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: morphine / sulfa (sulfonamide antibiotics) attending: chief complaint: transfer for radiation oncology evaluation major surgical or invasive procedure: intubation picc placement tracheostomy, peg, thoracentesis history of present illness: 55 yo female with history of tobacco abuse and chronic back pain transferred from for oncology and radiation oncology evaluation. the patient initially presented to on following an evaluation by ent for sinus congestion. per the patient's family, she had been complaining of upper respiratory symptoms including nasal congestion, drainage, cough for approximately 2 months. she had been evaluated in by her pcp and ent. she was treated with antibiotics and antihistamines without relief. she came to to visit her family for . her daughter was concerned with facial and neck swelling. she noticed that her neck veins were engorged. her daughter referred her to her own ent who ordered a ct chest to evaluate for svc syndrome. the ct showed rul and rml collapse due to a central obstructing lesion as well as bulky lymphadenopathy. the patient was referred to the ed, and admitted for malignancy evaluation. on admission she had a thoracentesis which did not show evidence of malignancy. she was transferred to the icu on for respiratory decompensation. on , thoracic surgery performed a rigid bronchoscopy with biopsy which showed non-small cell lung cancer. the patient was intubated initially for this procedure, extubated, but then developed respiratory failure 20 min later requiring reintubation. she self extubated on , was in respiratory extremis and required reintubation. the patient was transferred to for further evaluation. her sedation medications have included propofol, precedex, fentanyl and ativan. on arrival to the , the patient is intubated and sedated. the patient's husband, daughter and son are present. they are concerned for her comfort. they feel she has been very uncomfortable on the ventilator, without adequate sedation. they report she has chronic severe back pain from scoliosis which is likely contributing to her discomfort. unable to obtain review of systems secondary to intubation. past medical history: non-small cell lung cancer diagnosed , svc syndrome scoliosis, chronic back pain s/p cholecystectomy s/p hysterectomy social history: the patient lives in with her husband. daughter and son are very supportive and live here in mass. she has smoked a pack of cigarettes per day since she was 18 years old (37 pack year history). denies alcohol or illicit drug use. family history: nc, no known lung cancer physical exam: general: intubated sedated in nad heent: neck has dilated veins, plethoric, normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mm dry. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . lungs: rhonchi bilaterally, decreased air movement on right upper, no wheezes or crackles. abdomen: nabs. soft, nt, nd. no hsm extremities: bl ue edema, no le edema, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: unable to assess given sedation psych: listens and responds to questions appropriately, pleasant pertinent results: from ct chest : rul and rml collapse, central obstructing mass, large right pleural effusion, bulky right paratracheal, subcarinal, precarinal and lateral vascular adenopathy. mri head : nonspecific small foci of increased t2 and flair signal in the subcortical white matter likely represent small vessel ischemic change. no mass or metastatic disease. ct abd/pelvis : large right pleural effusion, compressive atelecatsis, no liver lesions, no abdominal mass or adenopathy, 3mm right renal calculus, edema in the subcutaneous fat of the anterior chest wall as well as the right and left breast. no pelvic mass brief hospital course: #. respiratory failure: she was intubated at an osh for respiratory distress. she had a high a-a gradient throughout admission that was felt to be secondary to shunt physiology with collapse of her right upper and right middle lobe. she had an initial bronchoscopy the day after admission which showed a large tumor burden obstructing the airways. she had a stent placed by ip on to the right main stem bronchus to prevent further collapse. she then had a tracheostomy/peg placed on as well as a thoracentesis of 1.2 l of pleural fluid. the fluid was negative for malignant cells. on , she was liberated from the ventilator but required further ventilatory support overnight on several instances. ms. continued to do well, spending most of her time on trache-mask. repeat cxr showed slow reaccumulation of pleural effusion, but her respiratory function remained stable with attempts to diurese her further. if her respiratory function acutely worsens, would consider cxr to assess fluid status, diuresis with prn lasix and/or thoracentesis to drain pleural fluid. she also likely may require ventilatory support to rest overnight occasionally. she was on this at discharge at night. her settings were volume control tv 450, rr 16, peep 5, fi02 50%. #. non-small cell lung cancer: this was a new diagnosis immediately prior to admission. radiation oncology was consulted. she completed 4 doses of palliative xrt (400 cgy x 5 fractions) which was completed . medical oncology was consulted as well and offered chemotherapy as a possible option for the future. initial metastatic workup has been negative with negative abdominal and brain imaging. she was followed by palliative care. #. svc syndrome: she initiallly presented to the osh with facial swelling secondary to svc sydrome due to her lung mass and bulky lymphadenopathy. she was started on iv steroids which were tapered gradually. she was also started on a heparin gtt due to an svc and ivc clot which was transitioned to lovenox on . her neck and facial swelling worsened from , and she was restarted on dexamethasone 4 mg with a plan to slowly taper down to a low dose (4 mg x 2 days then decrease to 2 mg (on ) and assess response. if pt continues to have better controlled edema and no vomiting, it can eventually be decreased to 2 mg qd. if she has more symptoms may need to go up on dose to 2 mg tid or 4 mg . goal is smallest dose possible to keep symptoms under control and to allow of increase in dose if symptoms reoccur. #. bleeding: on , she had an episode of bleeding from her peg tube, increasing abdominal pain, and a hematocrit drop. she was given a total of 2 units of blood and her bleeding stopped. her anticoagulation was initially held. gi did an endoscopy on and found an ulcer which was injected with epinephrine and her hematocrit remained stable, although dropped slightly (2 points of the day of discharge). her hematocrit should be checked daily for 2-3 days to ensure stability after discharge. #. chronic back pain: she has chronic pain secondary to scoliosis. she was continued on fentanyl initially and was transitioned to dilaudid iv as needed however this caused delerium so she was changed back to oxycodone on . she was also started on methadone, but felt that this precipitated nausea and made her somnolent. consequently, she was changed to oxycodone 30mg pgt q4 standing, with oxycodone 30-60 mg pgt q2 prn. the patient was only requiring 30mg q2-4h at discharge and was tolerating this regimen well. #. anxiety: she had substantial anxiety and was managed with benzodiazepines scheduled and as needed. there was some concern that she had some confusion with ativan, but it was felt that the anxiolytic benefits outweighed the possible confusion. at the time of discharge, the patient was maintained on standing klonopin with ativan prn for anxiolysis as needed. the team felt that much of her pain was being relieved by treating this anxiety. #. vomiting/nutrition: patient had multiple episodes of vomiting without nausea during her radiation therapy. this resolved and was thought to be due to esophagitis. patient then re-developed vomiting on . this was initially instigated by suctioning but was then spontaneous. it was of unclear etiology though the patient thought it was due to methadone. as the steroids had been recently stopped, and there was increased neck swelling, there was concern for worsening svc syndrome, brain edema, and/or anxiety causing the vomiting. however, the patient felt this vomiting was due to methadone so it was stopped. the patient had no vomiting since . she had a video swallow study on the day of discharge which showed that she could not take po without aspirating and she chose to remain npo except for ice chips. however, if she decides that she would like to eat or drink for comfort, she can do this in the future knowing the risk of aspirating. #. tobacco abuse: her nicotine patch was discontinued prior to discharge. #. code status: she was made dnr during this hospitalization. #. communication: husband, hcp , (daughter) , medications on admission: home medications: oxycodone prn avelox and z-pak x2 mediciations on transfer: combivent 10puffs every 4 hours fentanyl 25mcg q2h prn propofol gtt precedex gtt oxycodone 30mg q6h prn pantoprazole 40mg iv qd ss insulin lorazepam 0.5mg q4h prn methylprednisolone 40mg iv q8h nicotine patch flexeril 10mg tid prn senna 1 tab prn allergies: sulfa/morphine discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. polyethylene glycol 3350 17 gram/dose powder : one (1) dose po daily (daily) as needed for constipation. 3. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 5. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 6 (six) puffs inhalation q3h (every 3 hours) as needed for wheezing. 6. ipratropium bromide 17 mcg/actuation aerosol : 6 (six) puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 7. ondansetron hcl (pf) 4 mg/2 ml solution : 4-8 mg injection q8h (every 8 hours) as needed for nausea. 8. enoxaparin 60 mg/0.6 ml syringe : fifty (50) mg subcutaneous q12h (every 12 hours). 9. lorazepam 0.5 mg tablet : one (1) tablet po every four (4) hours as needed for anxiety. 10. metoclopramide 10 mg tablet : 0.5 tablet po tid (3 times a day). 11. sucralfate 1 gram tablet : one (1) tablet po q6h (every 6 hours). 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 13. dexamethasone 4 mg tablet : one (1) tablet po q12h (every 12 hours): please give 4mg x 2 days, then 2mg x 2 days (starting ), and assess her facial/neck swelling. 14. oxycodone 15 mg tablet : two (2) tablet po q4h (every 4 hours). 15. oxycodone 15 mg tablet : 2-4 tablets po q2h (every 2 hours) as needed for pain. 16. clonazepam 0.5 mg tablet : one (1) tablet po tid (3 times a day): please hold for sedation or rr<12. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: non-small cell lung cancer superior vena cava syndrome secondary diagnosis: venous thrombosis discharge condition: ambulating only with physical therapy present, vital signs stable, requiring intermittent ventilatory support discharge instructions: you were admitted to with respiratory failure on an ventilator. you were diagnosed with lung cancer, which was causing compression of the veins in your chest and causing your face and arms to swell. you had blood clots in the veins in your neck and chest and were started on blood thinners to treat these blood clots. you had a tracheostomy and peg tube placed to help you breathe and help you get nutrition. you also had the fluid around your lung drained with a needle. you should have your hematocrit and na checked after discharge daily for 2-3 days to ensure stability. at the time of discharge, your hematocrit was 27.3 and your sodium level was 131. you should also continue dexamethasone at the following dose: 4mg by mouth twice daily x 2 days, then 2mg by mouth twice daily x 2 days (starting ), and assess her facial/neck swelling. if you continue to have better controlled swelling and no vomiting, it can eventually be decreased to 2 mg daily. if you have more symptoms, you may need to go up on dose to 2 mg three times daily or 4 mg twice daily. the goal is to give the smallest dose possible to keep symptoms under control. followup instructions: you are being discharged to a long term acute care facility. you were followed by the oncology team while you were in the hospital, and chemotherapy was discussed as a possibility in the future if you were doing well and feeling up to it. if you would like to discuss this possibility further, please contact the oncology team for an appointment. you were seen by dr. and his clinic phone number is (. you should have your hematocrit and na checked after discharge daily for 2-3 days to ensure stability. at the time of discharge, your hematocrit was 27.3 and your sodium level was 131. you should also continue dexamethasone at the following dose: 4mg by mouth twice daily x 2 days, then 2mg by mouth twice daily x 2 days (starting ), and assess her facial/neck swelling. if you continue to have better controlled swelling and no vomiting, it can eventually be decreased to 2 mg daily. if you have more symptoms, you may need to go up on dose to 2 mg three times daily or 4 mg twice daily. the goal is to give the smallest dose possible to keep symptoms under control. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] other intubation of respiratory tract temporary tracheostomy endoscopic control of gastric or duodenal bleeding other radiotherapeutic procedure diagnoses: pneumonia due to other gram-negative bacteria tobacco use disorder unspecified pleural effusion hyposmolality and/or hyponatremia other opiates and related narcotics causing adverse effects in therapeutic use pulmonary collapse nausea with vomiting acute respiratory failure compression of vein malignant neoplasm of other parts of bronchus or lung chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction scoliosis [and kyphoscoliosis], idiopathic drug-induced delirium secondary and unspecified malignant neoplasm of intrathoracic lymph nodes other venous embolism and thrombosis of inferior vena cava acute venous embolism and thrombosis of other thoracic veins 

Answer: The patient is high likely exposed to