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: respiratory arrest, acute copd exacerbation major surgical or invasive procedure: intubation and extubation central line placement and removal history of present illness: ms. is a 68yo f with history of copd who reportedly had cough and runny nose and called ems. she developed dyspnea while in the ambulance and required lma for respiratory support. she became pulseless and cpr was initiated for approximately 30 seconds before she regained spontaneous circulation. no shocks or medications were administered. in the ed, patient was emergently intubated with etomidate and succinylcholine. she was moving all 4 extremities prior to sedation. she then became hypotensive and was started on levophed through a r ij central line. patient was given fentanyl/versed for sedation and started on vanc/zosyn. her ekg showed sinus rhythm at 77 with cor pulmonale but no st changes. the post-arrest team was consulted and recommended against cooling given short period of pulselessness. blood cultures were drawn after initiation of antibiotics, and she received 5 liters of ivf. vitals on transfer were 74, 141/56 on 0.05mcg/kg/min, 20, ac 450x20, 100%, 5 peep. in the icu, she was intubated and sedated. her icu course was significant for subsequent extubation, steroids and completion of antibiotic course. she had no significant delirium following extubation, but did note persistent dyspnea and hypoxia. past medical history: copd raynaud's phenomena tobacco dependence social history: lives with husband, they own and run a grocery store/deli. patient worked until admission. known tobacco use long-standing, current. denies regular alcohol or illicit drug use. family history: daughter healthy, lives in area, no lung disease. physical exam: admission to icu vitals: t: 98.4 bp: 107/41 p: 80 r: 13 o2: 95% ac general: intubated, sedated, not following commands but withdraws to pain heent: nc/at, perrl, sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated lungs: bilateral coarse breath sounds on vent without clear wheezing or rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley ext: bilateral hands and feet cool and dusky (history of raynaud's), bilateral dp pulses dopplerable, no clubbing or edema discharge examination: (pertinent findings) patient 90-92% in 1l nc at rest, 2l with ambulation. mild dyspnea with extended conversation. axox3 without agitation, no jvd lungs with diffuse scattered rhonchi without wheezes, distant lung sounds. cv: regular, normal s1s2 abdomen benign, positive bs ext: no pitting edema. pertinent results: . studies: cxr : findings: single supine ap portable view of the chest was obtained. endotracheal tube is seen, terminating approximately 4 cm above the level of the carina. nasogastric tube is seen, coursing below the level of the diaphragm, terminating in the expected location of the stomach. the lungs are clear relatively hyperinflated, with relative lucency in the upper lobes, suggesting chronic obstructive pulmonary disease. no focal consolidation, pleural effusion, or definite pneumothorax is seen. two curvilinear opacities projecting over the left upper lobe and right lung apex are not present on subsequent imaging at 20:20 the same day. cardiac and mediastinal silhouettes are unremarkable. . ct : impression: 1. no acute intrathoracic process. 2. severe pulmonary emphysema, with multiple nodules and extensive scarring. recommend correlation to prior imaging; if unavailable, followup ct in months is recommended. 3. nasogastric tube terminates at the ge junction; recommend advancement so that it is well within the stomach. 3. severe atheromatous disease, with probable chronic mesenteric ischemia. . ct head w/o : impression: 1. no acute intracranial process. 2. mild paranasal sinus disease. . cxr : findings: there is an endotracheal tube in situ, the tip of which is approximately 3.5 cm proximal to the carina. the heart and mediastinal contours are within normal limits. there is no acute consolidation. no pleural effusion is seen. coarse lung markings are seen in addition to hyperinflation suggesting copd. a nasogastric tube is noted, the tip of which is below the diaphragm. there is a right internal jugular central venous catheter, the tip of which projects over the svc. impression: no acute consolidation. support hardware is as outlined above. . cxr : impression: no evidence of pneumonia. little interval change. . cxr : findings: in comparison with the study of , the endotracheal tube has been pulled back to approximately 4 cm above the carina. continued hyperexpansion of the lungs consistent with chronic pulmonary disease. indistinctness of pulmonary vessels suggests some superimposed elevation of pulmonary venous pressure. . micro: bcx : pending ucx : negative urine culture (final ): no growth. . legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. . sputum cx: **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. haemophilus influenzae, beta-lactamase negative. sparse growth. beta-lactamse negative: presumptively sensitive to ampicillin. confirmation should be requested in cases of treatment failure in life-threatening infections.. . **final report ** respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. . sputum cx : **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. admission labs: 08:20pm urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-2* ph-5.0 leuk-neg 08:20pm urine color-yellow appear-hazy sp -1.014 . discharge labs: brief hospital course: hospital course: ms. is a 68yo f with history of copd here after cardiac arrest likely in setting of respiratory failure and acidosis. pt was cared for in the micu where she was intubated. her hd status was monitored, and she required brief pressors. she was treated initially with broad spectrum abx given hypotension and concern for pna on top of copd exacerbation. pt was initially extubated on hod#2, but had increasing agitation and did not tolerate bipap and was reintubated. reintubation was complicated by hypotension likely propofol induction, requiring pressors. abx were tailored to ctx for haemophilus in the sputum for planned 10 day course. she was continued on steroids with a taper. she was re-extubated on hod#5. # post cardiac arrest: she likely had a pea arrest in setting of respiratory failure. the post-arrest team was already consulted in the er and recommended against cooling given short period of pulselessness. she was started on levophed for hypotension in setting of intubation and had dusky extremities but this was in setting of known raynaud's and reportedly common for patient. patient was started on broad spectrum antibiotic coverage for possible sepsis. pe was unlikely given her lack of findings on cta. mi was unlikely given her reassuring ekg and her elevated troponin is likely related to myocardial leak from cpr. serum and urine tox were remarkable for positive urine benzos but otherwise negative which suggested against ingestion. her lactate and ldh elevations were likely in the setting of ischemia from arrest. troponins were negative times three. her hd status improved and she was weaned off pressors. # respiratory failure/copd: her respiratory thought to be related to underlying infection causing her uri symptoms of cough and runny nose or copd exacerbation. her chest xray and ct do not show any clear consolidation but her rll opacity could be a developing pneumonia or related to aspiration during cpr. she was extubated the morning following admission and tolerated bipap for most of the day, however later that evening there was concern she was not tolerating bipap well and was reintubated, became hypotensive to propofol required brief levophed, got more ivf's, bronch showed thick secretions at carina. added tobramycin for double pseudomonal coverage. ctx grew out h flu and her abx were peeled back to ceftriaxone and cap. she completed a course of azithromycin for copd exacerbation. on hod#5, pt was re-extubated and tolerated this well, and was able to be weaned to nasal cannula. she was placed on standing nebs, and transferred to the medicine floors. on the floor she was started on spirvia daily and continued on albuterol nebs prn. she was continued on ceftriaxone and cefpodoxime to complete her 10 day course. she was placed on a slow prednisone taper. pt evaluated her and felt that she should go to rehab. she was initially resistant but after doing poorly with physical therapy, agreed to go to rehab. of note her cta on admission showed sequelae of pulmonary hypertension and was concerning for severe copd. the patient was set up with a pulmonary appointment at and will need formal pfts. she also should likely have a tte given concern for pulmonary hypertension. # acute haemophilus pneumonia: pt with thick secretions from bronch as above. sputum cx prior to reintubation grew haemophilus. he was treated with ceftriaxone and discharged home to complete a 10 day course with cefpodoxime. # hypotension: pt had hypotension with reintubation, thought to be most likely propofol. she required brief pressors, which were weaned off. this resolved completely on hod#4. # atrial flutter with rvr: pt had runs of aflutter, likely copd, with rates in 150s, requiring dilt while on cpap. once pt reintubated, this resolved. pt was in sinus rhythm prior to transfer to medicine floors. she was started on asa 325 mg daily for chads2 score of 2 and started on diltiazem for bp and rate control (patient likely to go back into a.fib at some point in the future given right heart strain on ct/plumonary hypertension). # transaminitis: most likely shock liver in setting of pea arrest. lft's were trended, and improved prior to transfer to medicine floor. # htn: pt became quite hypertensinve in icu to sbp 180s in the micu. captopril was initially started and transitioned to lisinopril 40 mg daily. diltiazem was started and uptitrated to diltiazem 360 mg daily. chlorthalidone 25 mg daily was started. she has pcp follow up early next week for blood pressure check. # severe atheromatous disease seen on cta: concerning for vascular disease. lipids were checked and were not very elevated, however she was started on simvastatin 40 mg daily due to the findings on ct. hgba1c was checked and was 6.2%. transitions of care: - patient will need repeat chest ct in months due to multiple nodules seen on chest ct here. - check labs in 2 weeks for monitoring of creatinine/electrolytes on new bp meds. - check lfts in 6 weeks on new statin. - follow bp and uptitrate/add more antihypertensives as necessary - the patient noted that she had not sought regular preventive care in quite some time, and was aware of the importance of follow-up with a new provider following her rehabilitation stay. medications on admission: albuterol prn discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*1* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*1 cap(s)* refills:*2* 4. diltiazem hcl 360 mg capsule, extended release sig: one (1) capsule, extended release po once a day. disp:*30 capsule, extended release(s)* refills:*2* 5. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. prednisone 10 mg tablet sig: see taper below tablet po once a day for 7 days: take 20 mg (2 tablets) for 2 days. then take 10 mg (1 tablet) for 2 days. then take 5 mg ( tablet) for 2 days. . disp:*7 tablet(s)* refills:*0* 7. calcium 500 + d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 8. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 9. chlorthalidone 15 mg tablet sig: one (1) tablet po once a day. 10. lab work please check chemistries, bun, and creatinine on and one week afterward to assess tolerance of anti-hypertensive medications. discharge disposition: extended care facility: center discharge diagnosis: primary: h. flu pneumonia hypercarbic respiratory failure copd exacerbation atrial fibrillation with rapid ventricular response hypertension diabetes type ii discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital due to difficulty breathing from a pneumnia and an exacerbation of your chronic obstructive pulmonary disease (copd). while you were being transferred to the hospital there was concern your heart was not able to pump blood effectively to the rest of your body for a very short period of time. when you arrived in the ed you were intubated (a breathing tube was placed). while in the icu you were extubated, but then reintubated due to difficulty with your breathing. your pneumonia and copd exacerbation were treated and you were able to be extubated. you will need pulmonary function tests and an echo of your heart as an outpatient. you were diagnosed with high blood pressure (hypertension) and started on multiple medications to control your pressure. on the chest ct on admission you were seen to have multiple nodules of unknown significance. it is recommended that you undergo a repeat ct scan of the chest in months to check for change in the nodules. you will need labs checked within a couple of days after you are discharged. it is also important that you acapella device to help your breathing. medication changes: start prednisone taper: - take 20 mg (2 tablets) for 2 days. - then take 10 mg (1 tablet) for 2 days. - then take 5 mg ( tablet) for 2 days. start spiriva daily (this treats your copd) start aspirin 325 mg daily start lisinopril 20 mg daily (this treats your high blood pressure) start dilitiazem 360 mg daily (this treats your high blood pressure) start chlorthalidone 15 mg daily (this treats your high blood pressure) start simvastatin 40 mg daily (this treats your cholesterol) continue using albuterol 2 puffs every 4 hours as needed for shortness of breath. followup instructions: you will need to establish care with a primary doctor and see a pulmonary specialist in follow up. it is important that you keep th following appointments: name: , k. location: healthcare - address: , , , phone: department: pulmonary function lab when: wednesday at 3:40 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: wednesday at 4:00 pm with: dr. & dr. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube insertion of endotracheal tube arterial catheterization closed [endoscopic] biopsy of bronchus cardiopulmonary resuscitation, not otherwise specified central venous catheter placement with guidance diagnoses: tobacco use disorder unspecified essential hypertension obstructive chronic bronchitis with (acute) exacerbation atrial flutter acute respiratory failure hypotension, unspecified cardiac arrest raynaud's syndrome influenza with pneumonia mixed acid-base balance disorder 

Answer: The patient is high likely exposed to