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: no known allergies / adverse drug reactions attending: chief complaint: s/p motor vehicle accident major surgical or invasive procedure: bone marrow biopsy right knee diagnostic arthrocentesis history of present illness: trauma icu history and physical - 61yo male driving after visit to doctor's office for medication adjustements - seeking percocet for knee/back pain. + loc, head-on collision into tree. blood pressure initially persistently in 80's. no injuries found on initial pan-scan other than left sided rib fractures but found to have a hct of 18.5, rechecked at 15.6. transfused 2u prbc in the ed with hct bumped to 22.3. transferred to icu . medicine accept note - 60y/o gentleman with htn and 1 month history of fatigue/malaise who was admitted to the ticu three days ago after mvc and was found to have a hct of 15 with no obvious source of bleeding, so he is being transferred to medicine for syncope and anemia workup. . he has had no issues with memory recently, with the exception of "blacking out" just prior to the crash. he was running errands and he remembers being at the top of the , but nothing else after that. he was told he crashed into a tree. no prodrome, no chest pain or palpitations prior. he has had no arrhythmias during the admission - he did have a troponin leak (peaked 1.04 yesterday but now downtrending) and cardiology was consulted. his trop leak was attributed to demand ischemia in the setting of anemia and he was started on asa with plans for outpatient stress test. he has had a tte and carotid u/s as part of syncope workup. . he does have a left fib fx and lower lip lac but besides this, he has had no other injuries and ct scan x2 have been negative for bleed in the chest/abdomen/pelvis. he was transfused 2u prbc in the ed and 2u prbcs in the ticu with hct stable at ~30 for the past 2 days. guaiac negative x1. . also of note, he has has a fever since yesterday am (100.5 at 8am on ). in retrospect, he notes that he has had a slight cough at home but did not think much of it until now (the cough is worse and is now productive of dark green sputum). denies dysuria, chills, headache, rash. past medical history: pmh: htn, gout psh: open appendectomy in childhood social history: occupation: unemployed but usually works in construction. home: lives with his mother and has no children. close support from brother. : 42 /year history, currently smoking. etoh: 5-6 beers/week. illicits: none. family history: father - died in of unknown cause mother - died at 92 of natural causes 5 brothers, 1 sister - htn physical exam: admission exam hr:80 bp:85/ o(2)sat:100 normal constitutional: comfortable, awake alert oriented, color and backboard heent: normocephalic, atraumatic, pupils equal, round and reactive to light, extraocular muscles intact. there is an inferior lip laceration that is through and through the lip. he has been inframandibular abrasion there is no posterior neck tenderness chest: clear to auscultation, nontender cardiovascular: regular rate and rhythm, normal first and second heart sounds abdominal: soft, nontender pelvic: pelvis stable extr/back: no cyanosis, clubbing or edema there is no evidence of trauma, back is nontender. dre with normal sphincter tone, no gross blood. neuro: speech fluent he is awake alert oriented, nonfocal, appropriate discharge exam vs: afebrile, sbp 100-120, o2sat 98%ra gen: nad heent: lower lip with sutured laceration; no pus cv: s1 and s2, crescendo-decrescendo murmur at rusb pulm: no rhonchi today, no rales, no wheezing extrem: bilateral l>r edema of ankles; no pain with active or passive rom of ankle but has pain with weight-bearing; left elbow with mild erythema and effusion pertinent results: admission labs 12:56pm blood wbc-12.8* rbc-2.15* hgb-5.7* hct-18.5* mcv-86 mch-26.3* mchc-30.5* rdw-15.4 plt ct-209 04:27am blood neuts-82.7* bands-0 lymphs-11.0* monos-4.7 eos-1.4 baso-0.3 04:27am blood hypochr-1+ anisocy-normal poiklo-occasional macrocy-normal microcy-normal polychr-occasional ovalocy-occasional 12:56pm blood pt-12.7 ptt-25.8 inr(pt)-1.1 12:56pm blood fibrino-672* 04:27am blood ret aut-2.3 09:07pm blood glucose-98 urean-36* creat-1.4* na-144 k-4.5 cl-114* hco3-21* angap-14 12:56pm blood ld(ldh)-293* ck(cpk)-164 totbili-0.5 dirbili-0.3 indbili-0.2 09:07pm blood calcium-7.7* phos-4.1 mg-2.0 pertinent labs 12:56pm blood fibrino-672* 04:27am blood ret aut-2.3 07:20am blood ret aut-1.6 12:56pm blood lipase-68* 01:30am blood lipase-34 12:56pm blood ctropnt-0.91* 09:07pm blood ck-mb-11* mb indx-4.0 ctropnt-0.77* 04:27am blood ck-mb-8 ctropnt-0.91* 02:21pm blood ck-mb-6 ctropnt-0.81* 01:30am blood ck-mb-4 ctropnt-1.04* 11:13am blood ck-mb-3 ctropnt-0.82* 12:56pm blood caltibc-352 hapto-332* ferritn-47 trf-271 08:00am blood caltibc-241 ferritn-387 trf-185* 01:30am blood triglyc-125 hdl-41 chol/hd-3.4 ldlcalc-72 07:20am blood tsh-3.8 08:00am blood lh-3.6 01:10pm blood prolact-4.9 07:10am blood testost-52* 08:00am blood cortsol-12.9 testost-64* 07:20am blood psa-0.8 08:00am blood crp->300 07:20am blood pep-no specifi 03:45pm blood hiv ab-negative 07:20am blood erythropoietin-test test result reference range/units erythropoietin 18.7 4.1-19.5 miu/ml discharge labs 07:20am blood wbc-4.7 rbc-3.47* hgb-9.4* hct-29.5* mcv-85 mch-27.1 mchc-31.8 rdw-15.4 plt ct-300 07:20am blood glucose-106* urean-30* creat-1.0 na-139 k-4.8 cl-103 hco3-23 angap-18 07:10am blood alt-20 ast-28 alkphos-98 totbili-0.7 07:20am blood calcium-8.9 phos-3.1 mg-2.2 urinalysis/urine culture 12:38pm urine color-yellow appear-clear sp -1.015 12:38pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-10 bilirub-neg urobiln-neg ph-5.5 leuks-neg 12:38pm urine rbc-2 wbc-1 bacteri-few yeast-none epi-0 3:53 pm urine source: cvs. **final report ** urine culture (final ): no growth. blood cultures and serology blood cultures x2 on , - negative blood cultures x2 on , , , - pending 3:45 pm immunology **final report ** hiv-1 viral load/ultrasensitive (final ): hiv-1 rna is not detected. **final report ** lyme serology (final ): no antibody to b. burgdorferi detected by eia. joint aspiration studies 11:30am joint fluid wbc-* rbc-* polys-88* lymphs-1 monos-11 11:30am joint fluid crystal-many shape-needle locatio-i/e birefri-neg comment-c/w monosodium urate stones 11:30 am joint fluid source: kneeright. **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. ekg baseline artifact. sinus rhythm. diffuse repolarization abnormalities especially in the anterolateral leads which, while non-diagnostic, could be due to ischemia, etc. no previous tracing available for comparison. clinical correlation is suggested. ct head w/o contrast no acute intracranial process. ct c-spine w/o contrast 1. no acute fracture. 2. minimal retrolisthesis of c5 on c6 with degenerative changes at that same level. ct chest/abdomen/pelvis w/contrast 1. nondisplaced fractures of the anterior left 4th and 5th ribs and possible fracture of the left posterior sixth rib. 2. bibasilar atelectasis. 3. minimal periportal edema may be due to fluid administration. 4. dense atherosclerotic calcifications of the abdominal aorta with significant plaque seen in the infrarenal aorta. ct chest/abdomen/pelvis w/o contrast 1. small amount of hyperdense fluid in the pelvis is compatible with hemorrhage, increased from study performed at 13:00 hours. however, the quantity of fluid remains small and no clear source of hemorrhage is identified. 2. no convincing evidence of solid organ injury although there is a suggestion that hemorrhage may be originating from the right retroperitoneum. this is of uncertain signficance however since there is no evidence for solid organ injury or focal hematoma, and there is slightly increased perinephric fluid on both sides which may coincide with fluid resuscitation. 3. distended, fluid-filled stomach. 4. no fracture is identified. known left anterior rib fractures are not included on the field of view. 5. aortic atherosclerosis, without aneurysm. 6. similar mild peripheral interstitial abnormality; correlation with chronic pulmonary symptoms, if any, is recommended. cxr as compared to the previous radiograph, signs of central pulmonary edema have markedly decreased. bilaterally, however, subtle signs of increased perihilar density are still seen. no pulmonary opacities have newly appeared. there is no radiographic evidence of pneumonia, but the further regression of pulmonary edema must be monitored by radiograph. minimal retrocardiac atelectasis. borderline size of the cardiac silhouette. no pleural effusions. cxr resolved pulmonary edema. no evidence of chf. panorex mandible no evidence of mandibular fractures or dislocations. ankle x-ray right ankle talar dome and ankle mortise are intact. there is mild bimalleolar soft tissue swelling. no fracture identified. three views of the left ankle demonstrate normal talar dome and ankle mortise. moderate bimalleolar soft tissue swelling. no fracture identified. foot x-ray bilateral juxtacortical erosions consistent with history of gout. bone marrow biopsy - pending at the time of discharge brief hospital course: mr. is a 60y/o gentleman with htn who was transferred from the ticu to the medicine floor after syncope/mvc in the setting of hct 15, mild aortic stenosis, and carotid stenosis. his anemia was worked up, and he was treated for a gout flare. when he was stable he was discharged home with plans to follow up as an outpatient. . active issues: . #. syncope: possibly due to cerebral hypoperfusion from anemia in the setting of as and carotid stenosis. he had moderate as by tte and he was found to have >70% carotid stenosis bilaterally. telemetry was unremarkable and syncope workup was otherwise unrevealing. during his stay, he ambulated and had no further episodes of syncope. he will have vascular surgery f/u as outpatient for carotid stenosis and will also need cardiology follow-up. he was advised not to drive until his outpatient doctors decided that it is safe to do so. . #. anemia: chronic, normocytic. on presentation his hct was <20, which was disproportionate to the extent of his injuries. he was told in the past that he had b12 deficiency and he has been taking b12; level here is normal. folate is normal. iron studies revealing low iron, low/normal ferritin, normal tibc could suggest anemia of chronic inflammation. hemolysis labs negative though they were checked after tansfused. retiulocyte count 2.4 but again, after transfusion. he was guaiac negative x3. had a normal colonoscopy 10 years ago and denies any dark stools, blood per rectum, hematemesis, hematuria. he had felt fatigued for a month but no concerning weight loss, no pruritus after etoh, no night sweats. tsh, spep/upep, psa normal. testosterone low but hematology felt this was not felt to be a likely cause of his anemia. after initial transfusion, his hct was stable and he did not require any further transfusions. he underwent bone marrow biopsy by hematology and was discharged home. he will be contact with the results and will be set up with a hematology follow-up appointment. he will need o/p colonoscopy. . #. lip laceration: s/p suture and antibiotics. s/p mvc he had a lip injury treated by omfs with a 1 week course of augmentin and a suture. appeared to be healing well by the time of discharge. he has very poor dentition and was started on chlorhexidine mouthwash with advice to find a denist. he will need to f/u in clinic after discharge for suture removal. . #. fever: gout flare. a few days after admission, he developed fevers which were low-grade at first but then he spiked to 102. he had no uti and no pna. was not bacteremic. infected lip laceration was considered but his fevers continued after treatment with augmentin. he was found to have knee and ankle effusions and arthrocentesis by rheumatology revealed gout. he was started on a 1-week course of prednisone and also was started on allopurinol. he defervesced. he will f/u with his new pcp for continued management of gout. . #. troponin leak: resolved, likely represented demand ischemia from anemia in the setting of fast hr on admission. per cards, this presentation may represent ischemia in someone with undiagnosed cad. his risk factors were managed. he was started on asa and a statin. continued a beta blocker. he will f/u with cardiology as an outpatient and may need stress test. . #. htn: reasonably controlled. his bp meds had initially been held but were restarted slowly with some adjustments. hctz was stopped due to gout. amlodipine was stopped because he did not require it to control his bp. he was continued on a lower dose of losartan and metoprolol. continued doxazosin. he will f/u with his new pcp for ongoing management of his blood pressure. . #. low testosterone: incidental finding. am testosterone was checked as part of anemia workup and was found to be 64. he did endorse low libido. he will f/u with endocrinology as an outpatient. . transitional issues . #. code status: full code #. emergency contact: (brother/hcp) #. pending at discharge: final result of bone marrow biopsy; this will be followed up by medical team and hematology and he will be called at home with a hematology follow-up appointment #. follow-up: -pcp: of change of insurance, patient requested new pcp and he was set up to see dr. in ma (phone ). to follow blood pressure and also for further management of gout. -omfs: for lip suture removal -vascular surgery: for carotid stenosis -endocrinology: for low testosterone -cardiology: for ongoing workup/management of any coronary disease and his aortic stenosis -hematology: for further workup/management of his anemia -dentist: for bone/gum health (he was advised to contact his insurance company in order to find a dentist) medications on admission: metoprolol 200mg losartan 100mg amlodipine 10mg doxazosin 2mg hctz 50mg discharge medications: 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. losartan 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 3. doxazosin 2 mg tablet sig: one (1) tablet po at bedtime. 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. atorvastatin 80 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 6. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 7. amoxicillin-pot clavulanate 250-125 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 3 days: 1 week course (). disp:*9 tablet(s)* refills:*0* 8. prednisone 10 mg tablet sig: 1-3 tablets po as directed for 5 days: sunday: 3 pills at once. monday: 2 pills at once. tuesday: 2 pills at once. wednesday: 1 pill. thursday: 1 pill. then stop. disp:*9 tablet(s)* refills:*0* 9. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane tid (3 times a day): please continue until you are able to follow up with a dentist. disp:*1000 ml(s)* refills:*1* discharge disposition: home discharge diagnosis: primary: syncope, motor vehicle accident secondary: anemia, gout flare discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. (using crutches for gout flare) discharge instructions: you were admitted to the hospital after losing consciousness and having a car accident. your blood level was found to be extremely low, and was not explained by the extent of your physical injuries. during this stay, your anemia (low blood level) was evaluated by hematology, including a bone marrow biopsy. your loss of consciousness may have been due to anemia, and also you have mild narrowings in your neck arteries (carotid stenosis) and heart valve (aortic stenosis), and this may have contributed as well. . during this admission you had a lip injury treated by oral/maxillofacial surgeery with antibiotics and a stitch (the stitch will be removed in clinic in a few days). . also, during this admission you had a fever and were found to have a gout flare so you were started on allopurinol and a short course of prednisone. . finally, you were found to have low testosterone. you have follow-up appointments with a new primary care doctor s to follow-up all of these important issues. your blood level is stable and you are safe to go home. . please do not drive until your outpatient doctors have decided that it is safe to do so. . we made the following changes to your medications: -stop amlodipine -stop hydrochlorothiazide -decrease dose of losartan -decrease dose of metoprolol -start aspirin daily -start atorvastatin -start allopurinol -start prednisone (for 5 more days, then stop) -start augmentin (for 3 more days, then stop) -start chlorhexidine mouthwash followup instructions: primary care name: dr. when: please call your insurance company now to change your primary care physician to dr. . after calling, you will be provided with a referral number. when you have your referral number, please call ( to schedule an appointment 1-2 weeks after your hospital discharge. address: location: phone: ( oral/maxillofacial surgery (for the lip injury and stitch removal) when: wednesday at 11:00am oral surgery clinic yawkey building - , ma phone: vascular surgery (for carotid artery stenosis) when: wednesday at 2:30 pm with: , md building: , bldg () campus: west best parking: garage endocrinology (for low testosterone) when: tuesday at 3:40 pm with: , md building: ra (/ complex) campus: east best parking: main garage cardiology (for your heart health) when: thursday at 9:30am with: building: sc clinical ctr campus: east best parking: garage hematology (to follow up the cause of anemia) after your bone marrow biopsy result is reviewed, you will be contact with a follow-up appointment. if you have not heard back within one week please call (. dentist you have severe tooth/gum disease. please check with your insurance company to see what dentists are in network and make an appointment as soon as possible. procedure: biopsy of bone marrow arthrocentesis closure of skin and subcutaneous tissue of other sites diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension osteoarthrosis, unspecified whether generalized or localized, site unspecified family history of ischemic heart disease open wound of jaw, without mention of complication fever, unspecified hypovolemia closed fracture of two ribs syncope and collapse other specified anemias open wound of lip, without mention of complication dental caries, unspecified open wound of knee, leg [except thigh], and ankle, without mention of complication motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle unspecified endocrine disorder pain in joint, multiple sites gouty arthropathy, unspecified 

Answer: The patient is high likely exposed to