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: dristan cold attending: chief complaint: hemoptysis major surgical or invasive procedure: bronchoscopy percutaneous gj tube placement radiation therapy history of present illness: 72yo woman with h/o newly diagnosed metastatic cancer (lung vs esophageal primary) with mass compressing the esophagus and left hip met presented with hemoptysis, melana, tachycardia. cancer diagnosed 3 weeks prior after patient noted progressive dysphagia. pt seen by dr. as outpatient who felt patient was not an operative candidate for curative resection. patient was started on weekly taxol/ and xrt treatment(palliative chemo regimen). egd showing nonulcerated submucosal mass. patient also treated for h. pylori . three days prior to presentation the patient noted onset of a nonproductive cough without fevers, chills, chest pain. on the morning of admission at 1am, she awoke with cough productive of bloody sputum. later that morning she passed a large loose black stool x 2. she has had poor po intake for the past week secondary to mass limited her ability tolerate solid food. when she presented earlier today to clinic, she complained of dizziness/lightheadedness and was found to be tachycardic and orthostatic, and was referred to the ed for further evaluation. in the ed, hr 128, bp 151/49, and hct noted to be 29.5 (baseline 36-39), inr also elevated to 1.5. she developed a transfusion reaction with fever. she was pretreated with benadryl and tylenol, and then transfused one unit prbc. she also received 3l ns. gi service was consulted and reported that endoscopy would put the patient at further risk for bleeding due friable esophagus secondary to xrt, and limited therapeutic benefit in face of bleed due to tumor or radiation. thoracic surgery consulted and recommended palliative esophageal stenting after acute bleed resolved, but not acute surgical management of tumor burden. today , patient stable to be called out of icu setting to regular medical floor to be followed by the oncology team. past medical history: cancer- esophageal vs lung, mets to left hip hypertension hypercholesterolemia pvd s/p bypass basal cell skin ca h/o polio as a child h. pylori h/o heartburn social history: widowed x 2 with 4 grown children tob: 1/2ppd x 40yrs, quit 12yrs ago etoh: occasional illicits: none family history: mother d. chf father d. mi 1 brother d. leukemia 1 brother d. cva 1 brother 1 sister with cad physical exam: physical exam on admission : t 97.7 hr 118 bp 123/45 rr 16 95% 2lnc gen: comfortable, lying in bed, nad heent: perrl, anicteric, mmm with blood in op neck: supple, no lad cv: tachycardic, regular rhythm, no m/r/g resp: decreased breath sounds with crackles r base to 1/2 up gi: +bs, soft, nt, nd, no masses, no hsm, vertical midline scar back: nt rectal: little stool in vault, guiaic negative skin: no rashes neuro: cn ii-xii intact, motor and sensation intact grossly physical exam on transfer to omed : vs: t 98.8 hr 126 bp 143/67 rr 18 o2 93% on gen: elderly f sitting in bed with faint voice nad, nasal canula o2 on. heent:perrl. eomi. mm dry. no cervical/ supraclavicular lad cv: tachycardic, regular. no m/r/g. some mild tenderness over lower right anterolateral ribs, mostly over intercostal muscles lungs: decreased bs lower r lung. no crackles. abd: hypoactive bs. soft. nt, nd. no palpable hsm. extr: warm pt 2+ b/l. no palpable cord. no asymmetry. no edema back: nontender. skin: dry. no visible rashes. neuro: cn 2-12 grossly intact, toes downgoing. no focal motor or sensory deficits noted. labs: pertinent results: endoscopic ultrasound (): a 35 x 41 mm heterogeneous mass with irregular borders was identified at 28 cm on the oposite site from the aorta in the mediastinum. the mass could not be traversed with an eus endoscope. no adenopathy was noted. fna x 3 with a linear endoscope was performed--> cytology consistent with non-small cell carcinoma. egd (): a submucosal mass 31 to 28 cm which could be traversed with an endoscope with resistance. chest x-ray(): extensive consolidation in right middle and right lower lobes and to a lesser degree in the right upper lobe and posterior segment of left lower lobe. these findings may be due to massive aspiration, infectious pneumonia, or pulmonary hemorrhage. a more chronic process such as bronchoalveolar cell carcinoma cannot be excluded. follow up radiographs and clinical correlation suggested. ct(): 1) hyperenhancing focus superior to the esophageal mass which abuts the carina, right main stem bronchus and esophagus which could reflect hemorrhage. 2) large lower esophageal mass displacing the left atrium. 3) mediastinal and right hilar adenopathy. 4) extensive alveolar opacities most pronounced in the right lower lobe which could reflect aspiration or hemorrhage. 5) unremarkable aortic bypass graft with no evidence of aortoenteric fistula. transthoracic echo : ef 60%. normal lv. trivial mr. l effusion. brief hospital course: 72yo woman with newly diagnosed metastatic nonsmall cell cancer (esophageal vs lung primary) presenting with hemoptysis, melana, tachycardia. 1. hemoptysis: the patient initially presented with hemoptysis and the ddx included esophageal tumor invading trachea or bronchi, lung cancer, pneumonia vs. aspiration from ugib. her ct scan on admission was concerning for a hemorrhagic lesion, and cxr for an aspiration event. treatment options were limited per thoracic surgery. she was transfused 4 units prbc to maintain a hct >30, and hct stabilized on the second day of admission. the patient suffered a tranfusion reaction consisting of tachycardia, tachypnea, and decreased oxygen saturation that resolved with benadryl and tylenol. she was pretreated for all subsequent transfusions. she had one treatment of xrt ; chemotherapy was held. she underwent bronchoscopy on the second day of admission which showed extrinsic compression of bronchi, blood in the rll c/w aspiration. patient continued to cough up sputum with dried blood, felt to be from aspiration. transferred to the floor in stable condition. 2. melena: patient presented with apparent ugib by history, but was guiaic negative on exam. gi was consulted and initially deferred endscopy unless emergent given risk of bleeding with friability of gastroesophageal mucosa secondary to xrt and limited therapeutic options. the ddx included esophageal tumor, mucositis secondary to xrt, pud, esophagitis, - tear. all services agreed that most likely etiology was tumor. hct remained stable after prbc transfusion. she was continued on iv protonix. diet was advanced to clears on hospital day 2, but she tolerated little in the way of a po diet given the tumor burden on her esophagus. - continue to guaic stools. - will request repeat endoscopy from gi tomorrow to evaluate if tumor has grown. 3. squamous cell cancer of unknown primary source (lung vs esophageal): the patient's palliative treatment regimen consisted of xrt and weekly chemo on admission. she received one xrt treatment on . chemotherapy has been held per dr. and dr. . - will continue to address with dr. when/if plan to resume chemotherapy. - will request dr. continues to discuss prognosis with family. 4. coagulopathy, inr 1.5 on admit: coagulopathy was thought to be nutrional given the patient's poor po intake. a dic panel was negative. tranfusion of ffp was attempted but failed due to tranfusion reaction. as the patient's level of coagulopathy was not so severe as to cause spontaneous bleeding, she was treated with sq vitamin k and monitored. inr has remained stable 1.4-1.5 since admit. 5. tachycardia: the patient presented with tachycardia that was felt to be due acute blood loss causing hypovolemia. she ruled out for mi. echocardiogram showed normal lv function and no pericardial spread of disease causing pericardial effusion. she was fluid rescuscitated but continued to be tachycardic. it was then felt that her tachycardia may be associated with the low grade fevers she experienced and anxiety. she continued in sinus rhythm with hr 100-120s on transfer to the floor. on the third night of admission, she developed acute pulmonary edema secondary to 4-5 liters ivf boluses for treatment of tachycardia. she was subsequently diuresed approximately 3 liters and her oxygenation and tachypnea improved by later that day. - continue aggressive diuresis, goal negative 500cc-1l. 6. arf: creatitine on admission was 1.1 from baseline 0.6, and was thought to be prerenal associated with her acute blood loss. it resolved by the second day of hospitalization after fluid rescusitation. 7. htn: patient has a history of htn treated with hctz. she was normotensive on admission. anti-hypertensives have been held out of consideration for continued blood loss. in the icu, the patient has continued to be normotensive to mildly hypertensive with sbp 140-150s during her hospitalization. - monitor blood pressure. consider resuming anithypertensives if hct remains stable. 8. pulmonary: aspiration pneumonia: on admission, a large rll infiltrate was noted on cxr that was concerning for aspiration pneumonitis, pneumonia, lymphangetic spread versus hemorrhage. today of antibiotics (levofloxacin/clindamycin) for possible aspiration pneumonia. her wbc has improved. she continues to have occasional low grade fevers. cxr today not sig changed from yesterday - continue to monitor respiratory rate, fever and wbc count. - continue nasal canula, wean o2 as tolerated. chf: pulm edema likely related to ivf boluses, improving with diuresis. 9. nutrition: on admission, the patient was kept npo. her diet has been advanced to clears, however she is taking little po per report of icu team. - continue mainenance ivfs. - once pt stabilized, will discuss with thoracic surgery the possibility of palliative esophageal stent. 10. pain: continue to manage pain with fentanyl patch and morphine iv for breakthrough 11. dispo: per icu team, the patient is full code. her son, , is designate health care proxy. we will continue to address code status given prognosis is poor. medications on admission: 1. /taxol 2. lipitor 10mg daily 3. asa 4. hctz 12.5mg daily 5. folate 6. mvi 7. xalatan eye drops 8. fentanyl patch discharge medications: 1. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): per gj tube. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 5. morphine sulfate 10 mg/5 ml solution sig: five (5) mg po q6h (every 6 hours) as needed. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. phenergan 12.5 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 8. ranitidine hcl 15 mg/ml syrup sig: ten (10) ml po twice a day. discharge disposition: extended care facility: of discharge diagnosis: metastatic adenocarcinoma of unknown primary icd-9 199 pelvic metastatic disease pulmonary hemorrhage melena volume depletion acute blood loss anemia esophageal compression with dysphagia hematemesis discharge condition: stable. ambulating well with assistance. tube feeds via gj tube are at goal. patient is afebrile. discharge instructions: call dr. if you have a fever > 101.4, lightheadedness, dizziness, trouble breathing or blood in your stool or black stool. followup instructions: follow up with dr. : provider: , md where: hematology/oncology phone: date/time: 9:00 provider: ,hem/onc hematology/oncology-cc9 where: hematology/oncology phone: date/time: 9:00 md procedure: fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells other radiotherapeutic procedure diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified hypopotassemia pneumonitis due to inhalation of food or vomitus malignant neoplasm of bronchus and lung, unspecified blood in stool hematemesis other and unspecified coagulation defects secondary malignant neoplasm of bone and bone marrow stricture and stenosis of esophagus secondary malignant neoplasm of other digestive organs and spleen 

Answer: The patient is high likely exposed to