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: history of present illness: the patient is a 57-year-old female referred for evaluation of gastric resection surgery and the treatment management of obesity by her primary care physician, . . the patient was seen and evaluated in gastric bypass clinic on and . has class iii obesity with a weight of 323 lbs, bmi 49.6. her previous weight loss efforts have increased weight watchers, lost 50 lbs in months, nutri-system, lost 90 lbs in months, and weight loss clinic 80 lbs in 3 months. in all instances she could not maintain weight loss and regained weight within 3-4 months. her lowest weight as an adult was 180 in her early 20's. she has weighed over 300 lbs for the past 20 years. she states she has developed significant weight problems and most events related to her weight gain are sexual abuse by family. factors attributable to her excess weight include poor exercise, stress, emotional causes as well as lack of exercise. she denies eating disorders but admits to food obsessions. she has a history of depression and is seeing a social worker for family sexual abuse. finished therapy 6 years ago with no psychiatric hospitalization, no medication. past medical history: hypertension since , type 2 non-insulin dependent diabetes with neuropathy in lower extremities since , gallbladder disease in , bell's palsy in , osteoarthritis in knees and ankles, chest pain, palpitations in with a negative stress test. she has a history of eczema, denies heart disease, asthma, sleep apnea, dyslipidemia, thyroid disease, gerd, post menopausal. past surgical history: cholecystectomy in , umbilical hernia repair in under general anesthesia. medications: adalat 90 mg q day, hydrochlorothiazide 25 mg q day, glucophage 500 mg , ecotrin 325 mg q day, senna for constipation. allergies: penicillin, erythromycin, sulfa. social history: smoked for 10 years, quit age 25, no alcohol or recreational drugs. drinks 2 cups of coffee in the morning, 2 large diet , caffeine free daily. family history: both parents deceased, age 77 for father with obesity and liver disease, mother at age with obesity and renal cancer. there is a history of diabetes and paget's disease in siblings. employed as a computer technician at an insurance company. married, living with husband, a program analyst for the state, and son. she has a married daughter outside the home. physical examination: upon presentation blood pressure was 132/76, pulse 94. on brief physical exam there were no skin lesions. sclera was anicteric. pupils equal, round and reactive to light. oropharynx without exudate. funduscopic exam was noted to be within normal limits. there was no cervical lymphadenopathy, thyromegaly or carotid bruits. lungs were clear to auscultation bilaterally and nor heart sounds are present, regular rate and rhythm without murmurs, rubs or gallops. abdomen is obese, soft, nontender, with good bowel sound activity. there is a well healed incision in the right upper abdomen and midline periumbilical area without evidence of hernias. lower extremities were noted for a mild erythema bilaterally, right greater than left, without warmth, tenderness or swelling. she has edema in the right lower extremity. neurologically left facial droop is noted, speech impairment and there is a decreased sensation in both extremities. ekg showed normal sinus rhythm at 94 with a left bundle branch block, not new, present on the tracing. pvc with p waves. fasting laboratory data from showed blood glucose of 191, hemoglobin a1c 8.3, remainder of electrolytes, lfts, chemistries, tsh, b12, cbc, basic labs were within normal limits. albumin 4.1, chloride decreased to 98, serum folate greater than 20, bun slightly elevated at 25, total protein slightly elevated 80.2, cholesterol 219, hdl 67, ldl 127, triglycerides 123. exercise treadmill test on , left bundle branch block. persantine sestamibi myocardial perfusion scan in 9/96 was inconclusive but a resting myocardial perfusion scan on was negative for ischemia. impression: patient is a 57-year-old class iii obesity, bmi 50 with significant co morbidities and thought to be an excellent candidate for gastric resection surgery. risks and benefits were discussed and patient decided to proceed with gastric resection surgery. for details of surgery please see operative note. postoperative day #1 the patient had borderline urine output. she was afebrile, vital signs were stable. she had only made 273 cc in the operating room and pacu and 41 cc in the last two hours that were checked. her exam was appropriate. she was continued on lr with 20 of potassium at 150. her ng tube was discontinued. she was started on a stage i diet and encouraged to get out of bed and ambulate. on postoperative day #2 the patient had a t max of 101.4 and pulse of 114. urine output was adequate. her abdomen was soft and the g tube was in place and incision was clean, dry and intact. a hematocrit done on postoperative day #1 was 30.7, potassium 4.8, creatinine 1.2 and on postoperative day #2 she was considered stable, started on stage ii diet and her iv was hep-locked. she was started on po lopressor and hydrochlorothiazide though urine output was decreased yesterday and picked up during postoperative day #2 and continued the foley to monitor urine output. she was started on roxicet an zantac po for pain control and prophylaxis respectively. on the night of postoperative day #2 to postoperative day #3 resident was called to see patient for left upper quadrant discomfort, incisional pain and shortness of breath. at this point in time patient was afebrile, was making adequate urine output, had decreased breath sounds at the bases bilaterally but otherwise exam was appropriate. the patient was 92% on room air and 97% on three liters. the chest x-ray was done at that point in time which showed extensive bibasilar atelectasis and left hemidiaphragm obscured because of atelectasis. the patient's respiratory rate was 20. respiratory care was called and patient was given a nebulizer treatment which patient stated she subjectively felt better. during the day, postoperative day #3, the patient was stating that she still feels that her breathing was limited but she denied chest pain in the morning, was afebrile, vital signs stable, adequate urine output with decreased breath sounds at the bases. abdomen was soft, slightly distended. she was continued on roxicet, continued on pulmonary toilet. her foley was discontinued. for diabetes she was started on a regular insulin sliding scale which she had been started on in the recovery room after surgery. her heparin subcutaneous was changed to lovenox. during the day on postoperative day #3 the patient started complaining of substernal chest pain without radiation and slightly increasing shortness of breath. she stated that her abdominal pain had decreased because her g tube was actually placed to gravity. her vital signs at this point were stable except her pulse was 129. she was slightly short of breath and slightly diaphoretic with decreased breath sounds at the bases. a chem 10 done on that day showed that she had sodium of 137, potassium 4.1, chloride 88, co2 23, bun 19, creatinine .9, glucose 233 and ekg showed a heart rate of 117 and left bundle branch block which did not change from her previous ekg except for the tachycardiac. thus, at this time on postoperative day #3 she had self limited chest pain with continued shortness of breath and tachycardia. cardiovascularly she was ruled out for an mi with serial enzymes, started on telemetry and her po lopressor was changed to iv. because of slight abdominal pain patient had a swallowing study done and was made npo and started on iv fluids, continued on supplemental oxygen. postoperative day #3 because of the patient's shortness of breath and abdominal pain, the patient had a cta and ct of her abdomen done. swallow study was inconclusive since patient could not complete the study secondary to dyspnea and tachycardia. ct angiogram on postoperative day #3 showed evidence of pulmonary embolus in the right upper lobe and right lower lobe. ct of her abdomen showed no evidence of active extravasation with slight amount of fluid around the sleep. the patient continued to be tachycardic and tachypneic, continued to make adequate urine output, decreased breath sounds bilaterally. abdomen was slightly distended. the patient was ruled out for an mi with cks of less than 200 and troponins of less than .3 times two. because of tachycardia, lopressor was increased to 7.5 mg q day. also on postoperative day #4, due to patient's critical status, patient required frequent blood draws and was a difficult stick and thus a three lumen catheter was placed at the bedside sterilely without any complications with a chest x-ray post procedure that showed adequate placement. on postoperative day #5 the patient still felt dyspneic without any chest pain, no nausea, vomiting or flatus. the patient was afebrile with a t max of 100.7 with a stable blood pressure, respiratory rate of 24, continuing to make adequate urine output. the patient looked distressed upon exam, using accessory muscles for breathing. she was tachypneic and tachycardic. chest cta showed an anterior segment of right upper lobe that had filling defects and right lower lobe had filling defects with atelectasis of the left lower lobe and small left pleural effusion with a high probability of pe read out for this final ct. labs over the last several days, on patient's hematocrit was 33, on at 7 p.m. was 29, at 11 p.m. was 27, 12 a.m. 27.3 and on at 4:30 a.m. had nadired to 26.5 with normal ptt. lfts were drawn which were within normal limits with an amylase of 41, lipase 16, total bilirubin .8, alkaline phosphatase 69, alt 17, ast 37 with a white count of 17.8 with 88% neutrophils and 6% bands. on postoperative day #5 the patient was continued on morphine which had been switched from roxicet when patient was made po. cardiovascularly the patient was continued on telemetry and continued to be tachycardic. pulmonary, patient was started on heparin sliding scale which started actually on evening of postoperative day #4 and was adjusted for a goal pt between 60 and 80. renal, patient continued to make adequate urine output. id, patient actually was started on levaquin on postoperative day #4, continued leukocytosis. gi, patient was again started on a stage ii diet after ct showed no extravasation. a foley was replaced. heme, patient received one unit of packed red cells with hematocrit to be checked, with a drop in hematocrit in the face of increasing abdominal pain. endocrine, patient was continued on increasing sliding scale. on postoperative day #5 at 5:45 p.m. the patient, because of abdominal pain, fluid that was seen around the spleen during original ct, patient underwent a ct guided drainage with a left upper quadrant collection, with a 10 french catheter without any complications. 50 cc of old blood was aspirated. sample was sent for culture and a pigtail drain was left in place. at this point in time patient was transferred to the surgical icu for closer monitoring secondary to patient's pulmonary embolism and status post drain placement due to intraperitoneal process. the patient remained stable in the icu and on postoperative day #6 levaquin day 3, patient was afebrile, remained tachycardic and tachypneic, was making adequate urine output and exam was unchanged with white count of 19.6, hematocrit 27.6 after one unit of blood on postoperative day #4. ptt was 36.6, normal electrolytes. culture from aspiration of intra-abdominal fluid showed gram positive cocci in chains with 4+ pmns. the patient was clinically improving, neurologically continued on morphine pca with aggressive pulmonary toilet and continued on iv lopressor. the patient's antibiotic regimen was changed to include vancomycin, levofloxacin and flagyl for empiric coverage of the abdominal process. heme, patient continued to be anticoagulated on heparin with a goal ptt between 60 and 80. the patient was seen by pt to help with ambulation. on postoperative day #7, levaquin day #4, flagyl and vanco day #2, patient's pain was controlled and clinically looked improved, was afebrile, was making adequate urine output, white count was 18.6, hematocrit 26.4, electrolytes were within normal limits. ptt was 56.2. exam showed decreased breath sounds at the bases. at this point in time the patient was continued on morphine, iv lopressor, antibiotics for empiric coverage, continued on anticoagulation with heparin for goal between 60 and 80, was encouraged to ambulate. on postoperative day #8, levaquin day #5, flagyl and vanco day #3, patient was able to receive coumadin along with heparin and was able to ambulate times two. the patient was afebrile, vital signs were stable. patient's abg was within normal limits while patient was in the sicu. white count was 17.1, hematocrit 21.4, potassium 3.2 which was repleted. culture continued to show gram positive cocci, question of staph at this point in time. exam was unchanged. the patient was transferred to the floor at this point in time. was changed to po roxicet. cardiovascular, po lopressor and nifedipine and hydrochlorothiazide. respiratory, patient was ambulated and continued on iv heparin, started on coumadin on postoperative day #8. gi, patient was started on stage iii diet. the patient continued to make adequate urine output thus the foley was discontinued on postoperative day #8. id, the patient was continued on antibiotics. heme, patient was continued on heparin. the patient was continued on zantac for prophylaxis. the patient was actually started on tpn on postoperative day #7 and this was continued while patient was on the floor for adequate nutrition and continued on an insulin sliding scale. postoperative day #9 the patient was still short of breath without any chest pain but was able to ambulate and void without difficulty. she was afebrile, her vital signs were stable, she continued to make urine output which was adequate. white count was 17.6, hematocrit 25.4. electrolytes were within normal limits. ptt 70.5. micro showed coag negative staph with no fungus or anaerobes and vanco peak of 25.1. the patient started to clamp her g tube, we did not check residuals to see whether this made the patient uncomfortable. the patient was continued on heparin. the patient was made kvo and allowed to continue on the stage iii diet. physical therapy came to see patient for home recommendations. postoperative day #10 the patient continued to have decreasing shortness of breath, was able to ambulate and void without difficulty. she had a t max of 100.5, her vital signs were stable, urine output was within normal limits. the patient's fingersticks were greater than 200. the patient had decreased breath sounds bilaterally. white count had gone up from 17.1 to 24 and hematocrit was stable at 26.6. ptt most recently was 110 with micro showing mrsa methicillin resistant staph aureus sensitive to vancomycin, no evidence of anaerobes or fungus and intraabdominal fluid which was drained. postoperative day #10 id, the patient was afebrile but white count had increased as a chest x-ray was checked and central line was discontinued with a picc line being placed. heme, hematocrit was stable, inr was 1.5, ptt 110. the patient was continued on heparin and coumadin for pulmonary embolus. gi, patient tolerated g tube clamping. gu, patient continued to make urine output. neuro, patient was continued on roxicet and zantac for prophylaxis. postoperative day #10 events, when patient had picc line placed it was actually placed by the venous access nurse and during chest x-ray for checking placement, it was seen that picc line was actually in the right ij and it was pulled at that point in time. the patient had a peripheral iv placed overnight and a picc line was actually placed on postoperative day #11 without difficulty and adequate placement checked by chest x-ray. the night between postoperative day #10 and postoperative day #11, the patient had 9 beats of non sustained wide complex tachycardia in the evening at 7:30 p.m. and at 2:30 a.m. the patient started complaining of increasing shortness of breath which patient thought was secondary to anxiety and at that point in time patient's telemetry was within normal limits. the patient as given ?????? mg of ativan without any help but was given benadryl for sleep which seemed to alleviate the shortness of breath. on postoperative day #11, levo day #8, flagyl and vanco day #5, patient's pain was controlled, she was slightly more increased short of breath than yesterday, no lightheadedness, dizziness or chest pain. patient as afebrile. her vital signs were stable. fingersticks were less than 200, making adequate urine output. she had decreased breath sounds at the bases. white count was 22.3 on postoperative day #11. hematocrit was 24.1. electrolytes were within normal limits. ptt was actually 24.7. line culture was negative. chest x-ray was done which showed mild bibasilar atelectasis with a small left pleural effusion with no infectious process. management on postoperative day #11 because of patient's increasing shortness of breath and wide complex tachycardia, patient was again ruled out for an mi. she was ruled out with serial enzymes of 57, 52 and 45 with troponins less than .3 times three. the patient remained afebrile with vital signs stable, sugars less than 200, exam unchanged. the patient received a unit of blood overnight. patient's hematocrit went from 21.2 to 22. the patient received another unit of blood during postoperative day #12. cvc tip culture was negative. electrolytes were within normal limits. the patient was continued on iv heparin. because of patient's stable hematocrit, though patient received two units of blood. the patient had a repeat ct of her abdomen at which time her heparin was stopped which showed a persistent subphrenic collection consistent with a hematoma, a new subcapsular fluid collection consistent with a hematoma injury to the left hepatic lobe and a stable 10 cm subcutaneous fluid collection. on postoperative day #13 there were no events overnight. the patient remained in control of the nausea and vomiting, afebrile, vital signs stable, adequate urine output. patient's exam was unchanged. white count had gone done to 17.4. hematocrit 22.1, most recent ptt 26.8. electrolytes were within normal limits. blood cultures of the cvc tip was negative. peritoneal fluid showed oxacillin resistant staph. because of the hematoma, patient overnight between postoperative day #12 and 13 was made npo, her heparin was stopped, she was given 2 mg of iv vitamin k and her coumadin was held. a type and screen was sent and a stat coag was sent at 4 a.m. to get patient ready for a ct guided drainage of the fluid collections in her abdomen with possible drain placement for the subcapsular fluid collection anterior to the left hepatic lobe. on postoperative day #13 she was continued on roxicet. she was continued on telemetry and ruled out for an mi times two during this hospital stay. pulmonary, she has a history of pe. we are holding the heparin. she was continued on incentive spirometry and pulmonary toilet, sats greater than 94% on two liters. gi, she was on a stage ii diet which she was tolerating but made npo for the ct guided drainage. she continued to make adequate urine output. heme, at this point in time holding the anticoagulation for procedure and anticoagulation was reversed with vitamin k 2 mg given iv. the patient was started on d5 ?????? normal saline while patient was npo. id, the patient's white count had gone down to 12.7. she was continued on antibiotics for oxacillin resistant staph. the patient's platelets were 370,000, most recent ptt was 26.1, inr 1.4, electrolytes were within normal limits. this dictation will be continued once patient is ready to be discharged with an addendum dictation. discharge diagnosis: 1. status post gastric bypass for morbid obesity. 2. pulmonary embolism. 3. anterior peritoneal bleed. 4. type 2 diabetes. 5. hypertension. condition on discharge: cannot be stated at this point in time since patient is not being discharged. discharge medications: cannot be noted. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances percutaneous abdominal drainage high gastric bypass diagnoses: hematoma complicating a procedure diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes pulmonary collapse paroxysmal ventricular tachycardia other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation morbid obesity iatrogenic pulmonary embolism and infarction 

Answer: The patient is high likely exposed to