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: keflex attending: chief complaint: left parapharyngeal mass major surgical or invasive procedure: on : 1. facial nerve monitoring. 2. laryngeal nerve monitoring. 3. transcervical resection of left glomus vagale tumor. 4. transcervical resection of left carotid body tumor. 5. left mastoidectomy with sigmoid decompression history of present illness: the patient is a 38 yo female with bilateral carotid body tumors and a large left skull base paraganglioma/left vagus glomus tumor. 3d ct angiogram demonstrated a glomus vagale 4.1x 2.2x 1.8cm that extends from below the region of the carotid bifurcation and up to the skull base. it does not enter the jugular foramen. she also has a small carotid body tumor on the contralateral side that is 1.7x 1.3x 2.1cm. an octreotide scan had tracer uptake in the area of the left glomus vagale. however, the carotid body tumor had no uptake. the spect/ct images also demonstrate a 5-mm nodule in the left anterior lung without evidence of tracer uptake. the patient carries the sdhd gene. she has been tested and found to have normal plasma normetanephrine, an undetectable calcitonin, and a normal ionized calcium. she underwent preoperative embolization which was successful for an upper portion of the tumor, however, a separate portion which was smaller and inferior could not be embolized adequately. in addition to this tumor, she has a contralateral carotid body tumor. past medical history: left vagal glomus tumor, as above bilateral carotid body tumors, as above hypertension. gastroesophageal reflux. head injury . question of history of disease. social history: she is employed as an executive administrator and is married. she currently smokes and has for 22 years. she has six to eight alcoholic drinks per month. family history: postive for fh of paragangiomas and pheochromocytomas. brother treated for malignant paraganglioma. + sdhd gene physical exam: on admission: 97.4, 66, 117/73, 20, 99% on room air nad, a&ox3 eomi, perrl cnii-xii intact, face symmetric full neck rom, soft, no lad oc/op: clear, no lesions, uvula midline cv: rrr, no murmurs lungs ctab abdomen soft, ntnd extremities warm and well perfused, faint peripheral pulses in lower extremities bilaterally. pertinent results: 09:01pm wbc-16.0* rbc-3.58* hgb-11.2* hct-31.5* mcv-88 mch-31.1 mchc-35.4* rdw-12.8 09:01pm plt count-251 09:01pm pt-12.8 ptt-25.0 inr(pt)-1.1 brief hospital course: the patient is a 38 year old woman with history of bilateral carotid body tumors and left glomus vagale who was admitted pre-operatively on . she had undergone pre-operative embolization, which she tolerated without issue. she was taken to the or on for left mastiodectomy, sigmoid decompression, transcervical resection of left glomus vagale tumor and resection of left carotid body tumor with facial and laryngeal nerve monitoring. for details, please see separately dictated note by dr. and dr. . the patient tolerated procedure without complications. she was taken to the icu for first 24 hours for monitoring of neurological status, which remained stable, and was thereafter transfered to the floor. the details of her hospital course are reviewed below by ststems: neuro: postoperatively, the patient was taken to the icu for closer monitoring of her vital signs and neurological function, given the proximity of the surgery to the carotid artery. her exam remained stable and she was transfered to the floor on pod 1. regarding her cranial nerve exam, post-operatively, she was noted to have some weakness with tongue movement to the left (left cn xii) as well as paralysis of the left true vocal cord, deceased peristalysis of left pharyngeal wall with some pooling of secretions on that side which was anticipated given intra-op resection of the left vagus nerve. as a result of anticipated difficulty with pos, an ngt was placed on pod #1; on pod #4, after evaluation by speech and swallow, a diet was initiated with compensatory maneuvers (see below) for her nerve deficits. pain was initially controlled with iv dilaudid while she was npo. after ngt placement on pod1, she was transitioned to pain medications through the ngt with good effect. cv: she had elevated bp to sbp 160-180 in the initial post-operative days which were attributed to pain and hemodynamic re-adjustment after carotid body removal. her blood pressure normalized by pod #5. she was instructed to follow-up with pcp as an outpatient to have her blood pressure monitored. resp: the patient had oxygen saturations >95% throughout admission. she demonstrated good cough and was able to control her oral secretions. she used suctioning as needed to help with any excess oropharyngeal secretions and arrangement were made for suction machine at home. gi: in light of vagus nerve resection secondary to the tumor, she was initially kept npo pending further evaluation. an ngt was placed on pod #1 and she was started on continuous tube feed diet with replete with fiber @ 60 cc/hr. nutrition was consulted who agreed with plan. speech/swallow was consulted on pod #4 and she underwent a video floroscopic examination to evaluate pharyngeal swallowing mechanism and aspiration. she had decrease mobility of the left side of her pharynx with some pooling on the left side, but this was compensated for by head turn to left, chin tuck and hand pressure to left neck. she was cleared for a pureed, moist thin food with thin liquid diet, which she tolerated. she was instructed on signs/symptoms to look for in terms of aspiration. she was discharged with a plan to continue on cycled tube feeds nocturnally with replete with fiber @ 80 cc/hr x 14 hrs and and diet as above with oral nutrition supplements as tolerated. she is to follow-up with nutrition and speech/swallow as an outpatient. gu: the patient voided throughout admission without signs of retention or uti. heme: the patient ambulated frequently and was given sch for dvt prophylaxis during admission. endo: no issues id: the patient recieved perioperative antibiotic prophylaxis with clindamycin until the drain was removed. her wound remained clean, intact and with erythema or signs of infection. she was afebrile throughout her hospital stay. wound: the patient had a neck drain in place, which was removed on pod#3 as it met output criteria. her neck incision is closed with sutures which will be removed as an outpatient. her wound remained clean, dry and intact. patient is being discharged , pod #5, to home with vna services: afebrile, tolerating regular tube feeding via ngt with pureed, moist food with thin liquid oral diet, pain well controlled on oral/per tube medication, voiding, and ambulating well. patient will follow-up with dr. and dr. in 1 week, nutrition and speech and swallow in weeks as well as her primary care physician weeks. medications on admission: tylenol prn discharge medications: 1. acetaminophen 650 mg/20.3 ml solution sig: one (1) 650 mg po q6h (every 6 hours) as needed for pain: po or via ngt. 2. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4h (every 4 hours) as needed for pain: po or via ngt. disp:*350 ml(s)* refills:*0* 3. tube feeding supplies tube feeding tansfusion pump tube feeding transfusion supplies 4. suction machine suction machine for suctioning of excess oral secretions 5. tube feeding: replete with fiber rx: replete with fiber nutrition supplement patient to received 80 ml/hr x 14 hours daily. dispense: 1 month supply. refill: 3 months discharge disposition: home with service facility: care discharge diagnosis: 1. glomus vagale left neck/skull base. 2. carotid body tumor left neck. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: seek immediate medical attention for fever >101.5, chills, increased redness, swelling or discharge from incision, chest pain, shortness of breath, or anything else that is troubling you. ok to shower. no strenuous exercise or heavy lifting until follow up appointment, at least. do not drive or drink alcohol while taking narcotic pain medications. narcotic pain medications may cause constipation, if this occurs take an over the counter stool softener. resume all home medications. call dr. office at and dr. office at to make follow up appointment to be seen in 1 week. call speech and swallow to schedule follow-up in weeks. follow-up with your pcp weeks. followup instructions: 1. call dr. office at to make follow up appointment to be seen in 1 week. 2. call dr. office at to schedule a follow-up appointment in 1 week. 2. call speech and swallow team at to schedule follow-up in weeks. 4. call nutrition at to schedule a follow-up appointment in weeks as you are weaning off of tube feeds and taking more pos to adjust your tube feed requirements. 5. follow-up with your pcp weeks. please have you hr and blood pressure checked at this time. procedure: enteral infusion of concentrated nutritional substances arteriography of cerebral arteries other mastoidectomy endovascular (total) embolization or occlusion of head and neck vessels other excision or avulsion of cranial and peripheral nerves other operations on carotid body, carotid sinus and other vascular bodies diagnoses: esophageal reflux unspecified essential hypertension unilateral paralysis of vocal cords or larynx, partial neoplasm of uncertain behavior of paraganglia 

Answer: The patient is high likely exposed to