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: morphine / augmentin / lisinopril / aldactone attending: chief complaint: hyperglycemia after starting dexamethasone major surgical or invasive procedure: : left frontal craniotomy for menigioma resection history of present illness: mr. is a 76 year old man with a history of cad s/p mi in (subsequent normal cath in ), cva w/o residual defecits, schf, dmii, osa (nonadherant with bipap), who is admitted for preoperative hyperglycemia management prior to meningioma removal scheduled for . per the patient and patient's family, he was in his usual state of health until this spring when he and his family noticed headaches and generalized cognitive decline. he began forgetting dates and mixing up his medications. he then went to on where an mri revealed a large frontal meningioma. he was then seen by neurosurgery there who recommended surgery, however, he decided to come to for a second opinion. he then established care here with neurooncology who noted rle edema and obtained an u/s which revealed a dvt. he was started on lovenox. it is unclear if this is provoked or not. he was started on dexamethasone and keppra for his meningioma but he has developed hyperglycemia as a result. his neurosurgeons therefore decided the patient should be admitted to medicine for hyperglycemia management prior to the operation. of note, his aspirin and plavix were discontinued on in preparation of surgery. ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. also denies focal weakness, visual problems. does report unsteady gate and memory difficulties. past medical history: 1. meningioma 2. cad s/p mi in . repeat cath here in revealed patent coronaries 3. schf (no echo in our system but admission at osh for chf) 4. diabetes 5. hypertension 6. dyslipidemia 7. left ear infection, hearing loss, had surgery 8. colon polyps removed 9. bilateral le blood clots 10. sleep apnea, does not tolerate cpap 11. prostatism 12. cognitive decline social history: he is married and lives with his wife. is a retired sheet metal worker, and had asbestos exposure in the shipyard. he is retired. he smoked ppd for 60 years family history: no family history of brain cancer, otherwise non-contributory physical exam: admission exam: vs: 97.8 124/74 88 18 95%ra fs 240 general: well-appearing man in nad, comfortable, appropriate. heent: nc/at, perrla, eomi, sclerae anicteric, mmm, op clear. neck: supple, no thyromegaly, no jvd, no carotid bruits. heart: rrr, no mrg, nl s1-s2. lungs: cta bilat, no rh/wh, good air movement, resp unlabored. bibasilar crackles. abdomen: soft/nt/nd, no masses or hsm, no rebound/guarding. scar from colectomy for polyps (precancerous). extremities: wwp, no c/c, 2+ peripheral pulses. 1+ edema on rle. skin: no rashes or lesions. lymph: no cervical lad. neuro: awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout ue/le flexion/extension with subtle rle weakness on knee flexion and extension, sensation grossly intact throughout, dtrs 2+ and symmetric, cerebellar exam intact, steady gait but with limp favoring right and + rhomberg sign. states days of week backward correctly without delay and states he is in hospital for meningioma to be removed. discharge exam: unchanged pertinent results: admission labs: 09:45am blood wbc-9.7 rbc-4.59* hgb-14.8 hct-43.4 mcv-95 mch-32.4* mchc-34.2 rdw-12.7 plt ct-199 09:45am blood neuts-78.8* lymphs-14.6* monos-4.8 eos-1.2 baso-0.6 09:45am blood plt ct-199 09:45am blood pt-12.1 ptt-26.3 inr(pt)-1.0 09:45am blood urean-14 creat-0.6 na-143 k-4.3 cl-103 hco3-29 angap-15 09:45am blood calcium-10.0 09:45am blood %hba1c-8.2* eag-189* 09:45am blood crp-14.1* ct brain findings: the patient is status post post-left frontal craniotomy, with changes related to excision of the previously described left frontal mass. a moderate amount of pneumocephalus is noted in the left frontal region. trace amount of dense material is seen layering in the resection cavity, compatible with subarachnoid blood. the sulci of the left frontal lobe are mildly effaced as is the frontal of the left lateral ventricle. subtle left-to-right shift of midline structures is seen, with the maximum displacement measuring 3 mm in the transverse plane (2; 15). otherwise, there is no large subdural collection, hydrocephalus, or intraventricular hemorrhage. small amount of subcutaneous gas is seen along the left aspect of the scalp in the region of the surgical intervention. the visualized paranasal sinuses and mastoid air cells are clear. incidental note is made of a hearing aid on the left ear. impression: immediately status post resection of left frontovertex extra-axial mass, with moderate post-procedural pneumocephalus and trace subarachnoid blood at the operative bed; mild effacement of sulci and the left frontal , with 3 mm rightward shift of midline structures, is unchanged from the pre-operative studies. mri findings: the patient is status post left frontal craniotomy, with post-surgical changes in the left frontal region as well as the adjacent parenchyma of the left frontal lobe. pneumocephalus and blood products and fluid are noted. there is moderate surrounding flair hyperintense signal that is not significantly changed from the preop study. areas of increased signal intensity are noted on the dwi sequence in the periphery of the resection cavity with decreased signal on the adc sequence, which may relate to blood products/areas of ischemia or infarction in the adjacent tissue. attention on followup can be considered (series 502, image 20). evaluation for enhancing areas is limited, given the pre-contrast t1 hyperintense areas. however, there is slightly vague enhancement surrounding the surgical resection cavity. no areas of abnormal enhancement are noted elsewhere in the brain. small fluid collection is noted in the left subdural space, in the frontal region. there is also soft tissue swelling with fluid collection in the soft tissues overlying the left frontal and the parietal bones (series 6, image 21) along with blood products. mild enhancement of the overlying dura in the left side. multiple flair hyperintense foci are also noted in the cerebral white matter, likely related to small vessel ischemic changes. there is mass effect on the frontal of the left lateral ventricle, with mild rightward shift of the midline structures and subfalcine herniation measuring approximately 5 mm. the major intracranial arterial flow voids are noted, with a diminutive distal vertebral and basilar artery with a fetal pca pattern. there is increased signal intensity in the mastoid air cells on both sides and in the petrous apices from fluid/mucosal thickening. impression: 1. surgical changes in the left frontal region and in the left frontal lobe parenchyma with presence of blood products as described above. unchanged appearance of the surrounding flair hyperintense signal in the left frontal lobe. interval development of an area of decreased diffusion surrounding the blood products, which may relate to infarction/ischemic changes in the parenchyma. assessment for infarction is limited given the presence of blood products adjacent. consider followup as clinically indicated for better assessment. 2. while there is no significant abnormal enhancement to suggest an obvious residual tumor, followup evaluation can be considered to assess residual tumor, after resolution of the post-surgical changes. 3. mucosal thickening/fluid, in the mastoid air cells on both sides and in the petrous apices. persistent mass effect on the left frontal and mild rightward shift of midline structures not significantly changed. brief hospital course: 76m with cad s/p mi, chronic diastolic chf (ef 50%), t2dm, h/o cva and recently diagnosed dvt who was admitted for pre-operative glycemic control in the setting of dexamethasone. #meningioma - patient noted having gait instability and difficulty with his memory, was diagnosed with a left frontal meningioma by mri at an osh. was started on dexamethasone and keppra for seizure prophylaxis. he had resection of the meningioma on by neurosurgery. this was done without complication. post op head ct was without hematoma. post op mri revealed good resection. #t2dm - patient reports that his diabetes had not been well controlled prior to starting dexamethasone, was reporting sugars in the 200s previously. since starting dex, his glycemic control even worsened and was reporting glucose in the 400s. he was admitted for pre-operative glycemic control. we held his home glipizide and started him on insulin. by the day of surgery, his sugars remained elevated but were improved from prior to admission. his insulin regimen was lantus 15 units and sliding scale humalog. during his post-operative course he was on dexamethazone and his sugars were difficult to control. he was placed on an insulin drip for > 24 hours. diabetes consult was obtained. he was transferred to a sliding scale and po meds were discontinued. his sliding scale insulin and morning lantus doses were adjusted and weaned consult in the setting of steroid taper. #dvt - he reports having a history of at least 2 prior dvts. was diagnosed with dvt prior to admission, had been on lovenox. was placed on a heparin gtt during this admission given his pending surgery. heparin was turned off approximately 6 hours prior to his surgery. post operative day #1 he was asa was restarted and on post-operative day #2 his plavix was restarted. on he was started on coumadin. #cad s/p mi - had cardiac cath in which did not show any significant lesions. he was continued on his home metoprolol, valsartan and amlodipine. he was continued on his cardiac meds on the day of the operation. #diastolic chf - tte from osh showed an ef of 50%. there were no clinical signs of volume overload, was given gentle fluids on the day of surgery while he was npo. #osa - was continued on cpap while he was an inpatient. on he was cleared for discharge home after being seen by pt. pain was well controlled, tolerating a po diet, voiding without difficulty and ambulating independently. he received insulin training prior to discharge and will have vna at home for furhter training. family was in agreement with this plan. medications on admission: 1. simvastatin 80 mg qday 2. glipizide 10 mg po bid 3. irbesartan 300 mg daily 4. amlodipine 5 mg daily 5. furosemide 20 mg daily 6. dexamethasone 4 mg daily 7. phenytoin 100 mg tid 8. aspirin 81 mg daily 9. clopidogrel 75 mg daily 10. metoprolol xr 100 mg 11. omeprazole 20 mg po daily 12. aspirin 81 mg daily 13. keppra 1000mg po bid 14. lovenox 120 sc bid discharge medications: 1. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 2. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). :*30 capsule, delayed release(e.c.)(s)* refills:*2* 4. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). :*120 tablet(s)* refills:*2* 5. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 6. valsartan 80 mg tablet sig: two (2) tablet po daily (daily). 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 10. warfarin 5 mg tablet sig: one (1) tablet po once a day: check inr on or . further dosing by pcp. :*30 tablet(s)* refills:*2* 11. dexamethasone 1 mg tablet sig: taper tablet po taper for 4 days: 1mg po qday on & . 0.5mg po qday on then d/c. :*qs tablet(s)* refills:*0* 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 13. insulin glargine 100 unit/ml solution sig: fifty five (55) units subcutaneous once a day: decrease to 35 units daily when taking 1mg dexamethasone daily and decrease to 25 units daily when taking 0.5mg dexamethasone daily. :*1 vial* refills:*3* 14. humalog 100 unit/ml solution sig: per sliding scale units subcutaneous before meals. :*1 vial* refills:*2* 15. diabetic supplies, miscellan. kit sig: one (1) kit miscellaneous as directed. :*1 kit* refills:*2* 16. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). :*30 patch 24 hr(s)* refills:*2* 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses: meningioma s/p resection hyperglycemia secondary diagnoses: cad diastolic chf osa discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: general instructions ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? your wound closure uses dissolvable sutures, you may shower after 3 days. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????please return to the office in days(from your date of surgery) for removal of your staples/sutures and/or a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????you have an appointment in the brain clinic on at 1pm. the brain clinic is located on the of , in the building, . their phone number is . please call if you need to change your appointment, or require additional directions. ?????? you need to follow up with your primary care physican early next week (mon or tues) to check on coumadin dosing/inr and blood sugars. you were seen in house by diabetes. you should follow up with dr. for titration of the insulin as you stop the steroids (decadron). the timing and need for this can be discussed with your pcp. phone number at diabetes is . procedure: excision of lesion or tissue of cerebral meninges other repair of cerebral meninges other computer assisted surgery diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids compression of brain other and unspecified hyperlipidemia benign neoplasm of cerebral meninges long-term (current) use of anticoagulants diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled acute venous embolism and thrombosis of deep vessels of proximal lower extremity chronic diastolic heart failure 

Answer: The patient is high likely exposed to