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: new r leg weakness major surgical or invasive procedure: radiation therapy history of present illness: 55 y/o m with pmhx of recent dx of mm c/b cord compression s/p t1-t8 laminectomy/decompression surgery on with residual bilat le weakness, s.viridans abscess s/p 4 wks of unasyn, copd, here with exacerbation of his rle weakness along with hypoxia in the ed. pt states that he noticed the insidious onset of sob over the past week. he has noticed difficulty maintaining his respirations over the past week, but denies any air hunger or inabililty to expire completely. he denies any f/chills, cough, sputum production or change in his sputum. he denies any cp, orthopnea, pnd, or other heart failure sx's. he has been immobilized due to his recent back surgery and spinal instability. today, he feels sob, but denies air hunger, fatigue, wheezing, or inability to expire completely. he denies any cp, f/chills, n/v/abd pain. admits to baseline back pain. no calf pain/tenderness. . in the ed, vs were: tc 99.1, hr111, bp107/74, rr22, 96%ra -> 92%ra and started on 4l o2. sats improved to 98% on 4l. pt received dilaudid 1mg x1, ativan 0.5mg iv x1. he was evaluated by neurosurgery in the ed who determined that there was no acute change to his neurological exam & no acute neurosurgical issue. he was admitted to medicine for further w/u and treatment of his hypoxia. past medical history: 1. recent dx of multiple myeloma, dx'ed on ct guided bx of posterior mediastinal mass s/p decadron treatment at last admission 2. spinal cord compression s/p t1-t8 laminectomy/decompression on 3. s/p strep viridans abscess; recently completed 4 wks of iv unasyn 4. hypercalcemia of malignancy s/p pamidronate at last admission 5. copd, 80 pk/yr smoker 6. hypercholesterolemia 7. s/p appendectomy 8. hernias, s/p multiple repairs with current umbilical hernia 9. sebaceous cysts 10. lipomas 11. s/p arthroscopic knee surgery social history: > 1ppd x40 years; separated from wife 4 months ago after 35 years of marriage. family history: mother with dm and died of colon ca at 64 father with emphysema physical exam: vs: tc:97.7 bp: 142/78 hr: 104 rr: 20 o2sat: 94%4l gen: male in mild resp distress with tachypnea. no accessory muscle use or intercostal retractions noted. heent: ncat, eomi. o/p clear neck: mild increase in jvp to 7cm resp: lungs relative ctab. no c/w/r noted throughout all fields. limited by effort and inability to move from supine position. cv: tachycardic, nml s1,s2. no m/r/g. abd: obese, soft, nontender, nondistended. no rebound/guarding. ext: no edema bilat. + venodynes. no c/c. dp 2+ bilat. r arm with picc line in place with erythema. no cords palpated bilat; sign (-) bilat. neuro: aaox3. cnii-xii intact. ue strength 5/5 bilat. rle with inability to dorsoflex. plantarflexion intact. knee flexors/extendors bilat, worse on r. pertinent results: c-spine ct (): no fracture or subluxation. within the upper cervical vertebral levels (c2-c4), there is no apparent indentation on the contour of the thecal sac; however, there is very limited evaluation below that level. there is mild spinal canal stenosis at those levels. . t-spine ct (): interval marked progression of compression fracture deformity involving the t4/5 vertebral bodies, with interval increase in marked focal kyphotic angulation, retropulsion of osseous fragments, and marked narrowing of the spinal canal at that level. postsurgical changes from prior laminectomy are also again seen in this area. these findings are concerning for interval cord compression, especially in the setting of patient's new symptomatology. . l-spine ct (): no new fracture or subluxation is identified. degenerative changes and compression deformities involving l1-l2 are similar in comparison to the prior mri exam of . . ct angio chest (): no pulmonary embolism. progression of thoracic vertebral compression fractures with retropulsion of fragments concerning for cord compression. bibasilar consolidations, left greater than right, raise the question of aspiration. 04:48am glucose-94 urea n-18 creat-0.4* sodium-136 potassium-4.0 chloride-101 total co2-28 anion gap-11 04:48am calcium-8.4 phosphate-3.8 magnesium-2.0 04:48am wbc-8.0 rbc-3.42* hgb-10.0* hct-29.4* mcv-86 mch-29.3 mchc-34.1 rdw-17.6* 04:48am plt count-179 03:19am type-art po2-88 pco2-41 ph-7.44 total co2-29 base xs-3 04:58pm lactate-1.1 04:50pm crp-2.4 04:50pm sed rate-30* 04:50pm pt-12.2 ptt-23.1 inr(pt)-1.1 12:00am blood wbc-7.9 rbc-4.03* hgb-11.4* hct-35.0* mcv-87 mch-28.4 mchc-32.7 rdw-18.1* plt ct-170 12:00am blood plt ct-170 12:00am blood glucose-116* urean-14 creat-0.3* na-134 k-4.6 cl-98 hco3-29 angap-12 12:00am blood calcium-8.5 phos-3.2 mg-2.0 brief hospital course: in the ed, the patient was evaluated by neurosurgery for new cord compression. a ct scan of the spine was performed (since he has been historically unable to tolerate an mri without sedation and intubation) which showed worsening of his t4/t5 compression fracture, expulsion of bony fragments into the spinal canal, and new compression of the cord at this level. per the neurosurgery consult, the patient was not a surgical candidate since he already had baseline bowel/bladder incontinence and left leg weakness from his prior cord compression, and surgery would be very unlikely to improve this baseline. upon arrival to the floor, there was concern that he had worsened hypoxia, and a ct angiogram was performed which showed no pe; it did however show bibasilar opacities consistent with aspiration (though he has never been febrile). he remained on 2l nasal cannula which is his baseline. for his cord compression, his oncologist dr. was called who recommended starting dexamethasone 40mg po daily. radiation oncology began an 8-dose treatment cycle of xrt to his thoracic spine on . he was transferred to the oncologic medicine service for the remainder of his admission. his dexamethasone was tapered first to 16mg for the remainder of his xrt treatments then to 8mg afterwards with plans to taper upon follow up with dr. . a pain consult was obtained to assist with his chronic pain control and they recommended starting a dilaudid pca on top of his chronic pain medications. although initially obtaining good control of his pain, he became increasingly oversedated and had an episode of decreased respiratory rate and obtundation which required transfer to icu for 2d, dsepite discontinuation of pca. he did well in icu and was transferred back to the oncologic service with decreased methadone (30 tid)dosing and prn dilaudid, on which he has been stable. mr. has an underlying anxiety disorder which prevented him from placing tlso brace at times as well as increased his level of pain. we started him on venlafaxine and dc'd his citalopram with hopes of addressing his baseline anxiety and he will be discharged with dose of 75mg with plans to increase to 150mg 2d after his discharge a wound care consult was obtained for his prior neurosurgical wound and his decubitus ulcers. they recommended wet-to-dry dressing to his surgical wound and local wound care with micoazole for his pressure ulcers. a neurology consult was obtained to evaluate if his aspiration could be due to his cord compression causing diaphragmatic hemiparesis or some other neurolgic defect. inspiration/expiration cxrs were obtained which showed good movement of his diaphragm. . meds on transfer: hydromorphone 0.25 mg ivpca lockout interval: 6 minutes basal rate: 0 mg(s)/hour 1-hr max limit: 2.5 mg(s) insulin sc (per insulin flowsheet) ipratropium bromide neb 1 neb ih q6h acetylcysteine 20% 600 mg po bid 4 doses lactulose 30 ml po tid acetaminophen 650 mg po q4h lidocaine 5% patch 1 ptch td qd apply to back for 12h every day. albuterol 0.083% neb soln 1 neb ih q6h:prn lorazepam 0.5 mg po q4-6h:prn anxiety allopurinol 300 mg po daily amitriptyline hcl 25 mg po hs megestrol acetate 800 mg po citalopram hydrobromide 10 mg po daily methadone hcl 40 mg po q 8h dexamethasone 40 mg po daily metoprolol 12.5 mg po bid docusate sodium 100 mg po bid miconazole powder 2% 1 appl tp gabapentin 600 mg po q8h pantoprazole 40 mg po heparin 5000 unit sc tid senna 1 tab po bid simvastatin 40 mg po hydromorphone 4 mg po q4h . studies: . c-spine ct (): no fracture or subluxation. within the upper cervical vertebral levels (c2-c4), there is no apparent indentation on the contour of the thecal sac; however, there is very limited evaluation below that level. there is mild spinal canal stenosis at those levels. . t-spine ct (): interval marked progression of compression fracture deformity involving the t4/5 vertebral bodies, with interval increase in marked focal kyphotic angulation, retropulsion of osseous fragments, and marked narrowing of the spinal canal at that level. postsurgical changes from prior laminectomy are also again seen in this area. these findings are concerning for interval cord compression, especially in the setting of patient's new symptomatology. . l-spine ct (): no new fracture or subluxation is identified. degenerative changes and compression deformities involving l1-l2 are similar in comparison to the prior mri exam of . . ct angio chest (): no pulmonary embolism. progression of thoracic vertebral compression fractures with retropulsion of fragments concerning for cord compression. bibasilar consolidations, left greater than right, raise the question of aspiration. . a/p: 55 yo man with mm and recent cord compression with residual weakness admitted with new cord compression causing paresis of right leg/foot now getting xrt. . # cord compression- neurosurg eval appreciated, unlikely to be a surgical candidate given low likely of regaining function. currently getting spine xrt, plan is for 8 total doses. today will be dose #5. exam relatively unchanged, continued pain, sl. improved, decreased po narcotic breakthrough requirement. - tlso brace when oob - rad/onc following; continue xrt, dexamethasone 4q6h - pain service following. cont methadone, dilaudid pca, po dilaudid prn, neurontin, elavil, tylenol and lidocaine patch. have decreased dilaudid dosing to 2-4mg po q3-4h from 4-10mg q3-4h. appreciate pain service recs. - anxiolysis may also aid with pain control . # multiple myeloma: holding systemic tx. until xrt finished - 4mg dexamethasone q6h - fotmonthly pamidronate (history of hypercalcemia) yesterday - renal function has been good - plan to start prednisone/melphalan vs. iv cyclophosphamide on monday s/p last xrt treatment . # copd: ct angio neg for pe and ?basilar consolidation. per reports has emphysema and 2l o2 baseline requirement - cont supplemental o2 at his baseline 2l - aspiration precautions - albuterol/ipratropium per outpatient regimen . # anxiety/dx: increasing anxiolytics as pt. with increased anxiety, especially given steroids. - started clonazepam as longer acting with ativan prn. as pt. with ams last night and on many mood altering meds, will decrease dose from 1 to 0.5 , d/c trazadone. - started effexor 37.5 for gad/dx. will increased if tolerated q4d. started . cont. citalopram. consider d/cing as effexor titrated up. . # anemia: chronic inflammation/bone marrow infiltration - cont to monitor, at baseline. . # hyperlipidemia: cont statin # fen - cardiac po diet, replete lytes as needed. # ppx - teds and sc heparin. decub ulcer prophylaxis (air mattress), ppi, bactrim while on steroids. # full code # contact: (son) ; (wife) # dispo: pending xrt, initiation of chemo medications on admission: zocor 40' senna/colace lidoderm patch albuterol/atrovent ih allopurinol 300' amitriptyline 25 qhs neurontin 300''' lactulose 30''' megace 800" lovenox 40 sc qd methadone 30mg po q8 dilaudid 4mg po q4 protonix celexa 10' unasyn 3g iv q8 completed yesterday pamidronate 90mg q4 wks discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 3. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 4. megestrol 40 mg/ml suspension sig: twenty (20) ml po bid (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) mls injection tid (3 times a day). 7. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical qd (). 9. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours). 10. toprol xl 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 11. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). 12. methadone 10 mg tablet sig: three (3) tablet po q 8h (every 8 hours). 13. mineral oil-hydrophil petrolat ointment sig: one (1) appl topical tid (3 times a day) as needed. 14. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: mls po q6h (every 6 hours) as needed. 15. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 16. oxycodone 5 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 17. nortriptyline 25 mg capsule sig: one (1) capsule po hs (at bedtime). 18. insulin regular human 100 unit/ml solution sig: as directed units injection asdir (as directed). 19. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for anxiety. 20. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 21. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day). 22. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours). 23. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 24. lactulose 10 g/15 ml syrup sig: forty five (45) ml po tid (3 times a day). 25. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h (every 4 hours) as needed. 26. venlafaxine 75 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po daily (daily) for 2 days: continue for 2 days, then increase to 150mg qday. 27. venlafaxine 150 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day: start on . 28. gabapentin 300 mg tablet sig: three (3) capsule po three times a day. 29. oxygen continuous oxygen at 2-4l titrated to keep o2 sats >93% discharge disposition: extended care facility: - discharge diagnosis: cord compression multiple myeloma discharge condition: alert and cognitively intact; hemodynamically stable; tolerating po; unable to reposition himself in bed or get up without assistance; satting >93% on 3l discharge instructions: take all medications exactly as prescribed. . attend all follow-up appointments as below . neurosurgery: watch incision for redness, drainage, bleeding, swelling any discharge, fever greater than 101.5 call dr office. no heavy lifting greater than 10lb. should wear tlso whenever out of bed. followup instructions: dr. (oncology): tuesday, 1:30 pm. 7, hospital. . dr. office will call you about when and if you need to follow up. if you have not heard from their office by next week, call , hospital. . dr. (primary care): schedule an appointment to establish primary care at . procedure: other radiotherapeutic procedure diagnoses: long-term (current) use of steroids anxiety state, unspecified other emphysema pressure ulcer, lower back multiple myeloma, without mention of having achieved remission unspecified sedatives and hypnotics causing adverse effects in therapeutic use urinary incontinence, unspecified paraplegia anemia in neoplastic disease other respiratory abnormalities neoplasm related pain (acute) (chronic) myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae kyphosis associated with other conditions other pain disorders related to psychological factors 

Answer: The patient is high likely exposed to