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: sob major surgical or invasive procedure: ivc filter placed history of present illness: 39 y/o m with pmhx of htn, iritis, who presented to his pcp's office with a 2 days of worsening sob, and dizziness on standing after going to the gym. patient said on tuesday he noticed left calf "knot" after swimming, with no other symptoms. on weds/thurs. he noticed he was sob, dizzy and diaphoretic with normal exertion (walked block). finally, on friday, his left calf "knot" was not resolved with vigorous massage, and his symptoms of sob, dizziness and diaphoresis were not improved so he saw his pcp. arrived to his pcp's office who found him to be hypotensive and tachycardic, and he was sent into the ed. interestingly, patient notes ~ 5 weeks ago he had some sob while boxing, and 3 weeks ago he also had sob after a long flight. . brief hospital course: in the ed, vs: t98.1, hr116, bp96/80, rr16 o2sat: 97% ra. his ct scan showed bilateral pes and he was given asa 325 x1, & started on hep gtt. the patient was admitted to the icu, and for his saddle emboli he was continued on heparin gtt, and had an ivc filter placed. he will start coumadin. his arf was treated with fluids, which led to improvement. in the setting of pe/hypotension, his blood pressure meds were held and he was aggressively hydrated past medical history: 1)htn 2)iritis social history: the patient grew up in a farm in , currently works for escription services for the past 3 years. there is a lot of traveling around the country for up to a week at a time. he works pretty hard but likes his job. he has no history of alcohol, drug abuse, or smoking. he currently lives in the . he lives alone. he has an occasional male partner with whom he is sexually active. he does use condoms. he has no history of sexually transmitted diseases. family history: mother has hypercholesterolemia and history of alcohol abuse; diagnosed with breast cancer one year ago. his father has nonmelanoma skin cancer. no other fam hx of blood clots or malignancy. physical exam: on admission to icu... vitals: t 99 bp 106/63 hr 95 rr 22 o2: 98% on 2l gen: well appearing male in nad; able to talk in complete sentences heent: anicteric sclera. o/p clear. mmm. neck: no elev jvp. no cervical or supraclavicular lad. cardio: regular, nml s1,s2. no murmurs resp: ctab. no c/w/r. abd: soft. ntnd. no ttp. no inguinal lad ext: 2+ pulses bilat, no edema. no erythema. (-) sign neuro: aaox3 gu: no testicular masses palpated. rectal: guiaic (-) in ed per notes. . on floor: vitals: 98.4, 104/70, 96, 16, 95% ra gen: well appearing male in nad heent: anicteric sclera. o/p clear. mmm. neck: no jvd noted, no , no bruit noted cardio: regular, nml s1,s2. no murmurs resp: ctab. no c/w/r. abd: soft. ntnd. + bs ext: 2+ pulses bilat, no edema. no erythema. no calf tenderness. ivc filter in right thigh neuro: aaox3 rectal: guiaic (-) in ed per notes. pertinent results: chest ct: massive bilateral pulmonary emboli involving the bilateral distal, lobar and multiple proximal segmental pulmonary arteries. focal gound glass opacity in the left upper lobe may represent focal infarction, although follow up films are recommended to ensure resolution. cxr: the heart size and mediastinal contours are normal. there is no pleural effusion or pneumothorax. the lungs are clear. echo - right ventricular cavity enlargement with free wall hypokinesis and preserved apical function c/w acute rv pressure overload/pulmonary embolism. le doppler - occlusive intraluminal thrombus is seen within the right distal superficial femoral vein extending inferiorly into the right popliteal and calf veins. . ekg on admission: sinus tachycardia. inferior q of waves doubtful significance. since previous tracing, rate faster. . admission labs: 11:10am d-dimer-4016* 11:10am wbc-12.2* rbc-5.80 hgb-16.1 hct-46.8 mcv-81* mch-27.7 mchc-34.4 rdw-13.3 11:10am ck-mb-6 ctropnt-0.11 11:10am ck(cpk)-684* 11:10am urea n-21* creat-1.4* sodium-137 potassium-4.2 chloride-95* total co2-27 anion gap-19 11:10am glucose-68* 08:30pm d-dimer-4256* 08:30pm neuts-66.6 lymphs-22.4 monos-5.5 eos-3.4 basos-2.1* 08:30pm wbc-10.7 rbc-5.63 hgb-16.0 hct-45.0 mcv-80* mch-28.3 mchc-35.4* rdw-13.4 08:30pm ck-mb-5 08:30pm ctropnt-0.03* 08:30pm glucose-95 urea n-24* creat-1.5* sodium-135 potassium-4.3 chloride-97 total co2-24 anion gap-18 brief hospital course: this is 39 y/o m with h/o htn who presents with intermittant sob, and hypotension found to have massive bilateral saddle emboli . 1) pulmonary embolism - the patient was admitted with extensive bilateral pulmonary emboli. as this is a very serious condition and the patient was unstable in the ed (but responding to fluids) the patient was admitted to the icu and started on heparin. in the icu, he was hemodynamically stable, so no lytic therapy was started. after transfer, the patient remained stable, and his course on the floor was without events. he remained on heparin and coumadin and we waited until he became therapeutic, by closely monitoring his pt, ptt and inr and adjusting his coumadin dose. as an outpatient he will remain on coumadin and should have a hypercoaguability workup, tte, and a repeat chest ct. . 2) deep vein thrombus: the patient was noted to have an intraluminal thrombus within the right distal superficial femoral vein extending inferiorly into the right popliteal and calf veins. as above, the patient was treated with heparin and coumadin, but due to this large clot that had potential to break off, he was placed with an ivc filter. the patient responded well to the ivc filter and anticoagulation, and should have this ivc filter in for life for protection. . 3) right ventricular strain: on admission, the patient was noted to have elevated troponins, and this was attributed to the right ventricular strain from the pulmonary embolism. the case was discussed with cardiology, and since he was hemodynamically stable and responding to anticoagulation they felt lytic therapy was unnecessary. the right ventricle is resilient and should recover, in time. the patient had no problems during his course, and will have a repeat echo in 3 months to revalute. . 4) anemia: the patient was noted to have a mild anemia. he was hemodynamically stable, and we felt this could be followed up further as an outpatient. . 5) hypertension - the patient was hypotensive on admission, and in the setting of a pulmonary embolism, his blood pressure medications were held. he remained normotensive during his course, and therefore we continued to hold his medications as they can be restarted as an outpatient. . 6) acute renal failure: on admission the patient presented with a creatinine of 1.4, increased from his baseline of 1.0. this improved with hydration, although increased again during the course to 1.3. the fena was calculated to be ~ 1% and therefore assumed to be pre-renal. hydration was provided and the patient improved, leading to the diagnosis of pre-renal failure. medications on admission: lisinopril 20mg qd claritin discharge medications: 1. claritin 10 mg tablet sig: one (1) tablet po once a day: you can retake your home claritin. 2. outpatient lab work please check pt, ptt, inr 3. warfarin 2 mg tablet sig: four (4) tablet po hs (at bedtime): take 8 mg daily. disp:*120 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: 1. pulmonary embolism 2. deep vein thrombosis 3. anemia 4. mulculoskeletal pain discharge condition: stable, tolerating medications, afebrile discharge instructions: 1. please attend all appointments 2. please take all medications as prescribed, we are holding your lisinopril because your blood pressure was low. this should be readdressed with dr. . 3. please return for worsening shortness of breath, chest pain, vomiting, high fever and inability 4. please have your labs drawn in 2 days (bring lab slip prescription), at dr. office. followup instructions: 1. would have a repeat chest ct in 3 months 2. you need a repeat echo in 3 months 3. you need a work-up for hypercoagulability, which dr. will help you coordinate. 4. you have an appointment with dr. (# ) on friday at 9:50 am. procedure: interruption of the vena cava diagnoses: unspecified essential hypertension acute kidney failure, unspecified hypovolemia other specified anemias other pulmonary embolism and infarction heart disease, unspecified acute venous embolism and thrombosis of deep vessels of distal lower extremity 

Answer: The patient is high likely exposed to