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: mevacor / codeine / tegaderm attending: chief complaint: respiratory distress major surgical or invasive procedure: none history of present illness: 76 yo f with recurrent stage iiib nonsmall cell lung ca s/p resection ' and then pleurodesis in (o2 dependent at baseline) presents from rehab with increasing shortness of breath. patient has been dependent on 2l of o2 since her pleurodesis in . she is comfortable at rest but has dyspnea with minimal exertion. on the day of admission she complained of dyspnea at rest beginning at 8 pm. o2 sat per report was 70%s on 2l. rr was 30s. she was transfered to ed. upon arrival to the ed, she was having difficulty speaking in full sentences. abg 7.24/87/87/36. she was placed on cpap with improvement in her respiratory status. repeat abg 7.27/81/155/39. she was also noted to be hypertensive with sbp in the low 200's. she was given iv hydral 10 mg and placed on a nitro gtt with improvement in bp to the 160's, however, her bp decreased to the low 100's when cpap was started. pt expressed to the ed resident that she did not wish to be intubated, however, wanted aggressive cardiac resuscitation. cxr revealed near-total opacification of the left hemithorax. bnp was 58. she was given broad spectrum abx (vanco/levo/flagyl) for suspected post-obstructive pna. upon arrival to the , she was on 100% nonrebreather breathing at 30-35 breaths/minute. abg was 7.25/92/101. at that point the patient expressed that she did not wish to be intubated. she agreed to bipap but only if it was comfortable to her. goals of care were discussed with the patient, dr. (her pcp) and the icu attending and agreement was for comfort to be the ultimate goal. past medical history: 1. non-small cell lung cancer diagnosed in and s/p left lower lobectomy. followed with cxr until when pt developed cough and doe. in cxr showed a new pleural density. ct guided biopsy was non diagnostic. in a new effusion was present and a diagnostic and theraputic thoracentesis and pleurodesis was performed which showed non small cell lung cancer. a pet scan was obtained in which showed uptake in the mediastinal and paraaortic lymph nodes, as well as peri-renal area. patient was started felt not to be a candidate for chemotherapy and was started on tarceva several days prior to admission. 2. osteopenia. 3. hypercholesterolemia. 4. obesity. 5. hypertension. 6. urinary tract infections. 7. irritable bowel syndrome. 8. pap smear, , not satisfactory for interpretation, mammogram, , normal. social history: patient is married. her husband is living at the due to parkinson's disease and moderate dementia. until recently, the patient visited him daily, however, several weeks ago, due to progressive dyspnea she moved into rehab as well. she had worked as a secretary, and her husband is a retired grocer. they deny any occupational or environmental exposures. she smoked two packs a day for 50 years and quit in . she does not use alcohol or other drugs. patient has a son in who is not very involved in her care. family history: her mother died in her 90s from old age, and father died at 72 from a cva. she does not have any brothers or sisters. there is no other malignancy in the family except for maternal grandmother with a history of breast cancer. physical exam: tc 96 bp 122/38 hr 96 rr 27 sat 100% on 100% nrb gen: ill appearing, breathing quickly with paradoxical abdominal movement and costal retractions. cannot speak in full sentances. hennt: perrl, eomi neck: no lad, jvd cv: rrr, nl s1s2, no m/r/g lungs: crackles bilaterally in all lung fields. diffuse wheezes. abd: soft, nt/nd, +bs, no hsm ext: 3+ pitting edema bilaterally neuro: a&ox3 pertinent results: 04:09am wbc-14.5*# rbc-4.36 hgb-11.9* hct-35.9* mcv-83 mch-27.3 mchc-33.1 rdw-15.8* neuts-86* bands-0 lymphs-5* monos-7 eos-1 basos-0 atyps-1* metas-0 myelos-0 hypochrom-2+ anisocyt-1+ poikilocy-1+ macrocyt-normal microcyt-1+ polychrom-occasional ovalocyt-1+ stippled-occasional plt count-481*# pt-13.1 ptt-23.4 inr(pt)-1.1 ck-mb-4 probnp-58 glucose-174* urea n-8 creat-0.7 sodium-138 potassium-4.1 chloride-96 total co2-36* anion gap-10 ck(cpk)-45 lactate-1.0 . . cxr : interval near-total opacification of the left hemithorax, likely secondary to pleural effusion and soft tissue density, perhaps secondary to the patient's history of metastatic disease. interval worsening of congestive heart failure with increased size of bilateral pleural effusions. . pet : findings consistent with left lung cancer and left pleurodesis. fdg-avid lymph nodes in ap window (suv 11.9), left internal mammary (suv 9.3), left & right hila (suv 8.2, 7.6), pre-cardiac (suv 6.7) and likely para-aortic (suv 8.0) at the level of the upper pole to the left kidney. . pft's : results are consistent with a restrictive ventilatory defect. since , fvc has decreased 1.55 l (58%) and fev1 has decreased 1.29 l (64%). . mibi : normal myocardial perfusion study. calculated ejection fraction of 74%. brief hospital course: a/p: 76 yo f with recurrent stage iiib nonsmall cell lung ca s/p resection ' and then pleurodesis in presents with increasing shortness of breath. shortness of breath resulting in hypoxic/hypercapnic respiratory failure secondary to worsening nonsmall cell lung ca, increased pleural effusion, and possible post-obstructive pna. pt's respiratory status improved with cpap, however, pt continues to be acidemic with bicarb of 81. patient is not tolerating cpap due to discomfort and expresses the wish to remain comfortable. patient met with dr. , her pcp, the icu attending and goals of care were discussed. it was explained that without intubation the patient would not be able to maintain oxygenation and ventilation. in addition, as she has a reaccumulating malignant effusion, there is little likelihood that her respiratory status could be reversed. patient expressed the wish to be made comfortable. her husband, , came to visit from rehab along with the patient's social worker. the social worker felt that the patient would be most comfortable at rehabiliation center. therefore, she is being transfered to rehab with a goal of comfort care at the end of life. code: dnr/dni medications on admission: 1. aspirin 81 po daily 2. citalopram 40 mg po daily 3. docusate sodium 100 mg po bid as needed. 4. senna po bid as needed for constipation. 5. atorvastatin 5 mg po daily 6. tolterodine 1 mg po bid 7. psyllium po tid as needed. 8. acetaminophen 160 mg/5 ml solution (20) ml po q6h as needed 9. trazodone 25-50 mg po hs 10. zolpidem 5 mg po hs 11. prevacid 30 mg po once a day. 12. bisacodyl 10 mg po bid as needed. discharge medications: 1. morphine concentrate 20 mg/ml solution sig: 0.5-5 ml po q30 min as needed for pain. 2. ativan 0.5 mg tablet sig: 1-2 tablets po q30min as needed for shortness of breath or wheezing. 3. scopolamine base 1.5 mg patch 72hr sig: one (1) transdermal every seventy-two (72) hours as needed for secretions. discharge disposition: extended care facility: for the aged - discharge diagnosis: stage iib non-small cell lung cancer with recurrent malignant pleural effusion hypercarbic and hypoxic respiratory failure discharge condition: critical discharge instructions: mrs. has respiratory failure due to her end stage lung cancer. she has elected not to be intubated. our goal is to make her comfortable. followup instructions: provider: , multi-specialty multi-specialty thoracic unit-cc9 date/time: 9:00 provider: , hematology/oncology-cc9 date/time: 9:00 provider: , m.d. phone: date/time: 9:30 procedure: non-invasive mechanical ventilation diagnoses: congestive heart failure, unspecified unspecified essential hypertension secondary malignant neoplasm of pleura acute respiratory failure malignant neoplasm of other parts of bronchus or lung 

Answer: The patient is high likely exposed to