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: promethazine attending: chief complaint: icu transfer for hypertensive urgency and nausea/vomiting major surgical or invasive procedure: ett intubation for mri. history of present illness: the patient is a 69 year old woman with a past medical history of dm type 1, pvd, right hip fracture s/p intramedullary nail c/b malunion with revision admitted with sudden onset nausea and emesis. . the patient reported sudden onset of nausea and emesis this am upon awakening. she noted slight loose stools with no hematochezia or melena. she denied abdominal pain. denied chest pain or dyspnea. she reports her current sensation is similar to her prior episodes of gastroparesis. denies fever or chills. . in the ed, initial vs: t 96.6, bp: 213/101, hr: 66, rr: 16, o2: 98% ra. she was given 2l ns. she also received 8mg iv zofran and 25mg phenergan. she received hydralazine with repeat bp of 184/98. she was also noted to be forcing emesis while in the ed by nursing. labs notable for wbc 6.4, chem 7 notable for an ag of 18, improved to 15 following ivf in ed. . on the floor, she reports nausea and emesis. reports mild epigastric pain. during the evaluation she has emesis x 3. no hematemesis. denies chest pain or shortness of breath. denies dysuria or urinary frequency. . given persistent hypertensive urgency, with limited treatment options on the floor (not tolerating po, iv labetalol or nitro gtt not possible) she is being transferred to icu for bp treatment and close monitoring of symptoms. . ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, constipation, brbpr, melena, hematochezia, dysuria, hematuria. remained per hpi. past medical history: - h/o dvt - dmi on insulin pump - peripheral neuropathy - h/o gastroparesis - chronic lbp/sciatica - htn - hyperlipidemia - hypothyroidism - pvd/pad - autonomic dysfunction, orthostatic hypotension - history of seizure characterized by becoming less responsive, oriented to name only, gaze deviation and left arm shaking. fs 297 and was in the setting of receiving cipro, neuro felt infection vs pres. - barretts esophagus on egd - depression . past surgical history: - malunion right intertrochanteric hip fracture with protrusion of screw s/p revision arthroplasty comminuted right intertrochanteric hip fracture s/p right hip fracture open reduction internal fixation (intramedullary nail) rle angiography rle sfa-at bpg with nrsvg angioplasty of vein graft , l hip hemiarthroplasty - hiatal hernia - s/p laminectomy - s/p hysterectomy social history: the patient lives with her husband. she is a former secretary. former tobacco use, quit in , previous 60 pack/yr history. no history of etoh or ivdu. family history: mother - coronary artery disease with mi in her 50s, died at age 84. father - coronary artery disease with mi in her 60s, died at age 82. physical exam: admission physical exam: vs: tc: 99.5, bp: 200/91, hr: 100, rr: 22, o2: 95% ra. general: no acute distress heent: nc/at, perrla, eomi, mild conjunctival suffusion, dry mm, op clear. neck: supple, no jvd. heart: , soft systolic murmur, nl s1-s2. lungs: cta bilat, no r/rh/wh, good air movement, resp unlabored. abdomen: soft, mild epigastric/ruq ttp, no rebound/guarding extremities: wwp, no c/c/e, r hip well-healed, no erythema or ttp, decreased r pt/dp skin: faint maculopapular rash over bilateral ue, eschar over lateral heel - no erythema, no drainage lymph: no cervical lad neuro: awake, a&ox3, cns ii-xii intact, muscle grossly intact discharge physical exam: vs: tc: 98.0, tm:98.1 bp: 131/58, hr: 87, rr: 18, o2: 100% ra. general: nad, conversational heent: nc/at, anicteric sclera, mmm, pharynx clear. neck: supple, no jvd. heart: , soft systolic murmur, nl s1-s2. lungs: ctab, no w/r/r abdomen: soft, nt/nd, normal bs, no organomegaly extremities: minor soreness of b/l calves but no tenderness, no unilateral edema or discoloration, decreased distal pulses r>l skin: 1.5-2cm ulcer on posterior r heel with overlying black eschar no signs of infection neuro: awake, a&ox3, cns ii-xii intact, muscle grossly intact pertinent results: labs: cbc wbc rbc hgb hct mcv mch mchc rdw plt ct 9.5 4.59 14.0 43.4 94 30.5 32.3 15.1 292 . diff neuts lymphs monos eos baso 84.6* 10.7* 3.2 0.6 1.0 . chem 7 glucose urean creat na k cl hco3 angap 242*1 19 1.0 137 4.1 97 24 20 242*1 18 1.1 135 4.82 96 21 * 23* . lfts alt ast alkphos 7* . lipase 17 . cpk isoenzymes ctropnt <0.011 cxr - impression: no effusion, edema or pneumonia. . r femur - there is again seen an intramedullary rod with distal interlocking screw and proximal pin fixating an intertrochanteric fracture of the right proximal femur. there is good bridging callus at the site of the injury. there are no signs for hardware-related complications. a stent is seen within the medial soft tissues, likely within the femoral artery. no kinks within the stent is seen. the stent within the popliteal artery below the level of the knee joint, which is also intact and without kinks. . ecg: - nsr, lad, twi , dep v5-v6 w/ increase from prior . cxr (): cardiomediastinal contours are within normal limits allowing for accentuation by extreme lordotic projection and portable technique. lungs are grossly clear except for a questionable new patchy opacity in the left retrocardiac region. standard pa and lateral chest radiographs may be helpful to better evaluate this region and to exclude the possibility of a developing pneumonia at this site. . ct head (): no acute intracranial process. . cxr (): compared with , an et tube has been placed. the tip lies in satisfactory position approximately 4.1 cm above the carina. minimal bibasilar atelectasis of both lung bases again noted, without significant interval change. no consolidation. incidental note is made of marked degenerative changes about the right glenohumeral joint, incompletely evaluated. . mra neck (): bilateral carotid stenosis, left greater than right, partially evaluated due to motion artifacts, please consider obtaining the carotid doppler ultrasound if clinically warranted. . mri head (): lacunar ischemic change is demonstrated on the left pons, apparently new since the prior examination. stable lacunar ischemic changes identified at the posterior limb of the left internal capsule and lentiform nucleus. no diffusion abnormalities are detected to suggest acute or subacute ischemic changes. . carotid us (): right ica <40% stenosis. left ica 60-69% stenosis. . cxr (): 1. interval removal of the endotracheal tube. 2. stable mild pulmonary edema. . cxr (): 1. new left picc, at the level of the mid svc. no pneumothorax. 2. stable mild cardiomegaly. discharge labs: 06:00am blood wbc-6.0 rbc-3.30* hgb-10.2* hct-30.8* mcv-94 mch-30.8 mchc-33.0 rdw-14.5 plt ct-216 06:00am blood plt ct-216 06:00am blood 06:00am blood glucose-292* urean-27* creat-1.2* na-134 k-4.4 cl-96 hco3-30 angap-12 06:00am blood calcium-8.5 phos-3.6 mg-1.8 9:54 am urine source: catheter. **final report ** urine culture (final ): no growth brief hospital course: 69 year old woman with dm type 1, pvd with significant rle ischemia, r hip revision admitted with n/v and abdominal pain and transferred to the micu for hypertensive emergency. # hypertensive urgency/emergency - the patient had increased bp's of 210's/100's in the setting of n/v, improved with hydralazine in ed. she has recently been off of home bp meds with well controlled bp's. she was on a labetalol gtt for titration to bp's, and was transitioned to chlorthalidone which was uptitrated as she was weaned off labetalol gtt. she was previously on lisinopril and clonidine patch as an outpatient, and the clonidine patch was re-started in-house and d/c'd prior to dispo. her bp's came under better control and her dose of chlorthalidone was halved prior to discharge to prevent hypotension with good outpatient follow-up scheduled. # aphasic episodes - ams able to follow commands but not able to speak, sbp 198. fingerstick nl. labetalol 10mg iv given, gtt started. ct head obtained, no acute process. - had another episode of aphasia at 2pm with normal neuro exam, able to follow commands, but did not remember event subsequently. lasted ~20 mins and slowly recovered. mri head and continuous eeg ordered the patient had suspect this is due to high bps as pt has had no repeat episodes with bps in the 160 range. called yesterday stating no seizure activity on eeg, can d/c eeg. signing off. no further episodes occurred prior to d/c. . # n/v - pt presented with n/v and mild abdominal pain similar to her prior flares of gastroparesis. she was dehydrated on initial admission which improved with ivf. she was continued on her home gastroparesis medications with subsequent improvement of her n/v and abdominal symptoms. she was hydrated with ivf and diet was advanced without incident. of note, she had no clear ekg changes from prior with exception of increase st depressions in the setting of hypertension with negative ce's. she had stool studies and cultures sent which were negative. . # pvd - pt has severe ischemic rest pain of her right foot and nonhealing pressure ulcer of her right heel. arteriography showed peripheral arterial disease and she was scheduled to have a fem-distal anterior tibial bypass by dr. in the near future, and dr. was emailed. her ulcer had no evidence of infection. she is scheduled to f/u with d.r to reschedule the surgery. . # dm type 1 - patient was initially in dka which resolved on admission to the micu and she was covered with iss and glargine. the patient was subsequently continued on ssi and continued her home glargine rather than her home insulin pump initially, per patient request. she was restarted on her home insulin pump prior to callout from the micu, per patient preference, and was consulted. recommendations were implemented and a follow-up appointment was set up on day of discharge. . # code: full medications on admission: citalopram - 40 mg tablet - 1 tablet(s) by mouth once a day cyclosporine gabapentin - 800 mg tablet - 1 tablet(s) by mouth qam glucagon (human recombinant) - 1 mg kit - inject as directed for low blood sugar insulin glargine - 100 unit/ml solution - 5 units at bedtime insulin lispro - 100 unit/ml cartridge - on insulin pump basal rate levothyroxine - 88 mcg tablet - 1 tablet daily lorazepam - 1 mg tablet - 1 tablet(s) by mouth every six (6) hours as needed for anxiety metoclopramide - 10 mg tablet - 1 (one) tablet(s) by mouth 30 minutes before meals morphine - 30 mg tablet extended release - 2 tablet(s) by mouth qam and 1 tab qpm omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day oxycodone - 10 mg tablet - to 1 tablet(s) by mouth every hours as needed for pain simvastatin - 40 mg tablet - 1 tablet(s) by mouth qpm travoprost - 0.004 % drops - 1 drop ou daily calcium citrate-vitamin d3 carboxymethylcellulose sodium - 1 % drops - as needed cholecalciferol (vitamin d3) - 400 unit capsule - 1 capsule(s) by mouth once a day cyanocobalamin (vitamin b-12) - 1,000 mcg tablet - 1 tablet(s) by mouth once a day folic acid - dosage uncertain multivitamin - (otc) - capsule - 1 capsule(s) by mouth qam omega-3 fatty acids sodium chloride - 1 gram tablet - 1 tablet(s) by mouth twice a day discharge medications: 1. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 2. gabapentin 400 mg capsule sig: two (2) capsule po daily (daily). 3. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. chlorthalidone 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 6. metoclopramide 10 mg tablet sig: one (1) tablet po tid (3 times a day). 7. insulin lispro 100 unit/ml cartridge sig: pump subcutaneous continuous: continue your current regimen with your insulin pump. 8. morphine 30 mg tablet extended release sig: two (2) tablet extended release po qam (once a day (in the morning)). 9. morphine 30 mg tablet extended release sig: one (1) tablet extended release po qpm (once a day (in the evening)). 10. oxycodone 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 11. insulin glargine 100 unit/ml solution sig: seven (7) units subcutaneous at bedtime. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 13. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 14. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 15. lorazepam 0.5 mg tablet sig: 1-2 tablets po every six (6) hours as needed for anxiety. 16. calcium 500 + d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po once a day. 17. folic acid 1 mg tablet sig: one (1) tablet po once a day. 18. omega 3 fish oil 684-1,200 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge disposition: home with service facility: discharge diagnosis: primary: gastroparesis hypertensive emergency secondary: diabetes mellitus 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: dear ms. , you were admitted to the hospital with nausea and vomiting. this was related to your gastroparesis. you were treated for reglan and bowel rest and your symptoms improved. you also had very high blood pressures while you were in the hospital which required a transfer to the intensive care unit. when you had high blood pressures you had a couple of episodes when you had difficulty speaking and confusion. you were evaluated by and had an eeg and mri of your brain which showed no stroke or seizure activity. the episodes are believed to be related to your high blood pressure. you were started on medications for your blood pressure and it improved. as you were acutely sick in the hospital you were unable to have your bypass surgery. please follow up with dr. to reschedule this procedure. we have made the following changes to your medications: - start taking chlorthalidone for your blood pressure - start taking lisinopril for your blood pressure - start taking baby aspirin daily - change your dose of glargine insulin to 7 units daily - stop taking sodium chloride tablets it was a pleasure taking care of you at the . we wish you a speedy recovery. followup instructions: please follow up at the appointments below: department: when: wednesday at 11:30 am with: , md building: campus: east best parking: garage department: surgery when: monday at 3:45 pm with: , md building: lm campus: west best parking: garage diabetes center follow-up appointment dr. at 4pm procedure: venous catheterization, not elsewhere classified diagnoses: unspecified essential hypertension unspecified acquired hypothyroidism other and unspecified hyperlipidemia long-term (current) use of insulin pressure ulcer, heel delirium due to conditions classified elsewhere diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled atherosclerosis of native arteries of the extremities with ulceration gastroparesis insulin pump status peripheral autonomic neuropathy in disorders classified elsewhere pressure ulcer, unstageable 

Answer: The patient is high likely exposed to