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: copd flair, hypercarbic respiratory failure major surgical or invasive procedure: intubated (3x), central line (2x), arterial line (2x) history of present illness: 77 year old woman with a history of copd (fev1 0.4/fvc 1.2 in ), on chronic home o2 at 3l, nocturnal bipap at night for hypercarbia, who was directly admitted to micu from the clinic by dr. for management of copd with mental status changes and abg of 7.29/96/101. . ms. has been in her usual state of health until several months ago when whe started to complain of has which were attributed to her hypercarbia. her nocturnal bipap settings were changed from to 13/5, however, the patient did not do well on these new settings and developed abdominal distension that made her dyspnea worse. in the last few weeks she completed two courses of levaquin and prednisone for copd exacerbation. she did have cough productive of yellow sputum and increased shortness of breath. she completed last course of prednisone taper last firday, 4 days prior to this admission. prior to her current admission, she has had increased confusion and was noted to be more lethargic and somnolent at home. the patient was seen in the ed complaining of subacute progressive episodes of confusion and forgetrullness, on , where her abg was 7.36/77/63. hco3 39. head ct was done and was negative for intracranial hemorrhage but did show suprasellar mass. she then was discharged home. over the weekend, she reports that she did not feel well. on , the day of admission, she saw her pulmonologist, and an abg showed 7.29/96/101. following these labs, she was admitted to the micu. . she denies fevers, chills, nightsweats. she does complain of nausea, no vomiting, and diminished appetite while on prednisone. she denies urinary urgency, frequency or incontinence. no chest pain. past medical history: 1. copd. pfts on showed fev1 0.4, fvc 1.2. on o2 chronically, 4l when active, 2l at rest. one prior intubation at time of diagnosis in . followed by dr 2. hypertension 3. hypercholesterolemia 4. lung mass (lingula), enlarging, on chest ct, presumed neoplasm, 10 mm in . 5. sellar mass ?????? noted on head ct , thought to be benign pituitary adenoma, prolactin nl, tsh slightly elevated at 4.9 6. anxiety/depression 7. impaired glucose tolerance ?????? 2hr glucose of 197, hgba1c of 6.2 . no polyuria, polydipsia, visual changes 8. bilateral cataract surgery social history: ~70pack years. no etoh. lives in () with 2 sons, 3 other children live nearby. husband died a couple of decades ago. not formerly employed. family history: father died at 80 of lung cancer (smoker). mother at 79 from ??????diabetes??????. four sisters in good health, one died from ??????alcohol??????. five children. one son with cancer at age 50. physical exam: vitals 98.6 117/52 122 25 92% on 3l nc gen: elderly woman lying in bed, no apparent distress, able to speak in full sentences heent: ncat, mucous membranes dry, oropharynx clear, eomi. +dentures. surgical pupils. neck: supple, no bruits, no masses, no lad. jvd non-elevated. cv: nl s1, s2. no murmurs, rubs, gallops. pulm: soft crackles bilaterally, decreased air movement, no wheezes back: no cva tenderness, no spinal tenderness abd: nabs, soft, nt, nd, no organomegaly ext: warm, well-perfused. no clubbing, cyanosis, or edema. dp 1+ bilaterally skin: no exanthems neuro: alert and oriented x 3. confused at times, but answers questions appropriately. cnii-xii intact. motor: good tone, strength in upper and lower extremities; sensation: intact to light touch and vibration sense in upper and lower extremities bilaterally. reflexes: 1+ in ue and le bilaterally. pertinent results: 08:37pm blood wbc-10.3 rbc-4.19* hgb-13.2 hct-41.5 mcv-99* mch-31.5 mchc-31.8 rdw-13.3 plt ct-254 04:39am blood wbc-12.8* rbc-4.12* hgb-12.8 hct-39.5 mcv-96 mch-31.0 mchc-32.4 rdw-13.4 plt ct-323 02:58am blood wbc-19.1* rbc-3.95* hgb-12.4 hct-37.4 mcv-95 mch-31.5 mchc-33.3 rdw-13.6 plt ct-271 04:26am blood wbc-18.6* rbc-3.87* hgb-11.7* hct-37.9 mcv-98 mch-30.2 mchc-30.8* rdw-13.4 plt ct-83*# 04:01am blood wbc-47.6*# rbc-3.49* hgb-11.0* hct-33.2* mcv-95 mch-31.5 mchc-33.1 rdw-13.6 plt ct-164 04:09am blood wbc-33.5* rbc-3.51* hgb-11.0* hct-34.4* mcv-98 mch-31.2 mchc-31.9 rdw-13.2 plt ct-157 04:40am blood wbc-19.9* rbc-3.29* hgb-10.4* hct-32.0* mcv-97 mch-31.5 mchc-32.4 rdw-13.3 plt ct-150 03:08am blood wbc-18.1* rbc-3.42* hgb-10.7* hct-32.1* mcv-94 mch-31.2 mchc-33.3 rdw-13.3 plt ct-140* 03:29am blood wbc-17.4* rbc-3.30* hgb-10.1* hct-31.9* mcv-97 mch-30.7 mchc-31.7 rdw-13.1 plt ct-138* 03:40am blood wbc-15.0* rbc-3.28* hgb-10.5* hct-31.1* mcv-95 mch-31.9 mchc-33.7 rdw-13.5 plt ct-151 04:10am blood wbc-19.1* rbc-3.41* hgb-10.9* hct-32.7* mcv-96 mch-32.1* mchc-33.4 rdw-13.5 plt ct-152 08:37pm blood neuts-76* bands-2 lymphs-10* monos-5 eos-5* baso-0 atyps-2* metas-0 myelos-0 03:02am blood neuts-93.7* bands-0 lymphs-2.6* monos-3.4 eos-0.1 baso-0.1 04:26am blood neuts-95.7* bands-0 lymphs-1.7* monos-2.2 eos-0.3 baso-0.1 04:09am blood neuts-98.3* bands-0 lymphs-0.8* monos-0.8* eos-0.1 baso-0 04:16am blood neuts-96* bands-2 lymphs-1* monos-0 eos-0 baso-0 atyps-0 metas-1* myelos-0 04:10am blood neuts-97.0* bands-0 lymphs-1.8* monos-0.8* eos-0.4 baso-0.1 08:37pm blood pt-12.6 ptt-30.6 inr(pt)-1.1 01:41am blood pt-12.6 ptt-31.7 inr(pt)-1.1 03:53am blood pt-11.9 ptt-35.9* inr(pt)-0.9 04:40am blood pt-11.6 ptt-30.6 inr(pt)-0.9 08:37pm blood glucose-159* urean-9 creat-0.5 na-141 k-4.2 cl-93* hco3-45* angap-7* 01:41am blood glucose-223* urean-9 creat-0.6 na-144 k-4.5 cl-101 hco3-37* angap-11 03:53am blood glucose-124* urean-11 creat-0.4 na-143 k-4.4 cl-103 hco3-35* angap-9 08:45am blood glucose-175* urean-13 creat-0.5 na-142 k-4.1 cl-97 hco3-41* angap-8 04:09am blood glucose-190* urean-12 creat-0.3* na-140 k-4.2 cl-98 hco3-39* angap-7* 03:08am blood glucose-88 urean-16 creat-0.4 na-142 k-3.6 cl-95* hco3-42* angap-9 03:32am blood glucose-178* urean-15 creat-0.3* na-139 k-4.3 cl-93* hco3-43* angap-7* 04:10am blood glucose-145* urean-14 creat-0.3* na-137 k-4.4 cl-93* hco3-39* angap-9 08:37pm blood alt-11 ast-17 alkphos-89 01:41am blood ck-mb-notdone ctropnt-<0.01 08:37pm blood albumin-4.1 calcium-9.8 phos-3.4 mg-2.1 04:39am blood calcium-9.1 phos-1.6*# mg-1.9 03:53am blood calcium-9.4 phos-3.1 mg-2.1 08:45am blood calcium-9.0 phos-1.6*# mg-1.9 04:09am blood calcium-9.0 phos-2.1* mg-2.0 04:16am blood calcium-9.2 phos-2.9 mg-2.0 02:48am blood calcium-9.0 phos-3.2 mg-2.0 03:32am blood calcium-9.0 phos-4.1 mg-2.2 04:10am blood calcium-9.2 phos-4.4 mg-2.2 08:37pm blood tsh-2.3 03:37am blood free t4-0.8* 02:38pm blood cortsol-40.4* 01:59pm blood cortsol-32.5* 04:13pm blood type-art po2-101 pco2-96* ph-7.29* calhco3-48* base xs-15 01:07am blood type-art temp-37.1 po2-353* pco2-151* ph-7.14* calhco3-54* base xs-15 intubat-not intuba comment-bipap 04:55am blood type-art temp-36.7 po2-201* pco2-50* ph-7.46* calhco3-37* base xs-10 12:41pm blood type-art temp-37.1 rates-14/0 tidal v-550 peep-5 fio2-40 po2-146* pco2-55* ph-7.44 calhco3-39* base xs-11 04:13am blood type-art temp-36.0 po2-152* pco2-56* ph-7.38 calhco3-34* base xs-6 11:55am blood type-art po2-92 pco2-76* ph-7.24* calhco3-34* base xs-1 03:58pm blood type-art temp-36.1 rates-/20 tidal v-400 peep-5 fio2-35 po2-84* pco2-74* ph-7.29* calhco3-37* base xs-5 intubat-intubated vent-spontaneou 09:21pm blood type-art temp-36.9 rates-/20 tidal v-400 peep-5 fio2-30 po2-72* pco2-75* ph-7.31* calhco3-40* base xs-7 intubat-intubated vent-spontaneou 04:03am blood type-art temp-35.7 rates-/20 tidal v-400 peep-5 fio2-30 po2-68* pco2-84* ph-7.30* calhco3-43* base xs-11 intubat-intubated 03:14pm blood type-art po2-87 pco2-68* ph-7.35 calhco3-39* base xs-8 03:46pm blood type-art po2-60* pco2-60* ph-7.41 calhco3-39* base xs-10 intubat-not intuba 05:28pm blood type-art po2-89 pco2-63* ph-7.43 calhco3-43* base xs-13 02:05am blood type-art po2-133* pco2-66* ph-7.39 calhco3-41* base xs-12 -assist/con intubat-intubated 01:07am blood type-art temp-36.4 rates-/12 tidal v-500 peep-5 fio2-36 po2-93 pco2-67* ph-7.38 calhco3-41* base xs-10 intubat-intubated vent-spontaneou 08:32am blood type-art rates-20/ tidal v-400 peep-5 fio2-35 po2-38* pco2-75* ph-7.37 calhco3-45* base xs-13 -assist/con intubat-intubated 05:03am blood type-art po2-108* pco2-65* ph-7.40 calhco3-42* base xs-12 03:12am blood type- temp-38.3 tidal v-400 peep-5 fio2-35 po2-49* pco2-77* ph-7.38 calhco3-47* base xs-15 intubat-intubated vent-spontaneou 06:37am blood type-art temp-36.9 rates-/14 peep-5 fio2-35 po2-100 pco2-73* ph-7.42 calhco3-49* base xs-19 intubat-intubated 06:35am blood type-art temp-36.6 rates-/8 peep-5 fio2-35 po2-90 pco2-67* ph-7.42 calhco3-45* base xs-14 intubat-intubated 04:55am blood lactate-2.2* 04:28pm blood lactate-1.8 . ct head () stable appearance of the brain parenchyma since the prior examination including unchanged appearance of large round sellar mass. no intracranial hemorrhage noted. . ct-chest () an enlarging mass in the lingula, suspicious for cancer. multiple stable noncalcified pulmonary nodules. new 1.4-cm nodule at the left lung base. attention to this on the followup ct is recommended. severe diffuse emphysema. diffuse esophageal wall thickening with air along the esophageal wall extending from the inlet to the carina, likely esophagitis. . ct-chest/abd/pelvis () 3.5 x 3.3 cm region of inflammatory fat stranding in the midline abdomen, just medial to the g-tube insertion site, most consistent with a phlegmon. no focal fluid collections are identified. this region of inflammation extends from the subcutaneous tissues into the peritoneum. this is most likely related to the recent g-tube manipulation. unchanged left lingula mass. unchanged mediastinal lymph nodes. interval resolution of the left lung base nodule, which likely was infectious in etiology on the prior scan. the esophageal wall thickening, unchanged. emphysematous changes throughout the lungs, unchanged. . cxr () ap chest compared to and , . hyperinflation indicates copd. aside from the left lung nodule, lungs are clear of any focal abnormality. heart is normal size. there is no pneumothorax or pleural effusion. thoracic aorta is tortuous and calcified, but not focally dilated. heart size normal. . cxr () 1. left mid lung zone nodular opacity, which has grown compared to older chest radiographs and is highly concerning for primary lung malignancy. 2. emphysema. 3. minor bibasilar atelectatic changes. . ekg : sinus tachycardia, no ischemic changes, occasional pvcs. . echo ():the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. . cytology (): bal washings positive for squamous cell carcinoma. . micro: . blood cultures: () - mrsa; () ngtd . sputum cultures: (, , ) - mrsa . urine cultures: (, ) - ng . stool cultures: () - c. diff neg . tissue (esophagus) culture () - brief hospital course: hospital course by problem: . 1. respiratory failure. mrs was admitted with hypercarbia and mental status changes. at baseline, she has severe copd with an fev1 of 0.4l, and was on nocturnal bipap with settings of prior to admission without resolution of symptoms, and with abg of 7.29/96/101/48. on admission to the micu, she was placed on bipap and started on a methylprednisolone taper and continued on albuterol and ipratropium. at 10pm that evening, abg was 7.24/115/82/52. at approximately 1am that night, she suffered respiratory arrest, and was emergently intubated and placed on mechanical ventilation with fentanyl and versed sedation. on , her ventilatory requirements were weaned, and that morning she was extubated. however, she quickly went into respiratory distress and was re-intubated. midday, she self-extubated, and with increased work of breathing and respiratory distress, she was again re-intubated. subsequently, she was maintained on mechanical ventilation with continuous sedation via fentanyl and versed. she was evaluated daily for possibility of extubation, but the combination of her anxiety and agitation on lowering of sedation and low tidal volumes with low pressure support led to the conclusion that she was not a candidate for extubation. on , she went to the or and a tracheostomy, left lingular bal, egd, and open g tube were performed. notably she had concretized tube feeds in her esophagus, and follow up formal egd and biopsy were recommended. the procedure was otherwise uncomplicated. post op, her course was marked by tachycardia and hypertension, with sputum cultures continuing to grow mrsa. a 14 day course of vancomycin was completed, and the patient was placed on a 14 day course of linezolid. the patient successfully underwent multiple trach mask trials. on , the patient pulled out her tracheostomy tube; after briefly being intubated, the tracheostomy tube was re-placed that morning, and trach mask trials were re-initiated. . 2. blood pressure. during the intubation on the night of arrival, she became hypotensive with sbps in the 80s and was given ivf boluses and started on phenylephrine and norepinephrine drips. cortisol stimulation test was normal. this episode of hypotension was ascribed to hypovolemia, lv preload dependence, and sedation. following placement of a central line, she was given fluid boluses to maintain cvp 12-14. she was again placed on pressors -- a neosynephrin drip -- on her re-intubation; this pressor requirement quickly resolved. she then maintained her blood pressure ~90-100 systolic, with hypertensive episodes when anxious/agitated. . 3. mrsa bacteremia. on , she spiked fevers to 103.5, developed thickened and copious secretions and failed to wean from vent, and was started on vancomycin and zosyn for presumed vent associated pneumonia. central line and a-line were replaced. central line culture grew mrsa, as did blood cultures and sputum cultures. her wbc jumped to 47.6 with a clear left shift on , and then trended down to baseline (high 10's, low 20s) over the next several days. zosyn was d/c'd and a five day course of gentamicin was added for synergy with vancomycin. tte was negative for vegetations or lesions. by , secretions were no longer thick, and were minimal; wbc was at baseline. her last positive blood culture was from , and surveillance cultures remained no growth. . 4. pneumonia. pt had been treated prior to admission with levaquin for two courses of management of copd flairs. cxr on admission showed bilateral lower lobe interstitial infiltrate concerning for pneuomonia. she was given a five day course of azithromycin for empiric treatment of cap. rapid viral cultures were negative. initial sputum sample was positive for gram positive cocci in pairs, a second sample was negative, and cultures only grew sparse oropharyngeal flora. sputum cultures on grew mrsa, and she was treated with vancomycin, which she was on for mrsa bacteremia, and then linezolid (14 day course, initiated ). . 5. mental status. while intubated, patient was kept on versed and fentanyl drips. however, she had periods of agitation concerning for thrashing movement and for her episodes of self-extubation. after attempting pharmacological intervention with ativan, haldol, ambien, and zyprexa, her regimens were simplified. she was weaned entirely off fentanyl and versed, and maintained only on prn ativan and zyprexa. she continued to have waxing and mental status, requiring restraints at night when in bed. . 6. gi. post-intubation, nutrition was provided by tube feeds of probalance at 55cc/hr. she had an open g-tube placement at the time of tracheostomy, and the g-tube was subsequently used for feeding. ct-abd on done for complaint of abdominal tenderness as well as persistent low grade fevers revealed a phlegmon extending from the subcutaneous tissues to the peritoneum with no focal fluid collections. this was deemed by surgery not concerning for abscess, and the tube remained in use. . 7. hyperglycemia. as an outpatient, she had been described as borderline diabetic, with elevated 2 hr glucose of 197 and hgba1c of 6.2. in addition, she was on steroids while admitted, and consequently her elevated blood glucose levels were managed with insulin drip and then insulin sliding scale with standing nph. . 8. hyperlipidemia. maintained on home dose of lipitor. . 9. lung mass. cytology of bronchoalveolar lavage done at the time of tracheostomy was positive for squamous cell carcinoma. family is aware. medications on admission: ativan 0.5mg po bid prn anxiety albuterol 90mcg ih 2puffs qid prn o2 4l when active, 2l at rest lipitor 20 mg po qd lisinopril 5 mg po qd servent diskus 50 mcg/dose 1 puff asa discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). disp:* units* refills:*0* 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q2h (every 2 hours) as needed. disp:*30 neb* refills:*0* 4. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). disp:*900 mg* refills:*0* 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q2h (every 2 hours) as needed. disp:*60 neb* refills:*0* 6. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) for 1 weeks. disp:*140 ml(s)* refills:*0* 7. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)) as needed for agitation. disp:*30 tablet, rapid dissolve(s)* refills:*0* 8. prednisone 5 mg tablet sig: one (1) tablet po daily (daily) for 1 days: last dose 11/19. disp:*1 tablet(s)* refills:*0* 9. insulin nph human recomb 100 unit/ml cartridge sig: twenty four (24) units subcutaneous qam. disp:*50 cartridges* refills:*2* 10. insulin nph human recomb 100 unit/ml cartridge sig: twenty two (22) units subcutaneous qhs. disp:*50 cartridges* refills:*0* 11. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) for 1 months. disp:*qs mcg* refills:*0* 12. lorazepam 0.5 mg iv q4h:prn agitation 13. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 9 days: 14 day course; started . disp:*18 tablet(s)* refills:*0* discharge disposition: extended care facility: hospital - discharge diagnosis: copd/respiratory failure mrsa bacteremia mrsa pneumonia s/p tracheostomy and open g-tube discharge condition: stable discharge instructions: notify a physician or nurse if you have difficulty breathing, chest pain, abdominal pain, dizziness or any other concerns. followup instructions: your physicians at the rehab center will arrange any necessary follow-up for your lung mass or other conditions. md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus other gastrostomy replacement of tracheostomy tube removal of intraluminal foreign body from esophagus without incision infusion of vasopressor agent diagnoses: urinary tract infection, site not specified unspecified essential hypertension long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled infection with microorganisms resistant to penicillins obstructive chronic bronchitis with (acute) exacerbation other and unspecified hyperlipidemia acute respiratory failure malignant neoplasm of upper lobe, bronchus or lung bacteremia methicillin susceptible pneumonia due to staphylococcus aureus infection and inflammatory reaction due to other vascular device, implant, and graft hypovolemia foreign body in esophagus other gastrostomy complications benign neoplasm of pituitary gland and craniopharyngeal duct 

Answer: The patient is high likely exposed to