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: patient recorded as having no known allergies to drugs attending: chief complaint: hypotension major surgical or invasive procedure: right ij cvl placement intubation bronchoscopy lung biopsy via repeat bronchoscopy history of present illness: mr. is a 68 year-old male with cad s/p cabg , copd on home o2, prior lung cancer (s/p rul lobectomy), vt s/p icd, hyperlipidemia, type ii diabetes mellitus, and atrial fibrillation who was transferred from outside hospital for management of hypotension. patient presented to on the afternoon of his admission on with sytolic blood pressures in the 70's. he was intubated, given ivf, started on levophed and dopamine, given broad spectrum antibiotics, decadron and nebulizers. he was then sent to ed for further evaluation. . per the patient's wife he was recently admitted to for a copd exacerbation requiring icu admission but he had not needed intubation. he was discharged on a lengthy prednisone taper. following discharge he remained short of breath, wheezy, and continued to have a productive cough at home. he also developed neck pain and shoulder pain over day prior to this presentation. on he became febrile to 101.1f. he saw his pulmonologist in clinic and was prescribed another course of antibiotics. then, on the way home from this appointment he was complaining of feeling worse weakness. when patient and wife arrived at home he was too weak to even stand up and fell to the ground exiting the car. his wife activated 911. . when patient arrived to ed, his pressors had been tapered to solely levophed and systolics were in the 80's. he was started back on neosynephrine, bolused a total of 5 liters, and started on heparin gtt given concern for pulmonary embolism. he was also given a dose of cefepime and tamiflu along with solumedrol 125mg iv x 1. he had atrial fibrillation with rvr to the 170's and bp again dropped to 70's. at this point levophed was weaned down. notably ecg showed st depressions in v1-v4 which appeared similar to prior tracings. he was seen by the cardiology fellow who suggested amiodarone if atrial tachycardia recurs. patient transferred to micu for further management. . please see hospital course details below for icu course summary. past medical history: -type ii diabetes -coronary artery disease: cabg done in , lima to lad, svg to ramus, svg to rca. additional pci : des placed lmca --> lcx, required. required aibp at the time. ventricular tachycardia: icd placed in for primary prevention ( dr, a 6949 right ventricular lead. has ppm in place) -lung cancer, s/p rul lobectomy chemo/rads -copd, on home oxygen -gout -hypertension -hyperlipidemia -atrial fibrillation social history: patient is a retired engineer, lives with wife in ma. prior to this admission the patient was needing more supervision as he easily gets confused and was often disoriented. he smoked 1ppd for nearly 45 years and quit in . rare etoh use and no prior illicit drug use. family history: father had cabg in 60s, died at 81, mother with fatal mi at 71. physical exam: admission physical exam: general: intubated, sedated heent: nc/at, perrl, op clear neck: supple, no lad lungs: anterior lung fields clear to auscultation bilaterally, no wheezes or crackles heart: tachycardic, s1/s2 present, no murmurs abd: +bs, soft, non-tender, non-distended ext: no lower extremity edema, warm, well perfused skin: right wrist erythema with raised circular lesion . no discharge exam: patient was pronounced dead on at 4:20pm. pertinent results: admissions labs: . 08:44pm urine rbc-* wbc-0-2 bacteria-occ yeast-none epi-0-2 08:44pm urine blood-mod nitrite-neg protein-25 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:44pm urine color-straw appear-clear sp -1.011 08:44pm plt smr-low plt count-140* 08:44pm pt-13.2 ptt-27.9 inr(pt)-1.1 08:44pm hypochrom-1+ anisocyt-normal poikilocy-occasional macrocyt-normal microcyt-normal polychrom-normal ovalocyt-occasional 08:44pm neuts-92* bands-5 lymphs-0 monos-3 eos-0 basos-0 atyps-0 metas-0 myelos-0 08:44pm wbc-21.0* rbc-3.67* hgb-11.0* hct-32.9* mcv-90 mch-29.9 mchc-33.4 rdw-15.7* 08:44pm calcium-7.4* 08:44pm ctropnt-0.06* 08:44pm ck-mb-5 probnp-4087* 08:44pm alt(sgpt)-19 ast(sgot)-26 ck(cpk)-179 alk phos-50 tot bili-0.9 08:51pm glucose-167* lactate-1.0 na+-130* k+-4.4 cl--95* tco2-25 08:51pm comments-green top 10:39pm type-art rates-16/4 tidal vol-450 o2-100 po2-366* pco2-56* ph-7.24* total co2-25 base xs--4 aado2-306 req o2-56 intubated-intubated vent-controlled 11:30pm type-art po2-108* pco2-52* ph-7.25* total co2-24 base xs--4 . . . microbiology studies: 6:35 pm catheter tip-iv source: femoral line. wound culture (final ): no significant growth . blood culture, routine (final ): staph aureus coag +. final sensitivities. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . consultations with id are recommended for all blood cultures positive for staphylococcus aureus and species. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s . 10:04 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. sparse growth. of two colonial morphologies. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s 4:51 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited. . 2:40 pm bronchoalveolar lavage / **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~/ml commensal respiratory flora. . urine culture (final ): no growth. urine culture (final ): no growth. urine culture (final ): no growth. . blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. ============================================== imaging: tte : the left atrium is elongated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe regional left ventricular systolic dysfunction with thinned inferolateral and inferior wall akinesis/dyskinesis and anterolateral hypokinesis. overall left ventricular systolic function is severely depressed (lvef= 25 %). the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. with mild global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. an eccentric, posteriorly directed jet of moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild to moderate pulmonary artery systolic hypertension. the pulmonic valve leaflets are thickened. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a promient fat pad. compared with the prior study (images reviewed) of , the severity of mitral and aortic regurgitation has increased. regional left ventricular systolic function may be slightly worse. no vegetations identified. if clinically indicated, a transesophageal echocardiographic examination is recommended to evaluate for endocarditis. ------ tee : no valvular or lead vegetations seen. mild to moderate aortic regurgitation. moderate mitral regurgitation. complex (>4 mm, non-mobile) atheroma in the descending aorta and aortic arch. depressed biventricular systolic function. . cxr: markedly abnormal radiograph with no comparison available. endotracheal tube is slightly high. consider advancement by 2.5 cm for optimal placement. there is a right upper chest thoracoplasty which results in significant distortion of the normal anatomy. patchy foci of opacity, particularly in the lateral left lung may represent foci of pneumonia or aspiration. . cxr: bibasilar atelectasis and bronchiectasis persist, left greater than right. small layering left pleural effusion is unchanged. there is no pulmonary edema. right upper thoracoplasty changes are noted. monitoring and support devices are stable in course and position. there is no pneumothorax. multiple calcified gallstones are seen in the right upper quadrant. . cxr : changes of right upper lobectomy and thoracoplasty are present. there is persistent bibasilar atelectasis, left greater than right. a small left pleural effusion is unchanged. mild cardiomegaly is stable. mediastinal clips and median sternotomy wires are well aligned. a right picc terminates at the cavoatrial junction. a left chest wall pacemaker has leads in the right atrium and ventricle. a dobbhoff tube courses into the abdomen and beyond the film. there is no pneumothorax. calcified gallstones are again noted in the right upper quadrant. . cxr: changes of right upper lobectomy and thoracoplasty are again seen. there is persistent bibasilar atelectasis, left greater than right. no focal consolidation is appreciated. probable small bilateral layering effusions are present. the cardiomediastinal and hilar contours are normal. monitoring support devices are unchanged in course and position. a right picc is indistinctly seen at the level of the clavicle. there is no pneumothorax. calcified gallstones are noted in the right upper quadrant. . cxr: in comparison with the study of , there is little change. monitoring and support devices remain in place. continued increased sharpness of the left hemidiaphragm, consistent with improved aeration at the left base.nevertheless, there are continued low lung volumes and bibasilar atelectatic changes. . cxr: as compared to the previous radiograph, there is no relevant change. the minimal further improvement of ventilation in the region of the pre-existing retrocardiac and left basal opacity. otherwise, unchanged appearance of the lung parenchyma, the cardiac silhouette and the chest wall. . cxr: pulmonary edema previously, it is gone now. multiple foci of atelectasis in the left lung are stable. heart is borderline enlarged. new feeding tube with the wire stylet in place ends in the stomach. gallstones noted in the right upper quadrant. transvenous right atrial pacer and right ventricular pacer leads follow their expected courses. no pneumothorax. small left pleural effusion or pleural thickening is longstanding. . lung pathology from fna / biopsy with bronchoscopy lul : lung (left upper lobe), fine needle aspirate: positive for malignant cells, consistent with squamous cell carcinoma. . admission ct imaging: chest/abd/pelvis report ct of the chest without contrast: there is a small left-sided pleural effusion. the patient is status post right upper and right middle lobectomies. there is a small right-sided pleural effusion and small areas of loculated fluid near the apex. there is bibasilar atelectasis. right chest wall deformity is present from prior thoracotomy. there are prominent coronary artery calcifications. a small linear area of fat density is noted along the left ventricle, consistent with fatty deposition. the patient has a pacemaker with leads in right atrium and ventricle. there is a left subclavian stent. the endotracheal tube ends approximately 4.0 cm above the carina. patient is status post sternotomy and cabg. ct of the abdomen without contrast: the non-contrast appearance of the spleen, adrenal glands, stomach, and intra-abdominal loops of bowel are within normal limits. the liver demonstrates a small area of pneumobilia in the left lobe of the liver. there are multiple, calcified gallstones within the gallbladder. the common bile duct and pancreas are within normal limits. the kidneys are slightly small bilaterally. there are prominent renal vascular calcifications. there is no retroperitoneal or mesenteric lymphadenopathy. there is no free air or free fluid. there is a small fat-containing umbilical hernia. an ng tube ends within the stomach. . ct of the pelvis without contrast: the rectum, prostate, and intrapelvic loops of bowel are within normal limits. a foley catheter is noted within a decompressed bladder. there is no free air or free fluid. there is no pelvic or inguinal lymphadenopathy. the patient is status post placement of right femoral venous line, which ends in the right iliac vein just prior to the bifurcation. areas of stranding and small foci of air within the right groin are likely due to recent line placement. there is dense calcification of the abdominal and pelvic arterial vasculature. bone windows: no concerning osseous lesions are identified. mild degenerative changes are noted most prominently in the lumbar spine. impression: 1. no acute intrathoracic or intraabdominal process. 2. status post right upper and right middle lobectomies with corresponding chest wall deformity. small areas of loculated fluid noted at the right lung apex. small left-sided pleural effusion. 3. cholelithiasis. . ========================================== ekgs: - rate 105, sinus tachycardia with ventricular premature beat versus aberrant conduction. -rate 80, atrial paced rhythm. right bundle-branch block. infero-posterolateral myocardial infarction of indeterminate age but may be old. diffuse st-t wave abnormalities are non-specific but clinical correlation is suggested. - rate 108, sinus tachycardia with rbbb, evidence of prior mi in lateral and inferoposterior distribution, similar to ekgs from 2/. . ========================================== last set of labs : 05:20am blood wbc-9.3 rbc-3.16* hgb-9.8* hct-30.7* mcv-97 mch-30.9 mchc-31.8 rdw-17.8* plt ct-319 05:20am blood glucose-253* urean-41* creat-1.7* na-146* k-4.4 cl-101 hco3-36* angap-13 05:20am blood calcium-9.1 phos-4.2 mg-2.5 . thyroid studies: 04:00am blood tsh-4.7* . drug monitoring: 04:11am blood vanco-20.9* 04:11am blood digoxin-0.2* brief hospital course: hypotension: patient was transferred from osh after presentation for weakness and pre-syncopal episode in his driveway witnessed by his wife. had notable systolic blood pressured in the 70s in ed at osh prior to transfer and he needed to be placed on both levophed and neosynephrine initially. hypotension likely due to his later established mrsa bacteremia and sepsis. ct done and no overt pulmonary emboli revealed to explain his marked hypotension. he was also ruled out for acute coronary syndrome given his prominent cardiac history and multiple risk factors. he also had rapid atrial fibrillation on day of admission which also contributed to poor cardiac output in setting of his already poor cardiac function with baseline ef of 35%. during his icu course he was weaned down to levophed alone and then slowly taken off pressor support completely with gentle fluid boluses for occasional low blood pressures which were predominantly limited to the setting of him requiring amiodarone boluses or iv metoprolol pushes when his atrial fibrillation episodes occurred throughout his icu stay. otherwise, blood pressures improved overall after patient had been adequately treated with iv vancomycin for his mrsa bacteremia and mrsa pneumonia. mrsa bacteremia: blood cultures from admission grew out mrsa. initially felt that his right hand cellulitis from recent iv placement may have been possible source. however, a sputum culture grew out mrsa within days of admission and his cxr had an area of patchy opacity in the lateral left lung on admission with was felt to represent foci of pneumonia vs. aspiration. during his hospital course he had immediate follow-up tte and tees which were both negative for vegetations. he was given a prolonged course of iv vancomycin starting on or mrsa bacteremia and mrsa pneumonia. he was followed by the id consult service. . respiratory failure: patient intubated at osh before transfer. he was extubated to bipap and required intermittent bipap for about 24 hrs following extubation. he continued to struggle with hypoxemia and shortness of breath and required re-intubation after additional hypercarbia developed on . treated with additional zosyn antibiotics for concern for additional aspiration pna which may have triggered need for his second intubation. he was given multiple iv lasix prn doses and even a lasix drip at times to help accomplish diuresis for his ongoing pulmonary edema which was also another factor felt to be contributing to his poor respiratory status. on had a bronchoscopy that showed area of small collapse in lul with question of recurrent lung cancer so interventional pulmonology team consulted and after holding plavix dose for about a week he had lung biopsy and repeat bronchoscopy which was consistent with malignant mass and pathology revealed squamous cell lung cancer. a formal oncology consult was deferred in setting of his very tenuous status in icu as team was waiting for patient to stabilize for formal consult and possible attempts for palliative radiation/medications but patient continued to clinically decline in icu. there were brief discussions for peg/tracheostomy placement but patient was able to be extubated successfully . he slowly declined again to the point of needing high flow face mask to maintain adequate oxygenation. patient and family changed code status to dnr/dni on and palliative care consult was called. overall, patient's persistent decline and respiratory failure felt to be combination of his underlying poor reserve with copd /prior lobectomy, recent pnas, recurrent lung cancer and pulmonary edema which lingered as well. he was made cmo on and passed away later that night. . copd exacerbation: initially treated more aggressively with steroids and standing nebulizers. copd flare up was attributed to persistent pneumonia. as above, respiratory failure required two intubations and multiple use of bipap and facemask at high flow to maintain oxygen saturations >88%. he continued to decline after second extubation and family and patient opted to be dnr/dni, then changed to cmo. . icu delirium: multifactorial and felt to be related to infection, steroids, and being in icu. patient was also noted to have recurrent lung cancer and brain metastasis is also possible although patient was never stable enough to pursue any additional mri or further workup for oncologic staging/management. notably, wife reported sun downing at home and issues with confusion for several months prior to admission. he was treated initially with olanzapine and then switched to standing haldol with good effect initially but he seemed to get more agitated so qhs zydis was combined with standing and prn haldol dosing. ekgs were monitored for qt changes. psychiatry was consulted and agreed with haldol therapy. unfortunately, his delerium worsened over the last few days of his icu course and he required soft restraints and additional doses of haldol with frequent re-orientation by staff. . rapid atrial fibrillation: patient had known atrial fibrillation in the past. during his icu course he had atrial flutter and fibrillation multiple times. likely triggers were sepsis, pressor use, and hypoxia. cardiology was consulted for additional guidance during his icu stay. patient's home regimen of quinidine stopped and he was loaded with iv amiodarone given his hemodynamic instability with rapid rhythm. patient followed by electrophysiology service. he was re-bolused with amiodarone for ongoing svt and later in hospital course metoprolol iv was added on a standing basis for additional control and worked well. . swallowing: failed speech and swallow. dobhoff placed for nutritional feedings. started on tf regimen. peg considered briefly but after goals of care discussion with family after recurrent lung cancer diagnosis and worse respiratory failure and progressive altered mental status the family wished to only keep patient comfortable and did not want any more surgeries. he was given dobhoff feedings up until day he expired. . esophagitis: thrush on admission with throat pain. treated with 7 day course of iv fluconazole for presumed esophagitis. resolved with therapy. . medications on admission: asa 325mg daily flucinolide 250mcg 2 puffs crestor 40mg daily plavix 75mg daily digoxin 125 mcg daily mwf floridil 12 mcg 1 lasix 40mg gabapentin 100mg levothyroxine 75mcg daily lisinopril 2.5mg daily proventil prednisone 10mg daily quinidine 324 mg qid spiriva 18 mcg daily spirinolactone 50mg daily discharge medications: no discharge medications to list . patient deceased, died on . discharge disposition: expired discharge diagnosis: patient deceased, passed away on discharge condition: patient deceased, passed away on discharge instructions: patient deceased, passed away on followup instructions: patient deceased, passed away on procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung diagnoses: thrombocytopenia, unspecified anemia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation personal history of malignant neoplasm of bronchus and lung obstructive chronic bronchitis with (acute) exacerbation aortocoronary bypass status personal history of tobacco use atrial flutter percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified pulmonary collapse other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord malignant neoplasm of upper lobe, bronchus or lung septic shock cellulitis and abscess of upper arm and forearm old myocardial infarction cardiac pacemaker in situ calculus of gallbladder without mention of cholecystitis, without mention of obstruction hyperosmolality and/or hypernatremia acute on chronic systolic heart failure delirium due to conditions classified elsewhere personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health methicillin resistant staphylococcus aureus septicemia candidal esophagitis other dependence on machines, supplemental oxygen methicillin resistant pneumonia due to staphylococcus aureus acquired absence of organ, lung 

Answer: The patient is high likely exposed to