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: codeine / nsaids attending: chief complaint: s/p mvc major surgical or invasive procedure: none history of present illness: 61 year old female, driving on highway, missed exit and backed up, struck by oncoming truck. + airbag deployment, +loc. at osh found to have small frontal contusion, and multiple rib fractures and small ptx. awake and alert on arrival to . multiple facial fractures. past medical history: pmh: diabetes, bleeding ulcer, htn, opioid abuse psh: total hysterectomy, back surgery social history: single, lives at home, smoker, no etoh family history: noncontributory physical exam: on arrival to : constitutional: uncomfortable heent: pupils equal, round and reactive to light, extraocular muscles intact oropharynx within normal limits chin laceration chest: clear to auscultation, tender to palpation -right cardiovascular: regular rate and rhythm abdominal: soft, nontender, nondistended extr/back: no cyanosis, clubbing or edema neuro: speech fluent, gcs 15, moves all extremities on discharge: vitals 98.5 81 122/73 18 93% ra constitutional: a&o, nad heent: pupils equal, round and reactive to light, extraocular muscles intact oropharynx within normal limits chin laceration sutures removed, well approximated, no drainage chest: clear to auscultation, tender to palpation -right cardiovascular: regular rate and rhythm abdominal: soft, nontender, nondistended extr/back: no cyanosis, clubbing or edema neuro: speech fluent, gcs 15, moves all extremities pertinent results: ct head/ sinus: 1. small subarachnoid hemorrhage in the sulci of the right temporo-parietal lobe. 2. hyperdense focus in the right frontal lobe, likely contusion. possible contusion in the left frontal lobe. 3. fracture of the right zygomatic arch and lateral wall of the right maxillary sinus with hemorrhagic fluid within the right maxillary sinus. facial bone fractures are better seen on subsequent ct sinus. 4. subcutaneous emphysema as outlined above. ct neck: 1. no acute fracture or traumatic malalignment of the cervical spine. 2. displaced fractures of the second and third ribs on the right. 3. left apical pneumothorax and atelectasis at the lung apices. 4. large amount of subcutaneous emphysema tracking to the fascial planes of the neck. no evidence of airway injury. ct sinus: 1. minimally displaced fractures of the right zygomatic arch, and lateral and anterior walls of the right maxillary sinus with hemorrhagic fluid within the sinus cavity. 2. minimally displaced fractures of the bilateral orbital roof with a small amount of associated subcutaneous emphysema. 3. mucosal thickening in the ethmoidal sinus as well as minimal mucosal thickening in the left maxillary and left sphenoid sinus. 4. cervical subcutaneous emphysema, better assessed on concurrent c-spine study. shoulder (ap, neutral & axillary) trauma right bone fragments projecting superior to the narrowed acromioclavicular joint could be acute avulsions. there also appear to be areas of erosion on the distal clavicle suggesting a chronic degenerative component. the head of the humerus is smooth, and there is no dislocation. glenoid is intact. chest (pa & lat) 1. no new focal consolidation. 2. increased small right pleural effusion and new, loculated, right pleural or extrapleural fluid, could be due to interval bleeding of displaced rib fractures. 3. pulmonary edema has resolved. 4. decrease in subcutaneous emphysema. 01:20pm wbc-13.4* rbc-3.45* hgb-11.5* hct-34.4* mcv-100* mch-33.4* mchc-33.4 rdw-13.7 01:20pm plt count-228 01:20pm pt-11.6 ptt-21.0* inr(pt)-1.0 01:20pm urine color-straw appear-clear sp -1.039* 01:20pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 01:20pm urine rbc-<1 wbc-<1 bacteria-none yeast-none epi-0 01:20pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 01:20pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 01:20pm lipase-20 01:20pm ctropnt-<0.01 01:20pm urea n-25* creat-1.2* 01:31pm glucose-140* lactate-2.4* na+-139 k+-4.0 cl--99 tco2-27 brief hospital course: 61 f s/p mvc admitted to the acs service for treatment of the following injuries: - small r sah - r frontal lobe contusion - r zygomatic arch fracture - fracture of lateral and frontal wall of r maxillary sinus - minimally displaced fx of the right and left orbital roofs - 3cm anterior neck laceration - rib fracures right 1,2,; left 2nd rib - small left apical pneumothorax the patient has a history of narcotic abuse and was on suboxone at the time of admission. she was admitted to the icu for neuro checks which were intact throughout her time in the icu. she was seen by neurosurgery who recommended a a follow head ct. this ct was not obtained as the patient able to participate in neuro checks. plastic surgery saw the patient and determined that her facial fractures were nonoperative and she will follow up with them in clinic and sinus precautions while she was hospitalized. her pain was difficult to manage because of the suboxone but became manageable after the medication cleared her system. events in the ticu were the following: : admitted to tsicu. acute pain consult - unable to place epidural. dilaudid pca. ophtho exam. : resumed regular diet, home meds. added po oxycodone to pain regimen. decreased frequency of neurochecks to q4h. she was transferred to the surgical floor on . she remained alert and oriented and neuro checks were performed q8h, with no changes in neuro status. her pain was frequently assessed and she remained on the dilaudid pca initially and was transitioned to an oral narcotic pain regimen subsequently, with which she reported adequate pain relief. her vitals signs were routinely monitored and she remained hemodynamically stable. she was placed on telemetry with continuous o2 monitoring given her rib fractures. it was noted that her o2 saturation was decreasing to the high 80's on ra. the patient denied sob and incentive spirometry and pulmonary toileting were encouraged. however, difficulty remained weaning supplemental oxygen and a chest xray was obtained on which showed a very small right pleural effusion (old) and new, small loculated, right pleural or extrapleural fluid. however the xray showed resolution of prior pulmonary edema when compared to prior xrays, no new focal consolidation, and no evidence of prior pneumothorax seen initially on ct scan at admission. the patient continued to deny any shortness of breath, and o2 her sats at discharge remained between 89-93% on ra (patient with significant smoking history). she was tolerating a regular diet and started on a bowel regimen given her use of narcotics. a foley catheter was placed on admission and removed on , at which time she voided without difficulty. she was evaluated by physical therapy and occupational therapy who initially recommended discharge to an extended care facility for further rehabilitation when medically stable. however, as she progressed toward discharge her mobility greatly improved and she become much more independent and was able to dress herself independently. she was out of bed ambulating with supervision at the time of discharge, and was discharged to home with vna services in place. her blood sugars were monitored routinely and managed with her home metformin and a sliding scale of regular insulin as needed. they remained controlled in the 100's at the time of discharge so she was not continued on the sliding scale insulin. plastic surgery was consulted initially for her facial fractures. it was determined that her facial fractures did not require operative intervention at that time. plastics recommended follow up as an outpatient, for which the patient was scheduled at discharge. orthopedics was consulted for new complaints of right shoulder pain. xrays were obtained (see pertinent results for details.) she was noted to have weakness in her right shoulder which may be secodary to pain vs. from a rotator cuff injury. however it was decided that there was no acute injury and the patient was scheduled for orthopedic follow up as an outpatient. the patient was given a sling for comfort. opthlomology was consulted when the patient was in the icu for her eye fracture who deferred to the plastic surgery team for acute management and recommended routine annual exams for dm/htn. neurosurgery was consulted initially for cerebral ecchymosis and sah. the patient remained neurologically stable the neurosurgery signed off. the patient was scheduled for follow up at discharge in the clinic on . medications on admission: lisinopril, atenolol, lasix, suboxone, simvastatin, asa, prilosec, prozac, amitryptiline discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 2. carisoprodol 350 mg tablet sig: one (1) tablet po tid (3 times a day). 3. atenolol 50 mg tablet sig: two (2) tablet po daily (daily). 4. fluoxetine 20 mg capsule sig: one (1) capsule po qam (once a day (in the morning)). 5. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 8. metformin 500 mg tablet sig: one (1) tablet po daily (daily). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 14. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 15. morphine 15 mg tablet extended release sig: one (1) tablet extended release po q8h (every 8 hours). disp:*65 tablet extended release(s)* refills:*0* 16. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for breakthrough pain. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: s/p mvc injuries: sah in the right sylvian fissure right frontal lobe contusion rib fractures- right: 1,2,. left: 2nd rib fracture of right zygomatic arch fracture of lateral & frontal wall of the right maxillary sinus minimally displaced fracture of bilateral orbital roofs 3cm anterior neck laceration discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after a motor vehicle accident. you sustained multiple injuries including a small head bleed and bruising, multiple facial fractures, multiple rib fractures, and a laceration on your neck. you are being discharged with the following instructions: 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 medicine as as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. if the pain medication is too sedation, 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 samll 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. do not smoke. return to the ed right away for any acute shortness of breath, increased pain or crackling sensation around your rips (crepitus). narcotic pain medication can cause constipation. thefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. if your doctor allows, non steriodal anti-inflammatory drugs are very effective in controlling pain (i.e. ibuprofen, motrin, advil, aleve, naprosyn) but they have their own set of side effects so make sure your doctor approves. please follow up as instructed below with the acute care service, orthopedics and plastic surgery. you were also seen by the opthomology doctors were in the hospital who recommended that you have annual eye exams given your history of diabetes mellitus and high blood pressure. followup instructions: department: div. of plastic surgery when: friday at 9:15 am with: , md and dr phone building: lm bldg () campus: west best parking: garage department: orthopedics when: thursday at 11:20 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: thursday at 11:40 am with: , md building: campus: east best parking: garage department: general surgery/ when: tuesday at 1 pm with: acute care clinic with dr phone: building: lm bldg () campus: west best parking: garage you will need a chest x-ray prior to this appointment. please go to , clinical center, radiology 30 minutes prior to your appointment. md procedure: closure of skin and subcutaneous tissue of other sites diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled depressive disorder, not elsewhere classified opioid type dependence, unspecified open wound of jaw, without mention of complication 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 closed fracture of malar and maxillary bones closed fracture of other facial bones contusion of shoulder region closed fracture of eight or more ribs closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration personal history of peptic ulcer disease closed fracture of base of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration open wound of other and unspecified parts of neck, without mention of complication osteoarthrosis, localized, not specified whether primary or secondary, shoulder region 

Answer: The patient is high likely exposed to