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: penicillins / morphine / codeine / cefazolin attending: chief complaint: falls, bacteremia major surgical or invasive procedure: esophagastroduodenoscopy cardioversion intubation ir guided drainage of abcess picc placement history of present illness: this is a 78 year old male with type ii diabetes, severe peripheral disease, coronary artery disease s/p cabg and atrial fibrillation on coumadin who presents to the emergency room after two falls at home. the first fall occurred on at home when he fell in his kitchen. he hit is right shoulder and presented to the emergency room where he had a right clavicle xray which showed no fracture of dislocation and was discharged home with pain medications. the patient has very limited mobility at baseline and uses a wheelchair. he requires the use of his arms to help get out of bed and into his wheelchair and also for balance. he has had significant pain his his right arm since his fall and this has made getting around his house increasingly difficult. on he was trying to take a shower and had a plastic bag on his right foot to protect his foot ulcers. he tried to get out of the shower and he slipped on the plastic bag and fell on his right hip. because his arm was hurt as well he was unable to get himself back to a seated position and lay on the ground for an hour before a friend found him and called 911. ems came to his home but he did not want to come back to the hospital so they placed him in his bed. he reports that they placed him facing in the wrong position and he was unable to get out of bed or reach his pills so he has not been taking his pills now for 48 hours. he was so disabled that he ultimately called ems again so that he could be brought to the emergency room. . in the ed, initial vs were: t: 99 p: 108 bp: 131/81 r: 16 o2 sat 99% on ra. he had a cxr which showed mild prominence but no focal infiltrates. he had an xray of his right hip which was negative for fracture and a non-contrast head ct which showed no evidence of hemorrhage. patient was given one liter of normal saline, zofran 4 mg iv x 1 and vancomycin 1000 mg iv x 1 out of concern for possible right shoulder cellulitis. he is admitted to the floor for further management. . on the floor he continues to have significant right shoulder pain. he has mild right hip pain but is able to move his right leg. he denies fevers, chills, lightheadedness, dizziness, chest pain or shortness of breath. he did have nausea earlier in the day but this has resolved. he denies abdominal pain, constipation, diarrhea, melena, hematochezia, dysuria or hematuria. he has minimal sensation in his feet bilaterally but denies foot pain. all other review of systems is negative in detail. past medical history: 1. cad (s/p cabg, ) 2. chf (ef 17% on pmibi from ) 3. dm (diet controlled, hga1c 6.2 on no agents) 4. pvd s/p r ak popliteal to post tibial artery bypass in , percutaneous intervention s/p ptsg l s/p plasty & stent of r sfa, plasty of pt 5. afib/flutter on chronic anticoagulation 6. htxn 7. hyperlipidemia social history: he lives by himself and does all of his own activities of daily living. he quit smoking in but has a heavy smoking history. he uses a walker and a wheelchair to assist with ambulation. he does not currently drink alcohol or use illicit drugs. family history: he has one brother with diabetes and one sister with stomach cancer. his mother had diabetes. his father died at age 79 of unclear reasons. he has four daughters and one son who are healthy. physical exam: on admission: vitals: t: 100.0 bp: 154/96 p: 103 r: 20 o2: 99% on ra fs: 99 general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: scarce inspiratory crackles at the bases, no wheezes, or ronchi cv: irregularly irregular, normal s1 + s2, no murmurs, rubs, gallops, well healed cabg scar abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, severe peripheral disease, multiple toe amputations, small ulcer near nailbed on right second toe with dried blood, 2 x 2 cm healing ulcer on medial plantar right foot, dopplerable distal pulses bilaterally, decreased sensation in lower extremities throughout. right shoulder with mild erythema and pain over palpation of the right clavical. although he has 5/5 strength in the right upper extremity he is severely limited by pain, particularly with arm flexion. the right hip has pain over palpation near the right trochanteric bursa. there is no gross bruising. no significant pain with flexion or extension of the right leg. . on discharge: vss, lungs clear, rrr, full movement in legs to anti-gravity. sc pain, errythema resolved. foley in place. exam otherwise unchanged pertinent results: labs on admission . 10:43pm blood wbc-12.8* rbc-4.79 hgb-12.9* hct-38.4* mcv-80*# mch-27.0 mchc-33.7 rdw-15.8* plt ct-219 10:43pm blood neuts-90.2* lymphs-5.9* monos-3.7 eos-0 baso-0.1 10:43pm blood pt-24.0* ptt-33.6 inr(pt)-2.3* 10:43pm blood glucose-84 urean-50* creat-1.4* na-134 k-4.0 cl-100 hco3-21* angap-17 10:43pm blood alt-26 ast-56* ck(cpk)-786* alkphos-117 totbili-0.4 10:43pm blood ctropnt-0.04* 08:10am blood ck-mb-9 ctropnt-0.04* 05:05pm blood ck-mb-9 ctropnt-0.04* 08:10am blood calcium-8.3* phos-3.2 mg-2.1. on discharge: . 05:27am blood wbc-6.8 rbc-3.34* hgb-9.3* hct-28.0* mcv-84 mch-27.8 mchc-33.2 rdw-17.8* plt ct-171 05:27am blood glucose-91 urean-11 creat-0.8 na-136 k-3.9 cl-98 hco3-35* angap-7* 05:27am blood calcium-7.9* phos-3.6 mg-1.9 . other relevant labs: . 05:16am hct-22.1 . 04:34am blood esr-44* 05:26am blood esr-30* 05:59am blood esr-72* 05:59am blood caltibc-190 ferritn-252 trf-146* 04:34am blood crp-9.3* 05:26am blood crp-67.3* 05:59am blood crp-215.1* . microbiology . staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.5 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s . wound culture (final ): staph aureus coag +. moderate growth of two colonial morphologies. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. corynebacterium species (diphtheroids). moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s . joint fluid staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 1 s trimethoprim/sulfa---- <=0.5 s . helicobacter pylori antibody test (final ): equivocal by eia. . imaging hip xr impression: no fracture or dislocation with degenerative changes at the hips bilaterally and extensive atherosclerotic disease with right femoral stents. . cxr progression of mild pulmonary edema and redemonstration of large cardiomegaly. . ct head 1. no acute intracranial hemorrhage or acute fracture 2. mild paranasal sinus disease. . ct upper ext 1. low attenuation collection about the right sternoclavicular joint, which is superiorly and anteriorly subluxed with surrounding soft tissue and muscular edema. amorphous calcifications in both sternoclavicular joints. while infection must be excluded, these findings may be secondary to trauma in the setting of pre-existing cppd arthropathy. 2. circumferential thickening of the right pleura in the setting of prior asbestos exposure. if there is no recent outside chest ct, this should be further evaluated with a dedicated chest ct. . foot xray 1) new shallow concavity at the base of the fifth metatarsal. however, no aggressive features identified. please see comment. . echo mild spontaneous echo contrast is seen in the body of the left atrium. no thrombus is seen in the left atrial appendage. there is mild regional left ventricular systolic dysfunction with inferior and inferolateral hypokinesis (ef 40-45%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are moderately thickened with focal calcification of the right coronary cusp. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. no masses or vegetations are seen on the pulmonic valve, but cannot be fully excluded due to suboptimal image quality. there is no pericardial effusion. impression: no definitive evidence of valvular vegetation. focal thickening of the right aortic cusp that appears unchanged from prior study . . cxr as compared to the previous examination from , a picc line has been inserted over the right upper extremity. the tip of the line projects over the right atrium, the line should be retracted by 3 to 4 cm. there is no evidence of pneumothorax or other complication. otherwise, the radiographic appearance is unchanged. . mri spine though the evaluation for spine infection is quite limited in the absence of gadolinium and further, by the significant motion degradation of image quality, 1. findings are quite concerning for a septic right l4-5 facet joint with right paraspinal abscess and possible developing discitis. it is possible that there is a small epidural fluid collection at l4-5, as detailed above, though this is not conclusive. 2. severe multilevel spinal canal narrowing and cauda equina compression. 3. moderately severe multilevel bilateral foraminal narrowing. . xr pelvis 1. moderate to severe lumbar spine and si joint degenerative changes. 2. diffuse calcified atherosclerotic disease with left femoral stents; otherwise no radiopaque foreign bodies. . l-spine 1. moderate to severe lumbar spine and si joint degenerative changes. 2. diffuse calcified atherosclerotic disease with left femoral stents; otherwise no radiopaque foreign bodies. . kub small bowel loops and large bowel loops are distended. the small bowel loops measure up to 5.5 cm. this is consistent with ileus. moderate-to-severe degenerative changes are in the lumbar spine. . cxr cardiomegaly persists. low lung volumes limit assessment. left basilar and retrocardiac opacification is consistent with atelectasis although a pneumonitis from aspiration or infection can certainly be superimposed. peribrochial cuffing, cephalization, and a small left pleural effusion suggest continue volume overload/congestion. no pneumothorax. bilateral calcified pleural plaques. median sternotomy wires are again seen. . video swallow normal video oropharyngeal swallow exam without evidence of penetration or aspiration. . mri spine there is continued suspicion for question of septic arthritis of the right facet joint at l4-5 level with a small epidural and paraspinal fluid collection. examination is limited by motion. gadolinium-enhanced repeat study possibly under anesthesia is recommended to get better evaluation of the abnormality. multilevel degenerative changes are again noted. findings were discussed with dr. at the time of interpretation of this study on at 12:30 p.m. . echo the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. there is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the basal half of the inferior and anterolateral walls. the remaining segments are mildly hypokinetic. overal lvef is moderately reduced (lvef 35-40 %). no masses or thrombi are seen in the left ventricle (but apical images are suboptimal image quality). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a fat pad. compared with the prior study (images reviewed) of , the regional left ventricular systolic dysfuntion is more extensive c/w interim ischemia. . mri l-spine 1. suspicious finding on the recent non-enhanced examinations is demonstrated to represent a 2.5 cm (cc) relatively thick rim-enhancing fluid collection, centered at the l5 level, dorsal to and significantly compressing the thecal sac. in this clinical context, this very likely represents an epidural abscess. there may be a right ventral epidural component, as well. 2. at least two small rim-enhancing fluid collections the right paraspinal muscles, likely representing small focal abscesses, which may relate to septic arthritis of the right l4-l5 facet joint; however, this process is not definitely demonstrated on the present examination. 3. pathologic t2-hyperintensity within the l3-4 through l5-s1 discs, without definitive discal enhancement or endplate destruction; this may be degenerative in nature. 4. no other site of organized collection identified within the lumbar spine. 5. extensive multilevel, multifactorial degenerative changes with severe spinal canal stenosis at the l2-3 through l4-5 levels. . port line placement as compared to the previous radiograph, the patient has been intubated. the tip of the tube projects 5 cm above the carina. new central venous access line over the left subclavian vein. the tip of the line projects over the superior svc. unchanged sternal wires, unchanged moderate cardiomegaly with mild overhydration. no evidence of pneumothorax. . cxr . in comparison with the study of earlier in this date, there has been placement of a nasogastric tube, that extends well into the stomach. poor definition of the hemidiaphragms raises the possibility of developing pleural effusion and basilar atelectasis bilaterally. . cxr in comparison with the study of , the monitoring and support devices remain in place. enlargement of the cardiac silhouette persists with evidence of congestion. poor definition of the hemidiaphragms is consistent with bibasilar atelectasis and effusion. . in comparison with the study of , the monitoring and support devices remain in place. substantial enlargement of the cardiac silhouette persists with some evidence of congestion. the hemidiaphragms are somewhat more sharply seen on this study. persistent low lung volumes. . ct head 1. no evidence of acute hemorrhage or acute territorial infarction. . cxr as compared to the previous radiograph, the patient has been extubated and the nasogastric tube has been removed. the lung volumes have minimally decreased. there is unchanged moderate cardiomegaly, the radiographic signs suggesting overhydration have slightly increased. also, a potentially pre-existing right pleural effusion is better visible than on the previous image. otherwise, no relevant change. . the cardiomegaly is moderate, unchanged. the sternotomy wires are unchanged. the patient is in mild pulmonary edema, that is also unchanged since the prior study, accompanied by bilateral pleural effusions, moderate. there are no new focal consolidations, but bilateral basal retrocardiac atelectasis is unchanged. there is no evidence of pneumothorax. . kub there is a significantly dilated air filled stomach. there are multiple air filled and dilated small bowel loops (luminal diameter up to 3.5 cm) and large bowel loops (luminal diameter up to 6.5 cm). there is no evidence of air fluid levels or free air. . cxr in comparison with the study of , there has been a substantial increase in bilateral pulmonary opacifications in this patient with enlargement of the cardiac silhouette and evidence of midline sternal wires. the radiographic findings could reflect severe pulmonary edema, widespread pneumonia, or even ards. . abd ileus has resolved. there is no bowel obstruction. . cxr marked improvement of previously existing pulmonary edema. no pneumothorax. . ct spine severe multilevel disc degenerative changes throughout the lumbar spine as described in detail above. the previously identified epidural collection at l5 level is not visualized in this examination, correlation with mri is recommended, since ct is not able to provide the same anatomical detail in the thecal sac. pathology gastric biopsy: antral and fundic mucosa, no diagnostic abnormalities recognized. no bacillary forms consistent with h. pylori identified on stain. . eeg this telemetry captured no pushbutton activations. routine sampling showed a mild to moderately slow and disorganized background consisting of mixed theta frequencies. occasionally, this occurred in a burst suppression type pattern. this is suggestive of a moderate to severe encephalopathy which may be secondary to medications. no focal or lateralized abnormalities were noted and no epileptiform features were seen. . this telemetry captured no pushbutton activations. routine sampling showed a mild to moderately slow and disorganized background with occasional periods of burst suppression. this is consistent with a moderate to severe encephalopathy and may have been related to medications. no focal abnormalities were noted and no epileptiform features were seen. brief hospital course: mr is a 78 yo gentleman who initally presented for a fall, however was found to be bacteremic with a seeded sc joint infection. his hospital course was initially complicated by an ugi bleed leading to icu admission, then later complicated by vfib arrest in mri scanner while undergoing imaging for back pain concerning for epidural abcess, leading to ccu admission. he underwent cooling protocol and was discharged from the ccu in stable condition. he was found to have an epidural abcess, however given his high surgical risk, we proceeded with medical management. he continued to improve on the floor with no further complications. . #) bacteremia: pt presented with fever and elevated wbc and was found to have mssa in his blood. he was started on cefazolin (pt with pcn allergy) per id recs. his cultures cleared after the first positive set and his sc joint infection improved clinically. the source of his bacteremia was unclear, however the most likely source was his lower extremity ulcers vs possible indolent infection from prior surgery. he was seen by podiatry and who were not concerned for osteomyelitis or active infection of the foot. there were no valvular vegetations on tee, therefore little concern for endocarditis. he did have evidence of infection of his sternoclavicular joint and an aspiration was positive for mssa, and this was thought to be resulting from his bacteremia rather than a primary infection in the context of a fall. ct /ortho were consulted but felt that he was not a good surgical candidate for debridment of the joint given his hx of cabg. he will complete an 8 week course of cefazolin 2g iv q8 (day1=) and should follow-up with id on discharage and should also obtain weekly safety labs (cbc/diff, bun, cr, lfts, esr, crp) while on antibiotics (next set of labs due ). . # s/p cardiac arrest: during mri scan for assessment of back pain patient went into cardiac arrest. unclear whether he was in ventricular tachycardia/fibrillation vs. pea. he was intubated and coded for 40 minutes, intermittently regaining pulses during the code. nsr was finally achieved after amiodarone and defibrillation. however, the patient remained hypotensive and was started on pressors, sedation, and arctic sun cooling protocol in the ccu. eeg and head ct were unremarkable. tte was initially concerning for new wall motion abnormalities suggesting an ischemic etiology, but ekg showed no evidence of acs and ce remained flat. it is therefore thought that the patient may have had pea anesthesia for mri scan. after completion of the cooling protocol, the patient was successfully weaned off the ventilator and extubated without difficulty. he regained consciousness and appered to be back to his neurologic baseline. he stayed in nsr with only a few episodes of afib with aberrancy while on tele on the floor. the patient will need to follow up with ep on discharge for further assessment and evaluation. . #) epidural abcess: pt reported back pain with point tenderness and neurosurgery was consulted out of concern for epidural abcess. mri was performed and was concerning for epidural abscess as well as r paraspinal muscle abcesses by mri, however the study was inadequate. pt underwent mri under anesthesia in attempt to obtain a better study, however arrested in mri scanner. given these circumstances, it was decided that further intervention, including imaging or surgery requiring anesthesia, would be deferred. ir guided drainage of the fluid collection was attempted but minimal fluid was obtained and no organisms were isolated in the aspirate. he was treated with iv abx and monitored for neurological change. given his baseline disabiliy and ongoing issues with incontinence, we monitored for decrease in lower extremity strength (anti-gravity at baseline) and saddle parasthesia, and pt remained clinically stable. his pain also improved and on discharge was controlled with tylenol. neurosurgery plans for f/u with mri lumbar spine after completion of abx course, for which pt will be hospitalized given his inability to tolerate mri without sedation and high risk for complications with anesthesia. would also recommend monitoring neurologic status while at rehab, contacting neurosurgery urgently if change in neuro exam. . # chronic atrial fibrillation: his coumadin was initially held on admission due to supratherapeutic inr and then gi bleed. after defibrillation, the patient was noted to be in normal sinus rhythm. he remained in sinus rhythm throughout his time in the intensive care unit and medical floor. it was felt that although anticoagulation is often still used up to four weeks s/p conversion to nsr from af, in the setting of his recent gi bleed, anticoagulation should be held. he will be discharged on aspirin, consider restarting coumadin after colonoscopy. . #) coffee-ground emesis: the patient had increasing emesis throughout his admission, first occurring subsequent to meals. on he had 4-5 episodes of vomiting and then developed coffee ground emesis requiring micu transfer. he remained hemodynamically stable, but required 7 units of blood over a 24 hour period to maintain a hct>25. egd showed a single, clean base, 2.5cm x3cm non-bleeding ulcer with blood clot in the antrum. the clot was flushed away, epi injected at ulcer edge, cauterized area covered with blood. his hematocrit subsequently stabilized and he had no further coffee ground emesis at the time of his transfer back to the floor, however his hct was seen to slowly drift downwards and he received another unit of blood before discharge to the floor. he was treated for h pylori infection with flagyl, clarithromycin and iv ppi given equivicol h pylori ab screening test. plan was for colonoscopy as well but this was deferred cardiac arrest. in the cardiac icu, clarithromycin was switched to tetracycline as it was felt that the medication was prolonging the patient's qtc. he had no further episodes of hematemasis while on the floor and crit remained stable. egd and colonoscopy were deferred in the hospital given his instability, however he is scheduled for eg/colonoscopy on discharge and will also be discharged on a ppi. . #) hypertension: pt had periods of normal bp but tended to have higher bps in the am. his metoprolol and lisinopril were titrated to bp control prior to discharge, pressures in 120s-130s on discharge however may need further titration as an outpatient for optimal control. he was also re-started on lasix prior to discharge given his hx of volume overload as an inpatient, however at a decreased dose given that he had poor po intake and increased bicarb while in the hospital. . #) acute renal failure: elevated creatinine on admission. pre-renal and thought to be due to dehydration in the context of poor mobility/poor access to fluids. he was re-hydrated and his kidney function improved and remained normal throughout the admission. lasix and lisinopril were initially held, but restarted due to hypertension and volume overload. . #) ileus: pt with abd distension and decreased bms on return from the cardiac intensive care unit. kub showed no acute obstruction. pt improved with uptitration of his bowel regimen, which will be continued on discharge. . #) s/p falls: the patient had two mechanical falls in the setting of living alone and having little sensation and poor mobility in his lower extremities. his sore right shoulder likely also contributed to his second fall, also may have been disoriented bacteremia. there was evidence of chronic degenerative changes but no acute process. he was seen by pt/ot as an inpatient. he will be discharged to outpatient rehab and will require pt/ot/social work f/u. . #) type 2 diabetes: diet controlled, last hba1c was 5.7%. has had minimal insulin requirements as an inpatient, however qid blood glucose was initially continued due to poor nutrition and hypoglycemia. fingersticks were dc'd 2 days prior to discharge as sugars normalized with increasing po intake. . #) peripheral disease: s/p multiple surgeries, currently with ulcer on medial plantar right foot followed by podiatry and . foot xray not concerning for aggresive osteo at this time. he was treated with wound care per podiatry recs and continued on aspirin for his pvd. . #) chronic systolic heart failure: pt had some evidence of volume overload on cxr and by exam throughout the admission. he was treated with iv/po lasix and metoprolol. po lasix dose decreased on discharge given pts poor po intake and increased bicarb, however may need to be up-titrated as an outpatient. additionally, when adequate dose for bp/hr control is achieved, would consider switching to toprol xl for cardioprotection in the context of schf. . #) nutrition: pt with poor po intake therefore ng tube was placed when the patient returned from the cardiac intensive care unit. placement required ir guidance given his hx of prior nose surgeries. he pulled the tube before reaching goal tube feeds and it was not replaced given that his po intake was increasing. he was cleared for ground solids and small pills with applesauce by speech and swallow, who also stated that he could be advanced to solid diet as tolerated. . #) urinary retention: pt failed last voiding trial prior to discharge, therefore foley was re-placed and pt discharged to rehab with foley in place. he was continued on tamsulosin on dc. would recommend voiding trial in rehab. . #) ? mesothelioma: pleural thickening (in the setting of prior asbestos exposure) noted on chest ct, concerning for mesothelioma. bilateral calcified pleural plaques consistent with possible asbestosis on cxr . pt is scheduled to f/u with thoracic surgery on discharge. . #) hyperlipidemia: his home statin was continued . #) anemia: initially concerning for iron deficiency therfore was started on ferrous gluconate. worsened with gi bleed but improved after transfusions and stabilized. iron supplementation was held on discharge given his history of consitipation. . #) depression: home celexa was continued. medications on admission: brimonidine 0.15 % 1 drop in right eye q8h citalopram 20 mg daily ergocalciferol 50,000 units weekly famotidine 20 mg daily furosemide 40 mg 1-2 tablets daily lisinopril 5 mg daily metoprolol tartrate 25 mg nitroglycerin 0.4 mg sl prn oxycodone-acetaminophen 5 mg-325 mg 1-2 tabs prn simvastatin 20 mg daily warfarin 7.5 mg daily aspirin 81 mg daily bisacodyl 5 mg 1-2 tablets :prn cyanocobalamin 1,000 mcg daily colace tid:prn discharge medications: 1. brimonidine 0.15 % drops : one (1) drop ophthalmic q8h (every 8 hours). 2. citalopram 20 mg tablet : one (1) tablet po daily (daily). 3. ergocalciferol (vitamin d2) 50,000 unit capsule : one (1) capsule po once a week. 4. furosemide 20 mg tablet : one (1) tablet po daily (daily). 5. lisinopril 10 mg tablet : one (1) tablet po daily (daily). 6. metoprolol tartrate 25 mg tablet : three (3) tablet po tid (3 times a day). 7. nitroglycerin 0.4 mg tablet, sublingual : one (1) sublingual once as needed for chest pain. 8. simvastatin 10 mg tablet : two (2) tablet po qhs (once a day (at bedtime)). 9. aspirin 325 mg tablet : one (1) tablet po daily (daily). 10. tamsulosin 0.4 mg capsule, sust. release 24 hr : one (1) capsule, sust. release 24 hr po hs (at bedtime). 11. bisacodyl 10 mg suppository : one (1) suppository rectal hs (at bedtime) as needed for constipation. 12. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 13. ondansetron hcl (pf) 4 mg/2 ml solution : one (1) injection q8h (every 8 hours) as needed for nausea. 14. cyanocobalamin 1,000 mcg tablet : one (1) tablet po once a day. 15. simethicone 80 mg tablet, chewable : one (1) tablet, chewable po four times a day as needed for gas. 16. cefazolin 10 gram recon soln : one (1) recon soln injection q8h (every 8 hours): please continue for 8 week course (day 1=). 17. docusate sodium 100 mg tablet : two (2) tablet po bid (2 times a day) as needed for constipation. 18. outpatient lab work please obtain weekly cbc/diff, bun, cr, lfts, esr, crp, please send to infectious disease clinic, attn: (). first set should be drawn on . 19. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 20. acetaminophen 325 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain: not to exceed 4 g/day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: - bacteremia - sternal/spinal mssa osteomyelitis - antral ulcer with bleeding - acute blood loss anemia - acute renal failure - cardiac arrest secondary: - right pleural thickening nos - cad s/p cabg (lima-lad, svg-pda, and svg-om) - chronic systolic heart failure (40%) - atrial fibrillation - small secundum asd/pfo - left retinal artery occlusion - peripheral disease - s/p bilateral hallux amputations - chronic right foot ulceration - hypertension - anemia of chronic disease - diabetes mellitus type ii discharge condition: stable but frail discharge instructions: you were admitted for falls and you were found to have bacteria in your blood, therefore you were treated with intravenous antibiotics. while in the hospital, you developed an upper gastrointestinal bleed and were seen by gastroenterology who examined your stomach with a camera and found ulcers. these were cauterized and injected to prevent any further bleeding. additionally, while in the hospital, you had back pain and were found to have an abcess in your spine. while getting imaging of this abcess, your heart went into an abnormal rhythm and you were transferred to the cardiac intensive care unit. in the intensive care unit, you were stabilized and eventually returned to the medicine floor, where we decided to delay further imaging or surgery of your spine given the high risk of intervention. therefore, we continued to manage your condition with iv antibiotics. you remained stable however had decreased oral intake and urinary retention, therefore you were seen by nutrition and had a foley catheter placed. . please take your medications as prescribed and follow-up with your physicians as outlined below. the following changes have been made to your medications: -you will need to take iv cefazolin (day 1= for a total of 6 weeks -please take pantoprazole 40 mg by mouth every day . please return to the hospital if you have fevers, chills, shortness of breath, chest pain, increasing weakness in your legs, or any other symptoms that are concerning to you. followup instructions: please follow up with infectious disease regarding your bacteremia: . provider: . blood phone: date/time: 11:00 . you will need safety labs including cbc/diff, bun, cr, lfts, esr, crp on , and every week thereafter while on abx. . please follow up with gastroenterology in regards to your gi bleed: . dr. specialty: gastroenterology date and time: wednesday, at 11:00am location: , bldg , , ma phone number: . please follow up with cardiology in regards to your cardiac arrest: . dr. date and time: friday, at 10:20am location: , bldg , , ma phone number: . also, please follow up with thoracic surgery in regards to the pleural thickening that was found on your ct: provider: , md phone: date/time: 10:00 . please keep the following previously scheduled appointment: provider: , rn, cs phone: date/time: 8:40 . you will also need to be readmitted to the hospital in 6 weeks for follow-up imaging of your spine given your epidural abces. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube other electric countershock of heart arterial catheterization other exploration and decompression of spinal canal excisional debridement of wound, infection, or burn endoscopic control of gastric or duodenal bleeding esophagogastroduodenoscopy [egd] with closed biopsy arthrocentesis cardiopulmonary resuscitation, not otherwise specified diagnoses: abnormal coagulation profile congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis atrial fibrillation aortocoronary bypass status depressive disorder, not elsewhere classified atrial flutter methicillin susceptible staphylococcus aureus septicemia acute myocardial infarction of anterolateral wall, initial episode of care ulcer of other part of foot other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus cardiac arrest methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of anticoagulants paralytic ileus retention of urine, unspecified ventricular fibrillation chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction anticoagulants causing adverse effects in therapeutic use hyperosmolality and/or hypernatremia intraspinal abscess acute osteomyelitis, other specified sites acute on chronic systolic heart failure fall from other slipping, tripping, or stumbling asbestosis rhabdomyolysis helicobacter pylori [h. pylori] atherosclerosis of native arteries of the extremities with ulceration ulcer of heel and midfoot pyogenic arthritis, shoulder region ulcer of ankle other and unspecified general anesthetics causing adverse effects in therapeutic use osteoarthrosis, localized, not specified whether primary or secondary, shoulder region malignant neoplasm of pleura, unspecified 

Answer: The patient is high likely exposed to