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: abdominal pain major surgical or invasive procedure: : exploratory laparotomy, lysis of adhesions, ascites, drainage and open appendectomy. , , , : egd (endoscopy of upper gastrointestinal tract) : emg (to evaluate foot drop) : sigmoidoscopy : colonoscopy history of present illness: mr. is a 66yo man with a history of cad (s/p rca des ), chf (ef 40%-->60%), htn, and pud complaining of several months of abdominal pain. he describes the pain as generalized (worst in lower quadrants), constant, severe, exacerbated by eating, alleviated with burping, and notes associated significant weight loss (unable to quantify). he denies fever, chills, nausea, vomiting, diarrhea, melena, hematochezia, and never had similar pain prior to several months ago. . he was admitted / for this abdominal pain and underwent a workup including abdominal ct, mri, mra, mrcp, egd, and eus with fna of a pancreatic lesion in the body. the etiology of his abdominal pain was unclear; the differential at this time included pud, pancreatic malignancy, or mesenteric ischemia. at a followup appointment with his pcp , he developed severe pain and was brought to the ed by ambulance. physical exam was concerning for llq tenderness without rebound or guarding and labs were notable for wbc count of 14.1. ct abdomen revealed mildly distended loops of bowel without transition point so surgery was consulted concerning possible sbo, which was refractory to conservative management. on he underwent exploratory laparotomy with loa, appendectomy, drainage of hemorrhagic ascites. appendix pathology is notable for chronic arteritis, and so rheumatology was consulted and patient was transferred to the medicine service. . on the floor at time of transfer to medicine, the patient reports mild lower abdominal discomfort (+prior episodes) unlike the pain that brought him to the hospital (which resolved after surgery). . in the ed, initial vs: 10 97 88 172/97 18 100. he appeared very uncomfortable, and was very tender to palpation at llq, but no guarding or rebound. guiac was positive per rectal. he appeared dry. he received levo, flagyl, morphine, and zofran. . currently, patient reports his pain is about . he denies nausea/vomiting. he has no chest pain or shortness of breath. no fever, chills, no cough. . ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: - hypertension - hyperlipidemia, last ldl 55 and hdl 52 (). - coronary artery disease, status post right coronary artery drug-eluting stent in , complicated by vf. - left ventricular systolic dysfunction, ef 40%. - peripheral vascular disease status post bilateral lower extremity revascularizations s/p pta of b/l sfa in , atherectomy of peroneal artery and pta on the r in . - ectatic infrarenal aorta, 2.8 cm greatest diameter - renal insufficiency - peptic ulcer disease (noted on scoping in ) - tobacco abuse, ongoing. - pancreatic lesion as above - history of prostate cancer treated with cyberknife radiation therapy. - history of gout social history: patient is divorced. lives alone. has 5 children but one of the kids live in . daughter lives in . quit smoking since the last admission a week ago. denies etoh (last drink a year ago) or illicit drug use. used to work as a welder. family history: no family history of gi malignancy or gi disease. physical exam: vitals: t: 97.7 p: 73 bp: 187/95 r: 22 o2: 99%ra i/o (24hr): 1310/1350 general: awake, watching television, nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp 8cm, no lad lungs: good air entry throughout, bibasilar crackles, no wheezes/rhonchi cv: regular rate and rhythm, s1, s2, +s4 at apex, 2/6 systolic ejection murmur at base, no s3 or rub abdomen: well healing midline incision with surrounding ecchymosis, no erythema or drainage, soft, appropriately tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly or masses ext: warm, well perfused, no clubbing, cyanosis or edema neuro: alert and oriented x3. strength 5/5 in upper extremities, hip flexion, knee extension bilaterally; 0/5 dorsiflexion, plantar flexion on right; plantar and dorsi-flexion on left; 2+ patellar reflexes, absent ankle reflexes; sensation to light touch grossly intact in lower extremities, (sensory defect to temp/pinprick on lateral aspect of right foot/leg per neurology). . at discharge: avss/afebrile gen: thin male in nad. heent: sclerae anicteric. o-p clear. poor dentition. neck: supple. lungs: cta(b) cor: rrr; s1, s2, +s4, no m/r abd: well healed midline incision. nondistended, soft, mildly tender to palpation in luq, rlq. extrem: wwp; no c/c, mild pedal edema neuro: a+ox3. motor - normal tone except low in distal rle. strength 5/5 bilat in ip, quad. hamstring r, 5/5 l. ant tib r, 5/5 l. gastroc r, 5/5 l. foot inversion and eversion 0/5 r and 5/5 l. te r, 5/5 l. tf r, 5/5 l. dtrs 2+ bilat knees and absent bilat ankles. sensory - decreased sensation to cold and pinprick on dorsal and plantar surfaces of r foot, lateral worse than medial. also decreased over lateral lower leg up to mid lower leg. no proprioception of toes on right foot, proprioception of right ankle intact. decreased vibratory sensation on toes of right foot, normal over medial malleolus. sensation on left foot normal throughout. pertinent results: admission lab: 12:15pm blood wbc-14.1*# rbc-3.92* hgb-10.9* hct-33.4* mcv-85 mch-27.9 mchc-32.7 rdw-15.7* plt ct-141* 12:15pm blood neuts-90.9* lymphs-5.1* monos-3.2 eos-0.3 baso-0.6 12:15pm blood plt ct-141* 12:15pm blood pt-13.0 ptt-32.2 inr(pt)-1.1 12:15pm blood glucose-109* urean-24* creat-1.1 na-137 k-4.3 cl-95* hco3-27 angap-19 12:15pm blood alt-15 ast-19 alkphos-83 amylase-56 totbili-0.5 12:15pm blood calcium-9.2 phos-4.5# mg-1.9 01:22pm blood lactate-2.6* 09:18pm blood lactate-0.7 ------------------- discharge labs: wbc 4.5, hb 8.8, hct 27.2, plt 83 na 137, k 4.8, cl 107, hco3 25, bun 38, cr 0.9, glc 110 ------------------- studies: mri/mrcp (): 1. 0.8 x 1.5 cm lesion in the distal body of the pancreas with relative enhancement, might correspond to the pancreatic neoplasm. short term follow up in 3 months or eus study is recommended for further evaluation. 2. small amount of ascites. . egd (): - erythema, friability, granularity and congestion in the pylorus (biopsy) - a few scattered polypoid lesions were noted in the second part of duodenum. (biopsy) otherwise normal egd to third part of the duodenum - bx: a. antrum "hilar": chronic inactive gastritis; focal intestinal metaplasia; stains for h. pylori will be sent as an addendum.. b. duodenum, polyp: duodenal mucosa, no diagnostic abnormalities recognized; multiple levels have been examined. . eus (): - submucosal mass with overlying hemorrhagic mucosa was noted in the second part of the duodenum - unclear clinical significance. - eus: a 1.5 cm poorly-localized abnormal area was noted in the pancreas body - this showed features of focal chronic pancreatitis, however, a neoplasm could not be ruled out - fna was performed. otherwise normal appearing pancreas. - cytology : pancreatic fna: atypical. many isolated and small groups of columnar mucinous-type benign-appearing epithelial cells; these may represent low-grade panin (mucinous metaplasia) in association with chronic pancreatitis or a mucinous cystic neoplasm. degenerated and reactive glandular cells. benign-appearing squamous cells consistent with esophageal contamination. . mra abd (): 1. stable fusiform aneurysm of the abdominal aorta. widely patent sma and celiac arteries. the inferior mesenteric artery shows narrowing at its orgin, however remains patent. 2. stable t1 hypointense lesion in the body of the pancreas which remains indeterminate. . ct abd/pelvis (): - a few mildly distended loops of small bowel with no definite transition point. a paralytic ileus is favored; however, partial small-bowel obstruction cannot be entirely excluded. - cachexia. - severe atherosclerotic calcifications of the aorta and iliac arteries and sma and celiac arteries with stable fusiform aneurysmal dilatation of the aorta and focal aneurysmal dilatation of the iliac arteries as compared to ct from . . mr enterography (): 1. partial bowel obstruction likely explained by adhesions which could be due to prior prostate radiotherapy. 2. bilateral renal cysts. 3. atherosclerosis with 3.5 cm infrarenal aortic aneurysm. . mr l spine w/o contrast (): 1. multilevel degenerative changes of the lumbar spine as described above, most pronounced at l4-5, without evidence of high-grade spinal canal narrowing at any level. additional multifactorial multilevel neural foraminal narrowing as described above. 2. no evidence of metastatic disease to the lumbar spine on this noncontrast mri examination. . mr lumbar spine (with contrast ): multilevel degenerative changes of the lumbar spine, most pronounced at l4-5, without evidence of high-grade spinal canal narrowing at any level. no evidence of metastatic disease to the lumbar spine. . egd (): abnormal mucosa in the stomach and duodenum. polyp in the second part of the duodenum. abnormal mucosa in the duodenum (biopsy showed mildly active duodenitis). duodenal ulcer. . emg (): complex, abnormal study. there is electrophysiologic evidence for a severe, subacute and ongoing right sciatic neuropathy with axonal features. peroneal- innervated muscles are affected more than tibial-innervated muscles, and no axonal continuity was observed to tibialis anterior or extensor hallucis longus. the abnormal nerve conduction studies in the left lower extremity may reflect a concurrent, length-dependent polyneuropathy with axonal features, or, less likely, a polyradiculopathy. incidental note is made of a moderate median neuropathy at the right wrist. the myopathic units noted in short head of biceps femoris were not seen in any other muscle, and are a finding of uncertain clinical significance. the weakness noted in the right upper extremity does not appear to be due to an acute neurogenic process. . egd (): impression: -abnormal mucosa in the stomach - abnormal mucosa in the duodenum - polyp in the second part of the duodenum - abnormal mucosa in the duodenum (biopsy) - duodenal ulcer . tte (): mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the findings are similar. . persantine-mibi (): no evidence of ischemia, continued mild global hypokinesis and lv dilation. . ecg (): normal sinus rhythm. st-t wave abnormalities that are most marked with t wave inversions in leads ii, iii, avf and v3-v6. . cta abd/pelvis (): 1. no evidence of bowel ischemia. 2. stable infrarenal aaa and bilateral iliac aneurysms. . egd (): - friability, granularity and nodularity in the whole stomach compatible with gastritis - the pyloric channel was edematous and friable. - friability and nodularity in the whole examined duodenum compatible with duodenitis or ? vasculitis - there was no active bleeding. there was no blood or coffee-ground liquid. - erythema and congestion in the antrum compatible with gastritis - otherwise normal egd to third part of the duodenum . sigmoidoscopy (): - angioectasias in the rectum - there was dark red blood coating along the mucosa of colon, which precluded us from examining the mucosa of colon. a large amount of dark red blood was also seen beyond the splenic flexure. however, we did not see bright red blood. - otherwise normal sigmoidoscopy to splenic flexure . colonoscopy (): - the terminal ileum was easily entered and appeared normal. - polyp in the descending colon - ulcers in the rectum (biopsy) - ulcers in the sigmoid colon, descending colon and distal transverse colon (endoclip, biopsy) - there was old blood throughout the colon. - otherwise normal colonoscopy to cecum and terminal ileum . gi bleeding study (): report pending . le dopplers (): 1. no evidence of dvt in either lower extremities. 2. left cyst. . cxr : 1. right lower lobe pneumonia. 2. kinking of proximal aspect of right internal jugular approach central venous catheter, recommend clinical correlation for function. . cxr: 1. worsening right lower lobe pneumonia. 2. kink at the proximal aspect of right internal jugular approach central venous catheter, recommend clinical correlation for function. . portable abdomen: 1. worsening right lower lobe pneumonia. 2. kink at the proximal aspect of right internal jugular approach central venous catheter, recommend clinical correlation for function. . cxr: as compared to the previous radiograph, there is no relevant change. the subtle right lower lobe opacity has not increased in extent or severity. unchanged course and position of the monitoring and support devices. . cxr: status post extubation with otherwise no significant change. . cxr: as compared to the previous radiograph, the pre-existing right basal parenchymal opacity is unchanged in extent and appearance. no newly appeared focal parenchymal opacity. unchanged size of the cardiac silhouette. minimal tortuosity of the thoracic aorta. . unchanged course and position of the left-sided picc line. the right venous introduction sheath has been removed in the interval. . microbiology: stool clostridium difficile toxin a & b test: negative. blood culture, routine (final ): corynebacterium species all other blood/urine cxs negative . pathology: pathology: appendix: arteritis, predominantly chronic (transmural inflammation) with organizing thrombi, but focally acute and necrotizing. duodenum: mildly active duodenitis descending colon and rectum biopsies: colonic mucosa with focal ischemic colitis and extensive ulceration. brief hospital course: assessment: 66yo man with a history of cad (s/p rca des ), pvd, aaa, htn, hyperlipidemia, and pud admitted with acute worsening of chronic abdominal pain, right foot drop, and small bowel obstruction diagnosed with polyarteritis nodosa. course was complicated by acute gi bleeding and ecg changes. . course reviewed by problem: . #. polyarteritis nodosa. after presenting with abdominal pain and small bowel obstruction that did not respond to conservative management, the patient was taken to the or on . appendectomy revealed arteritis. rheumatology was consulted, and given the findings of gi symptoms and weight loss, pathologic arteritis, and sciatic neuropathy (see below), polyarteritis nodosa was diagnosed. pertinent labs included negative anca, negative viral hepatitis serologies (b&c), crp of 25.4 that came down to 3.1, esr of 102 that came down to 19, negative cryoglobulin, urine protein/creatinine of 0.2. starting , he was treated with iv steroids for three days, followed by po prednisone 50 mg po daily, and cyclophosphamide 75 mg po was started and titrated up to 100mg po daily, then dc'd due to decreasing white count, restarted on at 75 mg daily given stable cbc recs. the cyclophosphomide whould be taken with 1-2l of fluids; he should receive iv fluids if unable to tolerate po. usual course is 6 months but may be adjusted based on ability to tolerate. he was switched to iv steroids while having gi bleeding, which was tapered to methylprednisolone 16 mg iv q 12h on discharge; could consider change to prednisone 40mg if unable to give iv steroids. he will continue on this dose of steroids and cyclophosphamide on discharge, with weekly monitoring of cbc for evidence of toxicity and further gi blood losses. weekly cbc should be faxed to rheumatologist dr. at for review and recommendation regarding course of cyclophosphamide and steroids. he will follow up with rhematology on at 9am. while on steroids, he required an insulin sliding scale and was also started on atovaquone for pcp prophylaxis, both of which were continued on discharge. he was also started on calcium and vitamin d and will need a dexa scan and consideration of bisphosphonate as an outpatient. . #. acute gastrointestinal bleeding. on , the patient had two episodes of melena overnight and a hematocrit drop from 27.5 to 22.9 over 24 hours; he was transfused 2 units with appropriate response in hematocrit to 30.7. he never became hypotensive. egd revealed diffuse gastritis and duodenitis and a nonbleeding duodenal ulcer, but nothing to explain the acute drop in hematocrit. he continued to have bloody stools/melena and his hematocrit trended down, requiring the transfusion of one more unit prbcs. the patient was transferred to the icu on for hypotension in the setting of gib. he was electively intubated for procedures. he had a colonoscopy, which showed multiple ulcerations in the left colon and rectum. biopsy revealed focal ischemic colitis. no source of overt bleeding was noted, however the patient continued to ooze slowly and required units of prbcs per day, nearly 40 units total during the stay. he also required several platelet transfusions. hct was stable in the high 20s (27.2 on discharge) and plts in the 80s (83 on discharge) in the days prior to discharge and he was having no evidence of active bleeding. he will require further monitoring of his crit and prn transfusions for hct <25 and plt <50 at rehab; would recommend hct for several days until stable, then decrease to daily hct for several days, then frequency further decreased if also stable. he will continue pantoprazole po. . #. nutrition. the patient has had significant weight loss over the last six months, largely due to decreased intake and food fear secondary to postprandial pain. this pain has improved during the admission, but patient continues to require tpn to meet nutritional recommendations, especially as he has been npo in the setting of gib. his diet was advanced and pt was able to tolerate some pos prior to discharge. . #. leukocytosis: wbc 14.1 on admission. patient was afebrile, without localizing symptoms or signs of infection, negative chest radiograph, negative ua, urine culture, and blood cultures were negative. he received levo and flagyl in the ed, and was continued with iv cipro/flagyl for 10 days given concern of mesenteric ischemia. he remained afebrile throughout the hospitalization and wbc count trended down. in the icu, the patient had e/o rll infiltrate while intubated - he was initially started on vanc/zosyn/cipro for possible vap. however, as the pt improved quickly and it was more likely to be aspiration pneumonitis, the abx were discontinued on the 4th day. . #. hypertension: blood pressure was well controled on metoprolol iv when npo. pt maintained on metoprolol and captopril while in the icu - bp 130s-180s. on transfer to the floor, metoprolol was held to prevent blunting of hr response to gi bleed, and pt was switched to lisinopril and amlodipine for bp control. . #. hyperlipidemia: home dose simvastatin was restarted when able to tolerate oral intake. . #. coronary artery disease: patient is s/p right coronary artery drug-eluting stent in . home dose metoprolol and aspirin were restarted when tolerating pos, however then held in the setting of gi bleed. would recommend restarting as an outpt when stable. . #. left ventricular systolic dysfunction: ef 40% in , 45% in and >55% on . patient had no heart failure symptoms during this hospital stay. . #. right foot drop: experienced tingle of right foot two days after suregery with subsequent worsening right lower extremity weakness and numbness. neurology consulted. found severe sensory/motor deficits in (r) l5 and moderate deficits in s1 territories on examination. l-spine mri demonstrated multilevel degenerative changes of the lumbar spine, most pronounced at l4-5, without evidence of high-grade spinal canal narrowing at any level. additional multifactorial multilevel neural foraminal narrowing. no evidence of metastatic disease to the lumbar spine on this noncontrast mri examination. as recommended, a specific lumbo-sacral plexus mri following the sciatic nerve with and without contrast was performed, which was unchanged from the mri perfomed the day before. a review of the studies by neurology and radiology attendings determined that the spine imaging was unremarkable. his presentation was felt to likely represents compressive neuropathy in distal sciatic or proximal pernoneal. it was recommended to continue agressive pt, and, if not improved in weeks, to perform emg/nc. he was scheduled for neurology follow-up after discharge. physical and occupational therapy were consulted. the patient was fitted with a orthotic splint boot which should be used on discharge. neurology follow up should be scheduled on dc. . #. post-operative course: on , the patient underwent exploratory laparotomy, lysis of adhesions, ascites, drainage and open appendectomy, which went well without complication (reader referred to the operative note for details). the etiology of the small bowel obstruction was found to be due to pelvic adhesions. after a brief, uneventful stay in the pacu, the patient arrived on the floor npo with an ng tube, on iv fluids and antibiotics, with a foley catheter in place, and a dilaudid pca for pain control. he was continued on tpn. the patient was hemodynamically stable. . post-operative pain was initially well controlled with the pca, which was converted to oral pain medication when tolerating clear liquids. after a clamping trial, the ng tube was discontinued on pod#4, and the patient was started on sips of clears on pod#5. diet was progressively advanced as tolerated to a regular diet with ensure plus by pod#7. he was restarted on his home medications on pod#6. he was weaned off tpn on pod#8. the foley catheter was discontinued at midnight of pod#2. the patient subsequently voided without problem. the midline incision with staples experienced sigificant serosanginous drainage for the first two post-operative days, which was scant by pod#2. the patient's hematocrit remained stable. the incison otherwise remained clean and intact. . # deconditioning: pt experienced difficulty ambulating due to weakness and abd pain. after working with pt for several days on the general medicine floor, pt able to ambulate to the door. morphine was used for pain control prn. he will require further pt in rehab for maximum recovery medications on admission: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 4. terazosin 1 mg capsule sig: two (2) capsule po hs (at bedtime). 5. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 6. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for bloating. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 8. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 12. aspirin 81 mg tablet sig: one (1) tablet po once a day. discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation: over-the-counter. 2. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for fever or pain. 3. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 5. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 6. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for loose stools. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 9. cyclophosphamide 50 mg tablet sig: 1.5 tablets po qam: pt should drink 1-2 l of fluid with dose. if unable to tolerate this volume of fluid, please give ivf. please continue taking until your rheumatologist tells you to stop. . 10. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 11. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 12. atovaquone 750 mg/5 ml suspension sig: one (1) po daily (daily). 13. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 14. humalog 100 unit/ml solution sig: one (1) unit subcutaneous four times a day: please take according to inpatient sliding scale while on steroids. 15. morphine 2-4 mg iv q 6 hrs prn pain 16. methylprednisolone sodium succ 500 mg recon soln sig: sixteen (16) mg intravenous twice a day: please continue taking until your rheumatologist tells you to stop. 17. outpatient lab work please check cbc x 3 days. can decrease frequency to daily once stable. 18. outpatient lab work please check cbc once weekly (monday) and forward to rheumatologist dr. (fax ). discharge disposition: extended care facility: - discharge diagnosis: primary: polyarteritis nodosa . secondary: 1. small-bowel obstruction secondary to pelvic adhesions. 2. hypertension 3. coronary artery disease 4. right foot drop due to sciatic neuropathy 5. malnutrition 6. acute gastrointestinal bleed discharge condition: the patient is hemodynamically stable, without respiratory distress or uncontrolled pain. hematocrit stable for several days with no evidence of active bleed. mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to to evaluate your abdominal pain. you were found to have a small bowel obstruction and were taken to surgery to lyse these adhesions and take out your appendix. the pathology from the appendix showed that you have arteritis (inflammation of blood vessels). you also developed right foot drop, also thought to be from the arteritis. we are treating you with prednisone and cyclophosphamide for the arteritis. while you were in the hospital you were bleeding from your gastrointestinal tract, which is why you had endoscopy. the source of the bleeding was likely due to the arteritis in your small bowel. you received blood transfusions to keep your blood counts within normal limits while you were bleeding. your blood counts were stable for several days prior to discharge and you tolerated an oral diet. . please take all medications as prescribed and follow up with the doctors listed below. the following changes have been made to your medications: -stop taking metoprolol given your recent gi bleed. this should be slowly restarted as an outpatient given that you have coronary artery disease -increase your lisinopril to 40 mg daily -stop taking terazosin -stop taking ferrous sulfate as it may make it difficult to detect if you are having a gi bleed. you can restart this when you are stable -stop taking aspirin in the setting of your gi bleeding -stop taking simethicone -your nicotine patch was held while you were in the hospital as you didn??????t seem to need it. you may restart it as needed -start taking methylprednisone 16 mg iv q 12 hrs until rheumatology tells you to stop -start taking cyclophosphamide 75 q am for planned 6 month course if tolerated or until rheumatologist tells you to stop -start taking vitamin d and calcium -start taking insulin and atovaquone while you are on steroids -start taking amlodipine 5 mg for blood pressure -start taking morphine as needed for pain . please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. . incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. followup instructions: please schedule the following follow-up appointments prior to discharge from rehab: - with your primary care physician, , md, mph () - , md () in general surgery - , md () in gastroenterology . please go to the following follow up appointments: . department: rheumatology when: monday at 9:00 am with: , md building: lm bldg () campus: west best parking: garage . department: neurology when: thursday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: parenteral infusion of concentrated nutritional substances exploratory laparotomy esophagogastroduodenoscopy [egd] with closed biopsy other lysis of peritoneal adhesions arteriography of other intra-abdominal arteries closed [endoscopic] biopsy of large intestine flexible sigmoidoscopy other appendectomy diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia unspecified protein-calorie malnutrition peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia chronic systolic heart failure other ascites hemorrhage of gastrointestinal tract, unspecified intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) long-term (current) use of aspirin polyarteritis nodosa peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction other acquired deformities of ankle and foot 

Answer: The patient is high likely exposed to