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: nausea, emesis, lethargy major surgical or invasive procedure: : left craniotomy with metastasis resection : right frontal evd placement : removal of right evd and placement of right frontal vp shunt history of present illness: 53rh woman with stage iv non-small cell lung cancer with brain mets s/p steroid therapy and whole brain radiation completed on presented with sudden onset nausea/vomiting and lethargy. ct head showed increased size of her left occipital mass with significant vasogenic edema. prior to , her family reports that she had trouble seeing things in her right visual field but had no other neurological symptoms. in the ed she was noted to be lethargic but otherwise moving all extremities. she received 10mg iv dexamethasone and has been continued on 4mg iv q 6 hours. she was started on levetiracetam this morning for seizure prophylaxis. there has been no clinical activity concerning for seizure. past medical history: oncologic history: - stage iv non-small cell lung cancer (adenocarcinoma; egfr wild-type, eml-alk non-rearranged, kras mutated (p.g12c). current treatment - cisplatin 75mg/m2 + pemetrexed 500 mg/m2 with concurrent radiation therapy. - mri head revealed new brain lesions after new neurological symptoms of headaches, visual deficit of the right field, and right lower extremity weakness. she was initiated on steroids and then underwent whole brain radiation from to . - ct of the chest for refractory cough reveals a large right upper lobe mass extending into the chest wall with probable/possible chest wall invasion, with mediastinal lymphadenopathy. - bronchoscopy - transbronchial biopsy of the mass, 4l, 4r and 11r nodes, and bronchial wash positive for non-small cell lung cancer (adenocarcinoma) - pet/ct - fdg avid right upper lobe mass with surrouding ground-glass opacities suggestive of lymphangitic spread and fdg avid extensive mediastinal lymphadenopathy, but no other fdg avid lesions at other sites. mri head - concern of a single 4 mm left occipital mass, questionable metastases. - initiated radiation therapy - cycle 1 cisplatin (75 mg/m2) + pemetrexed (500 mg/m2) - cycle 2 cisplatin/pemetrexed - cycle 3 cisplatin/pemetrexed - completed thoracic radiation therapy - mri head - new brain mets - pet/ct partial remission - - whole brain radiation social history: the patient is single/lives alone in , never married, no children. occupation: previously worked fulltime as a waitress at legals restaurant mobility: unaided smoking: ex-smoker quir 10 years ago previously 30 per day for close to 30 years alcohol: occasionally family history: father, deceased, with lung cancer mother, alive, h/o breast cancer, colon cancer brother, 2 weeks ago from small cell lung cancer,smoker, rx at gfather, deceased, colon cancer gmother, deceased, lung cancer physical exam: on admission: vitals: t:98.9 p:70s r:20 bp:140s/70s sao2:98% ra general: eyes closed, no acute distress heent: nc/at, shaved head, no scleral icterus, mmm neck: no nuchal rigidity. pulmonary: lungs cta bilaterally cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. skin: no rashes or lesions noted. neurological examination: - mental status: eyes closed spontaneously, opens briefly to loud voice/noxious. resists eye opening. says "yes" to questions inappropriately. no other verbal output. does not follow commands. very inattentive. - cranial nerves: perrl 3mm -->2.5mm and brisk. resists eye opening. corneals intact bilaterally. ocr intact. no blink to threat bilaterally. when eyelids held open, eyes dysconjugate, bilaterally deviated laterally. at brief times when patient arouses and eyes are open, they start to converge closer to conjugate. face symmetric. - motor: normal bulk, tone throughout. no adventitious movements. all 4 limbs move at least antigravity to stimulus and occasionally spontaneously. - sensory: grimaces to noxious throughout with localization. - dtrs: br tt pa aj l 2 2 2 2 1 r 2 2 2 2 1 plantar response was extensor bilaterally although patient also have brisk voluntary withdrawal. on discharge: aox3, following commands, alert and interactive. right hemianopsia motor: full strength throughout pertinent results: ct head : increased size of the metastatic lesion within the left occipital lobe with increasing surrounding vasogenic edema. new mild hydrocephalus of unclear etiology. ct head : 1. stable appearance of the three known metastases in comparison to the prior exam performed 10 hours prior. there is no evidence of new hemorrhage, mass effect, or infarction. 2. stable mass effect on the left lateral ventricle with persistent ventriculomegaly, unchanged from the prior exam performed 10 hours earlier, but increased from the prior mri in . mri head : 1. increase in size of left occipital lobe lesion with increased mass effect on the occipital of the left lateral ventricle, similar degree of subependymal spread along the occipital of the left lateral ventricle and mild adjacent mass effect and rightward deviation of the posterior falx. 2. second lesion just adjacent to the vermis within the left occiput and right frontal lesion have decreased in size compared to the prior examination. 3. mildly increased size of the ventricles compared to the prior exam. mri head : 1. status post left occipital craniotomy, expected post-surgical changes are seen, consistent with edema in the surgical bed and residual blood products. there is persistent residual mass effect in the left ventricular trigone and associated vasogenic edema. 2. the area with enhancement in the left occipital lobe has been removed, the possibility of residual mass cannot be completely excluded, followup is advised. unchanged right frontal enhancing lesion. ventricular shunt is in place, terminating at the foramen of via right frontal burr hole with no evidence of hydrocephalus. noncontrast head ct (, post-vp shunt): 1. the right frontal approach intraventricular catheter terminates in the region of the foramen of . the ventricles have decreased in size since . small amount of intraventricular hemorrhage. 2. s/p left occipital mass resection. related findings are better assessed on the mri. brief hospital course: 53 yo rh woman with stage iv nsclc with brain mets s/p steroid therapy and whole-brain radiation completed on presenting with sudden-onset n/v and lethargy, found to have increased size of left occipital mass with significant vasogenic edema . # occipital mass: patient was admitted to medicine on after ct head showed large left occipital mass. in the ed she was started on dexamethasone and keppra. on hd#2 she became more lethargic so neurosurgery consult was obtained. she was transferred to icu and started seizure prophylaxis. dr. met with the family to discuss the option of surgery, and family met with palliative care to discuss comfort options.on hd#3 her neurological status significantly improved, and the decision was made to pursue operative care. that evening, she underwent right evd drain placement, followed by a left craniotomy with metastasis excision. the operation was without complications. following the procedure, the patient was extubated and transported back to the icu. her steroid dose was escalated with accompanying percautions. on hd#4 (pod #1), she was aaox3 with fluid speech and intact repetition/comprehension, but reported new right hemianopia likely secondary to mass resection. she was transferred to stepdown unit. on hd#4 (pod #2), her neuro exam remained stable. dressings were removed, wound c/d/i. her evd remained open at 10 mmhg. on hd#5, patient returned to or for vp shunt placement. her evd was clamped prior to procedure. right vp shunt was placed and evd removed during procedure. follow-up ct showed good shunt placement and small intraventricular hemorrhage. on hd#6 she was tolerating po diet and meds. she was seen and evaluated by physical therapy who recommended acute rehab. steroids to taper to dexamethsaone 2mg and continute until follow up in brain tumor clinic. . # goals of care: patient's family initially requested palliative care consult, and plan was for cmo until her neurologic status improved on hd#3 and patient requested surgery. on hd#6 she and family expressed interest in discharge to hospice. hospice consult was obtained and will follow her through her rehab period medications on admission: preadmission medications listed are correct and complete. information was obtained from pharmacywebomr. 1. dexamethasone 2 mg po daily taper per dr tapered dose - down 2. nystatin oral suspension 5 ml po qid 3. omeprazole 20 mg po daily 4. zolpidem tartrate 10 mg po hs insomnia 5. levetiracetam 500 mg po bid discharge medications: 1. zolpidem tartrate 10 mg po hs insomnia 2. omeprazole 20 mg po daily rx *omeprazole 20 mg 1 capsule(s) by mouth daily disp #*30 capsule refills:*3 3. nystatin oral suspension 5 ml po qid 4. levetiracetam 1000 mg po bid rx *levetiracetam 1,000 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 5. dexamethasone 1 mg po see taper below starting on , take 4 pills 3 times per day. on , decrease dose to 3 pills 3 times per day. on , decrease dose to 2 pills 3 times per day. on , decrease dose to 2 pills 2 times per day. continue this dose until neuro-oncology follow-up. tapered dose - down rx *dexamethasone 1 mg 1 tablet(s) by mouth see taper below disp #*80 tablet refills:*0 6. oxycodone (immediate release) 5-10 mg po q4h:prn pain rx *oxycodone 5 mg tablet(s) by mouth every four (4) hours disp #*60 tablet refills:*0 7. acetaminophen 325-650 mg po q6h:prn pain 8. docusate sodium 100 mg po bid 9. senna 1 tab po bid:prn constipation discharge disposition: extended care facility: hospital - discharge diagnosis: stage 4 non-small cell lung cancer metastasis to brain with mass effect and hydrocephalus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge 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. ?????? dressing may be removed on day 2 after surgery. ?????? **you have dissolvable sutures you may wash your hair and get your incision wet day 3 after surgery. 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) & senna 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. ?????? you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? if you are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (prilosec, protonix, or pepcid), as these medications can cause stomach irritation. make sure to take your steroid medication with meals, or a glass of milk. ?????? make sure to continue to use your incentive spirometer while at home. followup instructions: ?????? you have an appointment in the brain clinic on at 12pm. the brain clinic is located on the of , in the building, . their phone number is . please call if you need to change your appointment, or require additional directions. ?????? you will not need an mri of the brain. procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain ventricular shunt to abdominal cavity and organs insertion or replacement of external ventricular drain [evd] diagnoses: obstructive hydrocephalus personal history of tobacco use secondary malignant neoplasm of brain and spinal cord malignant neoplasm of bronchus and lung, unspecified cerebral edema 

Answer: The patient is high likely exposed to