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: no known allergies / adverse drug reactions attending: chief complaint: s/p mva major surgical or invasive procedure: thoracic epidural placement for pain control placement of picc line history of present illness: this is an 84-year-old female involved in a collision. she was the restrained driver involved in an accident. extensive damage to the car including bending of the steering wheel. the patient was complaining of pain in her chest as well as in her right lower extremity. hit her head on steering wheel. patient does recall loss of consciousness. in the ed, ct pan-scan was performed, showing injuries as below. a pigtail catheter was placed for the left pneumothrorax. past medical history: pmh: a-fib, renal artery stenosis, s/p l renal a stent placement , htn, dyslipidemia, copd (per d/c summary, pt denies), bowel obstructions s/p ex-lap (details unclear) c/b mesh infections, frequent falls. psh: aaa repair and abi , b/l tka, l3/l4 laminectomy, remote appendectomy, remote ovarian cystectomy, r thr , mult bowel obstructions s/p ex-lap (details unclear) c/b mesh infections social history: denies etoh, denies tobacco family history: non-contributory physical exam: hr: 90 bp: 150/100 resp: 20 o(2)sat: 100% on 2 l normal constitutional: general appearance: the patient arrives boarded and collared and is in no acute distress. the gcs is 15. head: the scalp is nontender and shows a laceration at the left forehead near the hairline. heent: the extraocular muscles are intact and the pupils both constrict to light, . the midface is stable. neck: there is no c-spine tenderness or step off. upper extremities: the upper extremities a extensive abrasion over the left arm near the elbow. thorax: the chest wall is tender on the left side. lungs: the lungs are clear and symmetrical. heart: the heart sounds are crisp. abdomen: soft, scaphoid, and mildly tender in the right abdomen. spine: there is no thoracic or lumbar spine tenderness. hips and pelvis: the pelvis is stable and the hips are nontender. lower extremities: no long bone signs; there is a large deep 12 cm laceration of the left leg below the knee. neurovascular function distally is normal. there is an abrasion on the right knee. she has dopplerable pulses in both legs. neurological: the patient moves all 4 extremities equally. pertinent results: ct chest w/contrast: 1. displaced fractures of the left anterolateral 3rd through 6th ribs with small left pneumothorax. 2. nondisplaced sternal fracture without significant hematoma or vascular injury. 3. trace left-sided pleural effusion measuring simple fluid density. 4. significant subcutaneous emphysema over the left anterior chest wall. ct c-spine w/o contrast: possible nondisplaced fracture of the left transverse process of t1. no other fractures identified. mild anterolisthesis of c6 on c7, age indeterminate, may be due to degenerative change. ankle (ap, mortise & lat) bilat port: right distal fibular fracture. echo: the left atrium is moderately dilated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal global and regional biventricular systolic function. mild mitral regurgitation. moderate pulmonary hypertension. 04:10pm wbc-14.9* rbc-4.10* hgb-12.8 hct-38.6 mcv-94 mch-31.1 mchc-33.1 rdw-14.1 04:10pm pt-12.8 ptt-27.5 inr(pt)-1.1 04:10pm plt count-432 04:10pm fibrinoge-347 04:10pm lipase-21 04:10pm urea n-26* creat-1.5* 04:20pm lactate-1.5 04:20pm po2-44* pco2-54* ph-7.37 total co2-32* base xs-3 comments-green brief hospital course: ms. was admitted on under the acute care surgery service to the trauma icu for further evaluation and management of her injuries. she remained hemodynamically stable on and was transferred to the surgical floor. she had a significant forehead laceration was sutured on admission. sutures were removed prior to discharge and site remained clean and dry at the time of discharge. neuro: a thoracic epidural was placed on for pain management given her rib fractures, which was removed on . she was transitioned from iv to po analgesics. by the day of discharge on , her pain was well-controlled with scheduled tylenol and prn tramadol and low dose oxycodone. on , ms. was triggered for a transient episode of altered mental status. urine cultures were sent which were negative. a chest xray was obtained which stable showed bibasilar atelectasis and no evidence of infiltrate. she remained hemodynamically stable during this episode, which resolved quickly without intervention. she remained alert and oriented at her baseline mental status upon discharge. cardiac: her vital signs were monitored routinely throughout her hospitalization. on arrival to the ed, her ecg showed rapid atrial fibrillation with rvr (history of known atrial fibrillation). she was rate controlled initially with iv beta blockers in the icu, and was then transitioned to her home cardiac medications. she remained in atrial fibrillation at her baseline throughout her floor course, with adequate rate control in the 60s and 70s. a bedside echo was performed to evaluate her cardiac function on (see pertinent results section). on , she became slighly hypotensive down to a systolic bp of 80 with diuresis. on albumin was given and her systolic bp remained > 100 thereafter. pulm: a pigtail ct was placed on admission given her left sided pneumothorax. it was removed on , with the post-pull chest xray showing no evidence of pneumothorax. subsequent chest xrays showed bibasilar pleural effesions, and aggressive pulmonary toileting and incentive spirometry were encouraged. a chest xray on revealed mild pulmonary edema, and gentle diuresis was continued with lasix. she was also started on nebulizers as needed. her o2 therapy was weaned and her o2 sats remained in the high 90's on 3l of nc at the time of discharge. gi: on admission she was kept npo and given iv fluids for hydration. on she was placed on a regular diet. on , she began to develop nausea. she continued to have intermittent episodes of nausea/vomiting, and a kub on showed evidence of an ileus. she was given a 1x dose of methylnaltrexone as well as a dulcolax suppository, and she subsequently had multiple bowel movements. she subsequently had multiple episodes of diarrhea, and stool samples were sent for c. diff and she was empirically started on oral flagyl. she continued to be intermittently nauseated and a repeat kub was obtained on which showed continued evidence of an ileus with dilation of the stomach, small, and large bowel. on she was c. diff negative x's 3 samples and flagyl was discontinued. on , she denied any further nausea and vomiting, and was tolerating a regular diet with no abdominal pain. gu: u/a on admission was suspicious for a uti and she was placed on a 3 day course of oral ciprofloxacin. a repeat u/a was normal. a foley catheter was placed for urine output monitoring on admission. it was removed on , however, she had an episode of urinary incontinence and retention on and the catheter was replaced. her i&o's were closely followed throughout her admission. her baseline creatinine was 1.5, which peaked at 1.9 and began to return to normal at 1.6 on . her urine output remained borderline at 20-25 ml/hour, with the return toward baseline kidney function and adequate po intake of fluids. she was discharged to rehab on with the foley in place for continued urine output monitoring. heme/id: her electrolyes were routinely monitored and repleted as needed. continued hypocalcemia and hypophosphatemia were noted at the time of discharge and she was discharged on 3 days of neutra-phos as well as calcium supplements. her initially leukocytosis of 14.9 resolved quickly, and her wbc count remained within normal limits throughout the remainder of her hospitalization. antibiotic courses were notable for cipro and flagyl as discussed above. her hgb and hct were routinely checked and remained stable. musk: orthopedics was consulted for her right distal fibula fracture. the injury was determined to be nonoperable and she remained weightbearing as tolerated in an aircast boot on her rle. physical therapy was consulted to evaluated her mobility, a discharge to an extended care facility when medically stable was recommended. the patient was encouraged to mobilize out of bed as tolerated. follow up was scheduled in the orthopedic clinic after discharge. prophyl: she was started sc heparin for dvt prophylaxis after removal of the thoracic epidural. her home dose of protonix was continued during her hospitalization. on , ms. remained afebrile and hemodynamically stable. she expressed adequate pain control and was tolerating a regular diet. she was discharged to rehab with plan for coninued physical therapy, cardiopulmonary assessment, urine output monitoring, and pain management. follow up was scheduled with orthopedics as well as the acute care service. medications on admission: advair diskus 250-50mcg'', amytriptyline 25'hs, amlodipine 5', cardizem cd 180' furosemide 60' labetolol 300'hs procrit solution unit/ml, 1ml subq/week pantoprozole 40' simvastatin 80' spiriva' terazosin 5' vesicare 10' ezetimibe 10' discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob. 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 4. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 5. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. furosemide 40 mg tablet sig: 1.5 tablets po daily (daily). 8. labetalol 200 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 9. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 10. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 11. terazosin 5 mg capsule sig: one (1) capsule po q 24h (every 24 hours). 12. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 13. diltiazem hcl 180 mg capsule, extended release sig: one (1) capsule, extended release po q 24h (every 24 hours). 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 16. oxycodone 5 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain. 17. tramadol 50 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. 18. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 19. ipratropium bromide 0.02 % solution sig: one (1) nib inhalation q6h (every 6 hours) as needed for wheezing. 20. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 21. potassium & sodium phosphates 280-160-250 mg powder in packet sig: one (1) powder in packet po tid (3 times a day) for 2 days. discharge disposition: extended care facility: hospital - discharge diagnosis: left rib fractures, right rib fractures, sternal fracture, right distal fibular fracture, multiple lacerations, and a left pnuemothorax secondary: renal artery stenosis hypertension dyslipidemia copd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: needs assistance to transfer discharge instructions: you were admitted to the hospital after you were in a motor vehicle accident. you sustained left rib fractures, right rib fractures, sternal fracture, right distal fibular fracture, multiple lacerations, and a collapse in your left lung. the orthopedic service saw you for your fibula fracture and recommended the aircast with weight bearing as tolerated until you follow up with them in clinic in 2 weeks. the acute pain service also was consulted to make sure you had adeuquate pain control and placed an epidural. you were then transitioned to pain medication by mouth after the epidural was removed. you were requiring some oxygen to maintain appropriate oxygen saturation levels. this was thought to be due to your rib fractures and some extra fluid that we gave you diuretics for. you were initially placed in the icu for your rib fractures and were brought to a regular hospital floor 3 days later. at the time of discharge you had your forehead sutures removed, you were having bowel movements, and your pain was well controlled. please follow up with the providers listed below. general instructions for rib fractures: you sustained rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. you should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. if the pain medication is too sedating take half the dose and notify your physician. is a complication of rib fractures.?????? in order to decrease your risk you must use your incentive spirometer 4 times every hour while awake.?????? this will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs.?????? you will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing.?????? symptomatic relief with ice packs or heating pads for short periods may ease the pain.?????? narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible.??????do not drive a vehicle or drink alcohol while taking narcotics. do not smoke return to the emergency room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus). you may bear weight as tolerated on your right leg while wearing the air cast boot we have given you. followup instructions: department: orthopedics when: tuesday at 10:00 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: tuesday at 10:20 am with: , np building: campus: east best parking: garage department: general surgery/ when: thursday at 2:30 pm with: acute care clinic building: lm bldg () campus: west best parking: garage notes: you will need a chest x-ray prior to this appointment. please go to , clinical center, radiology 30 minutes prior to your appointment. procedure: insertion of intercostal catheter for drainage closure of skin and subcutaneous tissue of other sites diagnoses: hypocalcemia unspecified pleural effusion urinary tract infection, site not specified atrial fibrillation other chronic pulmonary heart diseases open wound of forehead, without mention of complication closed fracture of sternum atherosclerosis of renal artery paralytic ileus closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury diarrhea chronic obstructive asthma, unspecified traumatic pneumothorax without mention of open wound into thorax other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle acute pain due to trauma open wound of knee, leg [except thigh], and ankle, without mention of complication closed fracture of eight or more ribs unspecified fracture of ankle, closed history of fall unspecified renovascular hypertension intracranial injury of other and unspecified nature without mention of open intracranial wound, with brief [less than one hour] loss of consciousness 

Answer: The patient is high likely exposed to