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: aspirin attending: chief complaint: headache for four days major surgical or invasive procedure: valve revision valve revision / programable valve inserted. history of present illness: hpi:asked to see this 47 y/o female with history of vps placement in 's for hcp (diagnosed in her 20's). pt states the problem at that time was aqueductal collapse with emergent placement of a vps/ she never had an external ventricular drain. pt admits to nausea at home, + emesis in er after meds, perceived disorientation and difficulty concentrating. denies visual changes, fever, seizure. past medical history: pmhx: hcp with vps, endometrial ablation for heavy menses in , anemia in past; vps for aqueductal stenosis as intial diagnosis social history: social hx: social etoh, no tobacco, no drug use, singer musician family history: family hx:non contibutory physical exam: physical exam: 123/80, 63,16 98.4 100% ra gen: wd/wn, comfortable, appears to have difficulty focusing on examiner heent:ncat, shunt palpable with good refill. reservior noted proximmaly. pupils: 3 to 2 mm bilaterally, eomi neck: supple. no nuchal rigidity lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. no c/c/e. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. language: speech fluent with good comprehension, preseverative. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3to2 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to finger rub bilaterally. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. no abnormal movements, tremors. strength full power throughout. no pronator drift sensation: intact to light touch, coordination: normal on finger-nose-finger, rapid alternating movements, heel to shin on discharge : awake alert oriented with non focal neuro exam. headaches persist but are greatly improved. pertinent results: , f 49 cardiology report ecg study date of 1:01:14 pm sinus bradycardia otherwise normal ecg since previous tracing of , no significant change read by: , w. intervals axes rate pr qrs qt/qtc p qrs t 58 170 88 436/432 56 66 29 () , f 49 radiology report csf shunt study study date of csf shunt study clip # reason: 49yr old with h/o vps s/p multiple revisions, presents w/ha diffuse ventriculomegaly on ct. ? shunt obstruction. final report radiopharmaceutical data: 1.1 mci tc-m dtpa (); history: 49 year old woman with headaches and enlarging ventricles on brain ct following recent csf shunt revision. interpretation: following the administration of 1.1 mci of dtpa in 0.1 ml preservative free saline directly into the patients csf shunt valve mechanism, both immediate dynamic flow images of the head and neck were obtained in the anterior and posterior positions as well as delayed static images of the head & neck and abdomen. there is normal anterograde drainage of tracer from the valve into the peritoneal cavity without evidence of obstruction or shunt disruption. impression: normal csf vp shunt study. , m.d. , m.d. approved: 3:39 pm , f 49 radiology report ct head w/o contrast study date of 8:19 am , eu 8:19 am ct head w/o contrast clip # reason: assess for hydrocephalus medical condition: 49 year old woman s/p revision vp shunt with ha, nausea, vomiting reason for this examination: assess for hydrocephalus contraindications for iv contrast: none. wet read: ajy tue 9:31 am interval increase in ventricular size since study dated , , with relative prominence compared to cortical sulci on current study. vps in unchanged position. no transependymal edema. basilar cisterns are preserved. no hemorrhage. final report indication: 49-year-old female status post vp shunt revision for overshunting, now presents 3 days status post discharge with headache, nausea and vomiting. assess for hydrocephalus. comparison: multiple prior head cts, most recently dated . noncontrast head ct: there is no hemorrhage, herniation, shift of normally midline structures or acute vascular territorial infarction. the ventriculoperitoneal shunt is in unchanged position with a right frontal approach and termination in the frontal of the left lateral ventricle. ventricular size is increased compared to the prior study. measuring across the bodies of bilateral lateral ventricles, the measurement was previously 12 mm, currently this same measurement is 20 mm. additionally, the size of the third ventricle and temporal horns have also increased. prominence of ventricular system is out of proportion to the appearance of the cortical sulci, which appear slightly more effaced on current study than on the previous study. there is no transependymal edema identified. the basilar cisterns are preserved. osseous structures are unchanged. there is minimal subcutaneous emphysema at the prior surgical site, decreased from prior study. visualized paranasal sinuses and mastoid air cells are normally pneumatized and clear. impression: 1. no hemorrhage, herniation or shift of normally midline structures. 2. increased ventricular size with relative prominence compared to the appearance of the cortical sulci, which is new compared to prior study dated . this suggests shunt dysfunction. findings were communicated to dr. at 9:30 a.m. on by dr. . the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 2:40 pm , f 49 radiology report chest (pre-op pa & lat) study date of 10:11 am , 10:11 am chest (pre-op pa & lat) clip # reason: please evaluate for pulmonary pathology medical condition: 49 year old woman with . reason for this examination: please evaluate for pulmonary pathology final report indication: 49-year-old female with vps dysfunction, referred for pre- operative evaluation prior to possible revision. comparison: . pa and lateral chest radiograph: the lungs remain clear, with no consolidation, effusion, or pneumothorax. the hilar and cardiomediastinal contours are within normal limits. pleural surfaces are smooth. pulmonary vasculature is normal in caliber and distribution. the catheter is again seen coursing along the medial aspect of the right hemithorax consistent, with ventriculoperitoneal shunt. the shunt track is somewhat irregular, suggesting possibility of calcification of the tract. visualized bony thorax and surrounding soft tissues are unremarkable. impression: no acute cardiopulmonary process. the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 2:45 pm , f 49 radiology report ct head w/o contrast study date of 4:51 am , nsurg tsicu 4:51 am ct head w/o contrast clip # reason: ? change in hydrocephalusplease repeat ct at 6 am on medical condition: 49 year old woman with hydrocephalus. please eval for possible change reason for this examination: ? change in hydrocephalusplease repeat ct at 6 am on to plan for or contraindications for iv contrast: none. final addendum no fracture is identified, mastoid air cell are clear. dr. approved: wed 9:32 am , nsurg tsicu 4:51 am ct head w/o contrast clip # reason: ? change in hydrocephalusplease repeat ct at 6 am on medical condition: 49 year old woman with hydrocephalus. please eval for possible change reason for this examination: ? change in hydrocephalusplease repeat ct at 6 am on to plan for or contraindications for iv contrast: none. final report indication: 49-year-old woman with hydrocephalus, please evaluate for possible change. comparison: prior head ct dated . technique: non-contrast head ct. findings: there is no hemorrhage. again seen is a right frontal approach ventriculoperitoneal shunt in unchanged position with its tip in the left lateral ventricle. lateral ventricles measure 37 mm (previously 34). again, there is prominence of the temporal horns, the fourth ventricle is normal, similar to prior, interval increased effacement of the sulci at the convexity and possible transependymal migration of csf (102:15). there is a fracture. mastoid air cells are clear. visualized paranasal sinuses are unremarkable. impression: mild enlargement of the lateral ventricles with possible transependymal migration of csf. unchanged right frontal approach ventriculoperitoneal shunt. these findings were communicated to dr. , at 8:55 hrs. by dr. . the study and the report were reviewed by the staff radiologist. dr. dr. approved: wed 9:10 am imaging lab , f 49 radiology report liver or gallbladder us (single organ) study date of 7:02 pm , nsurg fa11 7:02 pm liver or gallbladder us (singl clip # reason: please eval for cholecystitis medical condition: 49 year old woman with ruq abdominal pain with +murphys sign reason for this examination: please eval for cholecystitis wet read: arhb wed 7:59 pm tiny gallstones/ likely without acute cholecystitis. final report indication: 49-year-old female for right upper quadrant pain. comparison: none. findings: the liver demonstrates no textural abnormality and there is no intra- or extra-hepatic biliary ductal dilatation. a 1 cm round echogenic lesion in the medial aspect of the right hepatic lobe likely represents a hemangioma. the main portal vein demonstrates normal hepatopedal flow. tiny floating echogenic foci are noted in the gallbladder without frank stones. there is no pericholecystic fluid or gallbladder wall thickening and son sign is negative. no free fluid is seen in the right upper quadrant impression: 1. no frank cholelithiasis or cholecystitis. 2. small hepatic hemangioma. the study and the report were reviewed by the staff radiologist. , f 49 radiology report ct head w/o contrast study date of 12:04 pm , nsurg fa11 12:04 pm ct head w/o contrast clip # reason: please eval interval change medical condition: 49 year old woman with hydrocephalus reason for this examination: please eval interval change contraindications for iv contrast: none. provisional findings impression: 4:16 pm overall, minimal change from the study one day prior with persistent ventriculostomy catheter unchanged in position and ventricular enlargement, unchanged in magnitude. final report history: 49-year-old woman with hydrocephalus from congenital aqueductal collapse/stenosis, please evaluate for interval change. comparison: comparison is made to numerous previous head cts spanning from to . technique: contiguous axial ct imaging was acquired through the brain in the absence of intravenous contrast. findings: overall, study is minimally changed from that done one day earlier. again noted is increase in the size of the supratentorial ventricular system with the right frontal horns measuring approximately 35mm, compared with 34mm one day prior. also unchanged is a ventriculostomy catheter, terminating in the lateral ventricle on the left. periventricular hypodensity is consistent with transependymal migration of csf and is unchanged. there is no acute intracranial hemorrhage. effacement of cerebral sulci is unchanged and likely relates to diffuse cerebral edema. extracranial soft tissue structures are notable for subcutaneous gas and soft tissue thickening at the site of ventriculostomy catheter placement. the paranasal sinuses and mastoid air cells are unremarkable. impression: overall, minimal change from the study one day prior with persistent ventriculostomy catheter unchanged in position and ventricular enlargement, unchanged in magnitude along with diffuse cerebral edema component resulting in sulcal effacement, which needs clinical correlation. the study and the report were reviewed by the staff radiologist. dr. dr. peri approved: fri 10:22 am , f 49 radiology report ct pelvis w/o contrast study date of 5:40 pm , nsurg fa11 5:40 pm ct abdomen w/o contrast; ct pelvis w/o contrast clip # reason: please evaluate distal portion of vp shunt medical condition: 49 year old woman with hydrocephalus reason for this examination: please evaluate distal portion of vp shunt contraindications for iv contrast: none. final report indication: 49-year-old woman with hydrocephalus for evaluation of vp shunt position. comparison: none. technique: mdct-acquired images were obtained through the abdomen and pelvis without administration of oral or iv optiray contrast. multiplanar reformats were reviewed. comparison: abominal ultrasound performed . ct abdomen: the lung bases are clear without effusion, consolidation or nodule. heart size is normal. there is no pericardial effusion. a ventriculoperitoneal shunt is first imaged in the subcutaneous tissues anterior to the sternum, courses anterior to the left lobe of the liver through the mesentery to terminate between the uterus and bladder. there is no evidence of fluid collection near the vp shunt tip. on this non-contrast enhanced examination, the liver, gallbladder, spleen, adrenals, kidneys and pancreas are unremarkable. the intra-abdominal loops of large and small bowel are unremarkable without evidence of pneumatosis, free air or obstruction. there is no mesenteric or retroperitoneal lymphadenopathy. ct pelvis: the uterus, bladder, distal ureters, rectum, sigmoid are unremarkable. there is no pelvic or inguinal lymphadenopathy. bone windows demonstrate bilateral pars defects at l5-s1 with grade 2 anterolisthesis of l5 on s1. there is no osseous lesion concerning for metastasis or infection. there is soft tissue ossification along the left ischial tuberosity. impression: no evidence to suggesst ventriculoperitoneal shunt malfunction in an otherwise unremarkable ct abdomen. , f 49 radiology report ct head w/o contrast study date of 5:21 pm , nsurg fa11 5:21 pm ct head w/o contrast clip # reason: ? interval change worseing hydro cephalus medical condition: 49 year old woman with hydrocephalus- sudden onset paranoia and personality change reason for this examination: ? interval change worseing hydro cephalus contraindications for iv contrast: none. provisional findings impression: jkpe mon 1:38 am no interval change. final report history: sudden onset paranoid and personality change with known hydrocephalus. evaluate for acute pathology. comparison is made to , exam. non-contrast head ct: this exam is stable with unchanged appearance to the positioning of the right frontal approach vp shunt whose tip terminates against the anterior falx. the degree of hydrocephalus involving the third and lateral ventricles is also not appreciably changed. no parenchymal abnormalities are identified. there is no intra- or extra-axial hemorrhage. no bony lesions are identified and paranasal sinuses are well aerated. impression: no interval change in head ct with no findings to explain new onset symptoms. findings were discussed with on date of exam at 8:45 p.m. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 6:13 pm imaging lab brief hospital course: pt was asmitted to the hospital through the ed wiht c/o 4 days of headache. her vps valve apparatus was challenged manually by depressing the valve and assessing for refill and re-coil. this was noted. the pt was admitted to the icu for pain managment as well as further eval of her shunt system. a nuclear shunt series was ordered to assess distal flow. this was normal. she underwent a proximal/valve revision the following day on after headahce and ct scan did not demonstrate improvement. the pressure in the or from proximal csf flow was thought to be very low as the csf was randomly dripping from proximal catheter. a 2.0 pressure delta valve was placed. pt was recovered and still c/o peristent headaches. ct scan imaging remained stable. on the 17th the shunt was tapped for an opening pressure of 8 as she c/o peristent headaches. on the 19th a psych consult was called the pt demonstrating paranoid behavior, forgetfullness and labile mood. the psych team felt that the pt was not suffering from psychiatric issues at that time and recommended stat head ct imaging. this was performed. the images were reviewed by the on call attending. no interventions were taken that day as there were no acute changes. the following am the staff attending reviewed the ct and felt there was a degree of tran-ependymal flow of csf. the pt was consented with her husband present and brought back to the or for insertion of a programmable valve set to 0.5. day number 1 the pt reports having improved symptoms and is pleasant without paranoid behavior. she is tolerating po intake and voiding freely. post op ct imaging is stable and she is due for d/c and agrees with this plan. she will be seen by pt for stair safety eval prior to d/c. her valve setting was confirmed at 0.5 prior to discharge. medications on admission: tylenol, advil, mucinex discharge medications: 1. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: tablets po q4h (every 4 hours) as needed for headache: do not drive while on this medication . disp:*40 tablet(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. disp:*60 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: hydrocephalus discharge condition: neurologically improved discharge instructions: general instructions remove your outer dressing tomorrow / then leave your incision open to air. ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may wash your hair only after sutures and/or staples have been removed. ?????? you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????please return to the office in 10 days for removal of your staples or sutures. please call the office when you get home to arrange this. you will need a second appointment as part of your post-operative management.....please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast at that time. ??????you will / will not need an mri of the brain with/ or without gadolinium contrast. md procedure: replacement of ventricular shunt gingivoplasty replacement of ventricular shunt gingivoplasty ventriculopuncture through previously implanted catheter diagnoses: obstructive hydrocephalus cerebral edema surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation mechanical complication of nervous system device, implant, and graft 

Answer: The patient is high likely exposed to