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 / tylenol attending: chief complaint: dyspnea major surgical or invasive procedure: thorocentesis thorocentesis history of present illness: pt is a yo woman w/ h/o esophageal ca s/p palliative xrt ending in , chronic cough, h/o angina and chf with ef >55%, who presents with 2 weeks of progressive sob acutely worse over that past few days. of note, she was recently discharged from on at which time she was admitted for chf exacerbation, was diuresed with improving respiratory status and was sent home on lasix 10 mg po qod. since her discharge she has become progressively sob, worse over the past 2 weeks and much worse over the past couple of days. her pcp . increased her flovent dosing and added proventil, which helped but she began using more and more frequently. at baseline she is able to walk around her house with a cane. she denies cp and denies any worsening of her le edema. she reports that on her last admission they talked to her about getting a thoracentesis but did not want it at the time as she did not think she could tolerate the procedure. she otherwise denies any chest pain/pressure (her anginal equivalent), pnd, palpitations, n/v, diarrhea, brbpr, dysuria, fevers. in the ed, she was noted to have a t 99.0 bp 118/64 rr 24 o2 sats 96% on nrb and then started on bipap (setting not documented) satting 98%. she was started on a nitro drip, given lasix 30 mg iv x1 with little uop, combivent nebs, asa pr. . currently pt states she still feels sob, denies any cp, palpitations, abd pain. she did not feel she can tolerate the bipap mask and feels better on nc and face mask. past medical history: esophageal cancer, s/p palliative xrt ending in . she does not have an medical oncologist. has difficulty swallowing. can only swallow liquids breast cancer, underwent lumpectomy x 2 gastroesophageal reflux disease hypertension angina, previously used ngl, no longer uses cri (baseline cr 1.2-1.4) s/p appendectomy s/p cholecystectomy s/p cataract surgery social history: pt is a holocaust survivor from . she denies any tobacco or alcohol use and lives in , ma with her son. with a crutch from old b/l ankle fractures family history: h/o heart disease, not specified, colorectal ca - son physical exam: vitals - t 96.8 bp 103/65 hr 80s o2 sats 88% on 6l nc gen - cachetic, awake, alert, pleasant, lying in bed using accessory muscles to breath, answering questions appropriately heent - perrl, b/l cataracts, eomi neck - no lad, could not assess jvd cv - rrr nl s1 s2, grade iii/vi sem rusb. lungs - decreased bs at bases l>r, b/l crackles abd - flat, soft, nt/nd + nabs ext - 2+ b/l le edema, venous stasis changes, 1+ dp pulses, warm neuro - aaox3, cn ii-xii intact, strength 5/5 and equal pertinent results: cxr: 1. chf with left greater than right pleural effusions and interstitial edema, significantly worse since . 2. left retrocardiac opacity, likely related to above; focal consolidation cannot be excluded. . cxr pa/lat: impression: no major change in the appearance of the previously described pulmonary edema with bilateral pleural effusions. . cxr: ap: impression: successful left-sided pleurocentesis without evidence of pneumothorax. . labs: pleural fluid-cytology: adenocarcinoma- ihc showed esophageal in origin. . admission cbc: wbc-8.7 rbc-4.31 hgb-13.4 hct-40.1 mcv-93 mch-31.0 mchc-33.3 rdw-15.9* plt ct-242 chemistries: glucose-135* urean-69* creat-2.8*# na-133 k-6.5* cl-95* hco3-23 totprot-5.3* albumin-2.8* globuln-2.5 calcium-8.9 phos-5.2* mg-2.8* other labs: probnp-5433* . discharge chemistries: glucose-98 urean-35* creat-0.9 na-139 k-3.8 cl-96 hco3-35* . micro: pleural fluid cultures negative brief hospital course: ms. is a year old woman with a history of esophageal cancer s/p palliative xrt in , h/o angina, who presents with progressive sob with worsening pleural effusion and pulmonary edema. she had a brief stay in the micu upon admission to the hospital until her respiratory failure stabilized. she was then transferred to the medical floor for continued care. . # hypoxic respiratory failure: she was admitted to the micu with th ddx for her hypoxic respiratory failure included chf exacerbation, malignant pleural effusion, lymphangitic , , worsening renal failure. she had a thorocentesis on which ultimately showed malignant cells consistent with esophageal adenocarcinoma. over 1l of fluid was removed and she tolerated the procedure well and was less symptomatic afterwards. her oxygen was weened down to a nc and she was diuresed with furosemide prn. she was also continued on ipratropium and fluticasone nebs/ih. she was then transferred to the medical floor. on she had another thorocentesis for symptomatic relief and about 800ml was removed at that time. this second procedure was more difficult for her to tolerate and was more painful. she received some symptomatic relief afterwards with regards to her breathing. at discharge she had stable oxygen saturations in the mid to low 90's on 5l nc. she is being discharged with 5l nc, fluticasone ih, and furosemide 10mg daily to help relieve her shortness of breath from fluid overload. . # malignant pleural effusions: the pleural fluid suggested it was an exudate (ldh ratio 0.6 (right on the border), protein ratio 0.58) which was concerning for malignant effusion given her clinical history. the cytology returned with esophageal adenocarcinoma cells and no organisms. intervential pulmonology suggested a pleurex catheter to help drain the fluid. at this time, the patient does not want another procedure done. she will consider this for symptomatic relief in the future. . # arf: the reason for her acute renal failure was unclear. cr was 2.8 on admission (baseline 1.2). she was likely intravascularly dry despite her pulmonary edema. her cr continued to trend down throughout her admission and was 0.9 on discharge. . # esophageal ca: she has received palliative xrt in . the patient does not have an outpt oncologist. xrt done by dr. . her cancer and the xrt has made it difficult for her to eat. she tolerates a liquid diet and can take some medications as well. while in the micu, a palliative care consult was obtained. once the diagnosis of malignant pleural effusion was made, the palliative care team and social work helped to organize home hospice after conversations with dr. , the attending, and the patient and her son. . # pain control: she has an allergy to aspirin and acetaminophen which cause breathing difficulties and rashes. she was treated with round the clock ibuprofen liquid solution 400-800mg q8hrs. for breathrough pain, she was given morphine elixor 2-5mg q4-6hrs. . # arf: the reason for her acute renal failure was unclear. cr was 2.8 on admission (baseline 1.2). she was likely intravascularly dry despite her pulmonary edema. her cr continued to trend down throughout her admission and was 0.9 on discharge. . # anxiety: given patient's anxiety/palpitations, we will discharge her on toprol xl to help with those symptoms. . # htn: the patient was hypotensive initially and then her blood pressure increased to the low 100's. her outpatient medications were held initially. metoprolol xl 12.5mg was added back. her sbp remained around 100 and her hr was in the 80's. . # gerd: she has a history of hiatal hernia and gerd for which she often sleeps sitting up in bed to limit the acid reflux. she took prilosec at home and was switched to lansoprazole dissolving tabs to help ease her ability to take the medication. she will remain on this medication to help give her symptomatic relief. . # code: patient expresses that she would not want to be intubated or have cpr. son had further discussions with her and discussed with dr. who confers. she is being discharged home with hospice. . # dr. will be the primary physician involved with the hospice care. medications on admission: norvasc 5mg qam, 5mg qpm toprol xl of a 50mg tab qam prilosec 20mg proventil 90 mcg 3 puffs 5x/day flovent 110 mcg 2 puffs darvocet zofran 8 mg prn azopt lasix 10 mg qod advil prn discharge medications: 1. ibuprofen 100 mg/5 ml suspension : 400-800 mg po q8h (every 8 hours): please take with enough water following this mediciant to prevent throat burning. 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (). 3. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 4. metoprolol succinate 25 mg tablet sustained release 24 hr : 0.5 tablet sustained release 24 hr po daily (daily): for anxiety/palpitations. 5. furosemide 20 mg tablet : 0.5 tablet po once a day: to help relieve fluid overload and shortness of breath. 6. morphine concentrate 20 mg/ml solution : 1-5 mg po every 4-6 hours as needed for pain. disp:*30 ml* refills:*0* discharge disposition: home with service facility: hospice of the good discharge diagnosis: primary diagnosis: esophageal cancer malignant pleural effusion hypoxia . discharge condition: stable on 5l nc. discharge instructions: you were admitted with shortness and breath and were found to have fluid around your lungs. this was removed twice with a procedure called a thorocentesis. . you are going home with hospice care. you should call dr. or dr. with any questions or problems which arise once you are home. followup instructions: please call dr. office at as needed for follow up care. procedure: thoracentesis diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified secondary malignant neoplasm of pleura personal history of malignant neoplasm of breast hypopotassemia acute respiratory failure pressure ulcer, lower back encounter for palliative care diastolic heart failure, unspecified malignant neoplasm of esophagus, unspecified site 

Answer: The patient is high likely exposed to