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: sulfa (sulfonamide antibiotics) attending: chief complaint: esophageal stenting c/b post procedure aspiration/hypoxia major surgical or invasive procedure: egd with esophageal stent history of present illness: 86 year-old female with a history of esophageal ca who was admitted from egd suite after esophageal stent placement. the patient last received radiation to her esophagus on . the procedure was performed under mac and complicated post-op by one episode of desaturation to 89% and resp rate of 34 at the end of the procedure. patient was placed on o2 mask with 100% o2 and saturationg increased to 98%. she was given an albuterol neb. there was a question of possible aspiration during the procedure. she was aggressively suctioned with mainly clear secreations, but some "bilious" tinge per report. she was placed on 6l nc. she became nauseous and vomited small amount bile and given 4mg zofran iv. she remained in a-fib with hr in the 100's post-op. bp 181/96 and 94% 10l o2, rr: 25 in the pacu. she was transferred to the icu for closer monitoring overnight. ros: the patient denies any fevers, chills, diarrhea, constipation, melena, hematochezia, chest pain, orthopnea, pnd, lower extremity edema, cough, urinary frequency, urgency, dysuria, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. past medical history: a-fib (on amiodarone, not anti-coagulated) copd (on albuterol prn) htn hyperlipidemia gerd h/o shingles 7 weeks prior s/p tonsillectomy social history: lives in at emerald court. pt husband lives in a nursing home. quit smoking 45yrs ago, but 20 pp year history. no etoh or other drug use. family history: nc physical exam: t:98.5 bp:156/75 hr:95 rr:25 o2sat:93% 10l gen: elderly female, with mildly labored breathing. appears comfortable. heent: eomi, perrl, sclera anicteric, dry mm, op clear neck: no jvd, no cervical lymphadenopathy, trachea midline cor: rrr, no m/g/r, normal s1 s2 pulm: coarse rhonchi diffusely, no wheezes abd: soft, nt, nd, +bs ext: no c/c, trace edema back: right side erythemtous maculopacuplar lesions following a dermatome, tender neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: cxr : an esophageal stent extends from the level of the carina to the upper stomach, pinched to about half its general diameter at the level of the left atrium. mediastinum is shifted to the left. dense left perihilar consolidation could be pneumonia, could also be radiation change, and mass. heart is moderately enlarged whether due to cardiomegaly or pericardial effusion is indeterminate. large irregular opacity obscuring the apex of the aortic knob could be a pleural or lung mass or just atelectasis. small to moderate left pleural effusion is present. any prior imaging of the chest should be obtained for comparison purposes to determine the nature and significance of the multiple findings described above. . cxr : progression of the left lung consolidation with a new left-sided pleural effusion. the appearences are again very likely secondary to aspiration. . cxr : interval worsening of left upper and left lower lobe consolidation that might represent a combination of aspiration and atelectasis. the heart size is unchanged. there is no pneumothorax. . cxr : there is improvement in the left upper lobe consolidation, with persistent left lower lobe consolidation and a new left sided pleural effusion with left lower lobe and lingular atelectasis. mediastinal silhouette and esophageal stent are unchanged. . cxr : no short interval change in appearance of the left lung, with findings likely representing a combination of consolidation and atelectasis combined with a moderate left pleural effusion. considering presence of volume loss, ct may be considered to exclude an obstructing process if warranted clinically. cardiac silhouette remains enlarged and mediastinum remains widened. esophageal stent is unchanged in appearance. increasing interstitial opacities in right lung likely reflect asymmetric edema from fluid overload, and there is persistent right basilar atelectasis and adjacent small effusion, unchanged. . cta : 1. no pulmonary embolism. 2. large bilateral pleural effusions, left greater than right, with associated atelectasis. given cardiomegaly, these findings may represent congestive heart failure. 3. small amount of secretions within the right lower lobe bronchus and layering of material within the lower esophageal wall stent. aspiration is a diagnostic possiblity. 4. enlarged pulmonary artery suggestive of pulmonary hypertension. 5. probably patent lower esophageal stent. however, please note, stent patency or stenosis cannot be directly assessed on this evaluation and a barium esophagram could be performed for further assessment as clinically indicated. . ecg : sinus rhythm with a single ventricular premature beat. low limb lead voltage. no previous tracing available for comparison. . ecg : sinus rhythm. baseline artifact. poor r wave progression. compared to the previous tracing of the ventricular premature beat is absent and artifact is new. . cxr : large multiloculated left pleural effusion has changed in distribution but not in overall severity. left lower lobe is still collapsed. left upper lobe atelectasis has improved. small right pleural effusion is stable or slightly increased. pulmonary vascular congestion persists, but i see no pulmonary edema. cardiac silhouette is obscured by adjacent pleural abnormality but is probably large though unchanged. no pneumothorax. lower esophageal stent unchanged in position. . video swallow: impression: minimal penetration with thin consistency barium. otherwise, normal oropharyngeal swallowing evaluation. please refer to the full notes by speech and swallow pathologist from the same date, detailed in the treatment recommendations. . ct head: indings: there are diffuse hypodense areas in the bilateral frontal lobes and periventricular regions likely representing small vessel ischemic disease. there are no masses. there are no areas that enhance inappropriately with contrast. there is no disturbance of the -white delineation. there is no evidence of hemorrhage or mass effect. the ventricles and sulci are mildly prominent in nature, but appropriate for the patient's age. no bony lesions are noted. impression: 1. no evidence for metastatic disease. 2. mild small vessel ischemic disease. . 12:25pm blood wbc-11.0 rbc-4.23 hgb-11.6* hct-36.8 mcv-87 mch-27.4 mchc-31.5 rdw-15.7* plt ct-343 04:10am blood wbc-23.2* rbc-4.49 hgb-12.5 hct-39.4 mcv-88 mch-27.9 mchc-31.8 rdw-15.7* plt ct-325 04:10am blood neuts-95.7* lymphs-1.9* monos-2.2 eos-0.2 baso-0 12:25pm blood glucose-82 urean-8 creat-0.7 na-142 k-4.2 cl-102 hco3-29 angap-15 04:10am blood calcium-8.5 phos-3.6 mg-2.0 hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:05am 9.0 3.49* 9.5* 28.8* 83 27.3 33.0 16.1* 350 06:45am 8.4 3.65* 9.8* 30.7* 84 27.0 32.0 16.1* 352 06:45am 8.6 3.43* 9.6* 29.2* 85 27.9 32.8 16.2* 314 07:00am 10.0 3.63* 10.0* 31.2* 86 27.6 32.0 15.9* 349 06:40am 9.6 3.69* 10.2* 31.2* 85 27.7 32.7 16.0* 327 diff added @ 15:56 06:40am 10.3 3.59* 10.1* 30.3* 85 28.2 33.3 15.9* 305 06:10am 10.4 3.85* 10.7* 32.4* 84 27.9 33.1 15.8* 302 05:05am 10.1 4.12* 11.3* 35.4* 86 27.5 32.0 15.7* 305 04:23am 10.5 4.02* 11.1* 34.3* 85 27.6 32.4 15.8* 305 04:39am 15.1* 3.77* 10.6* 32.1* 85 28.1 33.0 15.8* 278 04:31am 20.3* 4.07* 11.5* 35.0* 86 28.2 32.9 15.6* 342 04:10am 23.2* 4.49 12.5 39.4 88 27.9 31.8 15.7* 325 08:43pm 23.6*# 4.46 12.3 38.1 85 27.6 32.4 15.2 312 12:25pm 11.0 4.23 11.6* 36.8 87 27.4 31.5 15.7* 343 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 07:05am 350 06:45am 352 06:45am 314 07:00am 349 06:40am 327 diff added @ 15:56 06:40am 305 06:10am 302 06:10am 12.4 33.7 1.0 05:05am 305 04:23am 305 04:39am 278 04:31am 342 04:31am 10.8 29.4 0.9 04:10am 325 04:10am 11.9 26.4 1.0 08:43pm 312 12:25pm 343 12:25pm 11.4 24.4 0.9 renal & glucose glucose urean creat na k cl hco3 angap 07:05am 95 10 0.5 132* 4.5 95* 28 14 06:45am 103 8 0.6 129* 4.3 91* 29 13 06:45am 109* 8 0.5 132* 4.4 95* 28 13 07:00am 99 7 0.5 135 4.7 100 28 12 06:40am 103 9 0.5 131* 4.3 97 28 10 lft & cardiac added @ 15:55 06:40am 110* 10 0.5 132* 4.1 96 28 12 06:10am 100 9 0.6 136 4.1 99 29 12 05:05am 104 10 0.6 134 4.0 98 29 11 04:23am 102 11 0.5 135 4.2 97 28 14 04:39am 124* 12 0.5 135 3.9 101 26 12 04:31am 135* 14 0.5 135 4.0 101 25 13 04:10am 159* 9 0.6 137 3.7 99 25 17 09:00pm 116* 8 0.6 139 3.5 100 25 18 12:25pm 82 8 0.7 142 4.2 102 29 15 enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 07:00am 61 09:05pm 65 06:40am 12 15 48 97 0.1 chemistry totprot albumin globuln calcium phos mg uricacd iron 07:05am 8.2* 4.0 2.0 07:00am 8.4 3.6 1.9 06:40am 8.4 3.5 1.9 lft & cardiac added @ 15:55 06:40am 8.2* 2.8 1.8 06:10am 8.1* 2.6* 2.0 05:05am 8.2* 2.3* 2.2 04:23am 8.2* 2.1* 1.9 04:39am 7.8* 1.8* 1.8 04:31am 8.4 2.3* 1.9 04:10am 8.5 3.6 2.0 09:00pm 8.5 3.8 1.9 micro: stool cdiff - negative. stool cdiff - negative. stool: cdiff - negative. fecal culture (final ): no enteric gram negative rods found. no salmonella or shigella found. urine cx - negative. blood cx - negative. blood cx - negative. brief hospital course: 86 f with history of esophageal and squamous cell lung cancer, admitted for paliative esophageal stent placement complicated by aspiration pneumonia. # shortness of breath - initially attributed to an aspiration pneumonia, this occured in the setting of esophageal stent placement. she was started on treatment with levofloxacin and flagyl on and completed a 8 9 day course. given this aspiration occured she was evaluated by speech and swallow and recommended thin liquids and regular diet. she continued to have shortness of breath over the course of . cta revealed a large left pleural effusion. she received ivf fluids on for orthostasis and again on for frank hypotension felt dehydration. in this setting, concern was raised for volume overload. she was treated by optimizing rate control, and gentle iv lasix on . her dyspnea was not markedly changed with lasix, and her atrial fibrillation and hyponatremia worsened. . given poor response to lasix, and ongoing tachypnea (with negative cta), discussion was held over the possibility of therapeutic thoracentesis. the effusion is new as it was not present on prior cxr on with her oncologist. after discussion with her oncologist ( anamur, ), this effusion was felt to be malignant (her lung ca is located in the lul and had improved s/p xrt), and felt likely to reaccumulate. her prognosis was felt to be poor given 2 primary malignancies, and her inability to tolerate chemotherapy. . after extensive discussion with the patient, her daughter (hcp), the patient declined thoracentesis, and elected to change goals of care to comfort measures only. she was treated with oral ativan and morphine for respiratory comfort. she will be discharged to hospice. she may receive lasix prn dyspnea, however these efforts have been limited by tachycardia and hypotension during this hospitalization. . on the day of discharge, the above plan was again communicated to the patient, and her son-in-law (alternate hcp) as her daughter was not available. . # dizziness - pt complained of dizziness after starting antibiotics. her neurologic exam was non-focal. head ct was unremarkable for metastasis. she demonstrated no nystagmus or evidence of bppv. her dizziness was attributed to orthostasis and medication. her neurontin, percoceet and flagyl were discontinued with mild improvement in her symptoms. she is being discharged to hospice with prn meclezine. . # diarrhea - likely antibiotics, and improving at the time of discharge. she had stool cultures x3 negative for cdiff, and general stool culture negative on . she will be discharged with prn lomotil. . #. atrial fibrilation: pt is rate controlled on dilt and amio at home, though she is not anticoagulated. she had intermittent episodes of breakthrough rvr in 120-130s in the icu thought likely due to underlying aspiration pna and hypoxia. she remained asymptomatic with the rvr, diltiazem regimen was titrated up and metoprolol was added to acheive better rate control. her heart rate ranges between 80-120 on this regimen and bp remains stable. she did develop pleural effusions in this setting requiring intermittent diuresis, as above. . she is being discharged to hospice on her regimen of metoprolol, diltiazem, and amiodarone for comfort, as she becomes anxious when she senses a rapid heart rate. . #. esophageal + lung ca: pt with 2 primary malignancies, including t3n1 esophageal adenocarcinoma, with squamous cell lung cancer s/p xrt, both diagnosed in . she is not a chemotherapy candidate per discussion with her oncology provider (above). she received a palliative esophageal stent placement. . as above, she is being discharged to hospice given large left pleural effusion and ongoing dyspnea #. depression: she is continued on home citalopram. #. post herpetic neuralgia: she had herpes zoster 7 weeks prior with residual pain. she had sedation/somnolence on neurontin so this was held, and liquid percocet was attempted. given ongoing dizziness, neurontin and percocet were discontinued with some improvement. her pain was controlled with tylenol. she will be discharged to hospice with morphine as above. . #. hypertension: previously hypertensive, for which she was continued on diltiazem, up titrated as above with metoprolol for rate control. she subsequently was treated with ivf for hypotension felt likely dehydration and poor po intake. #. copd: she only uses albuterol at home. #. gerd: continue ppi for comfort. #. hyperlipidemia: simvastatin was discontinued. . # code status - pt made dnr/dni after extensive discussion with family and patient. she is being discharged to hospice with comfort measures only, and understands no further role for hospitalization as she is not interested in thoracentesis or further surgical procedures to treat her malignancy, and is not a chemotherapy candidate. . # contacts: (hcp) (cell) (home), , , greater lowel family practice, , , . . medications on admission: asa 81mg daily miracle mouthwash multivitamin calcium bib citalopram 40mg daily simvastatin 80mg daily omeprazole 20mg daily ativan 0.5mg prn albuterol prn gabapentin 100mg tid amiodarone 200mg daily diltiazem 240mg daily discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 4. citalopram 20 mg tablet : two (2) tablet po daily (daily). 5. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours) as needed for sob. 6. amiodarone 200 mg tablet : one (1) tablet po daily (daily). 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q4h (every 4 hours) as needed for sob. 9. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension : 15-30 mls po qid (4 times a day) as needed for gerd. 10. diltiazem hcl 90 mg tablet : one (1) tablet po qid (4 times a day). 11. metoprolol tartrate 25 mg tablet : 0.5 tablet po tid (3 times a day). 12. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day) as needed for constipation. 13. morphine 10 mg/5 ml solution : 5-20mg po q6h (every 6 hours) as needed for dyspnea. disp:*1 bottle* refills:*2* 14. lorazepam 0.5 mg tablet : 1-2 tablets po q4h (every 4 hours) as needed for anxiety, dyspnea. tablet(s) 15. acetaminophen 500 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain. 16. meclizine 25 mg tablet : one (1) tablet po once a day as needed for dizziness. 17. lomotil 2.5-0.025 mg tablet : one (1) tablet po once a day as needed for diarrhea. discharge disposition: extended care facility: at rehab discharge diagnosis: primary: aspiration pneumonia. esophageal cancer, s/p stent placement squamous cell lung cancer malignant pleural effusion atrial fibrilation with rapid ventricular response secondary: hypertension copd depression post herpetic neuralgia hyperlipidemia gerd discharge condition: stable vital signs, breathing on 2-3l nasal cannula. discharge instructions: you were admitted to the hospital for aspiration pneumonia after an esophageal stent placement. . while here your heart rate has been elevated, requiring additional medications. you were also evaluated for safe swallowing and determined that you should eat and drink. . you were found to have a large fluid collection on the left lung, which is most likely related to your cancer. as we discussed, you are not a candidate for chemotherapy, and have chosen not to have further surgical procedures to drain this fluid as it is likely to reaccumulate. . you are being discharged to hospice, with treatment to be focused on maintaining your comfort, with medications such as ativan and morphine. please continue all medications as prescribed and follow up your primary care doctor, dr. , within 1-2 weeks of discharge. followup instructions: please follow up with your hospice provider at rehab. . please follow-up with your primary care physician, . as needed. procedure: other endoscopy of small intestine insertion of permanent tube into esophagus diagnoses: esophageal reflux urinary tract infection, site not specified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified atrial fibrillation depressive disorder, not elsewhere classified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified pneumonitis due to inhalation of food or vomitus malignant neoplasm of upper lobe, bronchus or lung other respiratory complications diarrhea encounter for palliative care personal history of irradiation, presenting hazards to health herpes zoster with other nervous system complications anemia in neoplastic disease dizziness and giddiness benign essential hypertension unspecified antibiotic causing adverse effects in therapeutic use malignant neoplasm of middle third of esophagus malignant pleural effusion 

Answer: The patient is high likely exposed to