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: shellfish attending: chief complaint: slurred speech, mental status changes major surgical or invasive procedure: - egd - endovascular repair of thoracic aneurysm with 34 x 15 tag endograft, aortogram and right proximal external iliac to common femoral artery bypass with 8-mm dacron graft. history of present illness: ms. is a 77 year old female admitted on with an approximately 2 day history of mental status changes and slurred speech. the neurology service was consulted, and and mri showed likely old small lacunar strokes, but no acute changes. it was felt that the mental status changes were due to hypertension. ms. had run out of hydrochlorothiazide and had not taken it for likely 1 week. blood pressure in the emergency department was 226/87. chest x-ray was suspicious for a dilated thoracic aorta. chest cta revealed a 6.6 cm aortic aneurysm of the descending aorta at the level of t10, and a smaller 4.6 cm focal aneurysmal dilation just below this area. she was admitted for further evaluation and management. past medical history: cerebrovascular accident times three transient ischemic attack hypertension social history: 6 pack year history of tobacco use. 2 rum and cokes a day. lives in with her nephew. family history: mother with heart problems. other family history of stroke or blood clots. physical exam: temperature: 96.8 bp: 140/60 hr: 72 rr: 18 o2sat;98% ra general: appears her stated age, pleasant in no acute distress heent: atraumatic, anicteric, pupils 2 mm, equal and reactive. clear oropharynx, dentures neck: no jugular venous distention, no carotid bruits, no lymphadenopathy cv: s1s2, regular rate and rhythm, no murmurs lungs: distant breath sounds, otherwise clear, no wheeze, no accessory muscle use abd: soft, non-tender, non-distended, normoactive bowel sounds, no masses; no flank tenderness ext: trace edema bilaterally, warm. dp pulses palpable bilaterally. no asterixis. no tenderness over vertbrae. neuro: cranial nerves intact, no facial droop, no dysarthria; alert and oriented, no focal deficits. strength 5/5 in all extremities, equal without pain with passive or active movement on lower extremities bilaterally pertinent results: head ct no intracranial hemorrhage or mass effect is identified. left basal ganglia chronic lacunar infarct and cerebellar atrophy. cta chest 6.6 cm focal lesion in the azygoesophageal recess abutting the aorta. quite possibly a thrombosed saccular aneurysm of the descending aorta at the t10 level. cta chest 4.9 cm fusiform aneurysm of the infrarenal aorta. 3.0 x 3.5 cm mass adjacent to the thoracic aorta at the t10 level which could represent a lung or neurogenic tumor or much less likely a duplication cyst or aortic aneurysm. 8 mm nodule at the right lung apex. followup ct of the chest in three months should be performed to ensure stability. carotid ultrasound non-hemodynamically significant stenosis of less than 40% was demonstrated in the right internal carotid artery. hemodynamically significant stenosis of 40-59% was demonstrated in the left internal carotid artery. video oropharyngeal swallow no evidence of aspiration. for further details, please see the dedicated speech and language pathology report of . mri 2.8 x 3.3 x 3.9 cm right paraaortic mass with features most likely represents a thrombosed pseudoaneurysm or thrombosed saccular aneurysm. the differential diagnosis also includes duplication cyst or pericardial cyst containing proteinaceous material, although these entities are considered much less likely. tee could be performed for further evaluation to determine whether duplication cyst may be present. 2. mild ectasia of the descending aorta and multifocal areas of mural plaque consistent with atheromatous disease. 03:40pm blood wbc-5.1 rbc-4.13* hgb-12.8 hct-37.4 mcv-91 mch-31.1 mchc-34.4 rdw-13.6 plt ct-199 06:15am blood wbc-5.9 rbc-3.98* hgb-11.7* hct-35.9* mcv-90 mch-29.5 mchc-32.6 rdw-13.7 plt ct-223 07:41pm blood wbc-12.3*# rbc-3.51* hgb-10.7* hct-30.9* mcv-88 mch-30.5 mchc-34.7 rdw-13.7 plt ct-190 03:08am blood wbc-12.9* rbc-3.58* hgb-11.1* hct-30.9* mcv-86 mch-30.9 mchc-35.8* rdw-14.7 plt ct-199 04:30am blood wbc-10.2 rbc-3.20* hgb-9.9* hct-27.9* mcv-87 mch-30.9 mchc-35.4* rdw-14.6 plt ct-211 01:57am blood wbc-10.5 rbc-3.39* hgb-10.3* hct-29.8* mcv-88 mch-30.4 mchc-34.6 rdw-14.6 plt ct-260 05:32am blood wbc-12.1* rbc-3.83* hgb-11.6* hct-34.2* mcv-89 mch-30.4 mchc-34.1 rdw-14.5 plt ct-330 03:40pm blood neuts-54.7 bands-0 lymphs-36.4 monos-6.7 eos-1.5 baso-0.7 03:40pm blood pt-11.6 ptt-23.0 inr(pt)-1.0 01:57am blood pt-13.3* ptt-22.0 inr(pt)-1.2* 03:40pm blood glucose-94 urean-11 creat-0.9 na-142 k-4.2 cl-104 hco3-28 angap-14 06:15am blood glucose-87 urean-13 creat-1.0 na-142 k-4.0 cl-106 hco3-28 angap-12 03:08am blood glucose-177* urean-15 creat-0.8 na-141 k-3.8 cl-100 hco3-31 angap-14 01:57am blood glucose-94 urean-14 creat-0.8 na-138 k-3.9 cl-99 hco3-29 angap-14 05:32am blood glucose-122* urean-20 creat-1.2* na-142 k-3.7 cl-97 hco3-31 angap-18 02:51am blood lipase-16 03:08am blood lipase-24 07:00am blood mg-1.9 cholest-199 05:32am blood calcium-9.0 phos-4.6* mg-2.4 02:51am blood albumin-2.9* calcium-8.4 phos-4.3 mg-1.8 microbiology: urine cx: negative tee: there is severe symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%) there are simple atheroma in the aortic root and ascending aorta. the aortic arch is mildly dilated. there are complex (>4mm) atheroma in the aortic arch. the descending thoracic aorta is moderately dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. at the distal visible extent of the thoracic aorta, a large aneurysmal pouch is identified. there is some flow seen, but a predominant large clot collection. in the sac. the full dimenisons cannot be identified by tee, but the sac is greater than 4 cm across. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are moderately thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is a small pericardial effusion. the pulmonic valve is normal without regurgitation. in the proximal pulmonary artery, an echogenic structure is seen as a luminal irregularity which could represent clot, intimal hyperplasia, or artifact from fluid in the transverse coronary sinus. suggest clinical correlation. post endostenting, the stent is poorly seen. flow can be seen in branch vessels, possibly intercostals, but no definite flow is seen in the aneurysm. lvef remains normal. aortic contours otherwise unchanged. remaining exam unchanged. results discussed with surgical team at time of the exam. endoscopy results: erosive gastritis duodenitis in the bulb extrinsic compression in the esophagus brief hospital course: ms. was admitted for further evaluation and management for mental status changes and hypertension and was found to have a large thoracic/descending aortic aneurysm. on admission, oral blood pressure medications were adjusted for optimal blood pressure control. she was evaluated by the cardiac surgical service. the vascular surgery service was also consulted. she underwent multiple chest ct scans as well as an mri to characterize her thoracic/descending aortic aneurysm (please see results section for reports). these were compared with mms reconstruction images of mri images from an outside institution. carotid ultrasound was done on and showed non-hemodynamically significant stenosis of less than 40% was demonstrated in the right internal carotid artery with hemodynamically significant stenosis of 40-59% demonstrated in the left internal carotid artery. as part of her pre-operative work-up, the gi service was consulted for long-standing dysphagia. oropharyngeal swallowing evaluation showed no evidence of aspiration. her esophagram was normal. egd showed erosive gastritis, duodenitis in the bulb with extrinsic compression in the esophagus. it was recommended that she undergo an outpatient esophageal motility study. after pre-operative workup was completed, the patient was taken to the operating room for endovascular repair of her thoracic aortic aneurysm on (please see the detailed operative note of dr. and dr. ). she was extubated on post-operative day 1 in the cardiac intensive care unit. she required a nitroglycerin drip for 2 days for blood pressure control and this was eventually weaned off. she received 1 unit of blood on post-op day 2 and her lumbar drain was removed. she was able to tolerate a regular diet and was able to get out of bed to chair. on postoperative day three, ms. was transferred to the cardiac floor for further recovery. of note, she had an episode of left lower extremity weakness with concurrent hypotension on the evening of post-op day 2. she had a drop in her hematocrit from 29 to 23 and required 2 units of blood. repeat imaging revealed a stable (not actively bleeding) left lower quadrant retroperitoneal hematoma. she was transferred back to the intensive care unit for closer monitoring. mri imaging revealed some lumbar cord edema but no epidural hematoma. neurology was consulted and recommended conservative management. her left lower extremity weakness spontaneously resolved. she had some nausea and a kub revealed a mild ileus and she was placed npo for a day. her diet then resumed without complication. she required a nitroglycerin drip for blood pressure control which was weaned off and she was transferred back to the floor on post-operative day 7. she then worked with physical therapy daily to increase her strength and mobility. oral antihypertensives were optimized for blood pressure control. ms. continued to make steady progress and was discharged on . she will follow-up with dr. , dr. , her cardiologist and her primary care physician as an outpatient. medications on admission: pravachol 40 mg qd asa 81 mg qd wellbutrin sr 300 qd plavix 75 mg qd norvasc 5 mg qd hydrochlorothiazide 25 mg qd mvi 1 tablet qd discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*1* 3. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. multivitamin capsule sig: one (1) cap po daily (daily). disp:*30 * refills:*0* 5. bupropion 150 mg tablet sustained release sig: one (1) tablet sustained release po qam (once a day (in the morning)). disp:*60 tablet sustained release(s)* refills:*0* 6. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 9. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*0* 10. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 11. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: caregroup discharge diagnosis: thoracic/abdominal aortic aneurysm/thrombosed pseudoaneurysm or saccular aneurysm transient encephalopathy nos poorly controlled hypertension discharge condition: good discharge instructions: please continue to take all of your medications as instructed. we have started you on a new medication to help control your blood pressure. please make an appointment with your primary care physician within one week of discharge to follow-up on further testing and establishing a neurologist. also make appointment with vascular surgery for follow-up tests. p instructions: pcp 2 weeks cardiologist 2 weeks dr. 3 weeks dr. for follow up of abdominal aneurysm. procedure: diagnostic ultrasound of heart aorta-iliac-femoral bypass aortography esophagogastroduodenoscopy [egd] with closed biopsy transfusion of packed cells insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt infusion of vasopressor agent endovascular implantation of graft in thoracic aorta diagnoses: tobacco use disorder unspecified essential hypertension hematoma complicating a procedure occlusion and stenosis of carotid artery without mention of cerebral infarction intestinal infection due to clostridium difficile paralytic ileus metabolic encephalopathy duodenitis, without mention of hemorrhage abdominal aneurysm without mention of rupture other malaise and fatigue stricture and stenosis of esophagus other atherosclerosis of native arteries of the extremities displacement of lumbar intervertebral disc without myelopathy thoracoabdominal aneurysm, without mention of rupture late effects of cerebrovascular disease, monoplegia of lower limb affecting unspecified side 

Answer: The patient is high likely exposed to