heart failure, unspecified unspecified essential hypertension other chronic pulmonary heart diseases anxiety state, unspecified other specified cardiac dysrhythmias loss of weight primary hypercoagulable state myalgia and myositis, unspecified other pulmonary embolism and infarction raynaud's syndrome unspecified gastritis and gastroduodenitis, without mention of hemorrhage other diseases of trachea and bronchus dyskinesia of esophagus nontoxic uninodular goiter systemic sclerosis 

Answer: The patient is high likely exposed to