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: chest pain major surgical or invasive procedure: tee history of present illness: 75 yo m w/ copd, cri transitioning to hd, mult cva, ongoing etoh abuse, esophageal varices presents with 1 day history of cp. the patient is a poor historian and most of the history was obtained from his wife. the pain is described as a substernal pressure which radiates to the back. the pain was not related to activity and did not improve with rest. it persisted from early this am until he arrived in the ed and received nitro. he also had n/v, chills but no diaphoresis. at this point in time the patient is pain free. his wife claimed the pain was worsened with deep inspiration and he was coughing productive of dark sputum. . also the patient recently had an av fistula placed in his l arm for hd on . he had cellulitis which was tx with oxacillin and then augmentin since. wife tells that patient is non compliant with meds despite her urging. . patient denies lh, dizziness, changes in vision/hearing, dysphagia, decreased appetite, sob, abd pain, dysuria, blood in sputum/urine/stool. he continues to drink 10 drinks a day. his last drink was 1am night prior to admission. also has a chronic cough. past medical history: afib cva - weakness on r side htn espohageal varices pm brady copd cri -> recent placement of av fistula for hd gout social history: former policeman, lives with wife etoh - drinks 10 drinks per day, last drink 1am night prior to admission tob - 1ppd x many years family history: nc physical exam: t 100.4 p 70 bp 170/80 r 24 o2 95 on 3l gen - confused but baseline mental status as described by wife. nad - eomi, perrl, op clear, extremely poor dentition neck - supple, no carotid bruit cor - rrr sys murmur chest - decreased breath sounds on bases r worse than l abd - distended tympanetic, non painful, liver edge palp, +bs ext - w/wp, +1 edema to knees left arm with incision no erythema, but pain, thrill over fistula pertinent results: 05:00am wbc-11.7*# rbc-3.55* hgb-12.6* hct-36.1* mcv-102* mch-35.6* mchc-35.0 rdw-16.7* 05:00am neuts-85.9* lymphs-10.0* monos-3.5 eos-0.5 basos-0.1 05:00am plt count-182 05:00am pt-13.6 ptt-30.9 inr(pt)-1.2 05:00am d-dimer-6953* 05:00am ck(cpk)-54 05:00am ctropnt-0.05* 05:00am ck-mb-3 05:00am glucose-107* urea n-36* creat-4.7* sodium-140 potassium-3.3 chloride-104 total co2-16* anion gap-23* 06:28am lactate-3.7* 08:42am lactate-1.8 11:45am calcium-8.3* phosphate-4.9*# magnesium-0.9* 11:45am ck-mb-notdone 11:45am ctropnt-0.04* 11:45am ck(cpk)-37* . cxr - rll infiltrate . tee- no dissection . cta: 1. no evidence of pulmonary embolism or aortic dissection. 2. small bilateral pleural effusions with associated compressive atelectasis. 3. moderate- sized pericardial effusion. 4. bilateral lower lobe opacities, which may represent infection vs. aspiration pneumonia. 5. multiple enlarged mediastinal lymph nodes. these may be reactive in nature. . ct abdomen 1. very limited study. there is no evidence of dissection, though it is not excluded given that no iv contrast was administered. 2. consolidation vs. atelectasis in the right lower lobe posteriorly. small pleural effusions bilaterally. 3. irregular contour of the left kidney. this was noted on a prior report, though the images are not available for direct comparison. etiology is not clear. 4. diffuse atherosclerotic disease. 5. small lymph nodes in the axilla and retroperitoneum that do not meet ct criteria for pathologic enlargement. 6. l4 compression deformity. the acuity of this finding is not clear, as the prior study images are not available for direct comparison. 7. sclerotic lesions within the pelvis as described. correlation with psa requested. . tee- no evidence of aortic dissection. . video swallow- significantly delayed oral transit and pharyngeal swallow initiation. piecemeal bolus handling. aspiration observed with swallowing materials and thin liquid. acute cough was effective in clearing the aspirated material. for a more detailed report, please refer to the speech pathology report. . tte- 1. the left atrium is moderately dilated. the left atrium is elongated. 2.the right atrium is markedly dilated. 3.there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed. resting regional wall motion abnormalities include apical distal inferior, basal and mid inferolateral hypokinesis. 4. right ventricular chamber size is normal. right ventricular systolic function is normal. 5.the aortic valve leaflets are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. 6. trivial mitral regurgitation is seen. 7.there is mild pulmonary artery systolic hypertension. 8.there is a small pericardial effusion. there are no echocardiographic signs of tamponade. 9. there is an echogenic density in the right atrium consistent with a pacemaker lead. brief hospital course: 75 yo m w/ copd, cri transitioning to hd, mult cva, ongoing etoh abuse, new dx of adenoca now txfx'd from the icu following chf exacerbation. originally admitted w/ pna after being ruled out for mi, neg cta, hct drop during admission led to colonoscopy w/ polypectomy- one of which was positive for adenoca ( b). neg liver u/s. course c/b by mult episodes of gib, stable over the last week. during that time pt rec'd lg volume resusciation after which he became increasingly sob after diuresis held. transferred to icu, underwent uf and hd w/ subsequent dramatic improvement in resp status. . 1) pna- patient initially admitted with diagnosis of pneumonia. found to be requiring 3-4l o2 via nc to maintain oxygenation. given that patient originally presented with pleuritic chest pain he underwent cta to rule out pe, which was negative. tee was ordered from ed to r/o ao dissection. completed 7 day course of ceftriaxone and azithromycin, w/ subjective improvement and decreased o2 requirement. given intial findings on ct felt that aspiration was possibly playing a role in the patient's lung disease. during transfer to icu resp failure/chf (see below) the patient was started on steroids for presumed copd contribution (although no pfts ever performed by pcp, previous o2 sat ever recorded in office, ct w/o bullae or hyperinflation). he will complete the steroid taper tomorrow. . 2) chf- following volume resusciation for gib (as discussed below) the patient was noted to have continued 2l oxygen requirement. pt had no h/o chf but tte showed mild systolic dysfxn. during week 3 of hospitalization the patient developed increasing sob. the attending physician had asked that diuresis be stopped as it was felt that the patient had a primary pulmonary process. in the interim, as further w/u, bnp and repeat cxr were obtained. bnp returned elevated at 21k, w/ increasing vol congestion on cxr. the patient was developing increasing sob and was transferred to the icu for emergent hd. a quintan catheter was placed and the patient underwent uf and hd w/ subsequent resolution of his sob. on transfer back to the floor the patient was oxygenting well on ra. plan to complete a steroid taper, as above. . 3) adenocarcinoma of colon- during admission, pt developed ongoing hct drop w/ guiac positive stools. colonoscopy revealed multiple polyps, 8 of which were removed. the pathology on a polyp removed from the transverse colon revealed adenocarcinoma within several millimeters of the margin. following polypectomy the patient had several episodes of brbpr, one of which necessitated transfer to the icu. the patient underwent multiple repeat colonoscopies which were unrevealing. hct remained stable and the patient should receive follow up colonoscopy in 3 months. heme/onc was consulted. the patient underwent staging u/s of the liver, which did not reveal any lesions. cea was elevaed but of unclear significance in the setting of renal failure. colonic resection was discussed with the surgical consultants on multiple occasions but it was felt that patient was not a surgical candidate. this was discussed with the patient and his family and they concurred with the management plan. . 4) crf- on admission pt was being transitioned to hd and had already had an avf placed. however, the fistula was not yet mature and when he developed resp failure it was necessary to place a quintan catheter. he subsequently had a tunnelled hd catheter placed, which was functioning well on discharge. he will require tiw dialysis, which was arranged prior to d/c. . 5) pt was discharged home once all of his medical issues were atble and he was cleared by pt. he will follow-up with dr. in weeks and has a f/u appointment with heme/onc next week. he will continue outpt dialysis tiw. pt will need vna services for med teaching and fs checks, as his bg has been running high while on the prednisone taper. he should be assessed for dm as an outpt and started on oral hypoglycemics, if necessary. medications on admission: allopurinol 150mg qday thiamine mvi folic acid norvasc 10mg qday lasix 80mg po bid protonix 40mg qday aldomet 500mg qam/250mg qafternoon/250mg qevening calcitriol 0.5mcg qday discharge medications: 1. multivitamin capsule sig: one (1) cap po daily (daily). disp:*30 caps* refills:*2* 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). disp:*15 tablet(s)* refills:*2* 5. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 inhaler* refills:*2* 6. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). disp:*15 tablet(s)* refills:*2* 7. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po daily (daily). disp:*90 tablet sustained release 24hr(s)* refills:*2* 8. hydralazine hcl 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. pantoprazole sodium 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:*2* 12. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 13. olanzapine 5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: 1) gib 2) pna 3) colonic adenocarcinoma 4) copd discharge condition: good, vss. discharge instructions: 1) please take your medicatations as directed 2) please attend your follow up appointments 3) return to medical care if you develop increased wheezing, sob, fever, bleeding per rectum, or abdominal pain. followup instructions: provider: , m.d. where: medical specialties phone: date/time: 11:30 . provider: , md where: /oncology phone: date/time: 10:30 . provider: , /oncology-cc9 where: /oncology phone: date/time: 10:30 . call to make an appointment to follow up with dr. within the next two weeks. md procedure: diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis colonoscopy endoscopic polypectomy of large intestine esophagogastroduodenoscopy [egd] with closed biopsy esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine transfusion of packed cells diagnoses: pneumonia, organism unspecified esophageal reflux tobacco use disorder congestive heart failure, unspecified acute posthemorrhagic anemia gout, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation systolic heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other late effects of cerebrovascular disease cardiac pacemaker in situ personal history of noncompliance with medical treatment, presenting hazards to health hemorrhage of gastrointestinal tract, unspecified benign neoplasm of colon alcohol abuse, continuous unspecified gastritis and gastroduodenitis, without mention of hemorrhage internal hemorrhoids without mention of complication esophageal varices without mention of bleeding malignant neoplasm of transverse colon 

Answer: The patient is high likely exposed to