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: demerol attending: chief complaint: pericardial effusion major surgical or invasive procedure: pericardial window history of present illness: 67 yf with h/o metastatic cervical cancer c/b bulky lad w/r hydronephrosis necessitating nephrostomy tube placement, hypercoagulability resulting in mult cvas and more recently, pe/ transferred to for management of pericardial effusion and ugib. 1 week prior to this admission, she was treated for pe/dvt and cap at , d/c'ed on lovenox / coumadin; she was treated with levaquin in-house, which was not continued on an out-patient basis. during that admission, she had an echo showing a pericardial effusion. she was d/c'ed prior to final read of a f/u echo, which showed increased size of the effusion. thus, she was called to return to the day after d/c (). incidentally, pt had hematemesis x3 on that day as well. pt was transferred from ed to and was admitted to the ccu where she was also followed by ct and gi. while in the ccu she received 2u prbcs for her ugib which had remitted. ngl cleared, so upper endo was not pursued. she underwent pericardial window for drainage of effusion. finally, she underwent r ureteral stent and ivc filter placment by ir. her acute cardiac issues had resolved and she was called out to the medicine service. . on the day of transfer to medicine, pt's creat (b/l 1.1) had risen to 2.0, despite stent placement, prompting a renal consult. in addition, her coags were elevated and trending up with an inr of 3.6 (dic labs neg; lfts wnl), despite being off coumadin since admission. past medical history: 1) cva 2) metastatic cervical cancer 3) pe/ dvt diagnosed one week ago 4) right hydronephrosis secondary to lymphadenopathy, s/p right nephrostomy tube 5) htn 6) hyperlipidemia 7) appendectomy 8) nstemi lvef > 55% 3/15 9) gout social history: retired pharmacy technician who lives with her daughter. no etoh, tobacco, or ivdu family history: nc physical exam: in the ccu: g: elderly female, nad heent: clear op, mmm neck: difficult to assess jvd lungs: decr bs bl at bases, crackles bl cv: s1s2, no murmurs abd: soft, nt, nd, bs+ ext: + pitting edema ... on transfer to the floor: pe: 98 109/66 117 16 96%ra gen: middle-aged f, appearing older than stated age and markedly pale, lying in bed, nad heent: mm dry, perrl, op clear cvs: rrr, no m/r/g chest: cta b abd: soft, nt/nd nabs ext: + edema; pneumoboots in place pertinent results: admission labs: 02:52pm blood wbc-11.3* rbc-3.30* hgb-9.5* hct-29.1* mcv-88 mch-28.9 mchc-32.7 rdw-16.6* plt ct-566*# 08:05pm blood hct-24.6* 02:52pm blood neuts-88* bands-2 lymphs-4* monos-6 eos-0 baso-0 atyps-0 metas-0 myelos-0 02:52pm blood hypochr-1+ anisocy-1+ poiklo-1+ macrocy-normal microcy-occasional polychr-1+ ovalocy-1+ tear dr 02:52pm blood pt-20.0* ptt-40.5* inr(pt)-2.6 02:52pm blood plt ct-566*# 02:52pm blood glucose-97 urean-38* creat-1.2* na-140 k-4.4 cl-110* hco3-19* angap-15 05:33am blood calcium-8.5 phos-2.9 mg-1.1* 02:52pm blood cholest-163 02:52pm blood triglyc-176* hdl-23 chol/hd-7.1 ldlcalc-105 echo : measurements: left ventricle - ejection fraction: >= 55% (nl >=55%) aorta - ascending: *3.7 cm (nl <= 3.4 cm) aortic valve - peak velocity: 1.3 m/sec (nl <= 2.0 m/sec) interpretation: findings: this study was compared to the prior study of . left ventricle: normal lv wall thickness, cavity size, and systolic function (lvef>55%). right ventricle: normal rv chamber size and free wall motion. aorta: focal calcifications in aortic root. mildly dilated ascending aorta. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: normal mitral valve leaflets. pericardium: moderate pericardial effusion. no significant respiratory variation in mitral/tricuspid valve flows. brief ra diastolic collapse. collapse. general comments: results were reviewed with the cardiology fellow involved with the patient's care. bilateral pleural effusions. ascites. conclusions: left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is a moderate sized circumferential pericardial effusion extending 2.4cm inferior and 2cm lateral to the left ventricle, but <1cm around the apex and anterior to the right ventricle. there is brief right atrial and left atrial diastolic collapse without eccentuation of transmitral e wave velocities. compared with the prior study (tape reviewed) of , the pericardial effusion is new. serial evaluation is suggested. . cta chest : 1. chronic pulmonary embolism in the right lung. 2. large bilateral pleural effusions, right greater than left. large pericardial effusion. 3. ascites. . pleural fluid cytology: rare atypical epithelioid cells present. scattered mesothelial cells and numerous lymphocytes. . pericardial fluid cytology: negative for malignant cells. . renal u/s : small kidneys bilaterally with normal arterial and venous waveforms. the right hydronephrosis has resolved status post stenting. large volume ascites is noted. renal scan: 1. renal parenchymal disease of the right kidney with no evidence of obstruction. 2. partial obstruction of the left kidney. superimposed renal parenchymal disease of the left kidney cannot be excluded. . cxr : resolution of previously seen apical pneumothorax on the left. unchanged appearance of bibasilar patchy atelectasis/consolidation. brief hospital course: 1. pericardial effusion: pt was found to have a new pericardial effusion on echo, was seen by thoracic surgery, and underwent thorascopic pericardial window with chest tube insertion. she was noted to have 100cc of serosanguinous fluid drained from the pericardium itself, along with 500cc of pleural fluid. both fluids were sent for cytology, with the pleural fluid noted to contain atypical cells concerning for malignancy and the pericardial fluid devoid of atypical cells. she had a repeat echo, which showed a small pocket of apical fluid collection and resolution of the larger pericardial effusion. oncology noted that the patient could be followed as an outpatient for further management of the pleural malignancy. the chest tube was pulled without complications. 2. gi bleed: the patient was initially started on heparin drip due to concerns about the presence of pe; however, this medication was discontinued as her hematocrit decreased while on the drip. she was transfused and her hct remained stable following. further workup of the gi bleed can be done as an outpatient. 3. chronic pe: as above, the patient was placed on the heparin drip for 1 day for concern of pe/dvt, but as she had an ivc filter placed this drip was discontinued. she was asymptomatic throughout. given her hypercoagulability, she will likely need long-term ac, which may be re-initiated on an outpatient basis after the ivc filter has been removed. 4. r nephrostomy/acute renal failure: on admission, pt's creat was 1.1, began climbing on hd#4, and peaked at 2.1 on hd#9. she had had a nephrostomy tube placed in obstruction of her r kidney and resultant arf at that time. on the weekend of , her urine output decreased and her nephrostomy output also decreased. she was given large amounts of fluid as her cvps were low (0-6), but her urine output failed to respond. her creatinine levels started to rise, and the etiology of her renal failure remained elusive. she was taken to ir on , where the r ureter was stented with good flow into the bladder, and the nephrostomy tube was kept in place with plans for capping. however, her urine output remained low post-procedure. urine lytes were sent, with fena of 1.5% indicating intrinsic renal or post-renal disease. the urine contained a large number of rbcs post-stenting, and we were unable to appreciate casts or eosinophils when it was spun. despite this, levofloxicin was changed to azithro/ctx due to concerns for ain. abdominal u/s showed resolution of prior r hydronephrosis, but was unable to visualize the renal arteries. renal artery u/s was done to evaluate for concerns of ivc obstruction of the renal arteries as an etiology of the arf--pre-renal that eventually became atn; however, this showed normal arterial and venous flow. both kidneys were noted be small, measuring 9.0cm r and 9.1cm l, suggesting bilateral intrinsic disease. the renal service was consulted for help in sorting out the etiology of her arf. they felt that, as her creat was rising despite the recent r ureteral stent, pt likely had bilateral disease. as she was never hd unstable to suggest possible renal ischemia, and there were no muddy brown casts on urine sedment exam, atn was unlikely. renal felt that findings were therefore most c/w post-obstructive physiology, metastatic dz. urology was consulted and recommended a nuclear scan of the kidneys, which showed a possible l-sided obstruction. pt was taken to the or for cystoscopy, left retrograde pyelogram and insertion of left double-j stent. after stent placement, her creat began to trend down and was 1.2 on the day of discharge. urology instructed the pt that the stent would have to be changed in 3 months and that it would increase irritability of the bladder and that she may have chronic hematuria, requiring transfusion. . 5. pna: the patient was febrile on arrival to the ccu, and remained febrile overnight. the etiology was initially attributed to atelectasis/post-op fever, but repeat cxr showed rll haziness concerning for pna (pt also had an elevated wbc). given the clinical concerns, she was started on levo for community-acquired pna on , which was changed to azithro/ctx on (see above). she will complete a 10 day course of abx, to end . . 6. coagulopathy: inr increased to 3.6. dic panel was negative and liver function normal. likely nutritional deficiency as pt w/low albumin and poor po intake. also with possible contribution of abx displacement of coumadin, although she is 7 days s/p stopping coumadin and inr is still rising, making this unlikely. vitamin k was held, given no evidence of bleeding; however, she receievd ffp prior to stent placement. . 7. malnutrition: the patient was noted to have a large amount of third spacing, as above, with a low albumin. the persistently elevated inr despite being off coumadin for days raised the concern for malnutrition (protein deficiency). nutrition was consulted, and transferritin/prealbumin were also sent. megace and boost supplements were started. hose were placed to help mobilize the fluid. . 8. metastatic cervical cancer: underlying cause for all of her current acute issues. dr., who has followed pt in-house on prior admits, but who is not pt's primary oncologist (dr.) discussed her poor prognosis with pt and family. she also attempted to contact dr. to let her know of the admission, but was unsuccessful. dr. recommended ct torso to restage pt; however, given her rising creat, this was postponed and may be done on an out-pt basis. in addition, dr. in neuro-oncology requested a brain mri w/gad to evaluate the changes seen on prior imaging (?mets vs. cvas). however, given the ivc filter placement, this too will need to be deferred until removal. . 9) dispo: pt was discharged home with services once her creatinine was decreasing and she was afebrile and hd stable. she has numerous follow-up appointments anbd studies, detailed at the end of this report. medications on admission: lovenox iron coumadin discharge medications: 1. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). tablet(s) 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 6. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 8. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily). 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 10. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 11. megestrol acetate 40 mg/ml suspension sig: five (5) ml po bid (2 times a day). 12. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* discharge disposition: home with service facility: nursing services discharge diagnosis: metastatic cervical ca pericardial effusion/tamponade s/p pericardial window acute renal failure upper gi bleed pulmonary embolism dvt s/p r and l ureteral stent placement ... cva vs. brain mets gout right hydronephrosis secondary to lymphadenopathy, s/p right nephrostomy tube placed htn hyperlipidemia appendectomy nstemi lvef > 55% discharge condition: fair discharge instructions: please call your doctor and return to the hospital for, chest pain, light headedness/confusion, if you are not making urine, if you are vomiting blood, or for any other concerning symptoms. . followup instructions: please follow-up with dr. in 1 week after discharge. please call for appointment: . please discuss re-initiation of your anticoagulation medication. . please have bloodwork drawn by vna prior to your appointment with dr.. please have results faxed to his office. . please follow-up with dr., nephrology, in days after discharge. please call for appointment: (^17) . . please folow-up with dr. after discharge. please call for appointment. please discuss obtaining a re-staging ct scan of the torso after your kidney function has improved . please follow-up with dr. in clinic. please call for appointment: (. please discuss scheduling of brain mri with gadolinium after your ivc filter is removed. . please follow-up with dr. in weeks after discharge. please call for apointment ( . please follow-up with interventional radiology in 1 week after discharge for removal of your ivc filter (. . please follow-up with gi for upper endoscopy with dr. . please call for appointment (. . please follow-up with urology for stent replacement in 3 months. please call for appointment (. md procedure: insertion of intercostal catheter for drainage other cystoscopy ureteral catheterization ureteral catheterization transpleural thoracoscopy pericardiotomy transfusion of packed cells retrograde pyelogram percutaneous pyelogram diagnoses: pneumonia, organism unspecified unspecified pleural effusion unspecified essential hypertension acute kidney failure, unspecified unspecified protein-calorie malnutrition unspecified disease of pericardium hemorrhage of gastrointestinal tract, unspecified hydronephrosis other ureteric obstruction malignant neoplasm of other specified sites of cervix 

Answer: The patient is high likely exposed to