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: cc: major surgical or invasive procedure: suboccipital craniectomy with evacuation of cyst and mass biopsy placement of right frontal external ventricular drain. history of present illness: hpi: 68m w/ h/o nsclca; now with 3 weeks of worsening h/a; past few days, nauseous and occasionally vomitting; also restarted on chemo which may be related in time with the n/v; noticed some gait unsteadiness; no fall; otherwise denies weakness, numbness, tingling, blurry/double vision or any other symptoms; past medical history: pmhx: 18mo h/o nsclca; s/p chemo+rad; recurred few weeks ago -> restarted on chemo; hypercholesterolemia; social history: lives with wife family history: unknown physical exam: physical exam: 97.9 150/98 88 18 98%gen: wd/wn, comfortable, nad. awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. language: intact. no dysarthria or paraphasic errors. fundoscopic exam: possible mild papilledema; ii: pupils equally round and reactive to light, to 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. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. strength full power throughout. no pronator drift sensation: intact to light touch bilaterally. reflexes: b t pa ac right 1 1 2 2 left 1 1 2 2 coordination: very discreete tremor r>l on finger-nose-finger, intact rapid alternating movements; on discharge : awake alert oriented - non focal without drift - remains anisicoric as was on admission l>r. speech clear. no drift. finger to nose to finger improved. ambulates with walker with contact . pertinent results: , m 68 radiology report chest (pa & lat) study date of 11:53 pm , eu 11:53 pm chest (pa & lat) clip # reason: evaluate lung ca medical condition: 68 year old man with brain mets from lung ca reason for this examination: evaluate lung ca final report indication: 68-year-old man with brain mets from lung cancer. evaluate lung cancer. comparison: none available. chest, two views: there is a right-sided central catheter with its tip projecting into the right atrium. heart size is normal. there is a spiculated mass at the left hilum. proximally there are surgical clips. no other mass is seen. there is no focal parenchymal consolidation. there is no pleural effusion or pneumothorax. the lungs are hyperexpanded with upper lobe lucency suggestive of emphysema. pulmonary vasculature is within normal limits. there have been three consecutive vertebroplasties in the mid thoracic spine. impression: 1. left hilum spiculated mass concerning for mass in this status post lung surgery patient. 2. right port-a-cath with tip in the right atrium. 3. mid thoracic vertebroplasties. 4. likely emphysema. the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 8:33 pm , m 68 radiology report mr head w & w/o contrast study date of 11:54 pm , eu 11:54 pm mr head w & w/o contrast; outside films read only clip # reason: evaluate medical condition: 68 year old man with brain mets reason for this examination: evaluate contraindications for iv contrast: none. wet read: gwp tue 12:45 am 3.4 x 3.5 cm r rim enhancing cystic lesion with enhancing mural nodule in r cerebellum ddx included mets, hemangioblastoma and cystic gbm gwlms wet read audit # 1 gwp tue 12:45 am 3.4 x 3.5 cm r rim enhancing cystic lesion with enhancing mural nodule in r cerebellum ddx included mets, hemangioblastoma and cystic gbm gwlms final report history: non-small cell lung cancer presenting with presumed brain metastases. no priors are available. technique: multiplanar t1- and t2-weighted sequences were obtained through the brain without and with intravenous gadolinium at hospital on at approximately 18:16 p.m. the images were submitted for second interpretation after the patient was transferred for more definitive neurosurgical care. mri of the brain without and with intravenous contrast: centered within the right cerebellum is a predominantly cystic 35 x 38 mm lesion with well-defined borders and a 8 x 20 mm enhancing mural component. additionally, there is enhancement of the capsule/pseudocapsule surrounding the lesion. there is mild-to-moderate surrounding vasogenic edema which extends into the left cerebellar hemisphere and results in complete effacement of the fourth ventricle as well as mass effect on the adjacent medulla. mild dilatation is noted involving the third and lateral ventricular system with slightly increased flair hyperintensity adjacent to the ventricular horns, which may relate to chronic small vessel disease or acute transependymal flow of csf. additional scattered punctate subcortical white matter lesions are noted within the frontal lobes bilaterally, likely related to chronic small vessel disease. there is no region of acute infarction, hemorrhage, or cerebral edema/enhancing lesions identified. major vascular flow voids appear preserved. impression: predominantly cystic lesion with enhancing rim/pseudocapsule as well as a large enhancing mural nodular component with mild-to-moderate surrounding vasogenic edema resulting in marked mass effect on the adjacent fourth ventricle as well as mild hydrocephalus. given the patient's history, a cystic metastatic lesion is felt most likely with the differential also including hemangioblastoma. in the appropriate clinical context/travel history, parasitic infection such as cysticercosis could also be considered. the study and the report were reviewed by the staff radiologist. dr. dr. . approved: tue 7:58 pm imaging lab , m 68 radiology report ct abdomen w/contrast study date of 1:43 am , eu 1:43 am ct chest w/contrast; ct abdomen w/contrast; ct pelvis w/contrast clip # reason: lung mets eval. field of view: 40 contrast: optiray amt: 130 medical condition: 68 year old man with lung mets. reason for this examination: look for other mets. contraindications for iv contrast: none. wet read: gwp tue 3:21 am extensive metastatic disease: left lung apex necrotic mass l upper paratracheal node r paratracheal conglomeration of nodes l hilar mass compressing l pulm artery and subsgmental brochi to lll multiple cystic and intermediate density in liver - cysts vs biliary hamartoma vs mets - recommend mr (can evaluate kidney hypodensities at that time) no obvious bone mets - but recommend bone scan gallstone, diverticulosis final report indication: 68-year-old man with lung mets, look for other mets. comparison: none available. technique: multiple mdct axial images were obtained from the base of the neck to the proximal thighs after the uneventful intravenous administration of 120 cc of optiray. enteric contrast was not administered. coronal and sagittal become reformations were derived. findings: ct of the chest with intravenous contrast: there is a central catheter with its tip in the right atrium. the thyroid enhances homogenously. there is no axillary lymphadenopathy. there is a left upper paratracheal 10 x 10-mm necrotic node. there is a large soft tissue mass that extends from the ap window to the right posterior infrahilar area and compresses the left pulmonary artery and bronchi to the subsegmental portions of the left lower lobe where there is some post-obstructive atelectasis (2, 34). this necrotic soft tissue mass measures approximately 6.8 x 2.5 cm in ap and transverse dimensions. the heart is top normal in size. there is a small pericardial effusion. on the right, central airways are patent to the level of subsegmental bronchi. secretions are seen in the right main stem bronchus (series 2, image 30). on the left the hila mass compresses the subsegmental bronchi to the left lower lobe. cystic changes upper lobe predominance suggests emphysema. there is an area of possible pleural thickening versus pulmonary nodule in the right upper lobe (series 2, image 19). there is a 1.5 x 2.3 soft tissue mass in the apex of the left lung. post-surgical changes are seen in the left thorax posteriorly (2, 28). ct of the abdomen with intravenous contrast: innumerable hypodensities are seen throughout the liver measuring to slightly 4.4 cm in diameter. while these could represent cysts or biliary hamartomas in this clinical context and with some of the cysts appearing of intermediate density (series 2, image 59) metastases needs to be considered. the gallbladder is unremarkable excepting for a radiopaque gallstone. the kidneys symmetrically take up and excrete contrast and there are multiple bilateral hypodensities. there are likley bilateral stagnorn calculi. the adrenals are normal. the spleen is unremarkable. the pancreas is normal. abdominal loops of bowel are unremarkable. there is no free air, free fluid or pathologic lymphadenopathy. the abdominal vasculature demonstrates moderate atherosclerotic vascular calcification. ct of the pelvis with intravenous contrast: there is diverticulosis without evidence of diverticulitis. the bladder and distal ureters are unremarkable. the prostate is enlarged at 5.4 cm. there is no pelvic free air, free fluid or pathologic lymphadenopathy. musculoskeletal: there have been vertebroplasties at t6, 7 and 8. post- surgical changes are seen in the right posterior hemithorax (series 2, image 28). no suspicious osteolytic or osteoblastic lesion is seen. multilevel degenerative change is seen. there is a sclerotic focus in the right iliac well marginated. in the usual clinical context this could be a bone island but in this clinical context consider a bone scan. incidental note is made of a lipoma involving the right shoulder musculature (series 2, image 4). impression: 1. extensive metastatic lung cancer with a soft tissue implant in the apex of the left lung, left upper paratracheal node, extensive left hilar mass causing compression of the left main pulmonary artery and subsegmental bronchi to the left lower lobe, right paratracheal conglomeration of necrotic nodes. 2. multiple cystic and mixed-density lesions within the liver concerning for metastases in this patient. recommend mr for further characterization. 3. multiple hepatic hypodensities. usually these are simple cysts but given this clinical context recommend evaluation at the time of abdominal mr. 4. no suspicious osteolytic or osteoblastic lesion although, with the sclerotic focus seen in the right iliac, bone scan is recommended for further evaluation. 5. cystic changes in the lungs suggest emphysema. 6. likely bilateral staghorn calculi. consider non-contrast ct comment: these results were posted to the ed dashboard at the time of interpretation, 20 minutes after scanning the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 10:32 am imaging lab , m 68 radiology report ct head w/o contrast study date of 2:41 pm , nsurg tsicu 2:41 pm ct head w/o contrast clip # reason: please evaluate for bleeding medical condition: 68 year old man with suboccipital mass reason for this examination: please evaluate for bleeding contraindications for iv contrast: none. provisional findings impression: jkpe tue 6:10 pm status post suboccipital craniectomy with cerebellar lesion excision. the surgical cavity contains a large hematoma within it measuring 37 x 40 mm with persistent surrounding vasogenic edema and complete effacement of the fourth ventricle. additionally, there is an interval increase in the size of both the lateral and third ventricular system suggesting a slightly increased transependymal csf flow likely reflective of increased intracranial pressure. final report history: status post suboccipital craniectomy for cerebellar mass lesion removal. comparison is made to , outside mri. non-contrast head ct in the interval, the patient has underwent a right-sided suboccipital craniectomy with removal of the previously described predominantly cystic right cerebellar mass in this patient with known non-small cell lung cancer. large hematoma is noted to fill the surgical resection bed measuring approximately 37 x 40 mm and there is persistent vasogenic edema around the surgical bed resulting in complete effacement of the fourth ventricle. additionally, there is slightly increased size to the lateral ventricular system and a more ballooned appearance and dilatation of the third ventricle as well as the slightly increased low attenuation surrounding the ventricular system suggesting elevated intracranial pressure/ transependymal flow of csf. the remaining brain parenchyma is unremarkable. expected pneumocephalus and subcutaneous emphysema is noted about the surgical site. impression: large hematoma within the surgical bed with persistent complete effacement of the fourth ventricle and surrounding vasogenic edema. interval increase in size of third and lateral ventricular system with suggestion of increased transependymal csf flow. the findings were discussed with dr. shortly after exam acquisition at approximately 4 p.m. the study and the report were reviewed by the staff radiologist. dr. dr. . approved: tue 7:58 pm imaging lab , m 68 radiology report chest (portable ap) study date of 3:08 pm , nsurg tsicu 3:08 pm chest (portable ap) clip # reason: ngt position medical condition: 68 year old man with ngt reason for this examination: ngt position final report chest radiograph indication: nasogastric tube position. comparison: . findings: as compared to the previous radiograph, the right-sided central venous access line is unchanged. newly inserted nasogastric tube, normal close, the tip of the tube is not included on the radiograph. otherwise, no relevant changes, known left central lesion, no newly appeared lung lesions. no other changes. dr. approved: fri 10:14 pm imaging lab , m 68 radiology report chest (portable ap) study date of 10:40 am , nsurg tsicu 10:40 am chest (portable ap) clip # reason: ? position medical condition: 68 year old man with new ng tube placement reason for this examination: ? position final report history: 68-year-old male status post malposition dobbhoff tube placement. now assess for location. comparison: , 10:06 a.m. ap upright portable chest radiograph: no evidence of ng tube seen in the intrathoracic portion of the esophagus. the right-sided port-a-cath is seen with the tip in the mid-to-low svc, unchanged in position. the cardiomediastinal, hilar contour and pulmonary vasculature are unchanged and within normal limits. there is no pneumothorax or pleural effusion. the previous lung masses in the left hemithorax are visualized again without interval change. there is no new opacity seen in the lungs. the multilevel vertebroplasty is seen in the thoracic spine, unchanged. impression: no evidence of ng tube in the intrathoracic portion of the esophagus. dr. has discussed the findings with the primary team, dr. , at 12:38 p.m. confirmation is made that the primary team was aware of the potential coiling of ng tube in the oropharynx and has subsequently removed the ng tube. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 10:19 pm , m 68 radiology report ct head w/o contrast study date of 10:52 am , nsurg tsicu 10:52 am ct head w/o contrast clip # reason: 68 year old man with cerebellar hemorrhage, with evd. weanin medical condition: 68 year old man with cerebellar hemorrhage, with evd. weaning evd, evaluate for hydro at 3pm. reason for this examination: 68 year old man with cerebellar hemorrhage, with evd. weaning evd, evaluate for hydro at 3pm. contraindications for iv contrast: none. provisional findings impression: rxra fri 6:18 pm pfi: in comparison with the prior ct dated at 17:23 hours, no significant change is demonstrated in the interim. persistent mild ventriculomegaly with unchanged shunt terminating at the third ventricle. unchanged right cerebellar parenchymal hemorrhage. persistent intraventricular hemorrhage layering the occipito-ventricular horns. final report ct of the head without contrast. clinical indication: 68-year-old man with cerebellar hemorrhage with evd, evaluate for hydrocephalus and cerebellar hemorrhage. comparison: prior ct of the head dated and prior mri of the head with and without contrast dated . technique: contiguous axial images were obtained through the brain. no contrast was administered. findings: in comparison with the prior examinations, no significant change is identified. persistent right frontal catheter terminating adjacent to the third ventricle, unchanged mild ventricular dilatation and intraventricular hemorrhage layering the occipito-ventricular horns. in the right cerebellar hemisphere, there is a persistent and unchanged parenchymal hematoma in the resection cavity demonstrating vasogenic edema as well as small amount of pneumoencephalus, essentially unchanged since the prior study. the foramen magnum appears patent. persistent mild mass effect on the fourth ventricle. impression: in comparison with the prior examination, no significant change is demonstrated, persistent intraventricular blood layering the occipital horns, unchanged right frontal shunt catheter terminating at the level of the third ventricle through the right frontal burr hole, minimal right frontal pneumoencephalus. unchanged and stable right cerebellar parenchymal hemorrhage within the surgical cavity with persistent small pneumoencephalus. dr. approved: sat 12:33 am imaging lab , m 68 radiology report mr head w & w/o contrast study date of 11:58 pm , nsurg tsicu 11:58 pm mr head w & w/o contrast clip # reason: please evaluate for residual mass contrast: magnevist amt: 16 medical condition: 68 year old man with suboccipital mass reason for this examination: please evaluate for residual mass contraindications for iv contrast: none. final report exam: mri brain. clinical information: patient status post suboccipital craniotomy. technique: t1 sagittal and axial, flair t2 susceptibility and diffusion axial images of the brain were obtained before gadolinium. t1 axial and mp-rage sagittal images acquired following gadolinium. comparison was made with the previous mri of and ct examinations of and . findings: since the previous mri study, the patient has undergone right-sided suboccipital craniectomy. the previously seen rim-enhancing region has been resected. blood products are seen in the surgical bed. minimal enhancement is seen in the medial aspect of the surgical bed, which is not explained by pre-gadolinium blood products. these findings may indicate some residual enhancement. the surrounding edema is unchanged and there is continued deformity of the fourth ventricle. moderate ventriculomegaly with mild periventricular hyperintensities are again seen, unchanged. new since the previous mri is a signal change within the right basal ganglia extending to the periventricular region. in correlation with the ct examinations, particularly that of it appears that the ventricular drain initially coursed down the right periventricular region through the basal ganglia and this could represent edema from that drain placement. there is no evidence of low adc in this region to indicate an acute infarct. there is no midline shift seen. impression: 1. postoperative changes with blood products and expected post-surgical change in the posterior fossa. mild residual enhancement is seen at the medial aspect of the surgical bed. the edema is unchanged and the ventricular size is also unchanged, which is moderately enlarged. 2. new signal change in the right basal ganglia could be explained from placement of the ventricular drain as this area was traversed by the drain on the ct of . this does not appear to be due to an acute infarct given the absence of adc abnormality. 3. findings were discussed with at the time of interpretation of this study. dr. approved: fri 5:07 pm imaging lab , m 68 radiology report ct head w/o contrast study date of 10:30 am , nsurg fa11 10:30 am ct head w/o contrast clip # reason: interval change following evd removal medical condition: 68 year old man with rt cerebellar mass reason for this examination: interval change following evd removal contraindications for iv contrast: none. provisional findings impression: cxwc sat 12:40 pm following removal of right frontal ventricular catheter, there is a small amount of high-density material and air along the catheter tract. within the lateral ventricles, posteriorly layering blood is unchanged, and there is a small amount of air antidependently. no new abnormalities. stable right cerebellar parenchymal hemorrhage. final report indication: 68-year-old man with right cerebellar mass, evaluate interval change following evd removal. comparison: . technique: contiguous axial images were obtained through the brain. no contrast was administered. findings: there has been interval removal of a right frontal approach ventriculostomy catheter. along the catheter tract, there is a small amount of high-density material and small foci of air. within the lateral ventricles bilaterally, there is air non-dependently and layering blood dependently. intraventricular blood is unchanged. ventricle size is stable. there is no new large area of hemorrhage. the hyperdense collection in the right posterior fossa reflecting right cerebellar hemorrhage in the operative bed is stable in size and appearance. air within the surgical bed is also unchanged. there is no new hemorrhage, edema, shift of midline structures, or evidence of major vascular territorial infarct. sulci are normal in size and configuration. there is no ventriculomegaly. the basilar cisterns are patent. the right occipital craniotomy, and the right frontal burr hole are stable. there are no new bony abnormalities. mastoid air cells and paranasal sinuses are well aerated. impression: 1. interval removal of right frontal approach ventriculostomy catheter, with small foci of blood and air along the catheter tract, but no large hemorrhage. no change in ventricle size. 2. stable appearance of right cerebellar parenchymal blood in the operative bed. 3. unchanged intraventricular blood layering in the occipital horns. the study and the report were reviewed by the staff radiologist. dr. dr. approved: sat 5:59 pm imaging lab , m 68 radiology report abdomen (supine & erect) study date of 10:26 pm , nsurg fa11 10:26 pm abdomen (supine & erect) clip # reason: 68 year old man with persistant nausea and vomitting. r/o bo medical condition: 68 year old man with persistant nausea and vomitting. r/o bowel obstruction. reason for this examination: 68 year old man with persistant nausea and vomitting. r/o bowel obstruction. final report indication: 68-year-old male with persistent nausea and vomiting. evaluate for obstruction. comparison: ct abdomen and pelvis dated . supine and decubitus views of the abdomen: the bowel gas pattern is nonspecific. there are no air-fluid levels or dilated bowel loops identified. there is minimal air seen within non-distended sigmoid and descending colon, with moderate amount of retained fecal material in the transverse colon. there is no pneumoperitoneum, pneumatosis, or bowel wall thickening. there are no abnormal soft tissue calcifications. visualized osseous structures demonstrate no suspicious lytic or sclerotic osseous lesions. there are degenerative changes in the lumber spine and bilaterally in the hips, with evidence of prior thoracic vertebroplasties. impression: no evidence for obstruction. the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 4:33 pm imaging lab brief hospital course: pt was admitted to the hospital after being transferred in from osh for right cerebellar cystic mass. pt was admitted to the icu for close observation. he was taken to the or for evacutaion of cyst as well as biopsy. the procedure was uneventful. post op examination was concerning only for slight lethargy. otherwise he was non-focal. post operative imaging was performed and revealed hemorrhage into the surgical bed. a right frontal external ventricular drain was placed for csf diversion as there was mild hcp. he tolerated that procedure well. a post operative mri demonstrates slight residual tumor. he was not placedon antiepileptics or steroids post operatively. he underwent a clamp trial and the evd was removed on . and he has not developed hydrocephalus in the meantime. he was transferred to the step down unit where he had episodes per day of vomiting that seem to be related to motion and position change. meds were adjusted to combat this. a kub was performed and the images do not demonstrate an ileus. he has had bm's while in house as well. neuro-onc consult was obtained and brain tumor clinic appointment arranged. he was seen by pt ot as well as st. their recommendations were followed. he was made floor status on . he is being dishcarged to rehab and agrees with this plan. final pathology is negative for malignant cells. the cytology from the cystic portion of the tumor is + for malignant cells with the final analysis still pending at this time. medications on admission: simvastatin discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 8. dexamethasone 4 mg tablet sig: one (1) tablet po q8h (every 8 hours): dr will decide on taper - please do not taper. 9. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 10. famotidine 20 mg iv q12h 11. metoclopramide 10 mg iv q8h:prn nausea 12. ondansetron 8 mg iv bid discharge disposition: extended care facility: medical center - discharge diagnosis: right cerebellar cystic mass hydrocephalus discharge condition: neurologically improved discharge instructions: general instructions ?????? 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. ?????? if you have been prescribed an anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. please have results faxed to . 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 have your sutures removed on friday please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain with / without contrast. you have a brain clinic appointment as below - if you cannot make this appointment - please call them to let them know provider: , md phone: date/time: 4:00 md procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain intravascular imaging of intrathoracic vessels diagnoses: obstructive hydrocephalus pure hypercholesterolemia compression of brain secondary malignant neoplasm of brain and spinal cord personal history of malignant neoplasm of bladder malignant neoplasm of other parts of bronchus or lung 

Answer: The patient is high likely exposed to