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: codeine / keppra attending: chief complaint: shortness of breath major surgical or invasive procedure: ridig bronchoscopy with stent placement then stent removal history of present illness: the patient is a 63 year-old man pmh follicular/variant papillary thyroid ca s/p total thyroidectomy and radical neck dissection in along with radioactive iodine as recently as , surveillance scanning revealing pulmonary nodules and hilar lymphadenopathy in with subsequent pet-ct demonstrating fdg-avidity to these areas as well as to bone. . since that time, he was additionally found to have cranial metastases found to be thyroid ca mets at craniotomy, and other scattered bone mets including, among others, thoracic and lumbar vertebrae. he cranial and bone xrt as well as chemotherapy with at first sorafenib then sutent after progression of disease. sutent was most recently stopped in after he developed a peri-met intraparenchymal hemorrhage. . he presented to clinic on complaining of shortness of breath and wheezing with a saturation of 94% on room air. he received cta for pe and ruled out mi, but did not want to be admitted for workup and left ed ama. . he re-presented on , with progressive dyspnea at rest and wheezing and subjective fevers. cxr suggested possible post obstructive pna so he was placed on levaquin and flagyl. he felt well but kept desatting. ip consulted who felt he had a post-obstructive collapse on the left side and planned to bronch. . on , he flexible and rigid bronchoscopy which revealed a near-complete obstruction of the left mainstem bronchus endobronchial lesion with near complete obstruction of the airway. epinephrine 1:10,000 applied followed by argon plasma coagulation done, followed by coring out and excision of the tumor. left mainstem patency was restored, only 15% residual obstruction remained. the lul and lll showed near complete obstruction, so mechanical debridement and argon plasma coagulation done to the distal left mainstem and lul and lll bronchi with only mild improvement of the patency. balloon dilatation to 12mm was done followed by deployment of a 12mm x 40mm after lms dimensions measured. balloon dilation within the stent also done. . the patient was transferred to pacu post-procedurally and was subsequently extubated. shortly thereafter, he developed desaturations, respiratory distress, and tachypnea. he was subsequently re-intubated. cxr showed complete opacification of the left hemithorax. bronchoscopy was performed again, and an occlusive mucuous plug of the left mainstem stent site was removed. he remained intubated post-procedure. the stent had evidence of migration, and was subsequently removed on . his micu was also complicated by coffee ground emesis; egd preformed did not demonstrate any lesions, and the finding was likely secondary to digested blood from the procedure. he was successfully extubated on but was delerious overnight. his decadron was tapered from 4mg q8 to 4mg q12 on . on arrival to the floor he states that he has a slight cough with white sputum since extubation, but is aox3 and otherwise feeling well. . ros: denies fever, chills, weight change, headache, shortness of breath, wheezing, chest pain or tightness, nausea, vomiting, diarrhea, constipation, melena, brbpr, focal weakness, rash. complete ros was otherwise negative. past medical history: oncologic history: mr. is a 63-year-old gentleman with thyroid carcinoma. in , he noted a lump in the right side of his neck. he was found to have thyroid carcinoma and a total thyroidectomy with right radical neck dissection. 20 lymph nodes were positive. pathology was consistent with follicular versus follicular variant of papillary carcinoma. per his report, he was not treated with radioactive iodine at that time but after a few years, when his thyroglobulin level increased, he received several courses of radioactive iodine. his last course of radioactive iodine was in 9/. ct in showed no recurrent or residual tumor, but there were small scattered pulmonary nodules. in , a neck ultrasound was notable for right posterior triangle lymph nodes. ct chest on showed multiple pulmonary nodules and bilateral hilar lymphadenopathy. pet scan on confirmed fdg avid right hilar lymph nodes, numerous pulmonary nodules, and a lucency in l5 concerning for metastasis. he was asymptomatic and the decision was made to follow him until he became symptomatic. ct chest in showed a slight increase in his pulmonary nodules, along with mediastinal and right hilar lymph node enlargement. in , he developed headaches and diplopia in his right eye. brain mri on showed a large spongy-appearing lesion on the posterior fossa within the calvarium. pet scan of the brain on showed a lytic mass lesion involving the suboccipital skull, centered to the right of midline. mr. craniotomy on . pathology was consistent with metastatic thyroid carcinoma. he completed radiation therapy to his skull on (total dose of 5000cgy) but then developed low back pain. mri l spine on revealed bony metastatic disease most prominent at l1 with extension into the left epidural space. additional metastatic foci were seen at the l4 vertebral body and left t12 transverse process, pedicle and lamina. he started radiation therapy from t12 to s1 on and completed it on . he began sorafenib on and had a significant radiographic response in his parenchymal disease, but his osseous metastases did not respond as well. his sphenoid metastasis was treated with palliative fractionated stereotactic radiotherapy, 2400 cgy in 3 fractions, completed on . he also standard ebxrt to his right pubic bone metastasis, performed with his local radiation oncologist and completed in late /early . he progressed through sorafenib in and developed a metastasis in his right glenoid cavity for which he radiation. he completed radiation around and stopped sorafenib shortly thereafter. he then started sunitinib on at a dose of 50mg po daily x 4 weeks, followed by 2 weeks off, until when he presented with an intraparenchymal hemorrhage due to a right parietal mass. sunitinib was stopped and he right craniotomy for resection of the right parietal mass on . he then completed cyberknife - 2400 cgy in 3 fractions - on . he had progression of his disease but declined further chemotherapy. past medical history: -cervical spinal laminectomy in and -spinal fusion in -, surgery for thyroid mass at medical center -, surgery for mass on his skull -, brain tumor metastasis removed. social history: social history: tobacco: 1ppd x 44 years, quit alcohol: occasional lives with wife, has 2 young adult children occupation: worked in a bindery department of a publisher, now on social security disability. family history: positive for cancer in one brother and heart disease in father. physical exam: on admission: . vs: temp 98.2f, bp 100/60, hr 78, rr 20, sao2 95% ra, pain wt 169.6#, ht 5'6" general: lying bed, nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated lungs: mild crackles at bilateral bases with normal effort, no wheezes 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: warm, well perfused, could not appreciate pulses by palpation. slight edema to midleg bilaterally. neuro: no focal deficits a&ox3 psych: cooperative, interactive . on discharge: . general: 98 (max 98.7), 160/96, 83, 20, 97% ra heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated lungs: mild crackles at bilateral bases with normal effort, no wheezes 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 ext: warm, well perfused, could not appreciate pulses by palpation. slight edema to midleg bilaterally. neuro: no focal deficits a&ox3 psych: cooperative, interactive . pertinent results: 02:55pm wbc-9.9 rbc-3.33* hgb-10.1* hct-29.2* mcv-88 mch-30.3 mchc-34.5 rdw-17.0* 02:55pm neuts-85.3* lymphs-6.4* monos-7.2 eos-0.8 basos-0.2 02:55pm plt count-652*# 02:55pm pt-14.4* ptt-31.7 inr(pt)-1.2* 02:55pm glucose-110* urea n-12 creat-0.6 sodium-133 potassium-4.5 chloride-97 total co2-25 anion gap-16 02:55pm calcium-8.6 phosphate-2.9 magnesium-1.9 02:55pm alt(sgpt)-20 ast(sgot)-28 alk phos-60 tot bili-0.4 02:55pm lipase-8 03:12pm lactate-1.3 . portable cxr: portable upright frontal chest radiograph demonstrates left lower lobe consolidation, which is new compared with prior. given the soft tissue narrowing of the left main bronchus on prior imaging, it is likely that this is post obstructive. again noted is lytic destruction of the left seventh rib. bilateral hilar lymphadenopathy is again evident. there is no effusion or pneumothorax. there is no intraperitoneal free air. impression: 1. interval development of left lower lobe consolidation, which given that it developed over a period of 12 days most likely represents pneumonia. this is likely post obstructive given the appearance of recent imaging. 2. stable appearance of metastatic thyroid cancer within the limits of the chest radiograph. . head ct: there is no intracranial hemorrhage, extra-axial collection, or mass effect. the ventricles and sulci are stable in configuration without evidence of hydrocephalus. note is made of a prominent cisterna magna. a hypodensity in the left insula is stable and probably represents a prominent perivascular space. there are post-surgical changes of right parietal craniotomy. a linear defect within the right temporal lobe is stable in appearance compared with mri of and is certainly postoperative. matter/white matter differentiation elsewhere is preserved. the orbits appear normal. the visualized soft tissues are normal appearing. the mastoid air cells are clear. there is mucosal thickening of the bilateral maxillary sinuses, the sphenoid, ethmoid, and frontal sinuses are clear. there is a stable appearance of lytic osseous destruction of the right sphenoid and occipital bones. impression: 1. no acute intracranial process. 2. post-surgical changes in the right parietal lobe are stable-appearing. 3. stable appearance of right sphenoid and occipital lytic osseous metastases. . cxr there is complete opacification of the left hemithorax with deviation of the cardiomediastinum towards the left consistent with a new left upper lobe collapse. the patient had already left lower lobe collapse. the amount of left pleural effusion cannot be evaluated, probably is small. et tube tip is 4 cm above the carina. there is a new stent in the left main bronchus. minimal opacities in the right upper lobe are new, could be due to atelectasis or aspiration. no evidence of right pneumothorax. . ct chest: 1. interval placement of a left main bronchus stent with opacification within the distal aspect of the stent and resorptive atelectasis of the left lower lobe with mediastinal shift to the left. this could represent mucous plugging within the distal aspect of stent, but soft tissue mass involvement cannot be excluded as the subcarinal region and left main bronchus appear encased by soft tissue mass. 2. small left-sided pleural effusion. 3. numerous osseous and pulmonary metastatic lesions with small new 1.2-cm right upper lobe pulmonary parenchymal lesion and increase in size of left lateral seventh rib lytic destructive osseous mass lesion with associated soft tissue component. 4. mediastinal and hilar lymphadenopathy, likely metastatic. . egd : blood in the esophagus blood in the stomach abnormal mucosa in the stomach otherwise normal egd to third part of the duodenum recommendations: prilosec 40mg for gastritis. this was not the etiology of his coffee ground emesis. no specific etiology of his coffee ground emesis could be found endoscopically. given his recent ip procedure it is possible he swallowed some blood into the stomach. . cxr : current study demonstrates substantial reexpansion of the left lung with resolution of the vast majority of atelectasis, but still present left perihilar consolidation. there is new right basal opacity that might reflect progression of infectious process versus aspiration. there is no pneumothorax. pleural effusion cannot be entirely excluded on the right and most likely present on the left. the et tube tip is in appropriate position. the ng tube tip passes below the diaphragm with its tip not included in the field of view. . cxr impression: 1. progressive improvement in left hemithorax opacification with some persistent retrocardiac opacification. minimal right basilar atelectasis. . lab results on discharge . 07:00am blood wbc-19.2* rbc-3.42* hgb-10.3* hct-31.1* mcv-91 mch-30.3 mchc-33.3 rdw-17.1* plt ct-461* 07:00am blood neuts-86* bands-6* lymphs-3* monos-4 eos-0 baso-0 atyps-0 metas-1* myelos-0 07:00am blood hypochr-2+ anisocy-1+ poiklo-occasional macrocy-normal microcy-normal polychr-normal ovalocy-occasional schisto-occasional acantho-occasional 07:00am blood plt smr-high plt ct-461* 07:00am blood glucose-126* urean-13 creat-0.4* na-139 k-4.0 cl-105 hco3-26 angap-12 07:00am blood calcium-8.2* phos-2.9 mg-2.1 brief hospital course: the patient is a 63 year-old man pmh follicular/variant papillary thyroid ca s/p total thyroidectomy and radical neck dissection in along with radioactive iodine as recently as , s/p multiple chemotherapy regimens who presented with dyspnea with pulmonary mass s/p endobronchial stenting complicated by hypoxemic respiratory failure from a mucous plug requiring intubation, s/p extubation on . . # pulmonary - patient was found to have an airway obstruction on the left side due to a mass. the mass was debrided and a stent was placed on . while in the pacu, a mucus plug obstructed the stent and he desaturated. he was taken back to the suite where the mucus plug was removed and the stent was also removed secondary to migration. the patient remained intubated and stayed in the micu for a few days. his condition improved and he was extubated and sent to the floor. after two days of stable condition on the floor, the patient was deemed ok to go home. he will require home oxygen therapy with ambulation. he is now on decadron, which will continue to taper at home. he is also using albuterol and atrovent prn along with mucinex . # lung tumor: likely primary. patient will be seen by radonc to determine if he is a candidate for radiation treatment. . gi - coffee ground emesis likely secondary to swallowed blood with procedure, as no culprit lesion appreciated on egd on . he will continue on ppi when he goes home. . # id - post-obstructive pneumonia: patient received a one week course of flagyl and levaquin, which appears to have resolved any signs of pneumonia that he had previously. the patient's cxr does not indicate pneumonia . # metastatic thyroid cancer: patient with a widespread history of mets to the brain, bone, lungs. current lesion may represent mets versus new primary, will followup pathology. patient has declined further chemotherapy . medications on admission: - vitamin d 50,000 units twice monthly - levoxyl 275 mcg daily - lorazepam 0.5-1.0 mg prn panic attacks - oxycodone 5-10 mg po q4hours prn pain discharge medications: 1. home oxygen home oxygen 1-2 litres nasal cannula with ambulation. dx: metastatic thyroid cancer 2. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po twice monthly. 3. levothyroxine 125 mcg tablet sig: one (1) tablet po once a day. 4. lorazepam 0.5 mg tablet sig: 1-2 tablets po prn as needed. 5. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours). disp:*1 inhaler* refills:*2* 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours). disp:*1 inhaler* refills:*2* 9. dexamethasone 1 mg tablet sig: see below tablet po once a day for 5 days: : take 4 pills daily; 10/7-8: take 2 pills daily; : take 1 pill daily. disp:*10 tablet(s)* refills:*0* 10. levothyroxine 150 mcg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: post-obstructive pneumonia endobronchial obstruction secondary diagnosis: metastatic thyroid cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , you presented to our service with trouble breathing. while with us, you were seen by the interventional pulmonologists who placed a stent in your airway. the stent plugged and did not work so it was then removed. following removal of the stent, you recovered and were deemed healthy for discharge the following changes were made to your medications: - use albuterol and ipratropium as necessary for breathing - use oxygen when ambulating - take pantoprazole daily - take dexamethasone for 5 days; 4mg on ; 2mg on -8; 1mg on followup instructions: radiation planning: thursday at 3pm building treatment planning center. provider: mri phone: date/time: 8:35 provider: , md phone: date/time: 11:30 provider: , md phone: date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine other intubation of respiratory tract closed [endoscopic] biopsy of bronchus endoscopic excision or destruction of lesion or tissue of bronchus endoscopic excision or destruction of lesion or tissue of bronchus bronchial dilation endoscopic removal of bronchial device(s) or substances diagnoses: pneumonia, organism unspecified secondary malignant neoplasm of brain and spinal cord unspecified gastritis and gastroduodenitis, with hemorrhage secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow other diseases of trachea and bronchus postsurgical hypothyroidism personal history of malignant neoplasm of thyroid acute respiratory failure following trauma and surgery 

Answer: The patient is high likely exposed to