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: headache. hypertensive emergency major surgical or invasive procedure: lumbar puncture history of present illness: ms. is a 20 y/o woman with pmh of esrd on hd (last dialyzed on friday ) who presents with bilateral frontal headache since last tuesday. the patient tells us that the she was discharged from an osh in , ri last tuesday; her headache developed upon discharge. she cannot tell me the exact moment that the headache came on just states that it "started." she says the headache did not come on gradually and that it waxes and wanes in severity. she reports photophobia without scotomata. she denies any neurologic symptoms including numbness/tingling of arms or legs, slurring of speech, or facial asymmetry. she also denies fever, nausea, and vomiting. she has never had a headache like this before. she does report some neck stiffness; she has been unsteady on her feet due to her "feet hurting." she has not missed any of her medications per her report. . in the ed, she was initially started on a nipride gtt for bp 190/103. her blood pressure decreased to 150s-160s systolic. ct head was performed and did not demonstrate any acute intracranial hemorrhage. she was then switched to nitroglycerin gtt with resultant bps 140s-150s. labs in the ed demonstrated initial k of 6.3 and the patient was given insulin, d50, kayexalate, and calcium gluconate. repeat k was 5.9. cardiac enzymes were sent due to mild lateral st segment depressions; ck was 30 with troponin 0.25 (no prior in our system). she received morphine 2 mg x 2 for pain as well as aspirin 325 mg x 1. . the renal team was contact with plan to dialyze the patient in the morning. she was maintained on nitroglycerin gtt and transferred to the for further management. . on arrival to the , the patient is complaining of fonrtal headache. she denies nausea or vomiting. . ros: she reports recent diarrhea and right upper quadrant abdominal pain. she says that her recent hospitalization for shortness of breath was complicated by constipation for one week. she has had loose bowel movements since being home. she has also had intermittent right upper quadrant pain without an obvious trigger. her feet feel "puffy" but her breathing is comfortable. she denies any chest pain or palpitations. she denies dysuria and hematuria. past medical history: * type i dm - since * esrd on hd (mwf in ) * pulmonary embolism on coumadin (diagnosed 1 month prior per patient) * hypertension * hyperlipidemia * retinal detachment l eye * bilateral cataracts social history: the patient lives at home with her parents and younger sister. she denies any alcohol or tobacco use. family history: no history of headaches or migraines. father and grandparents with hypertension. two grandparents are diabetic. physical exam: pe: t: 97 bp: 148/103 hr: 91 rr: 17 o2 98% on 2l nc gen: pleasant, young female in no acute distress heent: perrl on right, l eye opacified. + photophobia. eomi on right. no scleral icterus or conjunctival pallor. mmm, tongue midline, op clear. neck: supple, no lad, jvd < 10 cm. no thyromegaly. difficulty with flexion of the neck, reports pain in left ribcage and cannot touch chin to chest even with passive flexion. chest: hd tunnelled catheter in place over the right chest, nontender to palpation of tunnelled portion. cv: rrr. nl s1, s2. soft systolic murmur at the llsb. lungs: crackles which clear with cough at the bilateral bases. no wheezing. abd: soft, no organomegaly. normoactive bowel sounds. + tenderness to palpation in right upper quadrant, negative sign. also reports tenderness to palpation in epigastrium. ext: no peripheral edema, warm & well perfused throughout. skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 intact. preserved sensation throughout. 5/5 strength in bilateral hand grip, biceps, triceps, knee flexion and extension, ankle dorsi- and plantarflexion, and hip flexion. finger to nose testing intact on the right and left. + reflexes, equal bl. gait not assessed. psych: listens and responds to questions appropriately, pleasant pertinent results: admission labs: wbc 10.2 (75% neutrophils, 17% lymphs, 5% eos), hct 32.7, plt 477 . k 6.3 --> 5.9 sodium 134, chloride 93, bicarb 26 (ag 15) bun 62, creatinine 9.4, glucose 100 . ck 30, troponin 0.25 . inr 3.2, pt 30.2, ptt 34.9 . lactate 1.5 --> 2.2 . ua > 50 wbcs, 0-2 rbcs, epis, 500 protein, 100 glucose . other labs: lumbar puncture: tube 4: wbc-0 rbc-0 polys-0 lymphs-50 monos-50 chemistries: totprot-21 glucose-117 . studies: ct head : 1. no evidence of intracranial hemorrhage or edema. 2. chronic small vessel ischemic changes and cerebral atrophy. 3. phthisis bulbi of the left globe. 4. near complete opacification of mastoid air cells bilaterally. . ct head : no change from prior study. no acute hemorrhage. . parathyroid ultrasound : no enlarged parathyroid gland identified. if high clinical suspicion can correlate with sestamibi nuclear scintigraphy. . parathyroid scan: following the intravenous injection of tracer, images of the neck including anterior, pinhole and marker views were obtained at 20 minutes. at 2 hours pinhole views of the neck and spect/ct of the neck and chest were obtained. initial images show tracer uptake in the thyroid and another focus in the mediastinum. 2 hour delayed pinhole image shows washout of activity from the thyroid with no persistent focus in the neck. spect/ct images show a persistent focus in the anterior mediastinal, anterior to the superior vena cava. sestamibi uptake indicates tissue with high blood flow. in light of the clinical scenario this would most likely represent a mediastinal parathyroid adenoma. incidental note is made of right maxillary sinus polyp and scoliosis. impression: findings compatible with an anterior mediastinal parathyroid adenoma. no persistent uptake identified in the neck. . cxr: a right pic catheter terminates within the distal svc. a right subclavian hemodialysis catheter terminates in the right atrium. the cardiomediastinal silhouette and hilar contours are within normal limits. hilar fullness is significantly decreased from prior exam. the pulmonary vasculature remains minimally prominent, but is significantly improved. a small left pleural effusion is stable in size. impression: resolving pulmonary edema. stable, small left pleural effusion. brief hospital course: a/p: this is a 20 y/o f with esrd secondary to type i dm on hd here with headache x 6 days. . # hypertensive emergency: the patient presented to ed with bp of 190s/100s and was initially started on a nitroprusside drip. this was switched to a nitroglyercin drip in the ed due to her renal failure and concern for cyanide toxicity. this was switched to labetolol on hospital day two and she was placed back on her home antihypertensive regimen of losartan and metoprolol on and weaned off of the labetolol drip by with blood pressures in the 140s to 150s systolic. given that her blood pressures appeared to be better controlled on labetalol her metoprolol was switched to labetalol at equal conversion. she was discharged on labetalol, losartan, and nifedipine with good control of her blood pressure. . # headache: the patient presented with a severe headache, neck stiffness, nausea and photophobia. she received two non-contrast head cts which were negative for acute hemmorhage. on presentation she was anticoagulated for pulmonary embolism with coumadin and her inr was elevated. she received multiple units of ffp with difficulty in normalizing her inr. a lumbar puncture was performed on by neurology. there was no blood found in the csf and preliminary cultures have been negative. she is unable to describe the quality of location of the headache. she received zofran and compazine for nausea with good improvement. upon discharge, her headache had completely resolved. . # type i diabetes mellitus. patient has long standing type i diabetes. on presentation her blood sugars were fluctuating and she was unable to take pos secondary to nausea. her lantus was decreased given concern for hypoglycemia initially but was quickly increased back to her usual dose. she currently is taking lantus 14 in the am and 10 in the pm (normal dose is 18 in am and 8 in pm) with a humalog sliding scale. she is followed by a diabetologist in . last hemoglobin a1c was 6.2 on admission. she has diabetic nephropathy and retinopathy. she may well have a component of diabetic gastroparesis as well given her persistent nausea with po intake. . # anemia: on presentation the patient's hematocrit was 32.7. this decreased to 21.0 on hospital day two. this was intitially thought to be secondary to dilution as all cell lines were decreased. her hematocrit remained stable in the low 20s for the remainder of her micu course. she did not require transfusion. iron studies were consistent with an anemia of chronic inflammation. there were no obvious sources of bleeding. hemolysis labs were negative. the patient has not been getting erythropoetin at her dialysis sessions because of her hypertension. this will need to be readdressed. this will likely need to be resumed as an outpatient, given good blood pressure control. . # fever. patient has low grade temperatures with hemodialysis on two occasions with the highest being 101.6. no source of infection was found on blood cultures or on chest x-ray. this should be followed closely the next time she goes for hemodialysis with obvious concern for a line infection. . # hypercalcemia. patient has had hypercalcemia. her pth is elevated, suggesting primary or tertiary hyperparathyroidism. spep normal. she received calcitonin initially for her hypercalcemia. her dose of cinacalcet was increased. she underwent a nuclear medicine scan which showed an affected area in her mediastinal region suggesting a single mediastinal parathyroid adenoma. she was given the contact information to see endocrine surgery here at for evaluation. . # nausea/vomiting. patient has nausea and vomiting for past day. be related to headache and hypertension. be related to gastroparesis, although she does not carry this diagnosis. the patient was started on reglan prn for nausea/vomiting, and nausea was subsequently controlled with no further need for antiemetics. she was provided with a prescription for campazine as needed for nausea. . # esrd secondary to type i dm. patient requires dialysis mwf at home. patient has gotten hd every day during her hospital stay. . # hyperkalemia. hyperkalemia improved with dialysis. . # history of pulmonary embolism. the patient was continued on coumadin but held on occasion due to supratherapeutic inr. this level should be followed at hemodialysis and coumadin dose adjusted accordingly. # fen: she was maintained on a renal/diabetic diet during her hospitalization medications on admission: albuterol prn cinacalcet 30 daily humalog 5 u tid with meals humalog ss lantus 18u qam, 8u qhs toprol xl 200 daily losartan 100 daily sevelamer 800 tid coumadin 5 mg/2.5 mg discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*1* 2. prednisolone acetate 1 % drops, suspension sig: one (1) drop ophthalmic daily (daily). 3. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic daily (daily). 4. brimonidine 0.15 % drops sig: one (1) drop ophthalmic daily (daily). 5. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: one (1) tablet po every eight (8) hours as needed for headache for 10 doses. disp:*10 tablet(s)* refills:*0* 6. labetalol 200 mg tablet sig: four (4) tablet po tid (3 times a day). disp:*360 tablet(s)* refills:*1* 7. prochlorperazine 10 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea for 10 doses. disp:*10 tablet(s)* refills:*0* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours): take on an empty stomach, then may eat 1/2 hour after taking. disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 9. sevelamer 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). disp:*180 tablet(s)* refills:*1* 10. warfarin 2.5 mg tablet sig: 1-2 tablets po at bedtime: take 2 tablets (5mg)4x/week on mon, wed, fri, sat - and take 1 tablet (2.5mg) 3x/week on tues, thurs, sun. disp:*50 tablet(s)* refills:*2* 11. insulin glargine 100 unit/ml solution sig: 10 - 12 units subcutaneous twice a day: take 10 units with breakfast, and 12 units at bedtime or as instructed. 12. humalog 100 unit/ml solution sig: one (1) injection subcutaneous four times a day: as directed by insulin sliding scale. 13. cinacalcet 90 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 14. losartan 100 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 15. nifedipine 20 mg capsule sig: one (1) capsule po every eight (8) hours. disp:*90 capsule(s)* refills:*2* discharge disposition: home with service facility: vna of care discharge diagnosis: primary: hypertensive urgency, headache secondary: dm type i, end stage renal disease on hemodialysis, hyperparathyroidism - parathyroid adenoma, hypercalcemia, pulmonary embolism on coumadin, hyperlipidemia, retinal detachment l eye, bilateral cataracts discharge condition: hemodynamically stable, afebrile and tolerating oral medication and nutrition. discharge instructions: you have been hospitalized for severe headache and uncontrolled hypertension associated with nausea and vomiting. you have been evaluated with imaging of your head that did not reveal any abnormalities and lab tests to monitor your electrolytes and check for infection. your symptoms have been controlled with blood pressure medications, anti-nausea medication and continued hemodialysis. . while you were in the hospital you were found to have a brief fever on two episodes after hemodialysis. when you go for hemodialysis on monday you should let your center know about these fevers so they can monitor your closely for your next few hemodialysis sessions. . you had an elevated inr (or coumadin level) while you were in the hospital. your dose of coumadin was changed as instructed below. you should not take any coumadin tonight (), and start your new prescription for coumadin tomorrow. you should get your inr checked again soon - this should be done at dialysis on monday and checked 2-3 times per week until you are in good control. . because you had high levels of calcium in your blood, some of your medications were changed to help lower this level. more importantly, you had a special x-ray done (or nuclear medicine/sestimibi scan) which showed that you have what is likely a benign tumor (called a parathyroid adenoma) in your neck which is causing this elevated level. you should follow-up with here at with dr. (endocrine surgeon) for evaluation and possible removal of this gland. . you should continue to take your insulin as instructed prior to this hospitalization, including long-acting insulin (lantus) and short-acting insulin with meals (humalog). . in addition to your regular medicine, your medications have been changed in several ways: these medications have changed dosage cinacalcet 30mg has increased to 90mg daily sevelamer 800mg has increased to 1600mg three times daily with meals coumadin: 5mg 4x/week (mon, wed, fri, sat), and 2.5 mg 3x/week (tues, thurs, sunday) these medications have been added: labetolol 800mg three times daily calcitonin salmon 250 unit subcutaneous daily nephrocaps 1 cap orally daily nifedipine 20 mg orally three times daily prochlorperazine 10 mg orally three times daily as needed for nausea pantoprazole 40 mg oreally daily this medication has been discontinued: toprol xl 200 mg once daily cozaar 100mg daily you should keep all your regularly scheduled appoinments and take all medications as prescribed. you should return to the emergency department or contact your pcp . should you notice fever, shaking chills, headache not controlled by medication, or inability to tolerate adequate oral fluid intake. or, for any other symptoms for which you are concerned. followup instructions: follow-up with your pcp . in the next 1-2 weeks to discuss your hospitalization and any current issues. . call to make an appointment with dr. (endocrine surgery): (. his office is located at , , ma. . follow-up with your endocrinologist in the next 1-2 weeks to discuss further management of your hyperparathyroidism and hypercalcemia. . continue to follow-up closely with your gynecologist at women & infant's hospital. . follow-up with your clinic 3-5 days post-discharge for a inr check and dose adjustment. procedure: venous catheterization, not elsewhere classified spinal tap incision of lung hemodialysis transfusion of packed cells transfusion of other serum diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of anticoagulants personal history of venous thrombosis and embolism streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus other specified disorders resulting from impaired renal function diabetes with renal manifestations, type i [juvenile type], uncontrolled benign neoplasm of parathyroid gland unspecified retinal detachment 

Answer: The patient is high likely exposed to