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: adhesive tape attending: chief complaint: right renal mass major surgical or invasive procedure: right radical nephrectomy, caval extraction, dr. , . history of present illness: from service accept note: 64 m with h/o cad, prior mi, non-ichemic dilated cardiomyopathy (ef 12%), gout, tias x2, empyema s/p thoracotomy, s/p right radical nephrectomy w/ resection & primary repair of ivc on for renal cell carcinoma with ivc invasion. the patient is being transferred from t-sicu given his cardiac history. he had an uneventful recovery course thus far. currently extubated, off pressors, on pivoicaine (epidural) and toradol for pain control. at this time, he denies sob, cp, palpitations. he gets episodes of sharp pain at incision site lasting a few seconds, but otherwise his pain is under control. the patient also complains of gout fare in his right knee and left foot. his outpatient antihypertensives (carvedilol, lisinopril) and aspirin are being held. the patient received kefzol x 3 doses, which has been d/c'd. the patient is currently afebrile. . on review of systems, he denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. reports tias in and . all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: -pacing/icd: 3. other past medical history: dilated cardiomyopathy (ef~10%) prior mi (age unknown), incidental finding during workup for his tias x 2 gout empyema s/p thoracotomy, vats tias x 2 (, ) social history: lives in senior housing. divorced. retired plumber. -tobacco history: quit smoking in . 30 years x ppd prior to that. -etoh: the patient drinks 3-4 beers / day -illicit drugs: none family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. father with cancer, died at 86. mother with breast cancer and colon cancer, died at 73. maternal uncle with cancer history as well. physical exam: from service accept note: vs: t=afebrile bp=153/90 hr=100 rr= 18 o2 sat= 98% ra general: wdwn m in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of *** cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. lungs clear to auscultation anteriorly. abdomen: soft, ntnd. no abdominial bruits. surgical site c/d/i. extremities: no c/c/e. no femoral bruits. swollen, erythematous toes l>r, tophi on fingers. knees swollen and warm. skin: multiple tophi on fingers. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: labs on admission: blood: 01:50pm blood wbc-9.6 rbc-3.27* hgb-9.8*# hct-30.9* mcv-94 mch-30.1 mchc-31.9 rdw-12.9 plt ct-235 01:50pm blood neuts-88.2* lymphs-8.3* monos-2.9 eos-0.3 baso-0.3 01:50pm blood pt-12.4 ptt-31.7 inr(pt)-1.0 01:50pm blood glucose-149* urean-34* creat-1.6* na-136 k-4.5 cl-107 hco3-22 angap-12 01:50pm blood calcium-8.5 phos-3.8 mg-1.8 09:35am blood type-art tidal v-600 fio2-100 po2-406* pco2-45 ph-7.33* caltco2-25 base xs--2 aado2-279 req o2-52 intubat-intubated vent-controlled 09:35am blood glucose-137* lactate-0.8 na-136 k-4.8 cl-105 09:35am blood hgb-11.6* calchct-35 09:35am blood freeca-1.16 urine: 08:54pm urine castgr-0-2 08:54pm urine rbc-0-2 wbc- bacteri-none yeast-none epi-0-2 renalep-0-2 08:54pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-50 bilirub-neg urobiln-neg ph-5.0 leuks-neg 08:54pm urine color-yellow appear-clear sp -1.012 mrsa screen (): 1:50 pm mrsa screen no mrsa isolated. 8:54 pm urine culture source: catheter. no growth. 11:15 pm blood culture x 2 source: venipuncture. no growth. 12:27pm joint fluid wbc-* rbc-2700* polys-92* lymphs-0 monos-8 12:27 pm joint fluid source: knee. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. renal pathology (): macroscopic extent of tumor: tumor extension into major veins. microscopic histologic type: conventional (clear cell) renal cell carcinoma. histologic grade: g3: nuclei very irregular, approximately 20 microns;nucleoli large and prominent. extent of invasion primary tumor: pt3b: tumor grossly extends into the renal vein or its segmental (muscle-containing) branches, or vena cava below the diaphragm. regional lymph nodes: pn0: no regional lymph node metastasis. lymph nodes number examined: 6. number involved: 0. distant metastasis: pmx: cannot be assessed. margins margin(s) involved by invasive carcinoma: renal vein margin only. adrenal gland: uninvolved by tumor. venous invasion: present. additional pathologic findings: none identified. addendum: additional sections (p-r) were submitted. there is no definite invasion of the renal sinus or perinephric fat. echo (): the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis with overall left ventricular systolic function being severely depressed (lvef= %). there is preservation of the basal rim of myocardium. the mid to distal anterior, inferior, anterolateral and inferolateral walls are severely hypokinetic. the mid to distal infero and antero septal walls are dyskinetic. the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. ecg (): sinus rhythm. left bundle branch block. compared to the previous tracing of multiple abnormalities persist without major change. cxr (): the et tube tip is 6.7 cm above the carina, just at the level of the clavicular head. the ng tube tip is in the stomach. the swan-ganz catheter tip is at the right ventricle outflow tracts/main pulmonary artery. cardiomediastinal silhouette is stable. free air below the right hemidiaphragm is seen most likely related to recent nephrectomy and should be closely followed. there is no pleural effusion or pneumothorax. cxr (): persistent large volume of free air under the diaphragm with bilateral lower lobe atelectasis. cxr (): right subdiaphragmatic air (pneumoperitoneum) has decreased compared to . there is unchanged mild cardiomegaly without evidence of chf. xray of knee (ap, lat, oblique, ): there is some narrowing of the medial joint space compartment bilaterally, right greater than left. both knees show suprapatellar fluid. however, no erosive changes are visualized and there is no evidence for fracture or dislocation. brief hospital course: the patient is a 64 m with h/o gout, tias x2, empyema, dilated cardiomyopathy (ef~10%) s/p right radical nephrectomy w/ resection & primary repair of ivc on for renal cell carcinoma with ivc invasion. each of the problems addressed during this hospitalization are described in detail below. renal cell carcinoma: patient was admitted to dr. urology service after undergoing right radical nephrectomy, ivc thrombectomy. no concerning intraoperative events occurred; please see dictated operative note for details. the patient received perioperative antibiotic prophylaxis. the patient was transferred to the icu from the or in stable condition. the patient was successfully extubated in the icu. the patient's post-operative course was uneventful. the patient's pain was initially controlled with pca morphine, epidural and toradol. the patient was subsequently switched to po regimen for pain control with po dilaudid q3hrs prn; iv dilaudid for breakthrough pain. pca, epidural and toradol were discontinued. on discharge, the patient's pain is well controlled with oxycodone and tylenol prn, which he will continue to take as outpatient. the patient maintained good uop, and foley was discontinued. post-operatively, incentive spirometry was encouraged 10x/hr. the patient was given ondansetron 4-8 mg iv q8h:prn for nausea. the patient was initially held npo, and diet was gradually advanced to regular, which the patient tolerated well. the patient received physical therapy throughout post-operative course. ambulation was encouraged. hematocrit remained stable throughout post-operative course. there were no signs of bleed, and the patient remained hemodynamically stable. the patient's creatinine initially bumped to 2.2, which was attributed to expected exacerbation of renal function s/p nephrectomy. however, on discharge cr is down to 1.2, which an improvement from patient's pre-operative baseline of 1.4-1.5. the patient was discharged in stable condition, eating well, ambulating independently, voiding without difficulty, and with pain control on oral analgesics. on exam, incision was clean, dry, and intact, with no evidence of hematoma collection or infection. the patient has a follow-up appointment to with his urologist dr. in 3 weeks as outpatient. he will also follow up with his pcp. cad: the patient with a history of prior mi, age undertermined as well as dcm (ef 12%). last catheterization in per patient with no intervention. recent ett was not interpretable in the setting of lbbb and poor exercise tolerance. however, there was a noted patially reversible moderate defect of the apical -inferior wall on mibi. post-operatively, outpatient aspirin was held. the patient was instructed to hold aspirin and avoid nsaid use until he is seen by urology as outpatient. outpatient carvedilol was continued postoperatively. lisinopril was initially held given acute creatinine bump from nephrectomy, but was re-started prior to discharge. the patient was closely monitored on telemetry, which recorded no concenrning events. ekgs showed no acute changes. chf: dilated cardiomyopathy with ef of 12% per recent perfusion scan. the patient does not have icd, but states that he was evaluated for it recently. post-operatively, volume status was closely monitored to assure that the patient remains euvolemic despite anticipated fluid shifts. diuresis and fluid rescucitation were performed as necessary to maintain euvolemia. i&os, urine output and cr were monitored closely. the patient showed no signs of chf exacerbation postoperatively. he has an appointment to follow-up with his cardiologist dr. upon discharge. gout: post-operative course was complicated by significant pain in knees and feet bilaterally c/w acute gout flare. x-ray of the knees was significant for b/l knee effusions, uric acid level was measured to be 10.4. the patient was seen by rheumatology service, who aspirated left knee and performed bilateral gluocoritcoid injections. the patient received a single systemic dose of 20mg iv methylprednisone. pain was controlled as above. the patient was atrted on 0.6mg of colchicine daily, which he will continue as outpatient. the patient reported symptomatic improvement prior to discharge. he was able to ambulate with the assistance of a rolling walker. he will schedule an appointment to follow-up with rheumatology service as outpatient. medications on admission: lisinopril carvedilol 25mg aspirin 81mg daily indomethacin alleve and tylenol prn discharge medications: 1. gabapentin 100 mg capsule sig: one (1) capsule po tid (3 times a day). 2. carvedilol 6.25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 4. oxycodone 5 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain: do not drink or drive with this medication. . disp:*36 tablet(s)* refills:*0* 5. colchicine 0.6 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 6. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 7. rolling walker 8. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*30 capsule(s)* refills:*0* discharge disposition: home with service facility: visiting nurse and health discharge diagnosis: primary: right renal mass status post right radical nephrectomy, caval extraction, gout, dilated cardiomyopathy. secondary: chronic renal disease, hypertension, hyperlipidemia discharge condition: vitals stable, pain under control, able to ambulate discharge instructions: you were admitted to the hospital for surgery to remove your kidney and repair of your inferior vena cava after you were noted to have a large mass. you tolerated the surgery well. during your recovery period, you were amditted to cardiology service and we monitored you closely due to your prior history of a heart condition known as dilated cardiomyopathy. during this time, you also had a flare of gout, and were seen by rheumatology team, who injected your knees with corticosteroids to reduce inflammation. you were also given a short course of systemic corticosteroids. at this time, your gout flare is under control and you are able to walk with the assistance of a rolling walker. we made several changes to your medications as follows: -tylenol should be your first line pain medication. the maximum daily tylenol dose is 4gm. a narcotic pain medication has been prescribed for breakthough pain as needed every 6 hours. do not drive or drink alcohol while taking narcotics -we decreased your dose of carvedilol (coreg) to 6.25mg twice a day. - please take colchicine 0.6 mg every day for your gout exacerbation. -colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication, discontinue if loose stool or diarrhea develops. - do not take nsaid (aspirin, and ibuprofen containing products such as advil & motrin) until you see your urologist in follow-up. please ask dr. when you can restart your aspirin. -resume all of your other home medications you also have the following instructions from your urology team: -you may shower but do not bathe, swim or immerse your incision. -do not eat constipating foods for 2-4 weeks, drink plenty of fluids -do not lift anything heavier than a phone book (10 pounds) or drive until you are seen by your urologist in follow-up you have several follow-up appointments (see below). if you have fevers > 101.5 f, vomiting, or increased redness, swelling, or discharge from your incision, cheat pain, palpitations, shortness of breath, nausea, vomiting, excessive sweating, chills, or any other concerning symptoms, call your doctor or go to the nearest er -call dr. if you have any urological questions. followup instructions: 1. you have an appointment with your urologist dr. as follows: provider: , m.d. phone: date/time: 10:00 location: , urology cc3 (nhb) you may call dr. office (), if you have any urological questions prior to that. 2. you also have an appointment with your cardiologist dr. as follows: , md phone: date/time: location: , cc7 cardiology (sb) 3. you also need to call to set up an appointment with a rheumatologist for follow up of your gout in weeks. please call to schedule appointment. 4. you also need to set up an appointment with your primary care doctor , s. call to schedule appointment within 2 weeks at . procedure: injection of steroid nephroureterectomy other excision of vessels, abdominal veins incision of vessel, abdominal veins injection of therapeutic substance into joint or ligament diagnoses: other primary cardiomyopathies congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified secondary malignant neoplasm of other specified sites malignant neoplasm of kidney, except pelvis chronic kidney disease, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia old myocardial infarction chronic systolic heart failure personal history of venous thrombosis and embolism 

Answer: The patient is high likely exposed to