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: patient recorded as having no known allergies to drugs attending: chief complaint: dyspnea, hemoptysis major surgical or invasive procedure: icu monitoring history of present illness: 79 yo m with known metastatic nonsmall cell lung ca (mets to t-spine) p/w episodes every 2 hours of coughing up blood starting last night at 2300. associated with dyspnea over the past 2 days to the extent that he was unable to get out of bed yesterday. also, he had nausea and one episode of post-tussive emesis. he felt feverish and had chills last night, but did not take his temperature. he denies chest pain or abdominal pain. denies trauma. . in the ed, initial vs were: t 94.6f p afib 113 bp 92/50 r 20 o2 sat 90% on 2l nc. patient was given levaquin 750mg iv x1 for cxr showing lll infiltrate and effusion. the ekg showed afib with ventricular rate of 113, na, ni with no ste or changes from previous tracing. cta chest negative for pe, but showed tumor burden in l hilum with likely post-obstructive pneumonia in the setting of a left-sided pleural effusion. . on the floor, the patient had no complaints and was speaking in full sentences. . past medical history: # stage iv adenocarcinoma of the lung dx by bronchoscopy, mri with bony mets to t11, 50-75% narrowing of spinal canal and mild to moderate spinal cord compression. treatment: 1. status post palliative thoracic spine radiation to t9-t12 thoracic spine. total of 800 cgy (1 dose) completed . 2. status post cycle 1 of carboplatin 6 auc, paclitaxel 200 mg/m2 and anamorelin vs placebo as part of dfhcc 07-369. c1d1 given on . 3. status post cycle 2 of carboplatin 4.5 auc, paclitaxel 180 mg/m2 and anamorelin vs placebo as part of dfhcc 07-369. c2d1 given on . # dm2 # atrial fibrillation # htn # chronic renal failure # anemia # hyperlipidemia # copd social history: -tob: quit in , approx 150 pk yrs, + asbestos exposure -etoh: quit in -illicits: none -occupation: used to be a operator family history: no family history of lung cancer physical exam: vitals: t: 97 bp: 123/51 p: 113 r: 21 18 o2: 99/4l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, trace dried blood on lower lip neck: supple, jvp not elevated, no lad lungs: diminish bs l>r, scattered rales and rhonchi heard throughout cv: , normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, protuberant, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema ===================== discharge examination: vitals: tc 96 tm 96.7 bp 110/66 hr 104 rr 20 o2 sat 96% on 2l gen: well appearing, nad heart: irregularly irregular, s1/s2 present, -mrg lungs: diminished breath sounds at bases, scattered wheezes abd: +bs, soft, non-tender, non-distended ext: + le edema pertinent results: admission labs: 01:40pm blood glucose-162* urean-30* creat-0.8 na-134 k-4.6 cl-99 hco3-28 angap-12 01:40pm blood phos-3.3 mg-1.7 01:49pm blood lactate-2.0 01:40pm blood ck-mb-notdone probnp-7277* 01:40pm blood ck(cpk)-35* 01:40pm blood pt-15.9* ptt-31.7 inr(pt)-1.4* 01:40pm blood wbc-4.0# rbc-2.18*# hgb-7.2*# hct-21.0*# mcv-96 mch-33.1* mchc-34.3 rdw-17.3* plt ct-76*# 01:40pm blood neuts-87.6* lymphs-9.4* monos-2.4 eos-0.4 baso-0.3 09:56pm blood hct-19.0* 09:56pm blood pt-16.4* ptt-32.8 inr(pt)-1.5* ------- ------- discharge labs: 06:10am blood wbc-13.3* rbc-2.77* hgb-8.6* hct-24.6* mcv-89 mch-31.3 mchc-35.1* rdw-17.6* plt ct-74* 06:10am blood glucose-101 urean-14 creat-0.6 na-134 k-4.4 cl-95* hco3-34* angap-9 . . cxr: findings: portable upright ap chest radiograph is obtained. when compared with the prior radiograph there is interval increase in left basilar opacity compatible with effusion and likely post-obstructive atelectasis or pneumonia. increased vague opacity in the left mid lung is also concerning for post- obstructive pneumonia. left hilar mass is suboptimally assessed. right lung remains clear. impression: post-obstructive pneumonia and atelectasis in the left mid and lower lung with associated effusion. . cta chest: impression: 1. no pulmonary embolus. 2. left hilar mass results in total occlusion of the left upper lobe bronchus and near complete obstruction of the lingular bronchus. probable postobstructive atelectasis and pneumonia is present within the left upper lobe with probable lymphangitic carcinomatosis in the left upper lobe. 3. increased bilateral pleural effusions. 4. tree-in- opacification in the right lung and left lower lobe concerning for a small airways disease process including aspiration and/or infection. 5. marked attenuation of the pulmonary arteries supplying the left upper lobe and lingula. unchanged thrombus in the left superior pulmonary vein. 6. new t11 pathologic compression fracture with slight retropulsion of the vertebral body into the canal. unchanged t10 metastasis. mr is recommended to for further evaluation of the spinal cord. ------------ arterial embolization report3/11/09: tumor blush was visualized at the left hilar mass. the left bronchial artery feeding to the tumor at the left hilum, was embolized with particles until stagnation of the flow. cxr : no pneumothorax. left pleural effusion decreased brief hospital course: this is a 76 year old family who presented from home with hemoptysis. # hemoptysis: this was likely secondary to bleeding from patient's lung cancer which is now obstructing his left main bronchus. on admission hematocrit was 19 and patient transfused two units. he was observed to have continued hemoptysis and required an additional two units of blood. patient underwent flexible bronchoscopy on by interventional pulmonology with apc to active bleeding on tumor site. interventional pulmonology recommended left pulmonary artery embolization in order to more effectively prevent tumor bleeding. on patient underwent left artery embolization by interventional radiology with good effect. patient's hemoptysis has nearly resolved at time of discharge. patient's aspirin is being held given his risk of bleeding. # hypoxia/post-obstructive pneumonia/bilateral pleural effusions: on admission patient determined to have postobstructive atelectasis and pneumonia on chest ct. pna initially treated with unasyn and transitioned to levaquin for a total of 10 day course. sputum cultures have grown mixed oral flora. hypoxia improved with treatment of pna. in addition patient noted to have bilateral pleural effusions. he underwent therapeutic thoracentesis on with good effect however fluid re-accumulated and patient underwent placement of a pleurx cathether on which can continue to be drained. patient is sating in the mid to high 90's on 2 liters of oxygen at time of discharge. oxygen via nasal cannula should continue to be weaned as tolerated to maintain sats >93%. # atrial fibrillation: patient noted to be in atrial fibrillation with rapid ventricular response to 150's. patient treated with bolus doses of intravenous metoprolol and oral metoprolol titrated up to 100mg tid (100mg at home). patient was also continued on his outpatient regimen of digoxin. heart has stabilized in the high 90's and blood pressure has remained stable. # pancytopenia: likely secondary to recent treatment with pemetrexed (last dose ). blood cell count has risen to normal range. platelet count is is trending up. would anticipate that platelet would continue to increase. # right arm swelling: ulstrasound did not indicate a deep venous thrombosis. # non-small cell lung cancer: patient followed by dr. . he is cycle 2 of pemetrexed on . he is scheduled to follow up with dr. on . # back pain: patient has known metastasis to the spine with a particularly symptomatic lesion at t11 which he has received palliative radiation and more recently cyberknife therapy in . pain control much improved after patient switched from fentanyl patch 25 mcg/vicodin to fentanyl patch 50mcg/msir combination. patient may require continued increased titration of his current pain medication regimen to achieve comfort. # type ii diabetes mellitus: patient has diet controlled diabetes. #copd: patient had increased wheezing at time of discharge. he will certainly require pulmonary rehab, pulmonary toilet and incentive spirometry. he was continued on his outpatient regimen of fluticasone-salmeterol. his tiotropium bromide was changed to ipratropium bromide and xopenex was added to his regimen for wheezing/shortness of breath prn. we prefer he receive xopenex rather than albuterol given he has an underlying tachyarrthymia. patient was dnr/dni on this admission. code status discussed with patient and family members. medications on admission: albuterol - 90 mcg aerosol - 2 puffs qday dexamethasone - 4 mg tablet - 1 tablet(s) by mouth twice a day day before chemotherapy, and for 2 days following chemotherapy. digoxin - 125 mcg tablet - daily fentanyl - 25 mcg/hour patch 72 hr fluticasone-salmeterol - 250 mcg-50 mcg/dose disk with device - 1 puff intraoral twice a day folic acid - 1 mg tablet - daily hydrocodone-acetaminophen - 5 mg-500 mg tablet - tablet(s) by mouth every 6 hours as needed for pain for cancer-related pain lorazepam - 1 mg tablet - 1 tablet(s)(s) by mouth every 12 hours chemotherapy-induced nausea or anxiety metoprolol tartrate - 100 mg tablet - twice a day simvastatin - 20 mg - daily tiotropium bromide - 18 mcg capsule, w/inhalation device - 1 capsule orally daily . medications - otc aspirin - 325 mg tablet - daily blood sugar diagnostic check fs qid as needed for dm lancets - misc - check once a day nut.tx.gluc.intol,lac-free,soy - liquid - 2 bottles by mouth twice a day discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: 1 puff disk with device inhalation (2 times a day). 2. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: 0.5 tablet po daily (daily). 5. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10ml mls po q4h (every 4 hours) as needed for cough. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): apply for 12 hours at a time to lower back. 10. magnesium oxide 140 mg capsule sig: two (2) capsule po twice a day. 11. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours): take with food and water. 12. morphine 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 13. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed for constipation. 14. fentanyl 50 mcg/hr patch 72 hr sig: one (1) transdermal every seventy-two (72) hours. 15. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) inhalation qid (4 times a day) as needed for shortness of breath, wheezing. 16. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). discharge disposition: extended care facility: bear nursing center - discharge diagnosis: primary: hemoptysis secondary to left lung mass bleeding, atrial fibrillation with rapid ventricular response, post obstructive pneumonia secondary: stage iv non small cell lung cancer, spinal compression fracture at t11 secondary to lung cancer metastases, chronic obstructive pulmonary disease, type ii diabetes mellitus (diet controlled), hypertension, hyperlipidemia discharge condition: hemodynamically stable discharge instructions: you were admitted to the hospital for management of the blood you were coughing up. we determined that the blood in your lungs represented active bleeding from your lung tumor. you underwent two procedures to stop the bleeding, which have been successful. you were also treated for a pneumonia. your breathing has improved though you are still requiring oxygen. during your hospital stay your heart rate became very fast as a result of your atrial fibrillation. we have had to increase your dose of metoprolol to achieve better rate control. you have also had difficulty urinating which has required foley catheter placement. we will discharge you with the foley in place. we have made an appointment for you to follow up with urology. please take all medications as directed and attend all follow up appointments. if you begin coughing up blood, experience worsening shortness of breath or have fevers or chest pain please contact your primary oncologist or go to the emergency department for evaluation. followup instructions: you have an appointment to follow up with dr. in urology on at 9:00am. the office is located in building . the office phone number is (. you will need to follow up in interventional pulmonology clinic in two weeks to have the sutures securing your pleurx catheter removed. please call to schedule an appointment. you will need to schedule an appointment to see dr. in 2 weeks. his office phone number is (. you have an mri scheduled for at 1:00pm on the , building . the number for mri scheduling is (. procedure: insertion of intercostal catheter for drainage thoracentesis injection or infusion of other therapeutic or prophylactic substance aortography transfusion of packed cells diagnostic ultrasound of other sites of thorax diagnostic ultrasound of other sites of thorax diagnostic ultrasound of other sites of thorax diagnostic ultrasound of other sites of thorax transfusion of platelets endoscopic excision or destruction of lesion or tissue of lung diagnoses: pneumonia, organism unspecified unspecified pleural effusion acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation chronic kidney disease, unspecified pulmonary collapse other and unspecified hyperlipidemia malignant neoplasm of upper lobe, bronchus or lung antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow neoplasm related pain (acute) (chronic) personal history of contact with and (suspected) exposure to asbestos myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae swelling of limb other specified aplastic anemias 

Answer: The patient is high likely exposed to