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: calcitonin attending: chief complaint: hip pain and constipation with new hypercalcemia major surgical or invasive procedure: bone marrow biopsy port a cath placement chemotherapy history of present illness: ms is a 44 yo female with pmh of metaststic squamous cell carcinoma of the left mid medial thigh s/p excision in who presented to the with hip pain. she had been experiencing right posterior mid-hip pain for the last 3 weeks. the pain was sharp and did not radiate down her leg. it got as bad as . denies weakness in her legs, sensory changes, or incontinence. she was taking 1 percocet per day to help her sleep. she also has had 2 weeks of constipation and more recently increasing abdominal distension and lower abdominal pain. she used a saline enema on wednesday which produced some stool, then had diarrhea on thursday. she reports that her stool is black. for the past few days she has been experiencing nausea and occasional vomiting after eating. she also reports she has been gagging on pills recents and has had headaches on and off. . in she was found to have a ca of 18.7 and was given 1 l ivf. she also had k and mg repletion and was given zofran for nausea. she had an x-ray of her lumbar spine which showed no evidence of metastatic disease. she was transferred to the ed for further evaluation. . in the ed, initial vs were: t 97.5 p 94 bp 147/99 r 22 o2 sat 100% on ra. patient was given 4 l ns and 4 mg iv morphine for pain. she underwent a hip x-ray which showed no evidence of metastatic disease. . on arrival to the she reports her hip pain is well controlled with the morphine she received in the ed. past medical history: 1. metastatic squamous cell carcinoma - diagnosed within the last year after presenting to her pcp with fungating thigh mass. biopsy showed squamous cell carcinoma. metastatic workup revealed adenopathy involing the iliac vessles and superficial inguinal region. she underwent excision of the mass on at . she was evaluated for xrt, but decided against it as she felt the chance of reoccurance was low and the risks were high. 2. iron deficiency anemia - during workup for her scc she underwent an endoscopy and colonoscopy which showed no cause for her anemia. she was treated with iv iron dextran and epo which brought her hct to the low 30's. social history: she is a jehovah's witness. she lives in with her husband. she is a bookkeeper. denies tobacco, alcohol, or drug use. family history: her father and sister have had sebaceous cysts. there are a number of non-immediate family members with history of cancer; details are lacking physical exam: vitals: t 96.5 p 90 bp 153/79 rr 17 sat 93% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: patient is breathing comfortably. inspiratory crackles bilaterally at the bases. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: linear well-healed scar in her llq. her abdomen is moderately distended with hyperactive bowelsounds. slight tenderness to palpation in her lower quadrants. no rebound or guarding present. no hsm. gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. left mid medial thigh has a large area where a baseball-sized mass of tissue was removed with well-appearing scar tissue over it. back: no spinal tenderness. pain to palpation focally over her right iliac crest. no masses or abnormalities palpated. neuro: cn ii-xii grossly intact. sensation to light touch intact throughout. 5/5 strength in her upper and lower extremities. pertinent results: admission labs: glucose-84 urea n-44* creat-2.5* sodium-134 potassium-3.2* chloride-101 total co2-24 anion gap-12 alt(sgpt)-26 ast(sgot)-49* alk phos-139* amylase-43 tot bili-0.4 lipase-153* calcium-19.8* phos-4.9* mg-2.4 albumin-2.9* calcium-15.1* phos-3.9 mg-1.9 . discharge labs: . . . . pathology ilium/pelvis, right, biopsy: metastatic squamous cell carcinoma present. . images: bone biopsy: 1. known t10 vertebral body and pelvic osseous metastases do not demonstrate significant tracer avidity. 2. marked right upper thoracic anterior chest wall uptake does not have an obvious ct correlate, though early rib/chest wall metastasis is a diagnostic consideration. 3. bilateral femoral shaft uptake may reflect hypertrophic pulmonary osteoarthropathy. 4. difficult to exclude a skull metastasis in the setting of mild focal uptake. ct pelvis: 1. new lytic lesions throughout the pelvis and new subcutaneous left lower quadrant and left inguinal nodules, all indicative of marked progression of metastatic disease. 2. small amount of free fluid in the pelvis. 3. diverticulosis ct chest: 1. marked progression of extensive bilateral pulmonary nodules with large hilar masses inseparable from mediastinal lymphadenopathy as well as numerous ossesous lytic lesions. overall, these findings are new since and concerning for rapid progression of neoplastic disease in a person with known history of previous malignancy. 2. expansile lesion posteriorly at the t10 veterbral body with associated narrowing of the central canal 3. new bilateral pleural effusions. 4. inadequately characterized hepatic hypodensities. 5. cholelithiasis. brief hospital course: this is a 44 yo female with metaststic squamous cell carcinoma of the left mid medial thigh s/p excision in admitted with hypercalcemia of 19.8. . # hypercalcemia: this was most consistent with hypercalcemia pth-rp production and bone metastasis. the patient presents with constipation and was found to have a ca of 19.8. patient was given ivf and pamidronate. calcitonin was attempted, but a sample prior to the full dosage caused the patient swelling, so she was not given any more of this. she was given lasix as well. endocrine was consulted and monitored the patient closely. pth was normal at 21. vit d 25 oh was low at 10. pth-rp is pending. initially patient was unable to take in adequate pos, secondary to her mucositis, to meet her fluid requirement and her ca levels were difficult to control. she required ~6l ivfs daily to match her urine output. ultimately, the patient and family wanted to be discharged and follow up closer to their home. the decision was made to send her home and follow up with her pcp to receive as an outpatient. . # squamous cell carcinoma: chest and pelvic ct was performed which was concerning for pulmonary nodules, extensive lymphadenopathy, and lytic lesions in the pelvis all concerning for metastatic malignancy. a bone scan was performed which showed diffuse lytic lesions in pelvis, chest wall, femur, and possibly skull. all of these findings were highly consistent with metastatic scca. a bone biopsy was scheduled that showed squamous cell carcinoma in the iliac. a port a cath was placed and the patient was started on chemotherapy. she tolerate chemotherapy well except for mucositis that was improving prior to discharge. she also tempoprarily developed elevated lfts but this was an expected side effect of chemotherapy. . # htn: upon admission the patient's sbp was 140-150. however, in the her sbp rose to 200. it was thought that the large amount of fluids she was getting for her hypercalcemia had contributed to her htn. she had a good response to labetalol and amlodopine. . # acute renal failure: the patient's cr on admission was 3.2 (her baseline is 0.6-0.7). she appeared dry initially on exam and given her extreme hypercalcemia likely has prerenal arf vs atn from volume depletion. she had an abdominal us at which showed no evidence of hydronephrosis. part of her arf could also be due to the direct renal vasoconstriction effect of hypercalcemia on the kidney causing a fall in the gfr. nevertheless, she was given significant amounts of ivf's and her kidney function returned to prior to discharge. . # right posterior hip pain: the patient has focal iliac crest pain on exam, hip x-ray was negative, but ct showed lytic lesions in bone which may be the cause of her hip pain. she was given ms contin and morphine for pain relief. . # chronic iron-deficiency anemia: the patient's initial hct was 34.2 which was near her most recent baseline since being treated for iron-deficiency. she is a jehovah's witness and therefore would not want tranfusion of any type of blood products. her hematocrit slowly trended downward, without any evidence of hemolysis. lab draws were limited to daily basis. patient otherwise remained hemodynamically stable. . # tacchycardia: the patient's hr rate was in the 100s on admission and prior to discharge. based on previous clinic visit notes she has had tachycardia before. she was not tachycardic when her hgb was around 11 (after iron infusion) so this is likely anemia. medications on admission: vitamin b12 occasionally percocet prn discharge medications: 1. zofran 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. disp:*90 tablet(s)* refills:*2* 2. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety/nausea. disp:*180 tablet(s)* refills:*0* 4. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours): do not drink alcohol or drive while on this medication. disp:*60 tablet sustained release(s)* refills:*2* 6. morphine 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain: do not drink or drive alcohol while on this medication. disp:*180 tablet(s)* refills:*0* 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 10. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. disp:*120 tablet(s)* refills:*0* 11. oral wound care products gel in packet sig: fifteen (15) ml mucous membrane tid (3 times a day) as needed for mucositis. disp:*1350 ml(s)* refills:*0* 12. normal saline please administer 4l of ns at 250cc per hour daily. 13. potassium & sodium phosphates 280-160-250 mg powder in packet sig: one (1) powder in packet po qid (4 times a day). disp:*60 powder in packet(s)* refills:*0* 14. outpatient lab work please check basic metabolic panel including calcium and phosphorous daily for the next week. can start to decrease frequency as values improve. please check cbc twice weekly. 15. heparin flush 10 unit/ml kit sig: one (1) flush intravenous twice a day: with accessing port. disp:*60 flushes* refills:*2* 16. saline flush 0.9 % syringe sig: one (1) flush injection twice a day: as needed with accessing port. disp:*60 flushes* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: 1) hypercalcemia 2) squamous cell carcinoma 3) acute renal failure . secondary diagnosis: 1) anemia discharge condition: stable discharge instructions: you were admitted the the hospital for hypercalcemia. your hypercalcemia was treated with iv fluids and medications. it is improved, but still above normal. you will need to follow up with your pcp about this issue. after a bone marrow biopsy showed that you had squamous cell carcinoma in your bones, you were started on chemotherapy. you tolerated your chemotherapy well except for the development of oral ulcers. please use the medication, gelclair, for your ulcers. they should improve with time. you will need to follow up with your oncologist. we treated your pain with pain medications. you also developed high blood pressure while in the hospital. we treated this with blood pressure medications. . we have made the following changes to your medication list: 1) zofran 8 mg tablet by mouth every 8 hours as needed for nausea. 2) lorazepam 0.5 mg tablet by mouth every 4 hours as needed for anxiety/nausea. 3) labetalol 200 mg tablet by mouth 2 times a day 4) amlodipine 5 mg tablet by mouth once a day 5) morphine 15 mg tablet sustained release. one tablet by mouth every 12 hours: do not drink alcohol or drive while on this medication. 6) morphine 15 mg tablet. 1 tablet by mouth every 4 hours as needed for pain: do not drink or drive alcohol while on this medication. 7) bisacodyl 5 mg tablet by mouth daily as needed for constipation. 8) senna 8.6 mg tablet by mouth 2 times a day for constipation 9) docusate sodium 100 mg capsule by mouth 2 times a day for constipation 10) compazine 10 mg tablet by mouth every six hours as needed for nausea. 11) oral wound care products (gelclair) apply fifteen ml to the mucous membranes of your mouth three time a day as needed for mucositis. . please seek medical help if you develop shortness of breath, chest pain, nausea vomiting, fevers, chills. followup instructions: please follow up with dr. . phone number . an appointment has been made for you on: wednesday at 9:30am. . you also need to see him tomorrow. he has been spoken to and will give you zometa 4 mg once. . please follow up with an oncologist at . the doctor who will be in touch with him is dr. . his phone number is (. please call and make a follow up appointment with him if you need further oncology care in . procedure: insertion of totally implantable vascular access device [vad] biopsy of bone, other bones injection or infusion of cancer chemotherapeutic substance diagnoses: unspecified pleural effusion unspecified essential hypertension acute kidney failure, unspecified hypopotassemia personal history of other malignant neoplasm of skin antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use iron deficiency anemia, unspecified secondary malignant neoplasm of lung secondary and unspecified malignant neoplasm of intrathoracic lymph nodes secondary malignant neoplasm of bone and bone marrow acute pancreatitis hypercalcemia secondary and unspecified malignant neoplasm of lymph nodes of inguinal region and lower limb mucositis (ulcerative) due to antineoplastic therapy hypersomnia with sleep apnea, unspecified 

Answer: The patient is high likely exposed to