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: all drug allergies previously recorded have been deleted attending: chief complaint: vomiting major surgical or invasive procedure: endoscopy history of present illness: this is a 57 yo woman with borderline mental retardation, dmii, ?gastroparesis, who was seen in clinic today with a complaint of vomiting since sunday. in the clinic, the patient was noted to be hypotensive with sbps in the 80s. she was subequently sent to the ed for further evaluation. in the ed, the patient was noted to have a temp of 99.6, bp 128/82, hr 102, rr 19 and o2 sat 100% on ra. she was given a po challenge of water but was was noted to be spitting up anything she attempted to drink. she was given 2 liters of normal saline and admitted to medicine. . on arrival to the floor, the patinet reports difficulty swollowing for several years. she has not noted any specific progression of her symptoms. starting saturday night, however, the patient reports a fever to 104 and an inability to take anything by mouth without it coming back up. she has difficulty describing her vomiting, as she say the at times she vomits food, but most of the time, she is spitting up "foam". she reports that the food feels as though it is getting stuck in her throat. she denies esophageal pain, per se, but endorces a discomfort in the region of her lower throat. besides the reported fever to 104, the patient denies any additional symptoms including chills, nausea, diarrhea, abdominal pain. she denies sick contacts. . review of systems is otherwise negative for dizziness, changes in bowel or urinary habits, chest pain. she endorces weight gain over the last year (30lbs) as well as chronic joint pains and headache. she states she believes she had a partial seizure 2 days ago (leg shaking) but has had seizures/neurologic symptoms otherwise. all other ros is negative. past medical history: - mild mental retardation - dm, onset age 51 (poorly controlled, does not check fs; a1c 9.7%) - neuropathy - dysphagia - hx of with spontaneous remission - pvd, angioplasty of r femoral in - seizure disorder (per pt focal, partial) - lower back pain s/p fall, followed in chronic pain clinic - posterior mediastinal mass since , stable (likely neurofibroma). - hyperlipidemia - urinary incontinance - pneumonia () - ? gastroparesis- normal gastric emptying, no reflux in endoscopy with ? ; biopsy negative. . surgical history - angioplasty as above () - appendectomy . psychiatric history: patient reports going up in state care. she has a history of an impulse control disorder. she reports that she is not currently not seeing any psychiatrists. she has discontinued her use of amitriptyline. social history: the patient lives alone. she is disabled and on social security. dmr caseworker (phone #) . sister . gets home services from elder services through case worker tobacco: smoker since the age of 3, 2 packs per day. quit etoh/drugs: none family history: ovarian cancer, diabetes in mother and grandmother physical exam: t=98.7 bp=130/60 hr=95 rr=20 o2=100% . physical exam general: thin, dissheveled appearing, pleasant woman in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. dentures in place op clear. neck supple, no lad, no thyromegaly or erythema. tender to palpation over thyroid/cricoid cartilage. cardiac: regular rhythm, mildly tachycardic. normal s1, s2. no murmurs, rubs or . no appreciable jvd lungs: ctab, good air movement biaterally. abdomen: old midline scar. nabs. soft, nt, mildly distended. no hsm extremities: no edema or calf pain, 1+ dorsalis pedis/ posterior tibial pulses. 2+radial pulses skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. 1+ reflexes, equal bl. normal coordination. normal gait. psych: increased prosity of speach, tangential but directable. otherwise, listens and responds to questions appropriately. pertinent results: 12:00pm plt count-269 neuts-71.3* lymphs-22.4 monos-3.8 eos-1.2 basos-1.3 wbc-7.8 rbc-4.95 hgb-15.2 hct-40.5 mcv-82 mch-30.6 mchc-37.5* rdw-12.7 %hba1c-9.2* albumin-4.4 calcium-9.8 phosphate-3.5 magnesium-1.9 alt(sgpt)-16 ast(sgot)-16 ld(ldh)-216 alk phos-98 tot bili-0.6 glucose-154* urea n-25* creat-0.8 sodium-142 potassium-4.3 chloride-102 total co2-25 anion gap-19 . video oropharyngeal swallow study date of 1:11 pm pa and lateral chest, at 13:47 hours history: history of gastroparesis and inability now to tolerate p.o. comparison: multiple priors, the most recent dated . findings: the lungs remain hyperexpanded. no focal consolidation or superimposed edema is seen. mild tortuosity is noted at the aortic arch. a small hiatal hernia is evident. otherwise, the mediastinum is unremarkable with no radiographic findings suggestive of pneumomediastinum. the cardiac silhouette is within normal limits for size. no effusion or pneumothorax is noted. mild degenerative changes are noted in the mid and lower thoracic spine. impression: no acute pulmonary process. . radiology abdomen (supine & erect) supine and upright abdomen, at 1359 hours. comparison: multiple priors, the most recent dated . findings: no free intraperitoneal air is identified. there is a nonobstructive bowel gas pattern in the small bowel. extensive stool is seen throughout the colon including the rectum. the stomach is nondilated. there are no radiographic findings of ascites or organomegaly. a small hiatal hernia is incidentally noted. impression: small hiatal hernia with extensive stool throughout the colon. non-obstructive bowel gas pattern with no free air. incidental note is made of surgical clips grouped and projecting over the right hip. ct neck w/contrast (eg:parotids) study date of 4:33 pm impression: no mass or evidence of airway obstruction. note added at attending review: i agree with the above, but note that the mid esophagus is distended, with material within it. for evaluation of dysphagia, a barium swallow may be helpful. video oropharyngeal swallow study date of 1:11 pm summary: pt presents with normal oropharyngeal swallow function without aspiration. etiology of her intolerance of po appears to be below the level of the upper esophageal sphincter. immediately following this evaluation, pt was taken for barium swallow study to further evaluate the esophageal phase of the swallow. please refer to radiologist's report, filed separately, for results of that evaluation. this swallowing pattern correlates to a dysphagia outcome severity scale (doss) rating of 7, wnl. recommendations: 1. further esophageal work up prior to re-initiating po. 2. once esophageal phase issues are resolved, pt will likely tolerate return to full oral diet. . esophagus study date of 1:47 pm impression: markedly narrowed long segment of the distal esophagus, concerning for neoplasm, with filling defect more proximally and markedly dilated esophagus, which raises the concern for neoplasm versus retained food. . brief hospital course: the patient is a 57 yo woman with a pmh of dmii, borderline mr and seizure disorder who presents with a 3 day history of vomiting and inability to maintain oral intake. . #. vomiting/esophageal obstruction: the patient reported continued vomiting with all attempted oral intake. after further discussion, it appeared that her inability to take oral nutrition wa related to feelings of dysphagia and rather than actual vomiting. a speech and swallow consult evaluation was conducted. she was found have a normal orpharyngeal response on both bedside and video swallow. however, she was noted to have an apparent blockage in the upper esophagus. a barium swallow again was consistant with a proximal esophageal obstruction and the gastroenterology service was consulted for egd. an egd was performed while the patient was in the icu which showed retained food and esophageal ulcerations. she was placed on a clear liquid diet and transferred to the floor. her diet was slowly advanced to purees. the patient was discharged with instructions to continue a twice a day ppi and a pureed diet. she was scheduled for a repeat endoscopy in 2 weeks. . #. diabetes: the patient does not check fingersticks at home due to an inability to handle sliding scale. on the morning of hospital day 2, the patient was noted to be hypoglycemic with a blood sugars in the 40s. her lantus was held. over the next 48 hours, her blood sugars were stable in the 100s-200s. she recieved prn insulin but no lantus as she was npo. on hd#4, the patient's bicarbonate was noted to be 10 (an acute drop from the previous am value of 21). venous blood gas was notable for a ph of 7.14. the patient was started on d5 with bicarb and an endocrine consult was called. it was felt that the patient's presentation was consistant with diabetic ketoacidosis and she was transferred to the icu for closer monitoring. in the icu the patient's blood sugars were much better controlled. her non-gap and gap acidosis resolved with fluid resuscitation of d5ns and insulin therapy. the patient was discharged on a lower dose of lantus (22units every morning) and was instructed to follow up with her pcp, . . per the endocrine consult team, it was felt that the patient may have type i diabetes and may benefit from antibody studies in the future. . #. seizure disorder: per pt; these have been a life-long issue. the patient reported not taking carbamezapine regularly but prn. there was no evidence of seizure while hospitalized. . #. peripheral neuropathy: the patient reported a history of lower extremity neuropathy for which she took nortriptyline. according to the patient, she continued to have intense, burning pain in her legs daily, especially at night. given a noted allergy to neurontin, the patient was given a prescription for cymbalta on discharge and instructed to follow up with her pcp. . #. hyperlipidemia: the patient was continued on simvastatin. medications on admission: 1. clonazepam 0.5 mg po tid 2. simvastatin 40 mg po hs 3. ibuprofen 400 mg tablet 1-2 tablets 4. omeprazole 20 mg capsule qd 5. clotrimazole - 1 % cream - apply for 1 week; repeat prn 6. insulin aspart 6 units w/meals tid 7. insulin glargine 22 units qam 8. trazodone - 50 mg tablet qhs 10. loratadine - 10mg tablet prn allergies 11. glucerna- liquid - 1 can by mouth twice a day 12. tegratol 200mg (per patient, taking prn) discharge medications: 1. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). 2. simvastatin 40 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 3. ibuprofen 400 mg tablet sig: 1-2 tablets po q12 () as needed. 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day for 3 weeks. disp:*42 capsule, delayed release(e.c.)(s)* refills:*0* 5. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day) as needed. 6. carbamazepine 200 mg tablet sig: one (1) tablet po tid (3 times a day). 7. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 8. loratadine 10 mg tablet sig: one (1) tablet po once a day as needed for allergy symptoms. 9. glucerna shake liquid sig: one (1) po twice a day. 10. cymbalta 30 mg capsule, delayed release(e.c.) sig: capsule, delayed release(e.c.)s po once a day: please take 1 capsule per day (30mg) for 1 week then 2 capsules (60mg) per day thereafter. disp:*90 capsule, delayed release(e.c.)(s)* refills:*0* 11. insulin aspart 100 unit/ml insulin pen sig: six (6) units subcutaneous with each meal. 12. insulin glargine 100 unit/ml solution sig: twenty two (22) units subcutaneous qam. discharge disposition: home discharge diagnosis: esophageal impaction diabetes diabetic ketoacidosis peripheral neuropathy discharge condition: the patient was hemodynamically stable, afebrile and without pain at the time of admission. discharge instructions: you were admitted for evaluation and treatment of vomiting and throat pain. you were found to have food stuck in your esophagus and this was removed by endoscopy. a study of your throat showed that you have a possible narrowing of your esophagus and you will need a repeat endoscopy in 2 weeks. it is recommended that you continue to eat a modified diet consisting of ground up food to avoid having food get stuck again. please be sure to chew all food well and to eat slowly. . the food stuck in your esophagus caused irriation and you will need to take a medication (omeprazole) for the next 3 weeks to help your esophagus heal. . during this hospitalization, you were noted to have low blood sugars and you required a short stay in the intensive care unit while we corrected your blood sugars. you were seen by the endocrinologists who felt your symptoms were due to your inability to eat and changes to your insulin regimen during your illness. the have recommended that you take the following insulin at home: 22units lantus in the morning 6 units of novolog with each meal . because of the pain in your legs, we are discharging you with a new medication called cymbalta. . please follow up with dr. next week. in the meantime, please call your doctor or seek immediate medical attention if you develop a fever, inability to swallow, shortness of breath, chest pain, nausea, vomiting or any other symptom of concern. . followup instructions: endoscopy appointment: provider: (st-3) gi rooms date/time: 12:30 provider: , md phone: date/time: 12:30 gastroenterology follow up provider: , md phone: date/time: 10:30 . follow-up with dr. : monday , 9am . provider: lab phone: date/time: 10:15 provider: , md phone: date/time: 11:15 procedure: other endoscopy of small intestine removal of intraluminal foreign body from esophagus without incision diagnoses: personal history of tobacco use mononeuritis of lower limb, unspecified other and unspecified hyperlipidemia disorders of phosphorus metabolism long-term (current) use of insulin diabetes with other specified manifestations, type ii or unspecified type, uncontrolled localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy stricture and stenosis of esophagus ulcer of esophagus without bleeding foreign body in esophagus mild intellectual disabilities inhalation and ingestion of food causing obstruction of respiratory tract or suffocation diabetes with ketoacidosis, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to