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: iodine; iodine containing / morphine / sulfa (sulfonamide antibiotics) attending: chief complaint: pulmonary embolism, ica aneurysm major surgical or invasive procedure: : angiogram with coiling of left ica aneurysm history of present illness: 68 year old woman with htn, copd, s/p inital step in multistage stent-assisted coiling for l ica aneurysm and recent ankle fracture with immobilization who presented to hospital with one day history of shortness of breath, pleuritic chest pain, cough, fever, and leukocytosis. initially diagnosed and treated with levofloxacin for rll infiltrate presumed to be pna; blood cultures done are negative to date. was evaluated for pe and noted to have normal d- dimer, negative leg ultrasound for clot, low prob v/q scan. given clinical suspicion patient underwent cta of chest after premedication for iodine allergy which showed a pe. she was started on a heparin drip and underwent placement of an ivc filter . most recent ptt at osh was therapeutic at 71 on heparin weight based protocol at 900u/hr. . she is follwed by dr. at for her large left internal carotid artery aneurysm (measures 1.5 x 1.2 x 1.5 cm) and she is scheduled to have additional coiling on . she is being transfered to for further medical management of her pe and neurosurgical consultation. per report at time of transfer she remains on full dose aspirin, but is off plavix for the recent cerebral stenting. . on the floor, the patient reports feeling well without focal complaints. she had a bm at admission. denies sob, h/a, abd pain, nvd, f/c. states she has had some r sided pleuritic cp for the past few hours, c/w her known pe. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: 1.) hypertension 2.) emphysema- stable 3.) h/o chronic bronchitis 4.) r ankle fracture s/p orif 5.) s/p r rotator cuff surgery in 6.) s/p hysterectomy and bladder surgery suspension in . 7.) h/o brain aneurysm, s/p intervention with platinum coil and stent placement in . 8.) h/o gastric ulcer dxd by upper endoscopy at hospital about 2 y ago, no h/o gi bleed. 9.) gastroesophageal reflux disease 10.)known intermittent lateral visual field cut l eye social history: married, lives with husband. retired, former smoker 40 pack years, quit 10 yrs ago. seven-14 alcoholic drinks per week. family history: stroke in mother, cancer in father, aneurysm and disease in sister, hypertension in a brother. 3 healthy children. physical exam: admission exam: vitals: t:99.6 bp: 163/84 p:85 r:22 18 o2: 96ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, +lateral visual field cut l eye (pt's bl) neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, decreased bs r base. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mild ttp epigastrium, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. r ankle with well healing incision site, steri strips in place. +venous stasis changes. exam on discharge: xxxxxxxxxxxxxx pertinent results: labs on admission: 06:45pm wbc-11.2* rbc-4.57 hgb-9.7* hct-31.2* mcv-68* plt ct-370# 04:25am wbc-9.8 rbc-4.31 hgb-9.1* hct-29.9* mcv-69* plt ct-362 6:45pm pt-12.6 ptt-39.0* --> 4:25am pt-13.3 ptt-81.3* 06:45pm glucose-97 urean-12 creat-0.8 na-139 k-4.1 cl-101 hco3-28 06:45pm calcium-9.4 phos-2.9 mg-2.0 labs on discharge: 08:50am blood wbc-12.9* rbc-4.22 hgb-8.8* hct-29.1* mcv-69* mch-20.8* mchc-30.2* rdw-17.3* plt ct-693* 03:05pm blood pt-21.9* ptt-68.4* inr(pt)-2.1* 08:50am blood glucose-93 urean-12 creat-0.7 na-137 k-4.6 cl-103 hco3-25 angap-14 08:50am blood calcium-9.7 phos-4.3 mg-2.1 studies: mri/mra 1. no evidence of interval subarachnoid or other intracranial hemorrhage since the pre-procedure examinations of . 2. status post initial coiling of the large, lobulated left carotid terminus and possible carotico-ophthalmic aneurysm; however, the current examination suggests that there is still patency and flow within both the superior- anterior portion of the aneurysm which may, in fact, be carotico-ophthalmic, as well as a small amount of flow into the more posterior mid-portion of the aneurysm. 3. no evidence of vasospasm or ischemia. ct abdomen/pelvis : impression: 1. no retroperitoneal hematoma. 2. right pleural effusion with adjacent compressive atelectasis. 3. diverticulosis without evidence of active inflammation. 4. retained contrast within the renal collecting systems, as well as vicarious excretion of contrast from the gallbladder, presumably from patient's recent angiogram. cta head : findings: patient is status post coiling of a large left ica aneurysm. extensive streak artifact somewhat limits evaluation. within this limitation, the bilateral, aca, mca and proximal internal carotid arteries appear patent. there is no evidence of acute intracranial hemorrhage or shift of normally midline structures. there is no evidence of acute infarction identified. mild mucosal thickening of the bilateral frontal, ethmoidal and sphenoid sinuses is noted. the mastoid air cells are clear. impression: 1. no evidence of acute hemorrhage. 2. limited evaluation due to streak artifact from coils. within this limitation, the aca, mca and proximal internal carotid arteries appear patent. mra brain : brain mri: there are areas of hyperintensity on the diffusion and t2-weighted and flair images in the left frontal and parietal regions with several tiny foci in the subcortical region indicative of infarcts. these infarcts are not visualized on adc map indicating their infarcts to be of subacute nature. following gadolinium, no abnormal enhancement is seen. there is a large coil pack identified in the left supraclinoid region where coiling was performed for aneurysm. mild enhancement is seen in the surrounding region, but no intrinsic enhancement to the coil peg is identified. impression: probable subacute infarcts in the left side of cerebral hemisphere involving the cortex in the posterior frontal and anterior parietal region with several small subcortical infarcts. coil pack in the left supraclinoid region. mra head: the pre and post-contrast mra of the head demonstrate subtle enhancement within the coil pack indicating the thrombus. no definite flow signal is identified within the coil pack or adjacent to it to indicate residue aneurysm. no vascular occlusion or stenosis seen. the evaluation of the left supraclinoid internal carotid on projection images is somewhat limited secondary to artifacts from the adjacent coil pack. impression: coil pack is visualized from embolization of the left supraclinoid internal carotid artery aneurysm. no definite residual flow signal identified within the aneurysm. some intrinsic foci of thrombus are seen within the coil pack. no vascular occlusion in the arteries of anterior or posterior circulation. brief hospital course: 68 year old woman with hypertension, chronic obstructive pulmonary disease, status post inital step in multistage stent-assisted coiling for l ica aneurysm and recent r ankle fracture s/p orif with immobilization who was transferred from outside hospital on for management of pulmonary embolism and possible pneumonia. she is on levaquin orally for pna. she is status post mri compatible ivc filter placement at outside hospital on and is on a heparin weight based protocol for her pulmonary embolism. hospital course: -- patient was medically managed on a heparin drip in the therapeutic range. her pleuritic lung pain which was present on admission resolved within 24 hours. the patient has intermittent headaches present since her last left ica aneursym coiling. she was medically managed for these headaches. she underwent an mri/mra to evaluate her left ica aneurysm which was reviewed by dr. . the patient underwent intravenous contrast dye allergy preparation -- in anticipation of neurosurgical intervention planned for . in terms of her pulmonary embolism, the plan is to transition to either lovenox or coumadin to complete a 3 month course for a provoked pulmonary embolism. prior to transfer to from osh, the patient's daily 25 mg po hctz was discontinued as she was noted to have low systolic blood pressures. her blood pressures during her admission at through were normal off of this medication, so it was not restarted. on the morning of , the patient was noted to have an elevated systolic bp in the 150s, but this was deemed likely secondary to her treatment with high dose prednisone since the day prior. dr. was made aware of this and the patient's use of hctz at home. on patient went for an angiogram for a stent assisted coiling of l ica aneurysm and went to the icu for monitoring. the sheath was left in her r groin until the morning. on , the sheath was pulled and patient remained of bedrest. the heparin drip was discontinued. in the afternoon, pt reported r arm weakness with distal numbness. she had no speech deficits or facial droop. she was taken for a stat head cta which showed patent vessels. she was given a 5000 heparin bolus and 1000u/hr drip. her blood pressure is to be kept between 140-160. on , patient feeling better, rue moving well and numbness has subsided. she is now a in motor strength. she was transferred to the floor with the heparin drip and sbp 140-160. her right sided symptoms did not return. prior to discharge she had a mri coil pack is visualized from embolization of the left supraclinoid internal carotid artery aneurysm. no definite residual flow signal identified within the aneurysm. some intrinsic foci of thrombus are seen within the coil pack. no vascular occlusion in the arteries of anterior or posterior circulation. on she became therapeutic on coumadin and her heparin drip was stopped. she was cleared by pt on . she remained neurologically intact, she will follow up this week with her primary care to have her inr and coumadin monitored. medications on admission: outpatient medications: omeprazole 20 mg daily advair 100/50 mg daily asa 325 mg daily dulcolax 1 tab os-cal w vit d one tab po bid . medications on on transfer from outside hospital: weight based heparin per protocol levaquin 750 mg po daily, day 1 of 7 asa 325 mg po daily miralax 17 g po daily senna 2 tabs daily os-cal w vit d one tab po bid nexium 40 mg daily advair diskus 250/50 mcg one puff twice daily tylenol 650 mg po q 6 hr prn pain, fever colace 100 mg nebulizer tx albuterol and atrovent q 4 hr prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*3* 2. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 3. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever, pain: no more than 3.5 gm a day. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): use while on fiorcet. disp:*40 capsule(s)* refills:*0* 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours) as needed for trouble breathing associated with emphesema. 9. butalbital-aspirin-caffeine 50-325-40 mg capsule sig: caps po q6h (every 6 hours) as needed for pain, headache: no more than 6 tablets a day. disp:*60 cap(s)* refills:*0* 10. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: dose to be titrated by primary care. disp:*30 tablet(s)* refills:*2* 11. warfarin 5 mg tablet sig: one (1) tablet po once a day: titrated once a day to inr per primary care. disp:*30 tablet(s)* refills:*0* 12. outpatient physical therapy please treat and evaluate s/p subarachnoid hemorrhage and right leg fx discharge disposition: home discharge diagnosis: primary: pulmonary embolism left internal carotid artery aneurysm discharge condition: neurologically stable discharge instructions: you were transferred to for a blood clot in your lung (pulmonary embolism) and surgical management of your intracranial aneuysm. your pulmonary embolism is likely related to your recent immobility due to your right ankle fracture. you should be on blood thinners to treat this clot for a total of 3 months. the coumadin(warfarin) you are taking to treat this, must be carefully monitored by bloodwork. dr. , neurosurgery, evaluated your aneuysm and you went to surgery . the following changes were made during this hospitalization: stopped: hydrochlorothiazide 25 mg po daily angiogram with embolization medications: ?????? take aspirin 325mg (enteric coated) once daily. ?????? continue all other medications you were taking before surgery, unless otherwise directed ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort. what activities you can and cannot do: ?????? when you go home, you may walk and go up and down stairs. ?????? you may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal). ?????? after 1 week, you may resume sexual activity. ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate. ?????? no driving until you are no longer taking pain medications what to report to office: ?????? changes in vision (loss of vision, blurring, double vision, half vision) ?????? slurring of speech or difficulty finding correct words to use ?????? severe headache or worsening headache not controlled by pain medication ?????? a sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg ?????? trouble swallowing, breathing, or talking ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site *sudden, severe bleeding or swelling (groin puncture site) lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call our office. if bleeding does not stop, call 911 for transfer to closest emergency room! followup instructions: please make an appointment with your primary care physician as soon as possible to have your inr drawn and follow up for pulmonary embolism please call to and appointment to be seen by dr. in 6 months you will need an mra at that time. if you will be in please see dr at hospital in fl. have a cd of your mri sent back to dr please also call your primary care doctor an appointment for blood work(inr) to be drawn within the next two days. procedure: arteriography of other specified sites endovascular (total) embolization or occlusion of head and neck vessels diagnoses: pneumonia, organism unspecified esophageal reflux unspecified essential hypertension thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm cerebral aneurysm, nonruptured other emphysema long-term (current) use of anticoagulants iron deficiency anemia, unspecified other pulmonary embolism and infarction leukocytosis, unspecified 

Answer: The patient is high likely exposed to