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: ambien attending: chief complaint: dyspnea, hemodynamic monitoring major surgical or invasive procedure: picc line placement and removal history of present illness: ms. is a 74 year-old woman with a history of chf, copd on home o2, transferred from for further management of a newly diagnosed, 20 cm hepatic lesion, and also found to be dyspneic. she has been doing poorly at home for the past several months, with worsening pickwickian syndrome. her son states that she has been falling alseep at meals and sleeps approximately 16 hours per day. this pattern was gradually worsening until two days prior to arrival when she developed a nonproductive cough and more labored breathing. her son brought her to the , however, because she had an episode of possible uterine bleeding where they noted dried blood on a chair after she stood up. she has a history of significant uterine bleeding and her son was concerned that she was having a recurrence so he brought her to the ed. at the osh, she was noted to have left sided chest pain and luq pain. she was also found to be hypotensive to the 90s and a hct was found to be 26. a non-contrast ct torso was attained and demonstrated a 20cm low attenuation mass with possible areas of bleeding, a small amount of perihepatic fluid, and ?new bibasilar atelectasis. however, her management also addressed her dyspnea, and the initial impression was that she was also experiencing a copd exacerbation secondary to pneumonia. she was therefore given levofloxacin, solumedrol, and 1 unit of blood, and transferred to for hepatology management, hemodynamic monitoring, and possible ir procedure for hemostasis. on arrival, her vs were 98.8 100/62 120 22 93%4l (on home o2 at baseline). she was found to be mildly dyspneic and was given nebs. our radiology department assessed his osh scans and provided the read described above. the liver transplant service was also contact and concluded that they did not feel that this was an acute bleed, and that there was no role for acute operative or ir intervention. the surgical service was also consulted were concerned about a pe given her dyspnea; they also felt that anticoagulation with heparin would be reasonable. review of systems is otherwise negative for n/v/d/f/c. past medical history: atrial fibrillation (; briefly anticoagulated in but not currently) chf copd dm2 () cva () w/ left sided weakness (resolved) s/p cholecystectomy () uterine fibroid social history: she has a 75-100 pack year smoking history (~2 packs per day for 50 years) but quit smoking 15 years ago. she does not drink alcohol or use any other drugs. she lives with her son, who also has copd, and her husband. son notes increasing problems with and alertness and states that she has been falling asleep at the dinner table. family history: nc physical exam: general appearance: overweight / obese eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic lymphatic: cervical wnl, supraclavicular wnl cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (percussion: resonant : ), (breath sounds: diminished: ) abdominal: soft, non-tender, bowel sounds present, obese extremities: right: 1+, left: 1+ skin: warm neurologic: follows simple commands, responds to: verbal stimuli, movement: not assessed, tone: not assessed, very sedated and moving slowly, appears encephalopathic pertinent results: cxr : bibasilar atelectasis, however, no evidence of chf exacerbation. . ct abd: suggestion of lipomatous deposition in the interatrial septum of the heart. clincial correlation advised as this can be associated with arrhythmias. mri would be a more definitve examination to confirm this finding. 2. vascular atherosclerotic calcifications. 3. large, 20-cm predominantly low-density mass occupying the majority of the right lobe of the liver, with internal regions of hyperattenuation consistent with blood. calcified rim suggests a slow growing lesion. based on the characteristics, giant hemangioma is favored, but this remains incompletely characterized on this non-contrast study. further evaluation with multiphasic ct or mri is recommended as allowed by the patient's renal function. 4. additional hypoattenuating lesions within the caudate and the left lobe of the liver are incompletely characterized. 5. small amount of perisplenic and perihepatic free fluid. 6. degenerative changes of the spine with grade 1 anterolisthesis of l4 on l5. . echo: the left atrium is markedly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a small pericardial effusion. the effusion appears circumferential. impression: suboptimal technical quality. global left ventricular function is probably normal, but a focal wall motion abnormality cannot be fully excluded. mild right ventricular dilation with normal systolic function. moderate mitral regurgitation. mild pulmonary hypertension. small pericardial effusion without echocardiographic signs of tamponade. . leni: slightly limited exam without evidence of dvt. . cxr: as compared to the previous radiograph, there is a minimal increase of bilateral basal parenchymal opacities suggestive to represent atelectasis. no clear evidence of overhydration. no focal parenchymal opacity suggestive of pneumonia. unchanged position of the right picc line. . brief hospital course: ms. is a 74 year-old woman with a history of chf, copd on home o2, transferred from for further management of a newly diagnosed, 20 cm hepatic lesion, and also found to be dyspneic. . #. acute on chronic hypoxic respiratory failure: initially, multiple etiologies were considered including chf exacerbation vs pneumonia/copd exacerbation vs pe. despite the fact she had no wheezing suggesting worsening copd and was afebrile, as she appeared quite ill she was initially treated for pneumonia/chf exacerbation with furosemide for diuresis as well as levofloxacin. there was considerable concern for pe as well but due to concern about her liver mass as well as possible vaginal bleeding anticoagulation was held. on hospital day two, however, her respiratory status began to improve significantly with diuresis and further control of her atrial fibrillation (see below). as she had had no fevers and there was no clear infiltrate on chest radiograph with no wheezing antibiotics were stopped and she was just kept on inhalers. she diuresed greater than two liters over her first 18 hours in the hospital and this, along with improved rate control in the setting of her probable diastolic dysfunction, significantly improved her subjective dyspnea and o2 requirement so that she was having reasonable o2 sats of 92-97 on 2 l by nc. initially there were some attempts to increase her to greater than 95 % and she received increasing o2 but this seemed to contribute to a depressed respiratory drive (attributed to her copd and appearance of chronic co2 retention) so this was stopped. as of her second hospital day given negative lenis, resolution of her chest pain, and improvement of her respiratory status to near her baseline the primary team felt comfortable not empirically treating for pe, and her respiratory status eventually returned to near baseline. #chronic hypercarbic respiratory failure: the patient has copd and pickwickian syndrome and a chronically elevated bicarbonate suggesting an ongoing respiratory acidosis. as she had no significant wheezing steroids were held though she did continue to receive her home meds. after falling asleep in a chair on her second night in the hospital she was extremely difficult to arouse the following morning with abg showing a worsening of her chronic respiratory acidosis. this was thought due to hypoventilation due to habitus and perhaps increased o2 provided during the night due to fear of acs (as the patient complained of some chest pain), which could cause decreased respiratory drive in a chronic co2 retainer such as this. this improved with bipap as did her mental status. she would benefit from a bipap trial as an outpatient; this was not done as an inpatient because she will not be following up at so cpap will be continued until then. #. ?congestive heart failure: the patient was dyspneic on presentation and has evidence of chronic diastolic chf on tte. she was empirically diuresed with some improvement in her symptoms. she was discharged to rehab on her home dose of lasix that may continue to be titrated. #. a. fib with rvr: was in svt on arrival to and ventricular rate slowed with metoprolol 5mg iv x 1 and diltiazem 10mg iv x 2. eventually, she was placed on a diltiazem drip for improved rate control which led to improvement in her chest discomfort and dyspnea. on her second hospital day she was transitioned back to her po diltiazem with good effect. metoprolol and digoxin were also continued with good rate control. #chest pain: the patient had chest pain on her first and second hospital nights. these incidents of pain were atypical, there were no ekg changes, and cardiac enzymes remained flat. the first night this improved with diuresis and rate control. on the second this resolved with positioning and was thought largely due to the patient's habitus and difficult positioning herself in bed. #. hepatic hemangioma: surgery and her primary team remained convinced this lesion was an incidental finding that had probably developed slowly. no specific management was attempted though transplant surgery did follow her and recommended outpatient followup. #. chronic kidney disease: the patient reported a history of ckd of unclear etiology. her cr was 2.4 at presentation and improved over her hospital course to 1.3 on the day of discharge. all medications were renally dosed. #. history of uterine bleeding: the patient had a history of uterine bleeding and had a questionable incident of bleeding prior to presentation. obstetrics and gynecology was consulted on the morning after admission and managed to find records indicating the patient was undergoing a significant post menopausal bleeding work-up at brown. they deferred pelvic exam as there was no further bleeding noted and her hct remained stable. medications on admission: colace 100 mg po qd mvia 1 tab qd aspirin 81 mg po qd synthroid 0.175 mg po qd glipizide 10mg po bid prozac 20 mg po qd lisinopril 5 mg po qd toprol 50 mg po bid cardizem 180 mg po qd lasix 60 mg po bid lyrica 100 mg tid omeprazole 20 mg po qd potassium chloride 40 mg digoxin 0.125 mq po qsmw (not tues/thurs) zocor 20 mg po qhs ipratroprium and albuterol nebs albuterol inhaler flovent/advair discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 5. glipizide 10 mg tablet sig: one (1) tablet po twice a day. 6. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 7. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 8. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 9. dilt-xr 120 mg capsule,degradable cnt release sig: one (1) capsule,degradable cnt release po once a day. 10. furosemide 20 mg tablet sig: three (3) tablet po bid (2 times a day). 11. pregabalin 25 mg capsule sig: four (4) capsule po tid (3 times a day). 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 13. digoxin 125 mcg tablet sig: one (1) tablet po 5x/week (,mo,we,fr,sa). 14. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 15. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 16. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: three (3) ml inhalation q4h (). 17. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 18. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 19. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 20. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 21. insulin regular human 100 unit/ml solution sig: per sliding scale injection asdir (as directed). 22. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for constipation. 23. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 24. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 25. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. discharge disposition: extended care facility: southeastern ma health & rehabilitation center discharge diagnosis: primary: hepatic hemangioma, copd, atrial fibrillation with rvr secondary: chronic diastolic chf, dm2, h/o cva discharge condition: good, stable, mental status at baseline, not somnolent, breathing comfortably at rest with 0-2l o2 discharge instructions: you were evaluated for consideration of treatment of a hepatic hemangioma as well as for respiratory distress. the surgeons do not feel any intervention for the hemangioma is warranted at this time. your respiratory status improved with control of your heart rate, nebulizers, and gentle diuresis. you would benefit from a trial of bipap, but as you are not going to follow up here at , this may be done as an outpatient. if you have worsening shortness of breath, fevers, chills, chest pain, confusion, or any other concerning symptoms, have the doctors at rehab you. followup instructions: follow up with your primary care physician 1-2 weeks after being discharged from rehab. you should undergo a trial of bipap that your primary care phsyician can set up for you. call dr. office at to make an appointment. you may follow up with dr. of surgery regarding your hepatic hemangioma. call his office at ( to make an appointment. if you would rather follow up with a surgeon closer to home, have your primary care physician refer you. procedure: venous catheterization, not elsewhere classified diagnoses: hemangioma of intra-abdominal structures congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation chronic kidney disease, unspecified acute and chronic respiratory failure chronic diastolic heart failure 

Answer: The patient is high likely exposed to