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: inderal attending: chief complaint: traumatic fall major surgical or invasive procedure: arterial line history of present illness: the patient is an 82 year old man who was admitted in the afternoon of with a fall at home complicated by rib pain and found to have multiple rib fractures now transfered to the icu for hypoxic and hypercarbic respiratory distress. . he is an 82 m with hx of cad s/p des x4, cabg, chf with ef55%, hx of renal cell carcinoma, copd, and ckd presents with severe l rib pain, sob, and vomiting with exertion. on the morning of presentation (~9am)the patient slipped on ice landing on his r flank. he took an unknown amount of tylenol #3 prior to coming to hospital. he denied loc. denies striking head. ems called and pt refused transport. denies neck, back pain but has noted severe, pain with any inspiration over l flank. large ecchymosis over area. son reports pt s/p 2 episodes vomiting with exertion this pm, initially yellow. no hematemesis. denies abd pain. has chronic urinary incontinence. per ed patient recently increased his furosemide dose. . in the ed he had a cxr that showed no infiltrate, edema, or pneumothorax. he had rib films that showed multiple rib fractures (). he was admitted for pain control and evaluation of acute on chronic renal failure. on arrival to the medicine floor he was "lethargic and sleepy" was afebrile with repirations of 16 and o2sat 93%2l. he had received no pain medications since arrival to the medicine floor. at ~2:45 am he was found to be hypoxic with o2sat 71% on 2l. he received nebs and was able to wean his supplemental o2 to 2-3l. however at ~4am, he desatted again requiring a nrb and icu transfer. also he was found to have a bladder scan of ~500cc and a foley catheter was placed. . ros: no nausea. no vomiting. no leg pain. no increase in leg swelling. left chest pain. past medical history: hyperlipidemia hypertension cad: (outpatient cardiologist is dr. - s/p cabg status post coronary artery bypass graft in svg--> om1 (last stented in x 3), svg-->lad (last stented in ), svg-->rca (occluded) - mi , multiple cardiac catherizations and stent placements. av delay: - pacer av placed for av delay/conduction disease in - interrogated last chf (diastolic dysfunction, lvh, ef 40-45%) copd history renal cell carcinoma s/p nephrectomy chronic renal failure (baseline 2.4-3) pernicious anemia aaa diabetes prostate cancer lung nodules potentially from lung cancer vs mets (seen 2 years ago) social history: retired furniture salesman. married, has children, one daughter is a nurse and works at . he currently lives with his son and grandson. they are very involved and very supportive. he has an extensive smoking history (stopped 25yrs ago) and admits to minimal etoh. he denies use of illicit substances. family history: noncontributory physical exam: vitals: 98.3 82 142/66 15 99%nrb gen: ill appearing. moaning in pain heent: dry mm. perrl. eomi. no battle sign or racoon eyes. no head bruising neck: supple. no jvd seen chest: ecchymotic patch to left flank cv: regular. s1/s2 w/o murmur or gallop abd: adipose. soft. active bowel sounds ext: venous harvest on right. chronic venous stasis bilat skin: ecchymosis to left upper flank neuro: -ms: alert. oriented to self, "" "" -cn: pupils reactive. eomi. face intact. head turn intact -motor: moving -dtr: -: light touch intact to face, arms, legs pertinent results: ekg: sinus. pr prolongation (stable from priors). right axis deviation. rbbb. slow r wave progression. no st-t changes from prior . studies: cxr cardiomediastinal silhouette is grossly unchanged. patient is status post median sternotomy with wires intact. a left basal nodule measures 13 mm. right basal nodule is not well seen on today's study. there is no pneumothorax or focal consolidations. pulmonary vascularity is normal. left pleural thickening is stable since . osseous structures are diffusely demineralized. there is no displaced fracture. . rib xray - there are nondisplaced and mildly displaced fractures of four contiguous left-sided ribs (the sixth through ninth ribs). there is increased pleural density in this region which could reflect associated hematoma. no pneumothorax is seen. chest is unchanged in appearance with a seen in the left anterior chest wall and prominent cardiomegaly. subsegmental atelectasis is seen at the bases bilaterally. osseous structures are otherwise unremarkable. . cxr - (unofficial) patchy rounded opacities in right mid lung field and left base potentially atelectasis vs infiltrate 04:36pm urine color-yellow appear-clear sp -1.016 04:36pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:36pm urine rbc-1 wbc-0 bacteria-none yeast-none epi-0 04:33pm glucose-140* urea n-91* creat-3.4* sodium-141 potassium-5.4* chloride-105 total co2-24 anion gap-17 04:33pm ck(cpk)-66 04:33pm ck-mb-notdone ctropnt-0.02* 04:33pm calcium-8.8 phosphate-7.6*# magnesium-2.7* 02:23am glucose-179* urea n-85* creat-3.4* sodium-141 potassium-4.9 chloride-101 total co2-29 anion gap-16 02:23am estgfr-using this 02:23am ck(cpk)-77 02:23am ctropnt-0.02* 02:23am ck-mb-notdone probnp-4228* 02:23am wbc-8.7 rbc-4.71# hgb-13.0*# hct-41.4# mcv-88 mch-27.6 mchc-31.5# rdw-15.1 02:23am neuts-91.1* lymphs-5.0* monos-3.6 eos-0.3 basos-0.1 02:23am plt count-231 02:23am pt-12.4 ptt-26.4 inr(pt)-1.1 brief hospital course: the patient is an 82 year old man with history of extensive cad, chf, dm2, copd, rcc now presenting with rib fractures following a fall complicated by respiratory distress. the patient's daughter confirmed that he was dnr/dni. he was placed on bipap to help with his breathing which was particularly difficult given the need to balance treatment of his fracture pain with adequate mentation and respiratory effort. an epidural could not be placed as the patient was taking clopidogrel. the patient remained significantly acidemic with ph 7.1 and elevated co2. family members concluded that he would want comfort care only and did not want to continue with invasive interventions. the patient was made cmo status and appeared comfortable. he received morphine boluses prior to moving him but otherwise did not require additional therapeutics. . hospital course by problem prior to cmo status: # respiratory distress: likely secondary to pain with splinting from rib pain resulting in ventilation and oxygenation deficits. given normal or near normal serum bicarb likely not a significant co2 retainer at baseline. no fever or evidence for infection however with vomiting and altered mental status could have aspirated. likely dehydrated as opposed to in chf. no pneumothorax on imaging. other potentials could be pe however seems early in course for this and has no hemodynamic or ecg evidence for pe. - cycle cardiac enzymes: peaked at 0.04 - serial abg: most recent 7.21/77/101 - chest ct yesterday noted as above - nippv yesterday without signif improvement in pco2. still with myoclonus. will re-attempt with higher ps today. - a-line for bp monitor and frequent abg - cxr this am as above. limit fluid today . # altered mental status/myoclonus: non-focal neuro exam and altered mental status has waxed and waned with the respiratory distress (i.e. co2 narcosis) which supports this as the primary disorder. however with recent trauma, sdh also possible. - serial abg as above - ct head: negative - mental status improved yesterday. will target improving co2 status to improve mental status and myoclonus. -dc'd lidoderm patch yesterday without change in myoclonus. . # acute on chronic renal failure: likely pre-renal with component or post-renal given large bladder scan. - ua, urine lytes showing likely pre-renal etiology with high osmol and low urine na. - renally dose meds - uop improved this am. - limit further fluids now that uop increasing. . # fall: likely mechanical secondary to slipping on ice at home. no evidence of head trauma per history or exam. - monitor as above - low dose dilaudid for pain given renal impairment if needed - acute pain service: no epidural due to plavix. recs tylenol, neurontin, prn dilaudid. . #dm: sliding scale insulin with good coverage yesterday. . # cad: no ischemic changes on ekg and negative enzymes x 2. however with new respiratory changes reasonable to re-cycle enzymes - cycle enzymes. peaked at 0.04 - repeat ekg - continue aspirin/plavix/statin . # chf: appears dehydrated as shown in hct, cr, and mucous membranes. - hold home diuretics - received gentle ivf on . limit further ivf . - hold ace for now - continue bb . #lung mets from unknown primary, possible renal given history rcc. - no further eval at this time. will discuss with daughter. . # fen: limit further ivf. replace as needed. npo for now. . # prophy: hep sc, bowel regimen # access: piv # code: dnr/dni confirmed with daughter who corroborated with her 2 siblings. will discuss dni with daughter regarding possible temporary intubation for co2 reduction. # contact info: (daughter) cell: # dispo: icu medications on admission: asa 325 mg qd plavix 75 mg daily captopril 100 mg atenolol 100 mg daily lipitor 40 mg qd norvasc 10 mg qd lasix 40 mg imdur 120 mg doxazosin 8mg levothyroxine 50mg spirva zaroxolyn 5 mg daily albuterol prn epogen 3x/week discharge medications: expired discharge disposition: expired discharge diagnosis: primary: s/p fall hypoxic and hypercarbic respiratory distress secondary: hyperlipidemia hypertension cad s/p ppm chf copd chronic renal failure pernicious anemia aaa diabetes prostate cancer lung nodules discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: systemic arterial pressure monitoring diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified pulmonary collapse other and unspecified hyperlipidemia cardiac pacemaker in situ altered mental status encounter for palliative care secondary malignant neoplasm of lung abdominal aneurysm without mention of rupture dehydration personal history of malignant neoplasm of kidney fall from other slipping, tripping, or stumbling myoclonus pernicious anemia closed fracture of four ribs chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to