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: neoprene ankle support / reglan attending: chief complaint: nausea, vomiting major surgical or invasive procedure: examination under anesthesia, exploratory laparotomy, drainage of ascites, tumor debulking, intracolic omentectomy, small bowel resection with reanastomosis (stapled), bilateral salpingo-oophorectomy, supracervical hysterectomy, cystoscopy history of present illness: is a 52-year-old woman who presents with nausea and vomiting. she recently saw dr. for initial visit after being referred to him by secondary to a recent discovery of an adnexal mass. she has been nauseous and intolerant of po intake for the last 4 days. she feels that her abdominal distention is worse, and at times is making it difficult to breathe. denies cp, fever, chills. . she is a gravida 1, para 0 woman who noted 2 weeks ago a little bit of spotting and abdominal bloating. an ultrasound was performed, which revealed a complex solid right adnexal mass concerning for an ovarian malignancy. a small amount of free fluid was noted. the uterus was notably normal in size measuring 6.4 x 2.7 x 3 cm and there was only a thin stripe. the right adnexal mass measured 10.3 x 7.4 x 11 cm and had a moderate amount of internal vasculature. there were central cystic changes and obviously it was solid as well. reports feeling quite bloated. over the past couple of weeks, she notes that her pants do not fit, she is having difficulty taking a deep breath and actually ingesting food because she feels so bloated. she denies any chest pain, but does report feeling short of breath mostly from the pressure from her diaphragm. she denies any lightheadedness, visual or hearing changes. she does not have any family history suggestive of a predisposition to hereditary breast ovarian cancer syndrome. past medical history: past medical history: she does report a history of mitral valve prolapse. she does not use antibiotics for this. she does not have a history of hypertension, asthma, or thromboembolic disorder. she is not up-to-date with mammography. . past surgical history: at the age of six, she had eye surgery. no other surgery. . ob/gyn history: she is a gravida 1, para 0. she reports that her last real menstrual cycle was a year ago. she does report a history of an abnormal pap smear in the past, but biopsies have all been negative. she is up-to-date with her pap smears, and her last was a year ago. she denies any history of pelvic infections. . social history: she is a bookkeeper, denies tobacco, drug, or alcohol use. her partner, , and her live in . they have no children. family history: grandfather had cancer. physical exam: general: lying in bed, appears tired, nad. heart: rrr +systolic murmur lungs: cta bilaterally posteriorly, decreased breath sounds in lower lung fields. abd: +bowel sounds, soft, distended, nontender to palpation, no palpable mass. ext: no lower extremity edema, no calf tenderness . from dr. clinic note pelvic: reveals normal external genitalia. the inner labia minora is normal. digital exam reveals a normal vaginal canal and normal palpable cervix. i do not palpate any evidence of malignancy or irregularity. rectal exam reveals good sphincter tone. there is some nodularity in the posterior cul-de-sac that i can appreciate only on bimanual exam. there is a palpable mass noted in the midline that extends superiorly. pertinent results: hematology ========== 07:02pm blood wbc-13.8* rbc-3.30* hgb-10.1* hct-30.8* mcv-93 mch-30.5 mchc-32.8 rdw-12.4 plt ct-958*# 08:55am blood wbc-12.2* rbc-3.04* hgb-9.3* hct-28.5* mcv-94 mch-30.5 mchc-32.6 rdw-12.5 plt ct-928* 07:10am blood wbc-12.8* rbc-2.96* hgb-9.1* hct-28.2* mcv-95 mch-30.7 mchc-32.3 rdw-12.8 plt ct-1067* 07:02pm blood wbc-13.3* rbc-3.00* hgb-9.3* hct-26.8* mcv-89 mch-31.1 mchc-34.9 rdw-13.1 plt ct-599* 11:24pm blood hct-28.6* 05:35am blood wbc-16.8* rbc-3.71* hgb-11.7*# hct-32.4* mcv-87 mch-31.4 mchc-36.0* rdw-14.8 plt ct-594* 01:58pm blood hct-30.7* 06:15am blood wbc-17.3* rbc-3.32* hgb-10.2* hct-30.2* mcv-91 mch-30.8 mchc-33.8 rdw-15.3 plt ct-668* 06:24am blood wbc-10.2 rbc-3.00* hgb-9.3* hct-27.7* mcv-92 mch-31.1 mchc-33.7 rdw-15.1 plt ct-650* 05:20pm blood wbc-8.6 rbc-3.02* hgb-9.5* hct-27.6* mcv-91 mch-31.4 mchc-34.4 rdw-15.0 plt ct-625* 05:56am blood wbc-7.8 rbc-3.17* hgb-9.5* hct-29.6* mcv-93 mch-30.1 mchc-32.2 rdw-15.0 plt ct-669* 06:01am blood wbc-9.4 rbc-3.22* hgb-9.7* hct-30.2* mcv-94 mch-30.2 mchc-32.2 rdw-15.0 plt ct-695* 04:44am blood wbc-10.0 rbc-3.30* hgb-10.0* hct-31.0* mcv-94 mch-30.3 mchc-32.2 rdw-15.0 plt ct-684* 05:55am blood wbc-12.0* rbc-3.26* hgb-10.0* hct-30.8* mcv-95 mch-30.8 mchc-32.6 rdw-15.1 plt ct-719* 05:55am blood wbc-14.1* rbc-3.06* hgb-9.4* hct-29.1* mcv-95 mch-30.8 mchc-32.4 rdw-15.1 plt ct-726* 06:12am blood wbc-14.0* rbc-3.05* hgb-9.3* hct-29.1* mcv-95 mch-30.5 mchc-32.0 rdw-15.0 plt ct-765* 04:55am blood wbc-18.3* rbc-2.79* hgb-8.8* hct-26.5* mcv-95 mch-31.6 mchc-33.2 rdw-15.1 plt ct-819* 05:57am blood wbc-18.8* rbc-2.84* hgb-8.9* hct-27.6* mcv-97 mch-31.5 mchc-32.4 rdw-15.1 plt ct-900* 07:02pm blood neuts-91* bands-2 lymphs-2* monos-3 eos-0 baso-0 atyps-0 metas-1* myelos-1* 05:35am blood neuts-94.3* lymphs-2.8* monos-2.8 eos-0 baso-0 05:55am blood neuts-82* bands-4 lymphs-6* monos-3 eos-4 baso-1 atyps-0 metas-0 myelos-0 05:57am blood neuts-91.9* lymphs-5.1* monos-2.0 eos-0.8 baso-0.2 05:35am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 05:55am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-normal microcy-normal polychr-occasional . chemistry ========= 07:02pm blood glucose-101 urean-10 creat-0.6 na-133 k-4.9 cl-95* hco3-29 angap-14 08:55am blood glucose-116* urean-11 creat-0.7 na-133 k-4.7 cl-96 hco3-31 angap-11 07:10am blood glucose-122* urean-12 creat-0.6 na-134 k-5.3* cl-99 hco3-29 angap-11 07:02pm blood glucose-143* urean-9 creat-0.3* na-134 k-4.2 cl-107 hco3-24 angap-7* 11:24pm blood glucose-126* urean-8 creat-0.3* na-135 k-4.6 cl-109* hco3-24 angap-7* 05:35am blood glucose-130* urean-8 creat-0.4 na-137 k-4.7 cl-111* hco3-24 angap-7* 06:15am blood glucose-154* urean-10 creat-0.4 na-138 k-5.3* cl-107 hco3-27 angap-9 06:24am blood glucose-125* urean-12 creat-0.3* na-137 k-4.4 cl-107 hco3-28 angap-6* 05:56am blood glucose-105 urean-15 creat-0.3* na-139 k-4.2 cl-108 hco3-27 angap-8 06:01am blood glucose-124* urean-14 creat-0.3* na-136 k-3.9 cl-106 hco3-27 angap-7* 04:44am blood glucose-131* urean-14 creat-0.2* na-139 k-4.1 cl-109* hco3-27 angap-7* 05:55am blood glucose-110* urean-15 creat-0.3* na-139 k-4.4 cl-107 hco3-25 angap-11 05:55am blood glucose-131* urean-19 creat-0.3* na-135 k-4.5 cl-106 hco3-23 angap-11 06:12am blood glucose-137* urean-18 creat-0.3* na-137 k-4.5 cl-107 hco3-24 angap-11 05:57am blood glucose-134* urean-19 creat-0.4 na-135 k-4.7 cl-104 hco3-22 angap-14 04:55am blood glucose-143* urean-15 creat-0.4 na-134 k-4.7 cl-104 hco3-24 angap-11 05:57am blood glucose-140* urean-23* creat-0.4 na-134 k-4.9 cl-103 hco3-24 angap-12 07:02pm blood calcium-9.1 phos-3.4 mg-2.2 08:55am blood calcium-8.5 phos-3.8 mg-2.1 07:10am blood calcium-8.7 phos-3.8 mg-2.1 07:02pm blood calcium-6.2* phos-2.5* mg-1.4* 05:35am blood albumin-1.4* calcium-6.0* phos-2.6* mg-2.3 06:15am blood calcium-7.4* phos-2.3* mg-2.2 06:24am blood calcium-7.0* phos-2.1* mg-2.2 05:56am blood calcium-7.3* phos-3.4 mg-2.2 06:01am blood albumin-1.5* calcium-7.2* phos-3.1 mg-2.0 04:44am blood calcium-7.3* phos-3.1 mg-2.1 05:55am blood calcium-7.2* phos-3.6 mg-1.9 05:55am blood calcium-7.5* phos-3.7 mg-2.0 06:12am blood totprot-3.9* albumin-2.0* globuln-1.9* calcium-7.6* phos-3.6 mg-1.9 05:57am blood calcium-7.5* phos-3.4 mg-1.9 04:55am blood calcium-7.8* phos-3.4 mg-1.9 05:57am blood calcium-8.0* phos-3.8 mg-2.1 05:55am blood alt-115* ast-137* totbili-4.4* dirbili-3.3* indbili-1.1 06:12am blood alt-117* ast-132* alkphos-176* amylase-321* totbili-4.8* 05:57am blood alt-131* ast-148* amylase-288* totbili-6.0* 04:55am blood alt-135* ast-124* alkphos-143* totbili-5.3* 05:57am blood alt-110* ast-80* alkphos-122* totbili-3.8* 05:35am blood triglyc-94 05:56am blood triglyc-194* 04:58pm blood type-art po2-197* pco2-39 ph-7.41 caltco2-26 base xs-0 intubat-intubated 07:40pm blood type-art temp-36.8 rates-14/0 tidal v-500 peep-5 fio2-100 po2-412* pco2-37 ph-7.40 caltco2-24 base xs-0 aado2-273 req o2-52 -assist/con intubat-intubated 08:46pm blood type-art temp-36.8 rates-14/ tidal v-500 peep-5 fio2-60 po2-246* pco2-41 ph-7.39 caltco2-26 base xs-0 -assist/con intubat-intubated 11:35pm blood type-art temp-36.8 rates-14/ tidal v-500 peep-5 fio2-40 po2-145* pco2-44 ph-7.38 caltco2-27 base xs-0 -assist/con intubat-intubated 09:32am blood type-art rates-14/ tidal v-500 peep-5 fio2-40 po2-158* pco2-38 ph-7.40 caltco2-24 base xs-0 -assist/con intubat-intubated 02:11pm blood type-art temp-37.2 po2-99 pco2-42 ph-7.39 caltco2-26 base xs-0 04:58pm blood freeca-1.01* 09:32am blood freeca-1.05* 04:58pm blood hgb-11.1* calchct-33 04:58pm blood glucose-159* lactate-2.1* na-128* k-4.6 cl-102 08:46pm blood lactate-1.4 . serology ======== 06:12am blood hcv ab-negative 06:12am blood hbsag-negative hbsab-negative hbcab-negative hav ab-positive igm hav-negative . urinanalysis ============ 02:09am urine color-amber appear-cloudy sp -1.020 02:09am urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-4* ph-5.5 leuks-neg 02:09am urine rbc-0 wbc-0 bacteri-none yeast-none epi-0 02:09am urine amorphx-many 02:09am urine hours-random urean-641 creat-285 na-less than k-52 02:09am urine osmolal-530 03:10pm urine color-yellow appear-hazy sp -1.024 03:10pm urine blood-neg nitrite-neg protein-tr glucose-tr ketone-neg bilirub-lg urobiln-4* ph-5.5 leuks-neg 03:10pm urine rbc-1 wbc-6* bacteri-few yeast-none epi-3 03:10pm urine castunk-2* . microbiology ============ urine and blood cultures pending at the time of this discharge summary . radiology ========= chest port. line placement study date of 7:51 pm tip of the endotracheal tube is just above the sternal notch, approximately 6 cm from the carina, 2 cm above optimal placement. aside from mild bibasilar atelectasis, lungs are clear. no pneumothorax is present. pleural effusion, if any, is minimal on the right. normal cardiomediastinal contour. nasogastric tube ends in the lower esophagus and needs to be advanced at least 15 cm to move all the side ports into the stomach. right jugular line ends in the upper svc. . chest (portable ap) study date of 2:09 am ng tube tip is in proximal stomach with the sidehole at the gastroesophageal junction and should be advanced. new bibasilar opacities ____might be consistent with combination of atelectasis and aspiration, although infection cannot be excluded. mild vascular engorgement. . unilat up ext veins us right study date of 8:45 am impression: no evidence of dvt involving the right upper extremity. . duplex dopp abd/pel study date of 8:45 am 1. echogenic liver consistent with fatty infiltration. other forms of liver disease including fibrosis/cirrhosis cannot be excluded on this study. 2. cholelithiasis without evidence of acute cholecystitis. 3. ascites. 4. unremarkable doppler evaluation of the hepatic vessels. . cardiology ========== tte (complete) done at 7:47:28 am final mild bileaflet mitral valve prolapse with mild mitral regurgitation. preserved regional and global biventricular systolic function. mild pulmonary hypertension. . ecg study date of 10:45:16 am baseline artifact. sinus rhythm. q waves in leads v1-v2 with mild st segment elevation. consider septal myocardial infarction, age undetermined. other st-t wave abnormalities. compared to the previous tracing of no significant change in previously noted findings. brief hospital course: ms. was admitted for nausea, vomiting, and dehyration. on hospital day 3, she underwent examination under anesthesia, exploratory laparotomy, drainage of ascites, tumor debulking, intracolic omentectomy, small bowel resection with reanastomosis (stapled), bilateral salpingo-oophorectomy, supracervical hysterectomy, cystoscopy. please see operative note for complete details. post-operatively, she was transfered to the icu briefly through post-operative day 1 when she was transfered to the floor. her hospital course was characterized by the following issues: . *) neuro: upon transfer to the floor post-operative day 1, ms. experienced hypoventilation (rr 5-6 during sleep) thought to be secondary to narcotics. she received naloxone x2, with resumption of normal respiratory rate. she was fully arousable during the period of hypoventilation. her pain was subsequently managed with dilaudid and toradol with little relief of pain. the chronic pain service was consulted on post-operative day 3; she was subsequently placed on a morphine pca with toradol as needed. after being made dnr/dni (see below under palliative care), ms. pain was also managed with a fentanyl patch. to help minimize pain from bowel edema and distention, ms. was also placed on iv dexamethasone on post-operative day 13. . *) cardiac: given her history of mitral valve prolapse, an echocardiography was obtained and showed mild bileaflet mitral valve prolapse with mild mitral regurgitation; preserved regional and global biventricular systolic function mild pulmonary hypertension. . ms. had hypotension intra-operatively, requiring 3 untis of prbc and placement on a neosynephrine drip. she was transfused another 2 units of rpbc in the icu, bolused 3 liters of ivf, and eventually weened off of the neo drip. she had no other episodes of hypotension nor any cardiac complaints during her hospital course. . *) respiratory after extubation in the icu on post-operative day 1, ms. had no respiratory issues or complaints. . *) renal pre-operatively, ms. had decreased urine output from pre-renal etiology (fena <0.1), likely secondary to third spacing from increased vascular permeability and decreased intravascular oncotic pressures. her urine output remained marginal but adequate during her hospital course. her creatinine was stable throughout her hospitalization. . *) hematology/oncology ms. was anemic on admission. she was transfused a total of 5 units of prbc as described above. her hematocrit increased appropriately and remained stable for the remainder of her hospitalization. . rue extremity edema > lue was evaluated on post-operative day 9 with an unremarkable rue doppler study. . hematology oncology was consulted on post-operative day 8 for possible chemotherapy during hospitalization. her pathology report was finalized on post-operative day 9 and after discussion of prognosis and potential response to chemotherapy with the medical oncologists and the palliative care service (see below), ms. and her partner decided to decline chemotherapy. . *) palliative care ms. and her partner desired to meet with the palliative care service on post-operative day 10 after ms. had an elevated temperature (see below), for which she declined work-up of other than blood and urine cultures. she was made dnr/dni on post-operative day 10. . *) gi: ms. was admitted and made npo with ivf given her inability to tolerate po. her nausea pre-operatively was controlled with iv antiemetics. given her small bowel resection, a ngt was placed intra-operatively. it was eventually discontinued on post-operative day 4. ms. nausea was well-controlled on iv antiemetics until post-operative day 8 when she began having nausea and vomiting. ms. also began appearing jaundiced at this time and lfts revealed elevated ast, alt, and bilirubin. ruq ultrasound was unremarkable. hepatitis serologies were positive only for hepatitis a antibody. possible etiologies included tpn induced transaminitis, pre-existing fatty liver disease (as seen on ct scan ), or toradol induced hepatotoxicity. lfts were stable for the remainder of her hospitalization. plans were made for a repeat ct abdomen and pelvic to evaluate bowel patency; however, ms. later declined that study. after being made dnr/dni, gastric secretions were controlled with octreotide. she was also started on a scopolamine patch. she was given an intramuscular injection of octreotide prior to discharge from the hospital. . *) id: afebrile ms. received ancef and flagyl x 3 days post-operatively for infection prophylaxis. she remained afebrile until post-operative 10 when she had a t max 101.3. erythema was noted on her incision. she declined work-up, except for urine and blood cultures. she was started on empiric antibiotics levofloxacin and flagyl; these were discontinued on discharge. she otherwise remained afebrile for the remainder of her hospital course. . *) fen: ms. was started on tpn on post-operative day 3. she was unable to tolerate more than liquids during her hospital course and, after her nausea and vomiting recurred, was npo for the remainder of her hospital course. her electrolytes were checked daily and repleted as needed. . ms. was eventually discharged on post-operative day 13 with home hospice care. medications on admission: ativan prn for sleep discharge medications: 1. ketorolac tromethamine 30 mg/ml solution sig: thirty (30) mg injection q6h (every 6 hours). disp:*qs mg* refills:*2* 2. fentanyl 50 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*3 patch 72 hr(s)* refills:*2* 3. octreotide acetate 100 mcg/ml solution sig: three (3) ml injection every eight (8) hours. disp:*qs * refills:*2* 4. medication ativan 1mg transdermal every 8 hours as needed for nausea 5. medication dexamethasone 10mg transdermal every 8 hours as needed for pain and nausea 6. medication dexamethsone 20mg suppository every 12 hours as needed for pain and/or nausea 7. medication compazine 25-50mg suppository every 12 hours as needed for nausea 8. scopolamine base 1.5 mg patch 72 hr sig: patch 72 hrs transdermal once (once). disp:*qs patch 72 hr(s)* refills:*2* 9. ativan 2 mg/ml solution sig: 0.5-1 mg injection every hours as needed for nausea. disp:*qs * refills:*2* 10. dexamethasone sodium phosphate 10 mg/ml solution sig: one (1) ml injection twice a day. disp:*qs * refills:*2* 11. morphine pca pca settings: no basal rate, 0.7mg bolus with 6 minute lockout, maximum dose = 7 mg/hour discharge disposition: home with service facility: vna & hospice of discharge diagnosis: ovarian cancer discharge condition: stable discharge instructions: general instructions: * take your medications as prescribed. . incision care: * you may shower and allow soapy water to run over incision; no scrubbing of incision. followup instructions: please call dr. at if you have any questions md procedure: parenteral infusion of concentrated nutritional substances other partial resection of small intestine other cystoscopy other removal of both ovaries and tubes at same operative episode excision or destruction of peritoneal tissue transfusion of packed cells other and unspecified subtotal abdominal hysterectomy diagnoses: hyperpotassemia other iatrogenic hypotension mitral valve disorders other postoperative infection acute posthemorrhagic anemia secondary malignant neoplasm of other specified sites acute respiratory failure other ascites dehydration removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation secondary malignant neoplasm of retroperitoneum and peritoneum other specified analgesics and antipyretics causing adverse effects in therapeutic use malignant neoplasm of ovary secondary malignant neoplasm of small intestine including duodenum nonspecific abnormal results of function study of liver secondary malignant neoplasm of other urinary organs secondary malignant neoplasm of genital organs secondary malignant neoplasm of ovary 

Answer: The patient is high likely exposed to