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: right hip fracture status post mechanical fall major surgical or invasive procedure: open reduction and internal fixation of right hip intertrochanteric fracture intubation trach and peg placement picc placement egd and colonoscopy history of present illness: pt is an 85yo man who presented to the ed 1 day status post fall, pt relates fall in kitchen while he was attempting to turn around. states he tripped over his own legs, never lost consciousness, and denies associated symptoms before or after the event. pt fell on his right hip, had immediate pain, layed on the floor for a short while, then was able to ambulate with a walker. this morning pain was mush worse so he presented to the ed where he was found to have a right hip fracture. initially the patient was to be admitted to orthopaedics, but was then found to have hyponatremia and was admitted to medicine. the pt has no complaints except for hip pain currently. past medical history: htn prosate ca neuropathy cataracts osteomylitis social history: tob: quit 6 years ago, 50yr hx of cigar smoking /d heavy etoh in the past family history: htn physical exam: on presentation: vitals: 98.8 138/60 78 18 92% ra heent: ncat, perrl, eomi neck: from, nt chest: scattered wheezes bilaterally cardiac: rrr abd: soft nt/nd +bs ext: limited rom of r hip secondary to pain, venous stasis changes bles, no edema pertinent results: 02:55pm blood wbc-9.2 rbc-4.25* hgb-13.5* hct-37.0* mcv-87 mch-31.8 mchc-36.6* rdw-12.8 plt ct-172 05:21am blood wbc-9.0 rbc-3.69* hgb-12.1* hct-32.4* mcv-88 mch-32.8* mchc-37.3* rdw-12.7 plt ct-138* 08:48pm blood wbc-9.1 rbc-3.96* hgb-12.7* hct-35.7* mcv-90 mch-32.0 mchc-35.5* rdw-12.7 plt ct-178 05:22am blood wbc-10.4 rbc-3.42* hgb-11.2* hct-30.5* mcv-89 mch-32.7* mchc-36.6* rdw-12.6 plt ct-173 08:48pm blood plt ct-178 05:22am blood plt ct-173 05:22am blood pt-13.8* ptt-30.7 inr(pt)-1.2* 02:55pm blood plt ct-172 05:21am blood plt ct-138* 02:55pm blood pt-13.0 ptt-27.9 inr(pt)-1.1 02:55pm blood glucose-129* urean-11 creat-0.7 na-118* k-3.6 cl-82* hco3-28 angap-12 09:20pm blood glucose-131* urean-10 creat-0.7 na-119* k-3.5 cl-86* hco3-25 angap-12 05:21am blood glucose-102 urean-10 creat-0.7 na-121* k-3.5 cl-84* hco3-27 angap-14 08:10pm blood glucose-136* urean-16 creat-0.9 na-121* k-3.0* cl-86* hco3-26 angap-12 05:05am blood glucose-111* urean-13 creat-0.8 na-123* k-3.6 cl-89* hco3-27 angap-11 08:48pm blood glucose-131* urean-11 creat-0.8 na-125* k-4.6 cl-89* hco3-29 angap-12 05:22am blood glucose-154* urean-9 creat-0.8 na-126* k-4.6 cl-92* hco3-27 angap-12 08:48pm blood calcium-9.1 phos-3.3 mg-1.9 05:05am blood caltibc-276 ferritn-237 trf-212 05:21am blood osmolal-252* 02:55pm blood osmolal-253* 05:21am blood tsh-0.88 05:21am blood cortsol-16.1 : ua >50 rbc 21-50* wbc mod bact none yeast 0-2 epis bc x 4 ngtd chest (pa & lat) impression: no focal consolidations or chf and no significant change from . chest (pa & lat) impression: 1. no pneumonia or pneumothorax. 2. fracture deformities of the right posterior 7th and 8th ribs, clinical correlation is recommended to determine if there is an acute component. 3. bilateral pleural plaques reflecting asbestos exposure. ct pelvis ortho w/o c ct of the pelvis without contrast: there is a complex fracture line extending through the intertrochanteric region of the right femur. the fracture extends to both the anterior and posterior cortical surfaces. two main fragments are present. there is slight external rotation of the distal fragment with respect to the proximal fragment. no other pelvic fractures are identified. there is moderately severe concentric joint space narrowing in the left hip joint space with extensive osteophyte formation with subchondral cystic change. no fracture plane is visualized. there is mild joint space narrowing in the right hip with osteophyte formation, much less than on the left. there are colonic diverticula without evidence of acute diverticulitis. the appendix is normal. the bladder wall does not appear thickened. the prostate gland is mildly enlarged with several punctate areas of calcification. there is no free fluid in the pelvis. impression: 1. nondisplaced complex fracture through right femoral intertrochanteric region. 2. moderate, non-specific, arthropathy of the left hip. ct of the pelvis without contrast: there is a complex fracture line extending through the intertrochanteric region of the right femur. the fracture extends to both the anterior and posterior cortical surfaces. two main fragments are present. there is slight external rotation of the distal fragment with respect to the proximal fragment. no other pelvic fractures are identified. there is moderately severe concentric joint space narrowing in the left hip joint space with extensive osteophyte formation with subchondral cystic change. no fracture plane is visualized. there is mild joint space narrowing in the right hip with osteophyte formation, much less than on the left. . there are colonic diverticula without evidence of acute diverticulitis. the appendix is normal. the bladder wall does not appear thickened. the prostate gland is mildly enlarged with several punctate areas of calcification. there is no free fluid in the pelvis. . ecg sinus rhythm. a-v conduction delay. left atrial abnormality. p-r interval 0.24. right bundle-branch block. left anterior fascicular block. . ct pelvis/abdomen : comparisons: no prior cts are available on pacs for comparison purposes. technique: mdct acquired axial images from the lung bases to the pubic symphysis were acquired with intravenous and oral contrast material and displayed with 5-mm slice thickness. coronal and sagittal reformations were performed. ct of the abdomen with intravenous contrast: there are calcified pleural plaques at the lung bases consistent with prior asbestos exposure. there also are bilateral pleural effusions and basal atelectasis. an ng tube is seen with the tip in the antrum. the liver contains multiple hypoattenuating lesions, the largest one measuring 2.6 cm in segment vi. these lesions are consistent with metastases in the context of known prostate cancer. gallbladder is collapsed. the spleen and adrenal glands appear unremarkable. the kidneys are notable for cortical atrophy and the right kidney contains a hypoattenuating lesion seen on series 2, image 41, which may represent a cyst but a metastatic focus cannot be excluded. the pancreas appears unremarkable and is mostly fatty replaced. in the region of the cecum and ascending colon, note is made of an irregular-appearing bowel wall, and there is the suspicion of pneumatosis in this region. this may be due to infectious colitis, typhlitis or ischemia. alternatively, the appearance may be caused by fecal material. in the clinical context of bacteremia and guarding, however the concern for pathologic process in the region of the cecum and ascending colon persists. there also is a small amount of fluid tracking down the right paracolic gutter and there is a small amount of fluid surrounding the kidneys and tracking down into the pelvis. as far as this can be evaluated on this study, the aortic tributaries appear patent. no mesenteric or retroperitoneal lymphadenopathy is seen, however there are multiple small retroperitoneal lymph nodes that do not meet size criteria for pathologic enlargement. ct of the pelvis with intravenous contrast: normal-appearing contrast-filled appendix was visualized. sigmoid colon and rectum are unremarkable except for sigmoid diverticuli. bladder is normal, the prostate is enlarged measuring 5.8 cm in transverse diameter. a foley catheter was seen within the bladder. no pelvic or inguinal lymphadenopathy is seen. there is generalized anasarca. bone windows: there is a dynamic hip screw transfixing the right proximal femur. there is dish in the lower thoracic and lumbar spine. also degenerative changes with facet arthropathy in the lumbar spine. no suspicious lytic or blastic lesions are seen. impression: 1. possible pneumatosis in the cecum/ascending colon. this may be due to infectious colitis, typhlitis or due to ischemia. alternatively, the atypical appearance of the bowel wall may be caused by fecal material. 2. innumerable liver metastases. 3. calcified pleural plaques indicating prior asbestos exposure. 4. bilateral basal atelectasis and pleural effusions. 5. no evidence of bowel obstruction. 6. small amount of ascites. 7. enlarged prostate consistent with history of prostate cancer. . ct abd/pelvis: technique: mdct was used to obtain contiguous axial images from the lung bases to the pubic symphysis without administration of iv contrast. oral contrast only was administered. this study was compared with ct scan. ct abdomen without iv contrast: small bilateral pleural effusions and associated compressive atelectasis. calcified pleural plaques at both lung bases unchanged. ng tube is seen coursing below the diaphragm with its tip in the stomach. calcified aorta, which is normal in caliber. no pericardial effusion. this study is limited by lack of iv contrast; hypodensities can be seen in the liver, which probably correspond to the innumerable low-density lesions seen on previous ct scan. on this noncontrast study, spleen, splenules, pancreas, stomach, adrenals, kidneys, and small bowel are stable. nonspecific stranding seen around the kidneys and along both pericolic gutters is unchanged. no distended loops of bowel are identified. no free air. no free fluid. no evidence of obstruction. appearance of cecum and right colon are stable / slightly improved. slightly improved transverse colon. slight thickening of descending colon is probably due to collapse. no significant lymphadenopathy. . ct pelvis without iv contrast: sigmoid diverticula without diverticulitis. diverticulosis in left colon. vascular calcifications. vessels maintain their normal caliber. foley within the bladder. prostate is enlarged. no free fluid or free air or lymphadenopathy. . total hip prosthesis in right hip. degenerative changes of the spine. bone island in left iliac spine. no suspicious lytic or sclerotic lesions identified. . impression: . unchanged/slightly improved appearance of right colon. no definite pneumatosis, or evidence of obstruction. differential wall enhancement cannot be assessed on this non iv contrast study. . chest, single ap supine portable view. . the left costophrenic angle is excluded from the film. compared with , the et tube has been removed and a tracheostomy is now present. the tracheostomy tip overlies the trachea at the level of the upper clavicles, in nomimal position. a left-sided picc line is present, tip at svc/ra junction. no pneumothorax is detected. again seen is hyperinflation and multiple calcified pleural plaques. there has been some interval worsening in degree of left lower lobe collapse and/or consolidation. no gross effusion. doubt chf. . micro: negative bcx, ucx, negative for c. diff . hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 04:13am 13.8* 3.08* 9.6* 28.5* 93 31.2 33.7 14.4 370 09:11pm 27.1* 04:29pm 26.9* 03:41am 10.0 2.87* 9.3* 26.4* 92 32.3* 35.0 14.4 329 07:33pm 26.2* 03:41am 8.8 3.10* 9.9* 28.4* 92 31.8 34.7 14.3 351 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 04:13am 370 04:13am 14.3* 30.4 1.3* chemistry renal & glucose glucose urean creat na k cl hco3 angap 12:29pm 3.5 04:13am 161* 14 0.9 140 3.3 102 30 11 04:29pm 161* 12 0.9 141 4.0 106 28 11 03:41am 116* 12 0.9 144 3.6 108 28 12 05:08pm 13 1.0 3.0* 03:41am 124* 15 1.1 143 3.0* 106 28 12 chemistry totprot albumin globuln calcium phos mg uricacd iron 12:29pm 2.4 04:13am 8.5 2.1* 1.7 blood gas blood gases type temp rates tidal v peep fio2 o2 flow po2 pco2 ph calhco3 base xs intubat vent 12:25pm art 36.5 5 103 49* 7.43 34* 6 intubated imv 10:23am art 36.6 98 37 7.49* 29 4 whole blood, miscellaneous chemistry lactate k 12:25pm 0.7 10:23am 3.3* hemogloblin fractions ( cooximetry) hgb calchct 10:23am 9.9* 30 calcium freeca 12:15pm 1.17 brief hospital course: 85 yo m with h/o of prostate ca, admitted after r hip fracture s/p orif , transferred to micu with hypercarbic respiratory failure, intubated. his micu course is discussed by problem . #. hypercarbic respiratory failure: thought to be likely due to chronic lung disease plus abdominal distention pressing up on his diaphragms +/- aspiration pna. the patient was was started on vanc/levo/flagyl for aspiration/nosocomial pna and aggressive bowel regimen for ileus secondary to narcotics. he completed a one week course of antibiotics, successive cxrs following treatment failed to show any residual or new infiltrate to suggest persistent pneumonia. however, he then continued to have daily fever spikes, and he was empirically treated with a one week course of vancomycin and zosyn for possible vap pneumonia. the patient's ileus improved with bowel regimen and avoiding sedatives and so did his respiratory status. plan is to wean off ventilator and decrease sedation by adding haldol/prn for agitation. the patient encountered difficulty weaning, and a trach was discussed with his family/ hcp, would decided to pursue trach placement, which was done by thoracics on . sutures from this will need to be removed between , per surgery recs. he was continuously tried on c-pap and ps with a goal to wean. in addition, he was kept in negative fluid balance on a daily basis, as this seemed to improve his respiratory function although his cxr did not show overt chf. he was eventually weaned to a trach collar, which he tolerated well. his suctioning frequency also decreased, and he was fitted for a valve by speech therapy, with intentions to undergo a swallow study. . # anemia/transient melena: the patient was anemic, iron studies suggested anemia of chronic disease, possibly secondary to known malignancy. in addition, he had guaiac positive stool output. his hematocrit was monitored on a daily basis, and he was transfused intermittently for hct <21. he had one episode of melena (about 250 cc) on the morning after his trach/peg placement, and a drop in his bp to 80's systolic. he was transfused 2 units of prbcs, and gi was consulted. they recommended continuing on the ppi , and monitoring his hct ; with the thought that his melena was most likely secondary to blood loss from the peg procedure. the patient's hct continued to trend down, and he underwent an egd and colonoscopy on which showed an ulcerated, erythematous lesion in the proximal ascending colon. this was thought to be the explanation for his melena, and a biopsy was taken, with a differential diagnosis including ischemic colitis vs. crohn's disease vs. neoplasm. the biopsy was still pending at the time of discharge. the egd revealed a smooth nodule in the fundus of the stomach, which will need to be further evaluated in the future; was otherwise normal. it was thought that the patient's hematocrit should be monitored every 48 hours, or more frequently if melena develops. he should continue on the ppi and follow-up with gi on an outpatient, elective basis for a repeat endoscopy/ eus to evaluate the nodule seen in the stomach- as this may be possible gist. gi cleared the patient to restart his lovenox for dvt prophylaxis, but this may need to be stopped and other prophylaxis measures explored (i.e, filter placement) if he begins to rebleed. . # ileus/abdominal distension: likely due to narcotic -induced ileus. ileus improved with supportive care and avoiding narcotics, and patient was started on tube feeds. he underwent an abdominal ct to evaluate for any pathology, this revealed: 1. possible pneumatosis in the cecum/ascending colon. this may be due to infectious colitis, typhlitis or due to ischemia. alternatively, the atypical appearance of the bowel wall may be caused by fecal material. 2. innumerable liver metastases. 3. calcified pleural plaques indicating prior asbestos exposure. 4. bilateral basal atelectasis and pleural effusions. 5. no evidence of bowel obstruction. 6. small amount of ascites. 7. enlarged prostate consistent with history of prostate cancer. given these findings, surgery was consulted to comment on any surgical intervention that would be necessary, none was noted. the patient was started on empiric flagyl for c-diff, as he had persistently large volume, greenish, guaiac positive stool output. the abdominal ct was repeated a few days later, and showed slight improvement of previous findings, and still no signs of obstruction. the patient was ruled out for c-diff with three negative samples and two negative toxin b assays, and the flagyl was discontinued. the patient was restarted on his tube feeds once his peg tube was placed, which he tolerated well. he was followed by the nutrition service for tube feed recommendations. . # acute renal failure: occurred in the setting of hypotension and volume depletion. creatinine bumped up as high as >2.0. with hydration, creatinine returned to baseline 0.9. . # hip fracture: s/p mechanical fall and orif on . initially received too narcotics causing ileus and respiratory failure. the patient was continued on tylenol and avoided narcotics as much as possible. ortho followed the patient until staples were removed, rec , pt consulted and rec rehab. patient is to follow up with dr. as outpatient in six weeks. he was restarted on lovenox for dvt prophylaxis. . # hyponatremia: initially thought to be siadh and fluid restriction was enforced. later, however with fluid restriction, likely became hypovolemic causing renal failure. hyponatremia resolved with ivf. patient then became hypernatremic, which again resolved with free water repletion. . # htn: his triamterene-hydrochlorothiazide was discontinued in the setting of hypotension. however, he then became hypertensive on the day prior to discharge, and was started on an ace for management, this may need to be titrated for optimal bp control. . # prostate ca: per pcp has had metastatic prostate cancer for last ten years. can f/u re: prostate ca as outpatient, casodex was held during his icu stay. contact was maintained with his urologist, particularly after his abdominal ct showed liver metastasis. a psa, cea, and afp were sent, all of which returned normal. . he was maintained on lovenox for dvt prophylaxis, and provided with a ppi for gi protection. he should follow-up with both his pcp and orthopedist upon discharge from rehab. medications on admission: casodex 50mg qd triamterene w/ hctz 37.5/25 qd potassium cl er 600mg asa 81mg qd flomax 0.4mg qd discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours). 3. albuterol 90 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours). 4. ipratropium bromide 17 mcg/actuation aerosol sig: four (4) puff inhalation qid (4 times a day). 5. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day). 6. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 7. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 8. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 9. nystatin 100,000 unit/g ointment sig: one (1) appl topical qid (4 times a day) as needed. 10. insulin regular human 100 unit/ml solution sig: as directed injection asdir (as directed). 11. dolasetron 12.5 mg/0.625 ml solution sig: one (1) intravenous q8h (every 8 hours) as needed. 12. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours) for 7 days: then back to qd. 13. haloperidol lactate 5 mg/ml solution sig: 2.5 mg injection q4h (every 4 hours) as needed for aggitation. 14. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical prn (as needed). 15. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: right hip intertrochanteric fracture respiratory failure aspiration pneumonia ileus lower gi bleed discharge condition: stable discharge instructions: you have been discharged to an extended care facility for rehabilitation, your right hip fracture has been repaired. take medications as perscribed and follow up as indicated. . please follow up with the ortho clinic in six weeks with dr. as instructed below. followup instructions: follow up with orthopaedics after your discharge from rehab, call ( for an appointment with dr. (within six weeks) please follow-up with your pcp upon discharge from rehab as well. 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 percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of large intestine open reduction of fracture with internal fixation, femur bronchoscopy through artificial stoma transfusion of packed cells diagnoses: anemia of other chronic disease malignant neoplasm of liver, secondary unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of prostate acute respiratory failure pneumonitis due to inhalation of food or vomitus paralytic ileus hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia fall from other slipping, tripping, or stumbling volume depletion, unspecified closed fracture of intertrochanteric section of neck of femur 

Answer: The patient is high likely exposed to