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: shortness of breath and 30-40% tracheal stenosis major surgical or invasive procedure: - flexible bronchoscopy -rigid bronchoscopy history of present illness: ms. is a 69-year-old woman who had had a previous thyroidectomy and tracheostomy for tracheal stenosis. she was transferred from last night with the question of an obstructing lesion at the end of her tracheostomy tube. past medical history: 1. thyroid cancer dx in - papillary cancer with positive nodes status post sternotomy and partial right and total left thyroidectomy on . she was found unresponsive at home on . prior to this, the patient had neck swelling for 2 days which occurred in conjunction with administration of actos for newly diagnosed diabetes. laryngoscopy was performed revealing airway edema. a ct scan of the chest and neck revealed a goiter with airway compression. tsh was elevated at 7.13. path showed the patient to have papillary carcinoma of the thyroid with extrathyroidal invasion and nodal involvement, status post rigid bronchoscopy and tumor debridement on , status post open tracheostomy on , status post bronchoscopy and percutaneous endoscopic gastrostomy tube placement on . 2. s/p trach for tracheal stenosis 3. acinetobacter in sputum , mdr 4. pansensitive enterococcus in urine 5. diastolic dysfcn, echo , ef >75% 6. nosocomial pna : nosocomial pneumonia with sputum cultures positive for acinetobacter, pan-resistant, as well as enterobacter cloacae, pansensitive, treated with imipenem and tobra 7. atrial flutter during last hospitalization 8. newly diagnosed dm 9. htn 10.sinusitis diagnosed during last admission 11. h/o r ptx last hospitalization requiring ct placement (d/c'd) 12. ?hypoxic brain injury with paresis and cognitive deficit 13. picc line placement social history: social: the pt has six children living in the area, 2 children living in . she is from and speaks catnonese. she understands some english. apparently she was independent with mobility and basic adl prior to her last hospitalization. her functional capacity recently has been the need for maximal assistance to total dependency in most areas family history: nc physical exam: general- alert, follows commands, comfortable heent- trach- #7 ; .40 trach mask; resp-diffuse course ronchi bilat; cor-rrr abd- soft, non-tender, non-distended ext2+ dp/pt pulses bilat; no edema pertinent results: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 08:09am 6.4 3.50* 9.7* 28.7* 82 27.9 33.9 14.6 262 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 08:09am 262 chemistry renal & glucose glucose urean creat na k cl hco3 angap 08:09am 217* 12 0.9 134 4.0 100 27 11 chemistry totprot albumin globuln calcium phos mg uricacd iron 08:09am 7.7* 2.8 2.0 pituitary tsh 02:30am greater th1 1 greater than 100 thyroid t4 t3 calctbg tuptake t4index free t4 08:09am 3.2* 56* 1.21 0.83 2.7* blood gas blood gases type temp rates tidal v peep fio2 o2 flow po2 pco2 ph caltco2 base xs intubat 09:45am art 73* 41 7.44 29 3 03:09am art 36.7 201* 44 7.41 29 3 not intuba1 1 not intubated pituitary tsh 02:30am greater th1 1 greater than 100 thyroid t4 t3 calctbg tuptake t4index free t4 08:09am 3.2* 56* 1.21 0.83 2.7* radiology preliminary report video oropharyngeal swallow 9:37 am reason: eval for swallowing efficiency medical condition: 69 year old woman with s/p tracheostomy, s/p thryoidectomy. now w/ fair video swallow- needs video reason for this examination: eval for swallowing efficiency indications: 69-year-old woman status post tracheostomy and thyroidectomy with bronchomalacia, with swallowing difficulty. technique: videotaped oropharyngeal swallowing study. findings: the study was performed in conjunction with the speech and swallow pathologist. various consistencies of barium were administered orally. with all consistencies, the patient showed limited laryngeal elevation and a lack of epiglottic deflection. there was some spill-over with all consistencies as well, including delayed aspiration of residue, to a trace to mild extent, of both thin liquids and pudding. although spontaneous cough was present, clearance was ineffective. because of aspiration, the study was discontinued, suctioning performed via the tracheostomy tube by the radiology nursing staff. the oxygen saturation was checked at the end of the study, found to be 98%. impression: trace-to-mild aspiration with multiple consistencies, with ineffective cough clearance. please see the report of the speech and swallow pathologist for further details. radiology preliminary report video oropharyngeal swallow 9:37 am video oropharyngeal swallow reason: eval for swallowing efficiency medical condition: 69 year old woman with s/p tracheostomy, s/p thryoidectomy. now w/ fair video swallow- needs video reason for this examination: eval for swallowing efficiency indications: 69-year-old woman status post tracheostomy and thyroidectomy with bronchomalacia, with swallowing difficulty. technique: videotaped oropharyngeal swallowing study. findings: the study was performed in conjunction with the speech and swallow pathologist. various consistencies of barium were administered orally. with all consistencies, the patient showed limited laryngeal elevation and a lack of epiglottic deflection. there was some spill-over with all consistencies as well, including delayed aspiration of residue, to a trace to mild extent, of both thin liquids and pudding. although spontaneous cough was present, clearance was ineffective. because of aspiration, the study was discontinued, suctioning performed via the tracheostomy tube by the radiology nursing staff. the oxygen saturation was checked at the end of the study, found to be 98%. impression: trace-to-mild aspiration with multiple consistencies, with ineffective cough clearance. please see the report of the speech and swallow pathologist for further details. date: signed by , ccc-slp on affiliation: deferred passy muir valve consult thank you for referring this 69 y/o cambodian speaking female with recent h/o thyroid goiter, thyroidectomy, trach and peg placement. pt was admitted to osh with worsening sob and increased upper airway secretions, thought to have uri. pt was transferred here on for further management. pmh includes thyroid ca, tracheal stenosis with trach, uti, pna, dm, htn, possible hypoxic brain injury, cva, asthma, b-cell lymphoma s/p chemo, hiatal hernia. pt was seen by our service during the previous admission for a pmv and swallow evaluation. pt was unable to tolerate placement of the passy muir valve due to severe upper airway obstruction which prohibited her from being able to exhale adequately via the upper airway (nose and mouth) around the tracheostomy tube. with regards to swallowing, the pt had fees exam completed on that revealed "moderate pharyngeal dysphagia at with overt aspiration of secretions, thin and nectar thick liquids. while aspiration of puree material could not be confirmed due to limited appreciated of the trachea and vocal cords, there was frank penetration of purees, indicative of risk for aspiration with this consistency as well. the pt's limited abduction of the arytenoid cartilages made it difficult to appreciate vocal cord movement, but also made it highly unlikely that the pt could tolerate a speaking valve or even finger occlusion, regardless of the current trach tube." we were consulted this admission for a passy muir speaking valve. however, it was noted on the bronchoscopy completed on that there was "supraglottic edema" though the vocal cords looked "functional and normal in appearance". there was stenosis around the entry site of the tube and the bronchoscope could not be passed "alongside the tracheostomy tube even with the cuff down on the tracheostomy tube". the bronchoscope was passed "down the tracheostomy tube" where "absolutely no stenosis or foreign body occluding either the lumen of the tube or the airway of the distal trachea down to the segmental airway level bilaterally" was appreciated. given the pt's prior h/o inability to tolerate the passy muir valve with this current trach tube, supraglottic edema, and the limited airspace around the trach tube such that the bronchoscope could not be advanced around the trach tube, it is not felt that the pt will be able to tolerate the pmv at this time. while the pt may be able to inhale with the valve, she would not be able to exhale around the trach tube and through the oropharynx. the pt still has , #7, cuffed tts, extra long, flexible trach tube in place. for be unable to tolerate the pmv at this time given her stenosis and her current trach tube. i discussed with him that perhaps with a smaller trach tube the pt may be able to tolerate the valve, but that i did not know if that would be feasible and if the pt would have any difficulty with inhalation with a smaller trach tube. additionally, given the documented supraglottic edema, i discussed that i could not be sure that she would be able to exhale out the pharynx even if she had adequate airflow around particular trach that would be inserted, just that the pt was scheduled for a bronch/trach change today. as such, i discussed that we would follow up with the pt tomorrow to determine if she is a candidate for a passy muir valve at that time. , ms # operative report surgeon: , assistant: dr. . preoperative diagnoses: respiratory failure, status post tracheostomy, tracheal stenosis. postoperative diagnoses: respiratory failure, status post tracheostomy, supraglottic edema, subglottic edema and tracheal stenosis. procedure: rigid bronchoscopy. indications for procedure: assess airway patency. description of procedure: after informed consent was obtained, was brought to operating room thereafter where general anesthesia was employed by anesthesia in order to insure comfort and safety throughout the procedure. was intubated with a black rigid tracheoscope. as we approach her oropharynx with the tracheoscope there was redundant soft tissue at the level of the oropharynx, at the level of the supraglottic area the false vocal cords were edematous and difficult to visualize. the tracheoscope was advanced into the vocal cords and we could appreciate an area of subglottic edema, mild stenosis. the tracheoscope was not able to be passed through this area and at that point we stopped the procedure. impression: supraglottic edema, subglottic edema, tracheal stenosis. the patient should remain with her current tracheostomy tube and should return to the special procedures unit within 4 to 6 weeks for a flexible bronchoscope and reassessment of her airway anatomy. complications: none. attending physician: , md signed by , ccc-slp on affiliation: blue dye bedside swallowing evaluation: history: we returned today to follow up on this 69 y/o cambodian speaking female with recent h/o thyroid goiter, thyroidectomy, trach and peg placement. pt was admitted to osh with worsening sob and increased upper airway secretions, thought to have uri. pt was transferred here on for further management. we were initially consulted for a passy muir valve, however the pt's prior h/o inability to tolerate the passy muir valve with this current trach tube, the limited airspace around the trach tube such that the bronchoscope could not be advanced around the trach tube, and the current findings from yesterday's bronch that revealed supraglottic edema, subglottic edema and tracheal stenosis, it was felt that the pt would not be able to tolerate the pmv. however, np, pt's team would also like to be evaluated for swallowing. she has been evaluated in the past, but the recommendations were for npo with enteral nutrition/hydration via the peg tube. this status continues currently. evaluation: the examination was performed while the patient was seated upright in the bed. cognition, language, speech, voice: awake, alert, and participatory. pt required visual cues/models to follow commands for the oral motor exam given difficulty with the language barrier. teeth: in fair condition, noted some teeth missing secretions:oral secretions wfl. rn reports that the pt's tracheal secretions have not been excessive and she has not required frequent suctioning. he also reported that the pt has a strong cough. oral motor exam: wfl for labial and lingual strength, rom, and symmetry. palatal elevation was symmetrical. blue dye swallowing assessment: po swallowing assessment was completed at bedside with thin liquids and purees colored with food coloring. rn was present to suction the pt after bolus administrations. oral transit was timely and no oral residue was appreciated. laryngeal elevation was difficult to palpate due to presence of the trach tube. no coughing or throat clearing was appreciated. vocal quality cannot be assessed as the pt is unable to voice with her edema/stenosis. no return of po material was appreciated via the trach tube after suctioning. summary / impression: pt is not demonstrating any overt s&s aspiration at bedside today. however, given her prior h/o aspiration and dysphagia and current tube feeding dependency, would recommend that the pt receive a video swallow study prior to any advancement to a po diet at this time. recommendations: 1. remain npo with enteral nutrition at this time. 2. video swallow study on . these recommendations were shared with the patient, nurse and medical team. oropharyngeal videofluoroscopic swallowing evaluation evaluation: an oral and pharyngeal swallowing videofluoroscopy was performed today in collaboration with radiology. one tsp. of thin liquid, 2 tsp's and one sip of nectar-thick liquid, and 2 tsp's of pureed consistency barium were administered. results follow: oral phase: bolus formation, bolus control and anterior to posterior tongue movement were mildly impaired. premature spillover was consistently seen into the pharynx prior to initiation of the swallow. after the swallow, there was a mild amount of oral cavity residue that spilled into the pharynx triggering a spontaneous swallow. after the second swallow, a trace amount of residue or coating was observed on the tongue and in the valleculae. pharyngeal phase: there was a mild to moderate delay in initiation of the pharyngeal swallow. once started, palatal elevation, pharyngeal bolus propulsion and upper esophageal sphincter relaxation were normal. laryngeal elevation was moderately reduced. epiglottic deflection was absent. after the swallow, a mild amount of residue remained on the base of the tongue and in the valleculae. a spontaneous repeat dry swallow cleared this to a trace amount or a coating. aspiration/penetration: a trace to mild amount of aspiration occurred after the 5th & 6th swallows, after the 2nd bite of pudding and after the tsp of thin liquid. aspiration occured after the swallow and it was due to trace residue mixing w/secretions and dropping into her airway. due to her trach which can not be capped with a passy-muir valve due to severe tracheobronchomalaica, she was unable to cough to clear material from the airway. the study was stopped and nursing was called to deep suction the patient. o2 saturation after suctioning was 98%. summary: is not safe to take anything po because small amounts of residue remaining in her mouth, on her base of tongue and in her valleculae mix with pharyngeal secretions causing a small amount of aspiration after the swallow with all consistencies. she is unable to cough and clear the aspirated material because her trach can not be capped due to her severe tracheobronchomalacia. recommendations: 1. remain strictly npo w/peg feedings 2. repeat videoswallow when the supraglottic and subglottic edema has decreased brief hospital course: pt with above history presents to w/ sob and congestion. has bee maintained at home in care of duaghter and her husband w/ difficulty maintaining care w/ maximal home support arranged by w/ 6 ed admisssions over the past 6-8 weeks. pt has been having increased sob x4-5 weeks and noted to have 30-40% stenosis distal tracheal by bronch in ed. started on levoquin x4 days for uri. transferred to for evaluation by interventional pulmonary on . hd#1- aggressive pulmonary toilet of nebs and tracheal suctioning done w/ clearer breath sounds. central venous line placed for access. trach mask .40 95% sat. hd#- flexible bronchoscopy-- edema soft tissues superior to cords; + tracheobrochial malcia, subglottic stenosis.unable to do trach change due to edema. plan for rigid bronchoscopy. hd# now at baseline resp status w/ pulmonary toilet, nebs, suctioning. hd# hct= 28.7/ wbc wnl;d/c foley. tsh>100; t4=.5. endocrine contact. pt had just started levothyroxine 137 mcg , not started in hospital but was on short acting t3 rx ofliothyronine 12.5 . lioth d/c and levothyroxine 137 resumed. please refer to outpt endocrine notes provided for ongoing care plan. rigid bronchoscopy done in afternoon- superand intrglottic swelling, unable to change trach- see operative note for details. patient transferred to floor post-op in stable condition. hd#5//ppd#1- pt stable, resp status at baseline. pt consult, tube feedings resumeed and advanced to goal w/o complicaiton. disposition planning done in coordination w/ family considering the demands. screening for acute rehab. hd#- pt/ot consults and therapy done. bedside swallow eval, eval for passey/muir valve, and video swallow done. swallow eval= aspiration, maintain npo and cont peg tubefeedings to prevent aspiration. see notes in results for details. cvl d/c'd w/o complication. patient oob, stable. accepted at acute rehab facility- - , nh. . patient stable for transfer to facility afternoon. medications on admission: colace, promote with fiber at 50cc/hr, liothyronine 12.5", ca carbonate 500"', lansoprazole 30', metoprolol 37.5"', nph 20", discharge medications: 1. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours). 2. albuterol sulfate 0.083 % solution : one (1) neb inhalation q6h (every 6 hours). 3. docusate sodium 150 mg/15 ml liquid : fifteen (15) cc po bid (2 times a day). 4. metoprolol tartrate 25 mg tablet : 1.5 tablets po tid (3 times a day) as needed for per g-tube. 5. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection (2 times a day). 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. levothyroxine 137 mcg tablet : one (1) tablet po daily (daily). 8. insulin regular human 100 unit/ml solution : as dir units injection four times a day: q achs per finger stick. 9. insulin nph human recomb 100 unit/ml suspension : twenty (20) units subcutaneous twice a day: q am qpm. discharge disposition: extended care facility: discharge diagnosis: diabetes mellitus type 2, hypertension, hiatal hernia, b12 defidiency, b cell lymphoma, s/p chemotherapy, coompressing papillary cancer, s/p thyroidectomy c/b sepsis, pna, tracheostomy, peg tube, tracheal stenosis. discharge condition: good discharge instructions: call dr/ interventional pulmonary office or thoracic surgery office for : fever, shortness of breath, chest pain, or other breathing issues or post procedure issues. followup instructions: interventional pulmonary office bronchoscopy in weeks from --approx week of last week of 9:00 am , thoracic unit-cc9 1:00 pm xct radiology 15 -- airway ct bronchoscopy 9:00 am daycare,eight day care 8 240-- bronchoscopy 10:00 am , . procedures 90 10:00 am ip,room one ip rooms 90 10:00 am ip,staff ip procedures 90 2:30 pm , j. endocrinology-cc7 (sb) 30 procedure: enteral infusion of concentrated nutritional substances bronchoscopy through artificial stoma tracheoscopy through artificial stoma diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled asthma, unspecified type, unspecified other malignant lymphomas, unspecified site, extranodal and solid organ sites gastrostomy status chronic respiratory failure tracheostomy status personal history of malignant neoplasm of thyroid 

Answer: The patient is high likely exposed to