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: no known allergies / adverse drug reactions attending: chief complaint: right ankle pain major surgical or invasive procedure: r ankle arthrodesis cardiac catheterization s/p placement of 2 stents history of present illness: 82 m cantonese speaking, with h/o htn, hld, ckd, ra on chronic prednisone, stroke, who was initialy admitted to hospital for right ankle fracture s/p fusion 5 days ago. intra-op and post-op, pt received 10 l with net positive 6-7 l of fluid. on pod#2 pt had episode of htn (bp 200/100s), tachycardic hr 120-150s, tachypnea in 30s, while eating dinner on the phone. abg 7.43/38/60/26. cxr showed pulm edema. he was transferred to the for pulm edema in setting of gross volume overload and htn/tachycardia. he was given hydralazine 10mg iv x1, ekg showed v3-v5 st depressions thought to be demand ischemia. echo showed mild lateral hypokinesis on echo, trop-0.30. while in the , pt was diuresed. given lasix 20mg iv x 3, out 1.6 l, goal net neg 1-2 l), he was also briefly given nitro drip but weaned off. after diuresis he was transfered to the floor. pt had plans for rehab today but this morning (pod #4) he had episode of pre-syncope and chest pain. pt initialy felt fine, ate breakfast, took all meds. he was briefly sleepy but responsive. family briefly left room and returned and noticed pt was non-responsive (drooling, shook him, wouldnt wake up)-> a code called, however he had pulse and was breathing, he then vomited. during this time, he reported cp. today, pt returned to where he continued to have chest pressure, ekg new twi (biphasic) in v2, v3, twi in v4, v5, st depressions v4, v5, v6 (2mm)- new compared to prior ekg, trop stable at 0.3, flat mb and ck. he was given morphine, sl-nitrate (2 sl nitro resolved cp), asa 325, plavix 300 x 1, atorva 80, heparin drip. sl- nitro resulted in hypotension bp 120->80s->90s. he was given 1l bolus, his uo has been minimal x3 hrs. he was transfered to cardiology service for concern of nstemi and underwent cath. . cath lab: l femoral approach. u/s guided stick but developed hematoma early on in case. given bivalirudin only during case. moderate rca, l main with 50+% and prox lad 80% stenosis sp 2 long overlapping promus 28mm des. initialy thought bypass, then decided unlikely cabg candidate. asa, plavix 75. no heparin. received 240ml contrast, mild hyration overnight at 75/hr. pulled sheath, compressed x 40 min but still tiny ooze. fem-stop applied, leave for 2 hrs. if getting bigger, would re-apply fem-stp. if worse in am, can think of us. on mild nitro drop for htn. . on arrival to the floor, patient is comfortable, family at bedside. denies any chest pain, no sob. does report right groin fem-stop device is uncomfortable. pt requests to eat food. . review of systems on review of systems, he denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: rheumatoid arthritis hypertension hyperlipidemia ? h/o cva ? chronic kidney disease gerd social history: - tobacco: history of tobacco use, quit 10 years ago - alcohol: denies - illicits: denies family history: lung disease gastrointestinal problems physical exam: exam on admission to vitals: t: 94 bp: 188/128 p: 146 r: 30 o2: 99% on 6l nc general: elderly male in nad heent: sclera anicteric, mmm, oropharynx clear neck: no jvd, no lymphadenopathy lungs: clear to auscultation bilaterally, with decreased breath sounds on right>left base, course crackles with deep inspiration cv: distant heart sounds, tachycardic with regular rhythm, normal s1/s2. abdomen: +bs, soft, nontender, nondistended gu: foley in place ext: right leg bandaged to knee, exposed toes with brisk capillary refill. left leg cool but with brisk capillary refill, 2+ dp/pt pulses discharge physical examination: 98.0 128/74 (sbp 100s-120s) 85 (50-80s) 18 91%ra + bm yesterday i/o: 1/1600 total (-380 net) general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl neck: supple with jvp of 8cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 1/6 systolic murmur left sternal border. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab in anterior and posterior lung fields, no crackles, rhonchi or wheezes abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. l groin: ecchymosis, non-tender, non-expanding. no bruit appreciated. good femoral pulse. good distal pedal pulses to palpation. r lower extremity in cast/wrap skin: no stasis dermatitis, ulcers, scars, or xanthomas. warm extremities, no pedal edema pulses: left: carotid 2+ dp 1+ pt 1+ pertinent results: admission labs: 12:34pm blood wbc-5.9 rbc-3.34* hgb-10.3* hct-32.2* mcv-96 mch-30.7 mchc-31.9 rdw-13.7 plt ct-110* 12:34pm blood pt-12.1 ptt-29.8 inr(pt)-1.1 12:34pm blood glucose-114* urean-21* creat-1.7* na-141 k-3.8 cl-107 hco3-30 angap-8 12:34pm blood calcium-8.0* phos-3.2 mg-1.9 other pertinent labs: 01:32am blood wbc-8.4 rbc-2.87* hgb-9.0* hct-26.6* mcv-93 mch-31.2 mchc-33.7 rdw-14.1 plt ct-107* 07:05am blood wbc-6.0 rbc-2.90* hgb-8.9* hct-28.0* mcv-96 mch-30.5 mchc-31.7 rdw-14.1 plt ct-118* 07:05am blood glucose-94 urean-21* creat-1.4* na-139 k-3.8 cl-103 hco3-29 angap-11 10:10am blood alt-18 ast-29 ld(ldh)-227 ck(cpk)-85 alkphos-45 amylase-53 totbili-0.8 05:21am blood ck-mb-4 ctropnt-0.26* 07:00pm blood ck-mb-5 ctropnt-0.10* 01:32am blood ck-mb-8 ctropnt-0.35* 01:40pm blood ck-mb-5 ctropnt-0.26* 10:10am blood ck-mb-2 ctropnt-0.31* 12:16am blood ck-mb-4 ctropnt-0.30* 07:05am blood ck-mb-8 ctropnt-0.39* 08:30am blood ck-mb-3 ctropnt-0.62* 10:02am blood ck-mb-2 ctropnt-0.52* 07:05am blood calcium-8.0* phos-3.0 mg-2.2 01:32am blood triglyc-61 hdl-46 chol/hd-2.1 ldlcalc-40 10:31am blood lactate-2.4* discharge labs: 06:10am blood wbc-5.8 rbc-2.80* hgb-8.3* hct-26.2* mcv-94 mch-29.6 mchc-31.6 rdw-14.3 plt ct-170 06:10am blood neuts-53.9 lymphs-35.1 monos-7.7 eos-3.0 baso-0.3 06:10am blood glucose-102* urean-33* creat-2.1* na-138 k-4.1 cl-106 hco3-29 angap-7* 06:10am blood calcium-8.6 phos-3.3 mg-2.5 studies: ankle xray (): findings and impression: status post tibiotalar and subtalar arthrodesis. the hardware appears intact. please see operative report for further details. in addition, there is distal fibular resection. ankle (): three views of the right ankle: three screws transfix the tibiotalar joints in appropriate alignment. a screw is also noted going through the posterior subtalar joint. two screws transfix the distal tibiofibular joint. bone graft material was removed from the distal fibula. this detail is obscured due to overlying cast. no evidence of hardware complications or lucency is noted. impression: no hardware complication. foot xray (): three views of the right ankle compared to the prior study from of the same day demonstrate right ankle through a splint. there has been triple arthrodesis with cannulated lag screws traversing the tibiotalar joint, posterior middle subtalar joints. fine osseous detail is limited by overlying splint. no hardware complication at this time. ekg (): probable sinus tachycardia. isolated ventricular premature beat. non-specific st-t wave changes. compared to the previous tracing of the rate is now faster. ekg (): sinus rhythm. isolated ventricular premature beats. compared to the previous tracing of the sinus rate is now slower. ekg (): normal sinus rhythm. t wave inversions in leads v1 and v2 suggest possible anterolateral ischemia. compared to the previous tracing of the anterolateral t wave inversions are more prominent. clinical correlation is suggested. cxr (): interstitial abnormality, predominantly septal lines in the right lung, most pronounced at the base, is probably pulmonary edema. pulmonary vasculature is generally engorged. there is no pneumothorax or appreciable pleural effusion and no consolidation to suggest aspiration or pneumonia. heart size normal. aortic knob is heavily calcified. subsequent chest radiograph performed 5:25 a.m. on available at the time of this review shows with a slight difference in patient position, there is less apparent separation of intimal calcification from the lateral margin of and the shape of the aorta does not suggest acute dissection. echo (): the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). there is mild regional left ventricular systolic dysfunction with very mild lateral hypokinesis. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. impression: very mild lateral hypokinesis. mild mitral regurgitation. mild aortic regurgitation. very small pericardial effusion without evidence of tamponade physiology. cxr (): previous mild pulmonary edema has improved. there may be a new small right pleural effusion. upper lungs clear. heart size normal. cxr (): findings: as compared to the previous radiograph, there is no relevant change. mild fluid overload. bilateral areas of atelectasis. the presence of a small right pleural effusion cannot be excluded. no newly occurred parenchymal opacities. cxr (): impression: right lower lung opacity which rapidly appeared between to , has completely resolved over past 24 hours, suggesting it was from lung aspiration. there is no evidence of pneumonia or pulmonary edema. heart size is top normal. mediastinal and hilar contours are unchanged. no pneumothorax or pleural effusion. cxr (): pulmonary vasculature is moderately engorged, new finding, but there is no pulmonary edema or appreciable pleural effusion. the heart size is normal and the mediastinal veins are not dilated. cardiac catheterization (): comments: 1. selective coronary angiography of this right-dominant system demonstrated left main and lad single vessel coronary artery disease. the lmca had a 60-70% stenosis going into the lad. the lad had diffuse 70% disease back to the ostium witha focal 80-90% stenosis. the lcx had no significant disease. the rca had a proximal ulcer with signficant stenosis. 2. limited resting hemodynamics revealed severe systemic systolic hypertension with an sbp of 167 mmhg. 3. ivus assessment of left main and proximal lad diffuse disease, with successful stenting of entire segment using promus 2.5 x 28 mm drug eluting stent distally and overlapping promus 3.0 x 28 mm stent proximally into the left main. excellent result. final diagnosis: 1. severe left main and proximal lad coronary disease. 2. proximal ulcerated rca lesion with significant stenosis. 3. severe systemic systolic arterial hypertension. 4. pre- and post- ivus assessment of left main and proximal lad. 5. successful pci of lmain and lad using 2 overlapping promus drug eluting stents (promus 3.0 x 28 mm, promus 2.5 x 28 mm). 6. aspirin indefinitely, clopidogrel for minimum of 12 months. cxr (): findings: pa and lateral views of the chest. a rounded heterogeneous opacity with central lucency concerning in a lower lobe is concerning for a cavitary lesion. stable calcified aortic annulus. there is no evidence of pleural effusion or pneumothorax. the mediastinal and hilar contours are normal. heart size is normal. mild pulmonary edema has decreased. impression: 1. there is a possible cavitary mass in a lower lobe. recommend chest ct to better evaluate. 2. improvement in mild pulmonary edema. ct chest (): ct chest without iv contrast: the imaged thyroid gland is normal. small mediastinal nodes measure up to 7 mm but do not meet ct criteria for pathologic enlargement. there is no supraclavicular, axillary or hilar lymphadenopathy. heart size is normal, but there is left atrial enlargement. trace pericardial fluid is likely physiologic. there is extensive atherosclerotic calcification involving the coronary arteries, particularly the lad. the aorta is of normal caliber throughout with atherosclerotic calcification, particularly severe in the the proximal ascending aorta, but also involving the arch and descending aorta. the main pulmonary artery measures 3.2 cm and the right pulmonary artery measures 2.9 cm, both enlarged. there is mild paraseptal emphysema with an apical predominance. there are trace bilateral pleural effusions. there is no nodule, mass, or consolidation. there is no pneumothorax. airways are patent. in the imaged portion of the upper abdomen, two hypodense lesions in the dome of the liver measure approximately 12 mm and 9 mm possibly representing cysts or hemangiomas but inadequately characterized on this single-phase ct. bone windows: there is no suspicious lytic or sclerotic osseous lesion. there is multilevel degenerative change of the thoracic spine with calcification of the anterior longitudinal ligament. impression: 1. no cavitary pulmonary lesion. 2. trace bilateral pleural effusions. 3. apical predominant emphysema. 4. marked atherosclerotic calcification of the coronary vessels. 5. enlarged pulmonary artery suggests pulmonary hypertension. 6. incompletely assessed hepatic hypodensities, possibly cysts or hemangiomas. if clinically indicated, these may be evaluated further by ultrasound. lenis (): findings: there is normal grayscale appearance, compressibility, color doppler flow and pulse-wave doppler waveforms of the right and left common femoral, superficial femoral and popliteal veins. the left peroneal and posterior tibial veins are normal. the right calf veins could not be visualized. impression: no evidence of dvt in the right or left lower extremity. right calf veins are not visualized. brief hospital course: ============================== brief hospital summary ============================== 82 yo m with a history of ckd, htn/hl, was admitted to the hospital s/p right ankle fusion, presenting post-operatively with acute onset of tachypnea, tachycardia, and hypertensive emergency. was found to have elevated cardiac enzymes, with dynamic ekg changes, consistent with nstemi. patient received a cardiac catheterization on , where he had two stents placed. cath lab revealed large lad and left main disease sp 2 overlapping des. pt had a left femoral hematoma that is resolving. pt had a productive cough with dark sputum, with a ? of cavitary lesion on cxr. ct scan showed no evidence of cavitary lesion and afb slides have been negative x3. patient discharged to rehab on plavix therapy for at least one year. ============================== active issues ============================== # nstemi: s/p ankle surgery, cardiac enzymes found to be elevated . initially , to 0.35 on and was started on heparin gtt, aspirin, bb and uptitrated his lipitor. increased again on in the setting of acute onset chest pain this time with dynamic ekg changes (anterior twi). restarted heparin gtt, plavix loaded, further uptitrated lipitor. cardiac cath demonstrated moderate rca, l main with 50+% and prox lad 80% stenosis sp 2 long overlapping promus 28mm des. pt received 240cc contrast load during cath procedure. cardiac cath complciated with a l femoral hematoma. pt is currently chest pain free. patient and family educated about the stent placement and necessity of continuous plavix in the post-stent period. pt received ivf s/p procedure (1l) considering dye load, and tolerated well. pt is continued on aspirin 325 daily, atorvastatin 80mg daily, plavix 75mg qd, uptitrating metoprolol tartrate to 75mg (to rehab on 150 metoprolol succinate). procedure was complicated by l groin hematoma. femstop device was placed over l groin and achieved hemostasis. groin was monitored for expanding hematoma and/or pseudoaneurysm, and no evidence of either. serial hematocrits have been stable in 27-30 range s/p procedure. pt's home clonidine was continued at 0.1mg for blood pressure control. consider starting an acei as outpatient, pending renal function. s/p cath, pt had some brief periods of chest/epigastric discomfort, alwayst upon awaking and relieved after breakfast. pt was given maalox, which resolved the discomfort. pt is now on standing maalox every morning. #icu courses: pt initially transferred to icu on pod#2 for tachypnea. pt received approx 11l fluid perioperatively and was net positive 6-7l. likely flash pulmonary edema in the setting of fluid overload and hypertension. patient was diuresed, blood pressure improved and cardiac enzymes noted to increase, put on heparin drip initially then medically managed with heparin drip discontinued, in consultation with the cardiology team, as the troponin leak was hypothesized to be secondary to demand ischemia in the setting of hypertensive urgency and tachycardia. pt d/c'd back to the floor on pod#3, where code blue was called on patient on pod#4 for unresponsiveness. pt never lost pulse or blood pressure. vomit seen on pt and very hypertensive to 200s. likely aspiration. pt was transferred again to the icu, where troponins again started to rise with the dynamic ekg changes (twis), prompting the trip to the cath lab. pt transferred to service s/p cardiac catheterization. patient was evaluated by speech and swallow on the floor s/p cardiac catheterization, which demonstrated no problems, safe for regular heart healthy diet. # hypertensive urgency: developed acutely on in setting of tachypnea and tachycardia. trigger unclear. likely d/t missed dosing of home blood pressure medications. troponins trending up following event, demand ischemia vs nstemi, now trending down. initially on nitroglycerin drip, since dc'd dced, uptitrated metoprolol to 75mg , continued clonidine 0.1mg home dose. pt was normotensive on the 3 days prior to discharge. as an outpatient, would consider titrating down clonidine, as it is a relatively poor in this patient for blood pressure control. # productive cough: pt had three episodes of a dark sputum production. no white count, no persistent cough, no fevers. cxr on showed a ? of cavitary mass in a lower lobe. given pt on prednisone, from , tuberculosis was on the differential, so a ct chest was performed to better characterize the lesion. no lesion of any sort was seen on ct chest, which was reassuring. although very low likelihood, we performed three induced sputums to r/o tuberculosis. three af smears were negative for tuberculosis. no more dark sputum. it is most likely this is from a post-aspiration event, with some expressed plugs. # anemia: patient??????s hematocrit has been fluctuating throughout admission, with no transfusions and no signs of acute blood loss. hct variable from 26-32 during this admission. hct has been stable s/p surgery and catheterization, with no clear trend. pt should have this normocytic anemia further worked up after acute hospitalization. # s/p right ankle fusion- restarted lovenox after discontinuing heparin gtt on icu day #2. discontinued lovenox again around catheterization, and restarted on , after hct was stable (in regards to the l groin hematoma). orthopedics signed off on , with f/u in 4 weeks, continue lovenox for 4 weeks, and non-weight bearing until then. # acute on chronic renal insufficiency: baseline 1.7 per confirmation at pcps office. medications renally dosed. prehydrated for cardiac catheterization with hco3, and provided fluids s/p catheterization. pt has been at or near b/l cr throughout hospitalization. pt has had periods of oliguria in both the icu and floor, which were managed with closely watched administration of ivf. cr increased s/p catheterization, plateuing around 2.1 on day of discharge. this is most likely to dye in cath, as cr began rising 2 days s/p cath. urine electrolytes and urine eos pending on discharge. pt should have cr checked on to monitor renal fxn, and urine lytes/eos may be followed. # hyperlipidemia: lipid panel within normal limits with low cholesterol of 98, hdl 46, calculated ldl 40. given nstemi uptitrated atorvastatin to 80mg daily. # bph: continued home terazosin and tamsulosin. # rheumatoid arthritis: patient previously on embrel at home which was recently stopped. continued home prednisone. =================== transitional issues =================== 1. f/u ortho, pcp, 2. d/c to rehab 3. continue lovenox injections for dvt prophylaxis until seen by orthopedics, may increase dose to 40mg qd if cr improves to b/l. 4. keep cast clean, dry and intact, no weight bearing r leg until evaluated by orthopedics. 5. continue plavix 75mg qd for at least one year, with consultation of outpt cardiologist 6. would recommend titrating down clonidine and choosing alternative anti-hypertensive on outpt basis 7. observe l groin hematoma for expansion or pseudoaneurysm. 8. check cr on to monitor for resolution/progression of renal function. 9. pt should have anemia worked up by pcp in setting (has been stable since here). 10. pcp and rehab /u afb cultures from laboratory 11. pcp to /u hepatic hypodensities on chest ct, within one year, may consider starting with ultrasound. medications on admission: enbrel terazosin 2mg qhs prednisone 5mg po daily simvastatin 5mg po qhs aspirin metoprolol tartrate 50mg po bid clonidine 0.1mg po bid tamsulosin 0.4mg po qhs senna discharge medications: 1. acetaminophen 500 mg tablet sig: one (1) tablet po every six (6) hours as needed for fever or pain. 2. docusate sodium 100 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*28 tablet(s)* refills:*0* 3. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 4. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 5. terazosin 2 mg capsule sig: one (1) capsule po hs (at bedtime). 6. clonidine 0.1 mg tablet sig: one (1) tablet po twice a day. 7. vitamin d 1,000 unit tablet sig: one (1) tablet po daily (daily). 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 9. oxycodone 5 mg tablet sig: 0.5-1 tablet po q4h (every 4 hours) as needed for pain: do not drive or drink alcohol while taking this medication. . disp:*120 tablet(s)* refills:*0* 10. metoprolol succinate 50 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*0* 11. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 12. senna 8.6 mg tablet sig: one (1) tablet po hs (at bedtime). 13. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 14. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heartburn: (standing at 7am). 15. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 16. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 17. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 18. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: repeat up to three times, separated by five minutes each. notify md if giving. . 19. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 20. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q24h (every 24 hours): please continue to take until orthopedics follow-up. up-titrate to 40mg qd when cr improves. . 21. outpatient lab work please check chem 10 on to evaluate renal fxn and electrolytes. discharge disposition: extended care facility: - discharge diagnosis: s/p r ankle arthrodesis nstemi s/p stent placement discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair (non weight bearing on r lower extremity). discharge instructions: dear mr. , you were admitted to the hospital for a surgical repair of your right ankle. while in the hospital, you had chest pain and were found to have severe coronary artery disease of your heart. two stents were placed in your heart. 1. please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns. 2. please follow up with your primary physician regarding this admission and any new medications and refills. 3. resume your home medications unless otherwise instructed (see below). 4. please do not take any non-steroidal anti-inflammatory medications (nsaids such as celebrex, ibuprofen, advil, aleve, motrin, etc). 5. anticoagulation: please continue your lovenox for four (4) weeks to help prevent deep vein thrombosis (blood clots). 6. cast care: please keep your cast clean, dry and intact. 7. activity: non-weight bearing on the operative extremity. 8. medication changes: add acetaminophen 500 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain add docusate sodium 100 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. add enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q24h (every 24 hours) for 28 days. add aspirin 325 mg tablet sig: one (1) tablet po daily (daily). add oxycodone 5 mg tablet sig: 0.5-1 tablet po q4h (every 4 hours) as needed for pain. change metoprolol to metoprolol succinate 50 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po daily (daily). add atorvastatin 80 mg tablet sig: one (1) tablet po once a day. add clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). add alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heartburn, and standing at 7am. add cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). add calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). add polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. print mono add nitroglycerin 0.3 mg tablet, sublingual sublingual prn (as needed) as needed for chest pain: repeat up to three times, stop taking simvastatin followup instructions: name: - , md specialty: internal medicine location: medical center address: , box 796, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. they can call the number listed above. department: cardiac services when: monday at 3:20 pm with: , md building: campus: east best parking: garage department: orthopedics when: thursday at 10:40 am with: , pa building: sc clinical ctr campus: east best parking: garage md procedure: coronary arteriography using two catheters insertion of drug-eluting coronary artery stent(s) other change in muscle or tendon length ankle fusion subtalar fusion transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on two vessels arthrodesis of other specified joints diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified long-term (current) use of steroids cardiac complications, not elsewhere classified hematoma complicating a procedure other chronic pulmonary heart diseases hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation iron deficiency anemia, unspecified rheumatoid arthritis accidents occurring in residential institution oliguria and anuria hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified foreign body in larynx osteoarthrosis, localized, not specified whether primary or secondary, ankle and foot 

Answer: The patient is high likely exposed to