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: history of present illness: fifty-three year old male with a history of metastatic nonsmall lung cancer with metastasis to the left femur and adrenals, who presents with progressive shortness of breath over the past week. the patient had a chest x-ray done at his oncologist's office, which showed a small apical pneumothorax, new pulmonary nodules, and an enlarged cardiac silhouette. transthoracic echocardiogram was performed which showed a moderate-to-large circumferential pericardial effusion with impaired ventricular filling. the patient was sent to the emergency department for triage to the catheterization laboratory for pericardiocentesis. past medical history: 1. nonsmall cell lung cancer with metastasis to the left femur and to the adrenals bilaterally. it was initially diagnosed in as an undifferentiated mediastinal carcinoma of unknown primary. the patient has since had multiple courses of chemotherapy including the following: cisplatin and etoposide x1 regimen; carboplatin and taxol x1 regimen; low dose carboplatin and taxol with concurrent radiation therapy. the patient had a recent diagnosis of a left femur bone metastasis and had radiation therapy to this region. the patient then had two cycles of gemcitabine in , a course of iressa was started and the patient continues on this regimen. 2. history of near syncope and dehydration requiring iv fluids and ............. 3. diverticulosis. 4. anxiety. 5. orthostasis. 6. internal hemorrhoids. medications on admission: 1. fentanyl patch 200 mcg transdermal q72h. 2. celexa 40 mg po q day. 3. lorazepam 1-2 mg po tid prn. 4. motrin 600 mg po tid prn. 5. protonix 40 mg po q day. 6. iressa as prescribed by his oncologist, dr. . 7. adderall xr 10 mg po q am. 8. albuterol 1-2 puffs q4-6h prn shortness of breath. 9. oxycodone prn pain, dose unknown. 10. peri-colace and dulcolax as prescribed. allergies: no known drug allergies. social history: the patient is on disability, lives with his wife and daughter in , . he quit smoking tobacco in . prior smoking history includes 40 years of two packs per day leading to greater than 80 pack year smoking history. he denies alcohol use. family history: significant for father with cancer and his mother died of pneumonia. physical examination: in general, this is an ill appearing cachectic male appearing older than stated age in mild respiratory distress. vital signs: temperature 98.8, heart rate 100, blood pressure 111/65, respiratory rate 27, pulse oximetry 97% on 5 liters. heent is normocephalic, atraumatic. pupils are equal, round, and reactive to light and accommodation. extraocular muscles are intact. anicteric sclerae. moist mucosal membranes. neck: jugular venous pressure 6-7 cm, no lymphadenopathy, supple. lungs: dull breath sounds at the right base, clear to auscultation on the left side with good breath sounds. heart: regular, rate, and rhythm, normal s1, s2. abdomen is soft, nontender, and nondistended, normoactive bowel sounds in all four quadrants. extremities: no edema, 2+ distal pulses bilaterally, dorsalis pedis. laboratory data on admission: white blood cell count 11.2, 84% neutrophils, 9% lymphocytes, 5% monocytes, and 0 bands. electrolytes: sodium 134, potassium 4.8, chloride 93, bicarbonate 28, bun 14, creatinine 0.7, glucose 97. pericardial fluid: white blood cell count , red blood cell count . differential of the white blood cell count 15 polys, 2 lymphocytes, 1 monocyte, 8 macrophages, and 2 other cells. total protein 5.6, glucose 113, ldh 279, albumin 3.0. pt 12.8, inr 1.1, ptt 28.8. chest x-ray: small left apical pneumothorax, new pulmonary nodules most likely due to metastatic disease, enlargement of the cardiac silhouette without interval change in pulmonary vascularity. electrocardiogram: sinus tachycardia at 103 beats per minute, normal axis, normal intervals, no pulsus alternans. hospital course: patient was brought to the catheterization laboratory on , where the following was noted: a low pressure tamponade was present with equalization of the pericardial and right atrial pressures. cardiac index was estimated at 2.2 liters per minute per meters squared. pericardiocentesis was performed and 540 cc of clear fluid was removed and sent for evaluation. pericardial drain was left in place for close drainage. the patient was then admitted to the micu, where his pericardial effusion drained over the next three days. this was confirmed by serial echocardiography which did eventually show resolution of the effusion on . the patient remained hemodynamically stable throughout his micu stay. he was maintained on 5 liters nasal cannula, but did at times require increased o2 requirement, and was kept in good respiratory status with consistent albuterol nebulizer treatments every four hours. on , the patient was transferred to the general medicine floor. at that time he had moderate respiratory distress and was again maintained in good respiratory status with increased o2 administration and albuterol nebulizer treatments standing for the first 24 hours and then prn after that. during the initial 24 hours on the floor, the patient did require administration of oxygen via 100% nonrebreather mask to make him more comfortable. during the remainder of his stay, he did not require the nonrebreather mask to maintain his o2 saturations, however, it was decided that access to greater than 5 liters of continuous o2 administration would be necessary if he were to be discharged home. therefore, arrangements were made for a liquid o2 tank with a nonrebreather mask for administration of liters prn be available at his home. 2. patient's last echocardiography on showed resolution of the pericardial effusion. there was no evidence to suggest reaccumulation of the effusion. the patient did have mild tachycardia intermittently throughout his hospital stay thought to be related to his poor respiratory status. 3. hematology/oncology: the patient was aware of his terminal illness. comfort measures including pain control and nausea control were continued throughout his hospital stay in addition to administration of a nonrebreather mask of 100% o2 for improved controlled of respiratory distress. the patient was continued on iressa as prescribed by his oncologist. the option for hospice services at home was discussed with the patient, who said that he had considered this option in the past, and would consider it again in the near future after discussing the option with his family. the patient was fully aware of the stage of his disease and the sites of metastasis of his lung cancer. 4. fluids, electrolytes, and nutrition: the patient had a very poor nutritional status, however, he did tolerate high protein shakes prepared by his family. 5. pain: his pain was controlled with fentanyl patches and iv morphine prn for control of breakthrough pain. during the final 24 hours of his hospital stay, he required no additional morphine for control of his shoulder and leg pain. 6. gastrointestinal: patient was continued on a bowel regimen of laxatives and stool softeners to relieve the constipation caused by his large narcotic doses. 7. prophylaxis: the patient was put on pneumoboots to prevent dvt throughout his stay. 8. disposition: the patient was discharged to home on with vna services and with a new regimen for oxygen administration including 3-6 liters of continuous oxygen along with a liquid oxygen tank with a nonrebreather mask at 10-15 liters of oxygen as needed for comfort. condition on discharge: fair. discharge diagnoses: 1. pericardial effusion status post pericardiocentesis. 2. stage iv nonsmall cell lung cancer with metastasis. discharge medications: 1. citalopram 20 mg po three tablets q day. 2. ibuprofen 600 mg one tablet po q8h prn pain. 3. pantoprazole 40 mg po q day. 4. albuterol 1-2 puffs inhaled q6h prn shortness of breath. 5. prochlorperazine 10 mg po q6h prn nausea. 6. lorazepam 1 mg two tablets . 7. bisacodyl 5 mg two tablets po q day prn constipation. 8. docusate sodium 100 mg po bid. 9. fentanyl 100 mcg/hour patch transdermal q72h patches transdermal q72h as needed for pain. 10. oxycodone 10 mg one tablet q12h as needed for pain. 11. iressa as prescribed by dr. . treatments: 1. continuous o2 at 3-6 liter. 2. liquid o2 with nonrebreather mask at 10-15 liters as needed for comfort. followup: patient was advised to contact his oncologist, dr. regarding his hospital stay as well as his primary care physician to schedule appointment for this week for followup regarding his pain control, breathing status, and other concerns. the patient was advised to keep his appointment for a ct scan at the center radiology department on . , m.d. dictated by: medquist36 d: 20:34 t: 10:52 job#: procedure: pericardiocentesis right heart cardiac catheterization diagnoses: chronic airway obstruction, not elsewhere classified personal history of tobacco use anxiety state, unspecified malignant neoplasm of bronchus and lung, unspecified secondary malignant neoplasm of bone and bone marrow diverticulosis of colon (without mention of hemorrhage) acute pericarditis, unspecified secondary malignant neoplasm of adrenal gland 

Answer: The patient is high likely exposed to